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Laid off: Doctors no longer immune to pink slips

Losing a job can be traumatic for physicians, shattering self-esteem and causing them to question their abilities.

By Damon Adams, amednews staff. June 30, 2003.

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Max Burger, MD, didn't expect to get the proverbial pink slip.

He had been a family physician for about 18 years, was making a nice living and seemed to fit firmly in the medical landscape.

Then he got laid off.

Twice.

"I was crushed. I felt I wasn't much of a doctor if I couldn't hold a job," said Dr. Burger, 54, who now is in solo practice in Southampton, N.J. "Considering what the job situation is in this country, nobody is immune. Anything can happen."

Time was, doctors didn't lose their jobs, but maintained immunity through rough economic times. But now those rough times are hitting everyone, from automobile plant workers to dot-com employees, to health care professionals.

Hospitals, clinics and universities are trimming deep into their ranks to save money, or closing down altogether. Doctors are no longer untouchable.

"It's one of the new stressors of physicians. Historically, it was such a rarity for a physician to lose a job," said Wayne Sotile, PhD, co-director of Sotile Psychological Associates in Winston-Salem, N.C.

"In the last five years, we've seen more laid-off physicians than in the prior 20 years collectively. It's happening more that excellent physicians are getting caught in clinical crossfires and losing their jobs over nothing to do with their clinical skills."

Newspaper business sections tell the story:

• Allegheny General Hospital in Pittsburgh let several psychiatrists go in 1998.
• Las Vegas' University Medical Center in February announced it would lay off 15 doctors at satellite clinics.
• Detroit Medical Center in March said it would cut services, close beds and lay off 1,000 workers. Staff doctors may be among those looking for jobs.
• Officials at the 117-year-old Waltham Hospital in Waltham, Mass., last month said the hospital would close in July. Eight to 10 doctors could lose their jobs.

"I might move my practice to another hospital or I might choose to leave southeast Michigan," said Daniel Michael, MD, chief of neurosurgery at Detroit Receiving Hospital, which is part of the Detroit Medical Center. "There just won't be any paycheck until you find something. Hospitals and physicians are going to face this until we find an equitable way to pay for uninsured and underinsured patients."

Anger, then mistrust

Psychiatrist Charolette Hoffman, MD, thought her job at Allegheny General Hospital was safe. Then she heard rumors in the fall of 1997 that there might be layoffs.

"The hospital was definitely struggling at the time. The [psychiatry] department was in red ink. I figured, because I was the lowest paid, 'Why would they get rid of me?' " she said.

On Jan. 14, 1998, she was summoned to a nearly empty room where two hospital officials sat in chairs.

"One by one, we were called down to that room. We were told, 'This is no reflection of your performance, but you're being laid off,' " she recalled. "All day it was horrible, everyone waiting to get word."

It was the first time Dr. Hoffman, 56, had been let go from a job.

"I didn't like being out of a job. That was horrible," she said. "I had a little bit of anger. At that point, I really didn't want to work for anybody else because I didn't want that to happen again and I didn't trust any corporation."

Dr. Hoffman pondered opening a solo practice. Driving around the city, she and her husband, James, passed a building with a "for rent" sign. That was all it took -- they rented and renovated the building.

Less than a month after being let go from Allegheny, Dr. Hoffman saw her first patient at Mt. Washington Psychiatric Services. Last year, she bought a larger building for the practice, which her husband helps run. The office now has seven therapists and plans to add another psychiatrist to the payroll.

Dr. Hoffman, medical director of the practice, works 70 to 80 hours a week, including weekends, but she said the extra effort is worth it to be her own boss.

"We knew nothing about a solo practice. We just decided we would sort of forge ahead and learn along the way. We're just independent cusses to begin with," she said.

Going it alone

Solo practice was also the answer for Dr. Burger, the twice-laid-off family physician in New Jersey.

When his contract wasn't renewed at a medical center in Camden, N.J, he joined a group practice. Combative personalities, he said, led to his being let go.

"I felt awful, but I thought, 'Gee, I'm not going to sit around here.' I came to realize it wasn't me and moved on," he said.

Venturing on his own in 2001, Dr. Burger leased space in a hospital for six months before opening his practice elsewhere.

"It's me, myself and I. No one to answer to," he said.

Dr. Burger said other physicians who had lost their jobs helped him through the healing process. Most physicians, said Dr. Sotile, a clinical psychologist, are ill-prepared to handle the loss.

"If you're a CEO of a company, you're taught to expect that something like this might happen. Physicians, of course, don't have that attitude. The psychology of physicians does not set them up to handle that well," said Dr. Sotile, co-editor of The Resilient Physician newsletter. "Unfortunately, our culture doesn't give them much help. Our culture says a rich doctor can get work anywhere."

After a layoff, it's normal for doctors to be despondent, angry and resentful.

"They feel ashamed, like, 'I have failed,' " Dr. Sotile said. "Being a physician is not a job. Being a physician is a calling. When the world says you're not [working as a doctor] well, physicians hear, 'I'm not being a good person.' "

Time to take stock

Doctors who have been laid off should use the experience to evaluate what they want to do with their professional and personal lives, counselors said. This is a good time for physicians to examine what they love to do and what they want to do more of. They should talk to colleagues and explore what's needed in the market.

"Doctors are very poor at networking because their patient list is everything," said John-Henry Pfifferling, PhD, director of the Center for Professional Well-Being in Durham, N.C. "They must network. Get yourself a big Rolodex."

Networking helped family physician David Neidorf, MD, after he was laid off from a group practice in 1999.

Dr. Neidorf heard from a colleague that a physician's widow in a nearby community wanted to sell the building where her husband had practiced. He got bank loans to purchase the property, and he read books about opening a private practice. He advertised for patients in the local shopper's guide and was able to get his former patients to come to his new practice. In August 1999, Dr. Neidorf opened his own practice, and now has about 2,600 patients.

But the memory of being unemployed for 1½ months is still fresh.

"I lived on savings, mainly," he said. "Now the only person who can fire me is myself, and that will never happen."

Some solutions can be temporary

While Dr. Neidorf chose to become his own boss, other physicians work with locum tenens companies until they land a permanent position.

That path has provided a steady income for William Coutts, MD, a family physician.

Initially, he struggled when funding for his position ran out and he was laid off from a free clinic in Hot Springs, Ark., in April 2002.

His family helped him financially. He volunteered at his church to keep busy.

"I got pretty depressed there for a while. I guess I was in professional shock," said Dr. Coutts, 44.

Then a friend turned him on to locum tenens work. Dr. Coutts started taking temporary jobs in November 2002 and has worked in Alaska, Arkansas and North Dakota.

"I like traveling and getting to meet people, but it takes away your long-term continuity," Dr. Coutts said. "You just have to explore other avenues, at least, temporarily."

Doctors who have experienced layoffs said the key is not to lose confidence and to understand that economic factors came into play.

Most of all, remember that there is always hope.

"The nice thing about this all, is it's a happy ending," Dr. Burger said. "If you want to practice medicine, you can do it. Sometimes you have to go elsewhere to get satisfaction."

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