On the move

We are a transitory society, and physicians are no exception.

According to a four-year study by health care research firm SK&A, an average 14.2 percent of physicians make a move, retire or die each year‹with some specialties more mobile than others.

It’s obvious that doctors continue to move around for a wide variety of reasons, leaving hospitals and clinics clamoring to recruit their replacements.

Tommy Bohannon is the Divisional Vice President for Hospital Based Recruiting with Merritt Hawkins. “The most prevalent demographic we see contacting us about making a move are those two to five years out of training. They haven’t made partner or bought the big house, and the kids might not yet be in school, so they are more portable,” says Bohannon.

“Right out of training, most doctors settle within 50 miles of where they grew up, where they trained, or where their significant other has family,” he says. “That move often doesn’t work out, so they shift their focus more to the position itself, but they still give significant consideration to community makeup.”

The second most likely group to consider a career change are doctors in the last third of their career. “The kids are grown, and they’re more financially able to make a move,” he says.

On the other hand, older physicians might be looking to step away from leadership or management responsibilities and take a job where they’re employed, even if they earn less and give up some autonomy, in order to live where they’ve always dreamed of.

Physicians in the middle of their careers move for different reasons, says Bohannon. “These doctors contact us essentially saying, “I love where I live, but I don’t love my job.” Rarely, he says, is it the other way around. The middle-age physician often makes a career move for professional or financial advancement, although today many also move to be closer to aging parents or after a second or third child arrives and they realize the benefits of being closer to family. Even in this scenario, however, the details of the practice are a primary concern.

There are many ways to accomplish the goal of reinventing oneself within the realm of medicine, so there is no reason to become professionally stagnant and feel like toughing it out until retirement is the only solution.

These physicians share what propelled them into a career move.

Retiring the uniform

Col. Jonathan Briggs, M.D., began his career as an optometrist. After a year of practicing, he joined the Air Force.

Though he enjoyed employing his skills as a military health care provider, Briggs soon became restless. “I wanted a broader scope of practice,” he says. “I was able to go to medical school at the Uniformed Services University in Bethesda and remain on active duty.”

He finished his internship year, performed military duties as a flight surgeon in South Dakota for one year, completed his ophthalmology residency at Lackland Air Force Base in San Antonio, then did a civilian fellowship in Miami while remaining on active duty.

This was followed by a long military career where he served on the faculty at the residency training program back in San Antonio and became the chief consultant to the U.S. Surgeon General for ophthalmology. “I sort of had two full-time jobs,” says Briggs.

Taking what he now recognizes as excellent advice, Briggs started his post-military career job search two full years in advance of his discharge date. Briggs and his wife wanted to settle in the Northwest where they both have family. He used PracticeLink.com and the American Academy of Ophthalmology job opportunity website to target his search in that area.

After considering only two positions, Briggs joined the Wenatchee Valley Medical Center in Wenatchee, Wash., in May, 2011, where he practices with three other ophthalmologists.

“I knew I didn’t want to open a practice or join a small group because of my stage in life,” says Briggs, who is now 51. “Wenatchee Valley Medical Center has everything I was looking for. It’s a physician-led group, which is important in terms of leadership and perspective, and it’s been around for a long time. We have the infrastructure that will allow us to adapt to changes we know are coming.” The medical center has more than 200 physicians on staff.

Briggs says he would encourage other physicians considering a career transition to think not just about where they want to be in a year or two, but to take a long view. Briggs feels fortunate to have found a practice that works for him. “There have been no issues or surprises, which has been a blessing,” he says.

Location is also a critical factor, according to Briggs. “If you’re not where you want to be living, it will be harder to adapt to any difficulties that may arise. We love it here. We like the smaller town and the outdoor activities that are available.”

Family matters

For Arie Marancenbaum, M.D., the motivation to make a career change was largely family related. Upon completing his residency at San Jacinto Methodist Hospital in Houston, he accepted an academic position there and enjoyed teaching, particularly obstetrics. But Marancenbaum’s family had its own obstetrical event unfolding at the time. “My wife was pregnant with baby number three, and that triggered us to realize that we wanted to be closer to family,” he says.

Marancenbaum had attended a wound care presentation during residency and became intrigued with how hyperbaric therapy was used to treat chronic and difficult wounds. While interviewing for positions during residency, Marancenbaum had become acquainted with Dr. Han Pham Hulen, who operates Hulen Wound Care Professionals.

“She called me recently about an opportunity to work with her in a clinic about 20 minutes from Dallas, in Rowlett, Texas,” says Marancenbaum. With most of his family and friends living in that area, the decision to leave academic family medicine and accept this new opportunity was a relatively easy one.

Though he misses certain aspects of family medicine and obstetrics, Marancenbaum says he’s happy with his decision to relocate and work in a cutting-edge field of medicine. “It’s very satisfying work. Some of these patients had no hope. They had wounds for months and nobody could heal them, but we can,” he says.

If it sounds like Marancenbaum takes major change in stride, it may be because he’s used to it. Having grown up in South America, he immigrated to the U.S. where he did his undergraduate work at Southern Methodist University in Dallas before completing medical school in Mexico.

When his previously well-to-do family fell on hard times due to business difficulties, rather than going into residency, Marancenbaum returned to Bolivia for a number of years, where he worked odd jobs to help support his parents. While there, he managed to complete several years of surgical training, but political and economic conditions in Bolivia became untenable.

“There was a lot of turmoil, the streets became dangerous; Bolivia was in an economic depression,” says Marancenbaum. He decided it was time to return to the States.

His parents, now back on their feet in Dallas, had heard about teaching opportunities opening up in Texas. Marancenbaum returned to the Dallas area where he taught first and second grade for several years while studying to apply for a residency in the U.S. “I loved teaching at Routh Roach Elementary in Garland, Texas.

A lot of the kids were from broken homes and were low income, but most of them were reading 150 words a minute by the end of the first half of each year,” says Marancenbaum. His teaching career ended when he was accepted into a family practice residency program at the age of 33.

Now 38, Marancenbaum tells other physicians considering making a career change to go with their gut.

“Change is good. Sometimes you get too comfortable where you’re at. When you move, it’s an adventure. You’ll meet new people and make new friends. Most of all, believe in yourself. The sky’s the limit,” he says. It’s easy to imagine Marancenbaum offering this same bit of wisdom to his first and second graders. Some sage advice simply applies across the board.

Back to training

For Dan Lee, D.O., making a career change involved a commitment few practicing physicians are willing -or able- to make. After training as a family physician and completing a surgical OB fellowship, he worked for three years with a small group in Harlingen, Texas, where he had C-section privileges and practiced high-risk obstetrics. But something just wasn’t quite right.

“I was not getting the satisfaction out of practicing medicine that I thought I would,
says Lee.”I was getting burned out on the family practice part of it.”

Lee had originally considered an OB/GYN residency, but as medical school came to a close and he surveyed the landscape around him, he came to the conclusion that the demands of the specialty were inconsistent with a healthy family life.

“To me it looked like a career that ruined families because of the hours,” says Lee. ³But a lot has changed in the past 10 years. With the new work hour regulations, families do survive.

“It was a conversation with his uncle, a gastroenterologist, that made Lee seriously consider leaving practice to train in OB/GYN. “I thought it would be an insurmountable thing to do. He really encouraged me by telling me that I was still young and that four years would go by quickly,” says Lee, who was 34 at the time.

With his wife’s full support, he decided to apply to residency programs and see what would happen. Lee was accepted to several, and chose Oklahoma State University Medical Center, where he’ll complete his second full residency in June and return to Texas to practice in the same small town where he originally worked.

“Given there are not a lot of subspecialists there, as a generalist OB/GYN I’m excited about managing complex cases and doing a lot of surgery that I wouldn’t be able to do in a larger city,” says Lee.

One major concern for Lee in making the decision to do a second residency was financial.

He intentionally chose a program that allowed him to use his family medicine skills to moonlight in urgent care centers and rural emergency departments. “That gave me confidence going in,” says Lee. “It’s unrealistic to have a family on a resident’s salary.”

He and his wife, Sarah, have two small children. Sarah works part time as an occupational therapist. Lee has been chipping away at his medical school loans, and is happy with the fact that he’ll be able to pay those debts off more quickly now that his earning capacity will be higher as an OB/GYN.

“I didn’t do this for the money, but there is a difference,” say Lee.

Lee offers a couple of precautionary notes related to returning to residency. “If you’re promised that you’ll get some credit toward residency for years that you’ve practiced, get that worked out prior to starting the program,” he says. “I ended up doing the full four years.”

He also says doctors should be prepared to receive no special consideration for having been in practice. “It kind of surprised me that first year that I was treated like an intern,” says Lee. “I still had to follow the chain of command. That was a little frustrating. It felt sort of like the faculty wanted to make sure I knew who was boss.”

Asked what advice he might have for physicians considering changing course in terms of specialty, Lee recommends paying attention to sustained desire.

“If it’s not a fleeting idea, you’ll make it work,” he says. Though he has experienced some stress during his second residency, Lee says it’s been much easier than the first time around.You know how to manage patients more efficiently and your knowledge base going in is much better,” he says.

Though this does make for better time management, Lee admits his hours are long, but says his satisfaction level is high. “My wife tells me I seem much happier now, even though I’m working more hours than when I was in practice.”

Following a call

Upon completing his OB/GYN residency at Parkland Memorial Hospital in Dallas, Victor Obregon, M.D., was in private practice in Seattle for 15 years, during which time he and his family made medical missionary trips to Papua New Guinea. “When we were there for the second time, we knew we’d be back longer term,” says Obregon.

After much prayer and several years of planning, Obregon closed his practice in 2007 and he, his wife, Lori, and son, Alex, then 12, embarked on a four-year mission sponsored by the International Church of the Foursquare Gospel to Papua New Guinea.

During his work on the island, located just north of Australia, Obregon and a team of medical professionals (including Sarah, who is an RN), worked with locals to set up medical outreach programs. “We ran them at first, then together with the local people, and the last year or so we were just helping out to get them to the point where they could function on their own. A lot of what we did was networking with the local government and fundraising,” says Obregon.

About once a month, the team would go into remote areas of the island for three to four days at a time to provide medical care. “We did mostly ambulatory tropical medicine and an occasional minor procedure,” says Obregon.

Knowing that he’d eventually return to the U.S., Obregon maintained his Washington State medical license and board certification status. As his missionary work came to its inevitable end, Obregon began contacting health care organizations around the Seattle area. “MultiCare got back to me right away,” he says. It took several months upon returning to the U.S. to complete the interviewing and credentialing process, and he started working for MultiCare, a nonprofit health system with numerous clinics and hospitals in the greater Seattle area, in April of 2011.

It was an adjustment returning to the U.S. after four years abroad, and practicing within a large system required an adjustment after being in private practice. But Obregon is happy with his decision.’

“Thankfully, I’m working with a good team,” he says. Because he had been out of mainstream practice for several years, Obregon initially had a proctor who operated with him and observed his obstetrical work. But after just a few months, he was granted full active hospital privileges. “Had I stayed out longer, more than five years, I would have needed to be retrained,”says Obregon.

For physicians considering taking a break from traditional practice to do volunteer work, Obregon says they should be thoughtful in their decision-making. “If you have an idea that a change is coming, take your time. Make sure that everyone in the family is on board,” he says. “Seek counsel from people who have done it, and make sure it’s the right time financially by going over everything with your accountant.”

Obregon, now 52, says he misses the friends he made in Papua New Guinea and still finds himself thinking in the language of the island.

“This was the most important thing we’ve done in our lives,” he says of his experience abroad. “I have incredible memories…caring for sick babies who probably didn’t make it past their first year, but at least they got to be held and sense that they were loved. They got to see what compassion looked like.”

Stepping up to leadership

Relocation isn’t always necessary for a physician seeking a career change. Sometimes you can grow right where you’re planted. Such is the case for two physicians at Boice-Willis Clinic, one of the oldest private multispecialty groups in North Carolina.

Rheumatologist Nicholas Patrone, M.D., has practiced at Boice-Willis for 22 years. For 13 of those years, he’s worked in an administrative capacity, most recently for five years as chief medical officer and president of the organization, while also providing direct patient care.” This year, I’m transitioning out of being CMO, but will continue as president for another three years,” says Patrone.

At 59, Patrone says it’s time to work a little less. Until recently, it wasn’t unusual for his workday to begin as early as 5 a.m. and end with an extra hour or two at the end of each day to keep up with all of the administrative work.

“As president, I’ll deal with policy issues, work with the three local medical schools, and deal with interdepartmental issues,” says Patrone. Over the course of a year, day-to-day CMO duties are gradually being handed off to internist Martha Chesnutt, M.D. “If we’ve recruited another rheumatologist by the end of this year, I may cut back to two to three days a week of patient care,” says Patrone. “I’m ready to have some free time.”

Chesnutt completed her residency at the Greenville Hospital System in South Carolina in 2003 and has been with Boice-Willis ever since. “I was attracted to the fact that it’s a multispecialty clinic where good doctors practice good medicine,” says Chesnutt. “I knew pretty quickly that I had an interest in clinic operations.”

Chesnutt pursued leadership education by attending courses offered by the American College of Physician Executives; through the clinic’s medical liability carrier where she learned about risk management, disruptive physicians, and doctor-patient communication; and through her state medical society. Chesnutt began serving on the Boice-Willis executive committee in 2009.

Taking over the role of CMO feels both exciting and challenging for Chesnutt. “We’re going to be making a lot of changes to meet new requirements,” she says. “I foresee that quality will be a big indicator for reimbursement.” Chesnutt views the fact that Boice-Willis is a freestanding multispecialty clinic as both a strength and a potential weakness, given the changing health care environment. “When we’re together on issues, we’re unbeatable. When we get fractionated, we need to find a common goal to reach,” she says.

Chesnutt has assumed responsibility for a number of departments within the clinic, and by the end of the year-long transition will be managing all of them. She and Patrone meet weekly to ensure an orderly transition. “He’s my mentor,” says Chesnutt.

The somewhat daunting task of getting more than 50 health care providers to embrace change and new technology is interesting to Chesnutt, as is recruiting. “We’re always looking for family physicians, and right now we’re recruiting someone for pulmonary and critical care, as well as for a rheumatologist,” she says. “In the past, we’ve not used many physician extenders, but we’re getting our doctors used to that.”

Ultimately, Chesnutt will spend 30 to 40 percent of her time in the CMO role and continue to see patients during the remaining time. “I would not have credibility if I weren’t still seeing patients,” she says. “If I’m going to be managing physicians, it’s crucial to have a clinical practice.”

She advises any physician interested in taking on a management role to avail themselves of the many resources that are available, such as serving on hospital committees to gain leadership experience and taking courses through the ACPE and specialty societies.

For his part, Patrone is delighted to be passing the baton to his younger colleague. “I’m from a different generation of doctors,” he says. “This is such a relief to me. As I phase off responsibilities to Martha, I feel like storm clouds are being lifted off my shoulders.”