Letters: Readers comment on Medical Economics stories

Get creative and persevere

What an incredible story of perseverance! ("Shifting gears," [by George W. Hartzell Jr., MD, FACS], which focused on Dr. Hartzell's career changes in the June 25 issue.)

To those in any walk of life who sit at home and say, "Woe is me," I submit Dr. Hartzell's story as evidence that for those who wish to be productive members of society, there are often creative options that can be pursued.

RICHARD PETERS, MD
New York, New York

Additional obstacles

I am a board-certified (and recertified three times) surgeon. I was a partner in one of the busiest practices in one of the most competitive communities in Southern California. The partnership dissolved when the senior partner was nearing retirement and the other became full time at a university-affiliated hospital. After that, I concentrated more on a primary care setting for Japanese-speaking patients. Then, I went to law school and passed the California bar examination.

I make the following observations from my vantage point:

1. I concur with Dr. Hartzell that a "surgeon is an internist with something more." The fund of knowledge accumulated by a general surgeon in adult internal medicine, especially in acute conditions, is a lot more than I had realized.

2. Other obstacles for surgeons who want to convert to office-based practice are:

As for me, I am paying full general surgery malpractice premiums and take panel ED calls at a local nonteaching hospital, just so that I can maintain my hospital privileges and hospitalize my patients when necessary.

As soon as this year, the fiscal picture will be that I have a negative cash flow in my surgical practice, so I will need to work on building up my law practice, I guess, rather than exclusively practice primary care.

Policymakers need to realize that a lot of surgeons can be easily converted to general practitioners to meet the demand for primary care doctors (much easier than training new doctors), but they are precluded by these obstacles.

ROBERT Y. UYEDA, MD, JD, FACS
Los Angeles, California

Not as easy as it may look

The "Shifting gears" article in the June 25 issue by Dr. Hartzell is somewhat demeaning, in my opinion, to the thousands of primary care physicians (PCPs) who are residency trained and specialty board-certified, as it implies that one can be totally out of the practice of medicine for 8 years, but then get 60 hours of "review" on a CD, spend 4 weeks as a preceptee, and "presto," a PCP is formed.

I have no knowledge as to the capabilities of the author, nor do I wish to denigrate his expertise. I just wish to point out that the article may again exemplify the ivory tower attitudes of some limited specialists that it takes little training to practice family medicine.

ROBERT H. BOSL, MD, FAAFP
Starbuck, Minnesota