The Doctor is Out

Sickened by the shift to managed care, more physicians are claiming disability, moving into administration or leaving medicine altogether

Galofre thinks "today's students are going to be much better adapted" than physicians of his own generation, which he dubs "the Romantic period of medicine. You did everything you could for the patient, and you were treated as a god." He adds candidly, with a Latin twinkle, "I would think twice to go into the system we have now.

"Is there going to be a difference in the interaction between patient and physician?" Galofre asks abruptly. "In some ways, that is what we are seeing. But I hope in other areas it will be even better. An HMO in the long run cannot tolerate bad medicine, because the patient comes back and back and back. So good medicine should prevail."

Search consultant Lyons travels the country, looking for signs that it will prevail. "I hear scarily few success stories," she admits. "Where good things are happening, the single common denominator is the presence of a positive physician culture. Physicians understand why they are there, what their role is. They are committed to providing the best possible care." She pauses. "That describes very few health-care forums. It does describe a large number of physician-driven group practices, because physicians feel very empowered in those settings. I also found it at a hospital where seven of the eight board members were physicians."

Does this mean physicians need the reins back? Maybe so, but Lyons warns that they won't each get their own sets. "Physicians are more powerful than ever, but not on their own," she remarks. She's weary of their individual "bellyaching, the spiral of negativity that siphons off energy year after year." Her voice brightens temporarily. "You could send them all off to a career consultant ... but I don't know that there are enough career consultants.

"Physicians really have to do some soul-searching," she concludes. "If they absolutely must have autonomy, then they need to get out of medicine.

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