Is an M.D. worth it any more?

Black Enterprise, Feb, 1996 by Cassandra Hayes

Ever since she was a child, Dr. Yvonne Mason knew she would be a doctor. With her family's strong support behind her, she toiled many sleepless nights at her studies at Hunter College and Harvard Medical School in an effort to reach her goal.

In mid-1994, as the end of her residency at New York's Columbia-Presbyterian Hospital neared, Mason eagerly awaited the opportunity to finally practice as a full-fledged anesthesiologist. "Like everyone else, I thought, I'm a doctor, I shouldn't have a problem finding a job, but no one was grabbing me up," says a thirtyish Mason, who holds a master's degree in public health as well.

The market for anesthesiologists was bleak, Mason explains, and she, like many of her colleagues, faced stiff competition in a city where many hospitals were not hiring due to lack of funds. Seven months before the completion of her residency, the Brooklyn native mailed out 40 resumes to local hospitals. But solid job offers were few and far between.

With a seven-year-old daughter to care for and student loans to pay, Mason briefly considered several unconventional options, such as freelancing her services to local clinics. In the end though, she received five job offers, accepting one from Brooklyn Hospital. The unexpected difficulties she encountered in trying to carve out a successful career in the midst of a rapidly changing industry have not dampened her enthusiasm for what she still regards as her calling. As for what lies ahead, Mason says her success as a doctor is not a finite destination, but something for which she continually strives.

Young doctors like Mason are getting easier to find these days. Thanks to managed health care, the once predictable guarantees of independence, prosperity and prestige are no longer in the offing. Thus, those entering medicine today tend to be motivated more by altruism and a true desire to serve than by money. Mason, for example, was lured to the profession by traditional idealized notions. Like many before her, she finds personal success in the faithful discharge of care and the knowledge that she provides comfort to the needy, despite the cost.

As managed health care transforms once autonomous professionals into "employees," the demand for fewer specialists and more generalists increases and doctors are racing to keep up. But perhaps more importantly, they are being forced to adapt their goals and expectations as the image and the options for physicians go through a dramatic overhaul. Adapting, for some, is proving hard to do.

A stubborn resistance to change has already caused some doctors to abandon their practices altogether rather than give up their independence. In the end that may be shortsighted. "We need to protect our patients," says James Harold, a Baltimore psychiatrist who advocates the if-you-can't-beat-'em-join-'em approach to tackling the managed health care behemoth. Harold says many blacks on Medicaid and Medicare will find fewer black doctors if those doctors don't become more proactive. In an effort to galvanize strength, Harold, along with a group of other psychiatrists, formed the partnership Urban Behavioral Associates, which contracts with the Baltimore Hospital Liberty Health Systems.

Others - particularly those still drawn to medicine for the money - are less conciliatory. Six - digit salaries have long been a major enticement to medicine, and with good reason. Burdened with student loans, the average young doctor leaves medical school with a debt load of $100,000, the equivalent of a small mortgage. "Those thinking of entering the profession must be clear about what drives them," says Dr. Gregory Morris, a health care consulting partner at Ernst & Young L.L.P. in Atlanta. "If you are drawn for income potential, status, independence and autonomy - some of the strongest motivators - then you should reconsider."

Others agree. "Being a doctor is going to get worse before it gets better," warns Leonard Yaffe M.D., health care analyst at Montgomery Securities in San Francisco. "My concern is that we will make it so unattractive that the applicants will decline in quality and quantity by the time we do anything about it."

But students considering the field should not be discouraged by disgruntled doctors or recent efforts by some to reduce medical school admissions by 20%. What they do need to be is realistic about what it takes to become a physician and what one's career options are once that medical degree is signed, framed and ready to be put on display. If you have the science and math acumen, a capacity and enthusiasm for difficult work extended over long hours and can work efficiently under heavy responsibility, the field may be right for you. Furthermore, if you are African American to boot, the field desperately needs you.

THE NEED FOR MORE

BLACK DOCTORS

Although newspaper headlines heralded the record number of medical school applicants in 1995 - more than 46,000 - there was a 1.7% decline in the number of black applicants. Of the 3,595 blacks who applied to the nation's medical schools last year, almost 40% were accepted, and that's not enough.