Despite an increasingly hostile practice environment, physicians can still find enjoyment and satisfaction in medicine. Meet six doctors who reveal what keeps them motivated and moving forward. Then, try a few tips to salve your soul.
Frustrated with penny-pinching payers, administrative demands and long hours, physician morale is currently at an all-time low. Seventy-five percent of California doctors have become less satisfied with medical practice in the past five years, according to a recent California Medical Association survey. Low reimbursement, managed care hassles and government regulation were cited as the greatest sources of dissatisfaction.
"Most of the physicians I talk to are burned out and overwhelmed," says Christina Puchalski, MD, director of the George Washington Institute of Spirituality and Health, Washington, D.C. "There is a real sense that doctors no longer have autonomy, preventing them from practicing like they used to and want to.
"When they were medical students, they were very idealistic. They wanted to serve, to make a difference and to help people. Now, physicians don't have enough time to spend with their patients to establish rapport and trust. They are running from one exam room to the next, trying to get things done and hoping that they didn't miss anything or make a mistake. I often hear physicians say, 'This is not why I became a doctor' and 'I am not being honest to my calling.'"
Still, in the face of these difficulties, there are doctors choosing to remain optimistic and inspired. Instead of getting angry or demoralized, they are taking action to focus on the heart of medicine: helping people. Southern California Physician spoke with six physicians who share their personal motivations.
Ralph Di Libero, MD
President of the Los Angeles County Medical Association
Orthopedic surgeon for more than 25 years, Los Angeles
Heart of Medicine: Conducting International Advocacy
Ralph Di Libero, MD, a Los Angeles orthopedic surgeon and the president of the Los Angeles County Medical Association, finds inspiration in leading the association's collaborative efforts with medical societies abroad. In November, Dr. Di Libero, accompanied by LACMA Treasurer Robert Bitonte, MD, JD, visited the Hiroshima Prefectural Medical Association in Japan to commemorate the 30th anniversary of the relationship between the associations.
"The purpose of the visit was to honor our longstanding relationship with the Hiroshima Prefectural Medical Association," Dr. Di Libero says, "but also to show continued support for a radiation study that the organizations have been collaborating on for the past 30 years."
In 1977, the Hiroshima Prefectural Medical Association and LACMA launched the biennial Radiation Effects Research Project, which performs screenings and medical examinations on first- and second-generation atomic bomb survivors living in Southern California. Every other year, the project is carried out in Los Angeles by a dozen physicians from Japan, under the supervision of LACMA doctors.
More than 60 years after atomic bombs scorched the Japanese cities of Hiroshima and Nagasaki, the scars of health problems and traumatic injuries to those exposed remain, Dr. Di Libero says. It's estimated that more than 300 survivors of the attacks live in the Los Angeles area.
In the 2001 study, the sister organizations found that area survivors are an average age of 69.5 years. The number of female examinees was twice that of male patients. The exam included an interview, a clinical and physical examination, an EKG, and blood, urine and stool tests. The results showed that hypertension was the most frequently diagnosed condition, found in 39.3 percent of patients.
More recently, local physicians helped Japanese doctors collect data on thyroid diseases in atomic bomb survivors for their Journal of the American Medical Association article published in March 2006.
At a special ceremony during his Hiroshima visit, Dr. Di Libero presented letters of commendation from the California State Senate, the Los Angeles County Board of Supervisors and the Los Angeles City Council to Shizuteru Usui, MD, president of the Hiroshima Prefectural Medical Association. Later, Dr. Di Libero had an opportunity to meet Tadatoshi Akiba, the mayor of Hiroshima.
Dr. Di Libero also attended the society's general assembly where he exchanged ideas with more than 200 Japanese physicians. For two days, he lectured on historical trends and future forecasts in the American healthcare delivery system.
"The work of the Hiroshima Prefectural Medical Association, an organization dedicated to documenting health hazards of nuclear weapons, has mobilized and influenced medical specialists throughout the world to join together in seeing to it that no one should ever suffer like those in Hiroshima," Dr. Di Libero says. "We physicians must continue to work toward the abolishment of nuclear weapons and disarmament. Our combined medical and political efforts will produce a better and more peaceful world where absolutely no role for nuclear weapons can exist."
Ken Bell, MD
Chief Medical Officer of CalOptima
Obstetrician/Gynecologist for more than 40 years, Orange
Heart of Medicine: Delivering Babies
Ken Bell, MD, an Orange obstetrician and gynecologist, grew up in the Bronx, the son of a Russian immigrant who became a dentist. His father's professional example made an impression on the boy.
"I wanted to be a physician since the time I was born," says Dr. Bell, chief medical officer of CalOptima, Orange County's Medi-Cal managed care program. "I ended up doing the most gratifying thing that anybody can do: I became an obstetrician."
Dr. Bell received his medical training at the University at Buffalo in Buffalo, N.Y. He completed his internship in internal medicine and his residency in obstetrics and gynecology at King's County Hospital in New York. Nearly 10 years later, Dr. Bell was recruited by Kaiser Permanente Bellflower Medical Center to work as a staff obstetrician in sunny California.
"Delivering babies was such a thrill for me," Dr. Bell says. "When you deliver a baby and hand him to the mother that first time, it is such an incredible opportunity. The mother cries and it is the happiest moment of her life."
Dr. Bell eventually rose to the position of medical director of Kaiser Permanente Orange County Medical Center, where he worked for 14 years. However, when Dr. Bell became a full-time senior administrator, he continued to take call, because he didn't want to give up those happy moments. He has delivered more than 4,000 babies in his medical career.
Now an administrator at CalOptima, Dr. Bell advocates for Medi-Cal patients to ensure they have access to quality care. He no longer delivers babies. When asked, "When was the last time you delivered a baby?" he replies, "Five years, five months and 22 days ago to be exact, and I miss it tremendously."
