Bleak Days for Doctors

When Dr. George Lundberg was fired last month as editor of the Journal of the American Medical Association, he didn't get mad. He started talking to 60 Minutes. That alarmed the A.M.A. even more than its original gripe with Lundberg--his decision to publish a study on oral sex just as the impeachment trial was starting--and the board quickly began negotiations to rehire him.

To outside observers, it was one more example of how far the A.M.A., and by extension the entire medical profession, has fallen. In the group's heyday in the early 1960s, 70% of practicing physicians were members, and the A.M.A. wielded enough political clout to rewrite Medicare laws. Now roughly 30% of physicians belong, and the organization has been dogged by bungled decisions, like the short-lived deal it made two years ago to endorse Sunbeam products.

But if things look bad for the A.M.A., they've turned positively bleak for a lot of doctors. Managed care has slashed revenue as overhead continues to climb. Physicians have to see more patients in less time. Nurses and pharmacists are poaching on their territory. Bureaucrats second-guess their decisions. Is it any wonder that union membership and disability claims are soaring among doctors? Or that more and more have started moonlighting outside of medicine to supplement their income?

Take Dr. Gary Smith, for example. For the past four years, the Houston urologist has been picking up extra cash by promoting Amway products. Smith says he finds most of his clients at medical conferences, around the hospital or at social events and rarely pitches his patients unless they ask him about it.

Other doctors are not so squeamish. A Manhattan resident was startled last year when her gynecologist handed her a catalog of nutritional supplements (complete with the physician's vendor number) as part of her annual checkup. "Patients in a doctor's office are in a particularly vulnerable situation," says Dr. John Lantos, a medical ethicist at the University of Chicago. They might feel pressured to buy the products just to please their physician. Wouldn't it be less of a conflict of interest, he wonders, only half in jest, if doctors ran a fast-food restaurant in the lobby?

The retailing trend hasn't gone unnoticed by the A.M.A. Its ethics committee last summer recommended a new policy that would have barred members from selling vitamins and other health-related products to their patients. That move triggered a rash of protests--particularly among plastic surgeons and dermatologists, who have long sold facial creams to their patients. The A.M.A. agreed to reconsider the no-sales rule, and says it will revisit the subject later this year.

It's almost as if the medical profession were suffering an identity crisis. Some doctors have become so discouraged that they're leaving the profession entirely. A neurosurgeon in Texas folded his practice to become a police officer. A California radiologist quit to go canoeing in South Africa and bicycling in New Zealand. A San Francisco ob-gyn went to business school to learn how to manage other people's money.

Others, like Dr. Karen Hill, who practices internal medicine in Austin, Texas, are learning how to live without managed care. Hill dropped 1,500 managed-care patients last year and saw her income plummet two-thirds. But she's happier treating the remaining 500. "So often we find ourselves practicing insurance rather than medicine," she says. "We need to get back to the reason our profession exists: our patients."