Economy leads physician to shutter solo practice, join U.S. Army

Michael L. Steinberg, MD, a 57-year-old allergist and immunologist, closed his solo practice at the end of February. The chairs were sold to his receptionist's church. Other furniture went to his daughter. Some items were donated to charity. And his house is for sale as he and his wife pack up decades of memories.

Amid all that activity, he is running a few times a week and lifting weights. After all, Dr. Steinberg -- who says, like many men his age, he has a little extra weight around the middle -- needed to prepare for the reason for these changes: His basic training with the U.S. Army was to begin March 8.

Dr. Steinberg was a physician in an unusual circumstance -- deciding what to do with his small practice in an age of practice and hospital consolidation -- who chose an unusual solution. He joined the Army not only to serve his country, but also because it seemed to be the best business decision he could make.

"I'm not a youngster, but I didn't think things would get better," Dr. Steinberg said. "I'm older than the standard cutoff age for entering the Army, but they need and want physicians."

Dr. Steinberg lives in Pittsburgh and had a practice there. But the bulk of his work was at a practice he opened in 1989 around Bellaire, Ohio, along the Ohio River, near the West Virginia and Pennsylvania borders.

When the area's glass industry was in full bloom in 1920, Bellaire was a thriving town of 15,061. Around when Dr. Steinberg opened his office, the population was down to 10,480, according to the 1990 U.S. Census. But he said it was possible then to run a fiscally healthy solo practice. Also about that time, Bellaire got one of its claims to fame: A toll bridge there was used for some scenes in the 1991 movie "The Silence of the Lambs," starring Anthony Hopkins and Jodie Foster.

The fortunes of Bellaire, and the surrounding counties, continued to slide during Dr. Steinberg's time. The 2010 Census counted 4,278 people in Bellaire. The aging toll bridge was used again for another movie, 2010's "Unstoppable," except by then it had long been closed to traffic and is now marked for demolition.

Many of those who have stayed in Bellaire are on Medicare or Medicaid. The town is in Belmont County, where about 17.6% of residents are over 65. Nationally, the percentage is 13%. As of January 2011, more than 20% of the county's population was on Medicaid. This is comparable with the rest of the U.S., but although Ohio has not cut pay rates for the program, they haven't been raised in 10 years.

"I really enjoy the practice," Dr. Steinberg said. "But economically that area is not doing well."

He realized the time was coming when he no longer could operate his practice. Many physicians in his situation either retire or try to sell their practice to a larger one or a hospital system.

People who broker practice sales say even small practices in rural areas can attract buyer interest, but they have to be financially viable. Even those doing well, however, can take several years to draw a physician looking to work in a particular locale in a specific specialty.

"Depending on the actual location, it could take a very long time to try to find a buyer for it," said David Greene, president of Medical Practice Brokers in Colorado Springs, Colo. "And if they are not making much money, there is very little incentive for a physician to go there."

Dr. Steinberg said he wouldn't get much from selling his practice, especially since no institution was interested in two offices more than 60 miles apart. He said he had job offers from health systems, but none seemed to be places he would stay for more than a few months. He also didn't feel financially or mentally ready to retire.

As Dr. Steinberg was assessing his options, he started looking at the recruiting postcards the Army was sending to his office. The Army, like many health systems, is trying to recruit physicians. About three years ago, he started exploring this possibility and made the call because he realized the Army could be the best opportunity available to him.

You're in the Army now

"My children's first response was, 'Are you crazy?' " Dr. Steinberg said. "But they realize it's a tremendous opportunity. They see that I'm happy about it. I think they are being supportive."

The upper age limit to join the Army is 35, but about 10 age waivers for MDs and DOs are granted per year. It's not unheard of for older physicians to join up, either because they have served before or have children who are serving. What makes Dr. Steinberg a little different is that he had no prior military experience. It's not something he necessarily always wanted to do or felt he needed to do.

He was scheduled to start basic training at Fort Sam Houston in San Antonio on March 8. Afterward, the married father of two will become a lieutenant colonel stationed at Fort Knox near Louisville, Ky. His adult children are on their own, but his wife, Judy, will be joining him after their Pittsburgh house is sold.

Before he left, he had to prepare. One task was to get in better shape. Dr. Steinberg had never been athletic and took up running only recently. "I'm sure I'm going to have to work my butt off for a while, but I'm glad I'm healthy enough to do this," he said. "I have never been in the military, but I'm honored to have the opportunity to serve my country."

When Dr. Steinberg turned the lights off at his Bellaire office for the last time on Feb. 23, he was sad but relieved. He said goodbye to staffers, some of whom had worked for him for 20 years. For months he had been saying goodbye to patients, some of whom he had been treating for just as long. "It's been very touching, but it's also been very liberating," he said.

Physicians who worked with Dr. Steinberg say the Army's gain is the community's loss. Another allergist practicing within 30 miles has taken over Dr. Steinberg's Bellaire patients. Another practice in Pittsburgh has taken over the charts for the patients from the satellite office.

Charles Geiger, DO, is a family physician with an office in the building that used to house Dr. Steinberg's practice. He is employed by the local health system that owns the building. He also understands why Dr. Steinberg did what he did.

"He was an excellent allergist and an excellent physician," Dr. Geiger said. "It's a shame that physicians are feeling the need to make these types of decisions. Between declining reimbursements and increasing overhead, the military is an attractive option."