New docs, different priorities

Editor’s note: This is the second of three stories on rural health care.

Register Editor

Register/Susan Lynn
Dr. Becky Lohman represents a new generation of doctors who balances family and career. The Lohman family, from left, are Rio, Henry, Nich, O’della, Becky, Lily and Jo.

“Old school” doctors are taken aback by the perception that today’s family physicians are overworked, underpaid and misunderstood.
“It’s not that hard,” said Dr. Earl Walter of his job at Preferred Medical Associates. “At the hospital there’s coverage in the emergency room 24/7. There are doctors doing obstetrics. I can leave the office now and be done for the day” — a far cry from earlier days when all such responsibilities could fall on him as a primary care physician.
Even when it is his turn to cover for Drs. Wes Stone and Frank Porter for a weekend, Walter said having a cell phone means he need only be within calling range to direct care for patients.
“I used to have to be physically near a phone — a landline — when on call,” he said. “Now I’m free to go to a ball game, wherever. I enjoy this job. I don’t think it’s that hard.”
At 67, Walter said he had planned on retiring “at 65.” But because “I feel good and have lots of energy, I have no plans to quit. The job still fascinates me.”
In a recent interview with area physicians, the majority said they average 12-hour days. Dr. Tim Spears of The Family Physicians typically puts in more because he does obstetrics and moonlights in the emergency room at Allen County Hospital. Becky Lohman, M.D., of The Family Physicians also does obstetrics and works in the ER every other Tuesday. Still, her goal for the day is to be home by 6 p.m., “or else I miss dinner.”
Dr. Dan Myers, 53, resident surgeon at ACH, contends that the increase of females in the profession means fewer doctors are willing to take on what can sometimes be arduous schedules.
“I don’t mean to sound sexist,” he said, “But women physicians don’t want to work as hard as males.”
Lohman, 31, and two years out of residency, wasn’t offended, and in fact, agreed.
Today’s med school students have “a different perspective of what it means to be a physician,” she said.
When residency programs cut back work weeks to 80 hours, “many old-time docs complained and whined we were not getting a good education,” she said.
“It’s not that we don’t want to do the work or pay the dues to become a doctor,” she said. But “we try to make medicine a job, because we have to have a life. If you don’t have time to enjoy life, then what’s the purpose? This is my job, not my life.”

LOHMAN said today’s medical professionals are not willing to sacrifice family for career.
In her class at the University of Kansas Medical School, almost all the residents — save those pursuing surgery — had begun families of their own, she said. She had her son, Henry, when she was in her fourth year of medical school. For Lohman, medicine comes in second to parenthood.
“I have to make being a mom a top priority, even though I still miss out on a ton of their activities,” Lohman said of her five children. She’s incredibly thankful that her husband, Nich, a clinical pharmacist with Iola Pharmacy, has a less time-eating job and often pinch hits for her as a parent, including being the family’s cook.
Being both doctor and parent, though, means sacrifice in both departments.
“I don’t work 7 to 7,” Lohman said, which means she’s typically behind on her office paperwork — the bane of today’s physicians.
That philosophy differs from “old-timers,” she said, who believed in delaying gratification in order to succeed early. And while Lohman admires that work ethic, she said she’s also been advised by some of her cohorts not to follow their footsteps.
Time missed with family because of too much work exacts a high price.
She practices obstetrics as well as covers in the emergency room because “that’s the fun part,” Lohman said. “I love OB and the spontaneity of the emergency room.”
Plus, it’s in her makeup to take on the challenge.
“I have this drive — and I think this applies to doctors in general and their personalities — to be the best. I feel like I want to do everything.”

PRIMARY CARE has another advantage in the relationships doctors develop with their patients.
“I had a woman come in just yesterday who said, ‘I am so glad to see you again,’” said Dr. Glen Singer of The Family Physicians. “I’ve been her provider for more than 20 years and we do have a wonderful relationship.
“We take care of our patients from their child-bearing years all the way to the nursing home. We know them. We help them make life-and-death decisions. They trust us and it’s phenomenal to be entrusted with that relationship.”
Walter differentiated between a primary care physician and one who practices a specialty by saying, “Specialists deal with diseases. We deal with people.”
Spears said being a family physician means just that — dealing with entire families, which leads to knowing “the dynamics of the family. You know the interactions between family members which can help shed light on some of the underlying issues to their illnesses.”
Medical schools tend to downplay the rewards of family practice, Singer said. “You hear a lot of the negatives. The pressure, the paperwork. It seems more of a downer than it is.”
All the doctors agreed, however, that the increasing volume of forms to complete for patients, especially from insurance companies, is a negative.
“The longer hours today are not because of a patient overload, but more paperwork required,” said Dr. Frank Porter of the Osborn Clinic in Colony.
Mention Medicare’s Plan D and the room breaks out in a groan.
“It’s the worst,” said Singer. Complying with a patient’s plan “basically reduces us to haggling with insurance companies over what we prescribe. There’s no consistency with the program even if dealing with one insurance company, which can allow different medications at different costs for different patients.
“You don’t know year to year what drugs an insurance company will provide and what they will cost because they keep making deals with different pharmaceutical companies. It has nothing to do with the quality of care. It has everything to do with economics.”
And for patients who fall into the infamous “doughnut hole,” the point where their insurance for prescription drugs stops because a patient has incurred $2,700 worth of medications, “It’s a nightmare,” said Singer.
“What happens is that we scramble for samples or for indigent care for these people,” he said. “The scariest thing for those in the ‘hole’ is that they decrease their dosages in order to make them stretch further. They’ll go every other day, or cut a pill in half and they never tell us about it until we start seeing the effect.
“We start quizzing them as to why they’re doing so poorly and then we find out what’s going on.”

IT’S THAT intimate knowledge of a patient’s life that on the one hand is so rewarding to a primary care physician, but also keeps him awake at night.

Friday: What Allen County can do to recruit doctors.