Career curves: When it's time for a change

Three physicians describe what it's like to switch from one kind of medicine to another in mid-career. And they all agree that although it's a challenge, it's worth it.

By Myrle Croasdale — Posted Oct. 11, 2004

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Anson Thaggard, MD, had reached many of his goals in life. A family physician in the small town of Kosciusko, Miss., he was married with three children. He owned a house, and much of his medical school debt was paid. Yet he wasn't happy.

"My last year I practiced, 80-hour weeks were not uncommon," Dr. Thaggard said. "I worked 140 hours the week of spring break [when his partners were out]. I was a walking zombie."

Physicians' satisfaction with their chosen profession has been ebbing over the years, according to numerous studies and surveys. Doctors want more time with their families, better reimbursement, less stress and more balance in their lives. Some leave medicine altogether, but others are finding that they can change specialties or retool within clinical medicine to find deeper satisfaction.

Dr. Thaggard is one such doctor. He had spent eight years in family practice and obstetrics when he began thinking about making a change.

His group was planning to drop obstetrics because of the cost of medical liability insurance. A third of his practice was delivering babies, and obstetrics was one of the reasons he became a doctor. He didn't like the idea of practicing only internal medicine.

The constant intrusions into his family life also were becoming frustrating. "In a small town, you're never off," he said. "I had people even come to my door at home asking for medical advice. I felt like I was being consumed."

He has six class-action lawsuits pending against him in which plaintiffs seek damages related to a drug from the pharmaceutical company that made it and the physicians who prescribed it.

One night sitting in intensive care taking care of a patient, it hit him that at 34 years old he could manage the late nights, but at 64 it was going to get a lot harder.

The revelation led Dr. Thaggard to consider his options. He knew he wanted to stay in medicine, and eventually he decided on radiology. He liked the problem-solving aspect of it, and he had a friend who was a radiologist who was happy.

That radiologist "was one of the few people who still enjoyed going to work, while the rest of the group was biding their time until retirement," Dr. Thaggard said.

In 2003 he landed a residency in radiology at the University of Mississippi Medical Center in Jackson, about an hour from Kosciusko. He moved his family and sold his house, and his wife went to back work part time as a pharmacist.

He says the upheaval and sacrifices have been worth it. "I'm in the middle of the hard years, but it still beats being in clinic every day," he said. "I have to follow my heart. Even if the journey is difficult, the sense of 'this is the right thing to do' is there."

Richard Tompkins, MD, feels he made the right choice as well as he returns to clinical practice after a career in hospital administration and management.

A general internist, he started in academic medicine, eventually moving through the ranks of the University of Washington School of Medicine in Seattle during the mid-1970s and '80s. Next he built a career as the head of the Pacific Medical Centers in the Seattle area, then moved to Baltimore in 1989, where he led Johns Hopkins Medical Services Corp. before striking out on his own as a consultant. When he retired, he moved back to Seattle, but once there he discovered he wasn't ready to stop working.

"I wanted to complete what I'd entered medicine for," he said. "I'd done academics, done research, been heavily involved in administration and management. I had gone into medicine for clinical reasons and had gotten diverted."

So in 2002 at the age of 61, he took a fellowship in geriatrics at the University of Washington, working at Harborview Medical Center in Seattle and in the VA Puget Sound Health Care System.

It had been years since he had done clinical medicine, and he was anxious. "I didn't believe I had lost some of the fundamental skills," he said. "I was anxious because of changes in the technology and the physical demands of being on night call."

A difficult transition

His first three weeks were rough. The commute from his home to the hospital took longer than he expected. He needed to get up by 4:30 a.m. to negotiate the 20 to 30 miles to get to the hospital on time. He didn't know where the various hospital departments were, how to file orders, what the new drugs were or how to prescribe them.

He loaded his handheld computer with drug and prescribing information and questioned other residents on the ins and outs of the hospital and ordering tests.

But his past life in Seattle as a professor, hospital administrator and manager made for an uncomfortable relationship with attendings, nurses and fellow residents.

The awkwardness was exacerbated by a friend.

"It didn't help that my division chair was wandering around telling people that I was the only person he knew who'd published articles with Nobel Prize winners," he said.

A couple of medical students solved the problem by spreading a rumor that Dr. Tompkins had actually won a Nobel Prize.

"People were looking at me strangely," he said. "They had a huge laugh at my expense, but the impact was that everything else went away. It became a joke."

Dr. Tompkins became just another member of the housestaff, except that he wasn't. Putting his life on hold and immersing himself in the grueling task of medical training was a hard transition.

"I had 30 years of an established life," he said. "A lot of interest in the arts, a huge number of friends. I just didn't have the energy or time for anything. I'd arrive home after falling asleep at every stoplight on the way, then every fourth night not show up at all. I was an absolute wreck."

Yet he knew it was exactly the right thing to do, and the geriatrics fellowship worked for him, in part because it could be done in one year. "I didn't think it would take more than one year to get up to speed," he said. "Neither did the colleagues I talked to."

As he was wrapping up his fellowship, a friend from his academic medicine days at the University of Washington School of Medicine was considering cutting back his practice hours. Hugh Clark, MD, offered to split his practice with Dr. Tompkins, and a partnership was born.

They each work every other month, giving their multispecialty group practice the equivalent of one full-time geriatrician who never takes a vacation. The two have a deal that they clear the desk of paperwork before leaving for their month away.

Dr. Clark's patients are glad he didn't retire completely, and if they want to see him, they may schedule their visits during the months he's in the office.

Dr. Tompkins' transition back into clinical medicine has included a battle for his own health. He was diagnosed with prostate cancer right before he began working at Minor & James Medical in September 2003.

Following chemotherapy and surgery, he's made a solid recovery. He's found the ability to care for others a welcome relief from his own illness, and in its own way having cancer has contributed to how he practices.

"Practicing medicine as a 60-plus-year-old with life experience, it's really different than being young and just out of training," Dr. Tompkins said. "I have a base of experience to be able to talk with patients. They know that, and that makes the relationship real different, real positive. I've worked on multiple sides of health care, and I'm able to sit back and put things into perspective. It's a lot more fun practicing medicine now than if I'd done it fresh out of school."

Giving teaching a try

Edward Vandenberg, MD, a geriatrician and assistant professor at the University of Nebraska Medical Center in Omaha, said he also made the right choice when he left private practice in northern Wisconsin to pursue a career in academics.

He picked up board certification in geriatrics during the mid-1980s, when physicians were allowed to take the certification exam without doing a fellowship. His patient base was aging, and he felt he needed to know better how to take care of them, so he studied and passed the exam.

Over the next five years, he noticed there was a difference between what was known and what was practiced in treating older patients.

"I thought I had something to offer trainees," he said, and he began teaching part time. When his children left home, he and his wife decided to move back to Nebraska to be near their aging parents. He also decided to take the plunge into full-time academics, accepting a job at the University of Nebraska in 1998.

"Full-time faculty was the biggest jump," Dr. Vandenberg said. "That's where I ran into the time, money thing." He found he had less of both.

"I actually work harder now than I did in private practice, which most private physicians find hard to believe," he said.

He also makes less, while his health care expenses have increased. Before, when he needed extra cash, he would work a few shifts in the hospital emergency department. Now he doesn't have the energy. But he knows he made the right choice.

"I have no regrets," Dr. Vandenberg said. "The teaching is rewarding. It's absolutely rigorous and stimulating. It's fun to see your learners' light go on when they get something. I'm leaving a little bigger tread mark on the Earth than I did before. It's the culmination of where I wanted to be in my life."

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How to find a fellowship

  • Your first stop should be FREIDA Online (link) or a medical school library for a copy of the Graduate Medical Education Directory, otherwise known as the Green Book. Either source lists all accredited resident and graduate programs in the United States, along with relevant statistics. For instance, on FREIDA, a search for geriatric fellowship statistics shows an average salary of $44,448. Contact information is provided for each program.
  • Many programs interview and hire applicants directly. If you've been out of residency for a while, consider contacting your old program or medical school for references. Having connections counts.
  • To find out which fellowships are handled by the National Resident Matching Program, go online (link). Application deadlines vary, and the application fee is $25.

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Factors when thinking of switching

Here are some things to consider if you're thinking of recareering within clinical medicine:

  • The federal government is more interested in adding doctors to the physician work force than retraining physicians already in practice, so the hospital that hires a physician taking a second residency is paid half of what it would get for someone going through for the first time.
  • Program directors are likely to have some unspoken questions that you might consider addressing as you investigate your options. They include: Will you'll be able to handle the work load and late nights? Will you be asking for more flexibility for family responsibilities? Will you be able to handle taking orders from attendings who may be younger than you are?
  • Using any of your networking connections might be the turning point in landing a job, particularly in competitive specialties. If you've been out of residency for a while, reconnecting with your past program or tapping into ones in your area could be a way to start.
  • If you are applying for a fellowship, you are on equal footing with other applicants in terms of how much the government will pay the hospital on your behalf. Programs get the same amount of money no matter what previous training you've had.
  • Fellowships in geriatrics and sports medicine for family physicians or general internists are only one year in duration. Residents are paid from $40,000 to $50,000 a year, depending on the program. One internist with a subspecialty in gastroenterology, interviewed for this article said he had applied to 10 geriatrics programs, and three showed more than a casual interest, suggesting that for those willing to take the cut in pay, there are open doors for practicing physicians seeking fellowships.

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