Still practicing after all these years

Still practicing after all these years

More and more doctors may be looking forward to early retirement.But here are a half-dozen who are still going strong after 50 years in practice.What keeps them motivated?

By Berkeley Rice, Senior Editor

The arrival of the millennium seemed like an appropriate time to talkwith some physicians who've been practicing for half a century. At first,we weren't sure how many we'd find. After all, many doctors these days startthinking about retiring by the time they turn 50.

To our surprise, however, we found quite a few doctors who met our50-year criterion, all of them solo practitioners. Sure, they've cut backa bit, because of age, health problems, or, in some cases, managed care.But none uses the term "semiretired," and all say their patientsbeg them not to stop practicing.

Some of those patients have been with them for nearly 50 years, andthink of them not only as their physicians, but as old friends with whomthey have shared the joys and sadness of their lives.

When asked for the secret of their longevity, these doctors came upwith several common answers: supportive spouses, loyal staff, good genes,and good luck. But the main reason they continue to practice is that theystill get a kick out of treating patients, and they genuinely love medicine.As one says: "Medicine isn't just what I do--it's who I am."

"Practicing medicine is what sustains me"

Otto Baum, MD, West Orange, NJ

Internist Otto Baum was 13 in 1924 when his father, a physician in Germany,brought his family to America. "He didn't push me into medicine,"says Baum. "I just never considered anything else." The youngerBaum graduated from Harvard Medical School in 1936. After internship, residency,and military service in WWII, he practiced with his brother for 37 years,first in New York City, then in South and West Orange. He's been practicingalone since his brother retired 15 years ago.

At 88, Baum now works five mornings a week, seeing about eight to 10patients a day. Some of them have been coming to him for more than 50 years,although he still sees new patients of all ages. He continues to round attwo hospitals, and makes occasional house calls for patients who can't getto his office.

He has only one employee: an office man-ager/receptionist who handlesthe phones, bills, HMOs, and paperwork. "She's been with me nearly20 years," says Baum, "and she's very good. If she quit, I'd stoppracticing."

Because he's cut back, Baum's practice income isn't what it used to be."But as long as I'm breaking even, I'll continue," he says.

He's no fan of HMOs. "I have to belong to them, because many ofmy patients have been forced to join them," he says. "But I'venever practiced the way many HMO doctors do today. With some of them, it'sjust, 'How do you do, and here's a prescription,' with no time for an exam."

Baum spends at least 15 minutes with each patient, and half an hour ormore if they have particular ailments. "You need that much time tofind out what the real problems are," he explains. "Often, thecomplaints they come in with aren't their only problems, or not the mostimportant ones. That's why my last question is always 'Is there anythingelse you wanted to ask me?' "

For many patients, Baum serves as counselor as well as physician. "That'spart of the practice of medicine," he explains, "and it's whyI take so much time with my patients. I think that's why they keep comingback."

Since his wife died four years ago, Baum no longer travels much. He spendshis afternoons at home keeping up with medical journals and rereading hisfavorite classics by Twain, Shakespeare, and Goethe. On weekends, he stillgoes to concerts, opera, and ballet in New York.

Since he developed spinal stenosis 10 years ago, Baum no longer exercisesregularly, and he needs a cane to get around. Nevertheless, he remains cheerful."At my age," he says, "you make the best of each day as longas you can still function."

Asked whether he plans to retire soon, Baum replies, "Absolutelynot--not as long as I'm physically and mentally able to continue and mypatients still want me. Besides, I'd go crazy just sitting around and notworking. Practicing medicine is what sustains me."

"Medicine isn't just what I do. It's who I am"

Theodore Dushan, MD Swampscott, MA

Like many doctors who began practicing 50 years ago, pediatrician TheodoreDushan has an office at home. This assures him a short "commute"in his coastal town north of Boston, and makes life easier the nights he'son call. "I don't have to drive to an office to see patients or sendthem to the ER," he says.

Dushan, now 80, still puts in a four-day, 40-hour workweek. But he hascut back on his workload. He sees 12 to 15 patients each day, about halfas many as he saw years ago. He still makes hospital rounds, however, andoccasional house calls. And on evenings and weekends, he shares call withfour other solo pediatricians with whom he maintains a close association."We're like a bunch of dinosaurs," he jokes.

He has two employees, including an office manager who's been with him23 years. He does not have a nurse, however, "because I like to bethe one to touch the infants and to give the shots. I want that close relationshipwith my patients."

He has the same attitude about phone calls: "We get 30 to 40 callsa day from parents," says Dushan, "and I answer or return mostof them myself. When their children are sick, parents don't want to talkto a secretary; they want to talk to the doctor."

Although he's convinced that managed care has hurt the practice of medicine,Dushan participates in several HMOs. "I don't like arguing with themabout authorizations for each test and referral," he says, "butI try not to let them bug me too much." What does bother him is theeffect managed care has had on many of his younger colleagues. "Myfather was a GP who defined pediatrician as "a doctor who caresfor children," he says. "But I don't see much of that anymoreamong the younger doctors, particularly the ones who see 50 patients a day.They don't understand any other kind of medicine. To most of them, it'sjust a regular 9-to-5 job. "

Dushan's practice income has dropped over the years, but he still makesenough to afford vacations with his wife in Aruba and other luxuries. Andhis lighter load gives him more time to read and visit his children.

Dushan devotes much of his "free" hours to parenting programsat local schools and hospitals. "I consider that part of my practice,"he explains. "But the programs aren't worth a damn if there's no oneat home to follow up on them and provide the love and care kids need."Unfortunately, Dushan feels, much of today's child-rearing has been turnedover to the schools, churches, day care centers, and psychologists. "Whatabout the parents?" he asks. He worries that "we haven't preparedour young people to be caring, concerned, committed, responsible adults."

How long Dushan will work depends on his continued good health. He hadan angioplasty several years ago, but says he's fine now. He played regulartennis until a few years ago, when a hip problem stopped him. But he stillexercises at a gym four times a week.

"Why retire," he asks, "when I already have plenty oftime to do the things I want to do? Besides, I really enjoy my practice.You see, medicine isn't just what I do. It's who I am."

"I'll keep working as long as God lets me"

Abe Lucks, DO, Queens, NY

Fresh out of pharmacy school in 1932, Abe Lucks worked for 10 years asa detail man during the days, and as a pharmacist in the evenings at hisbrother's drugstore in Queens, NY. He grew restless, however, and went backto school for a BS and DO. In 1947, he opened a solo practice in an officeabove the pharmacy. Thirty years later, at the age of 66, he became board-certifiedin family practice. Today, 53 years after starting his practice, he's stillat it.

In the old days, Lucks worked from 7 am to as late as midnight, seeingas many as 100 patients a day, and doing minor surgery and obstetrics. Butat 89, he now works three days a week, from 7 am to 1 pm. (One reason forthe morning hours is his concern for his safety. The neighborhood has changed,and Lucks was held up three times in his office. He now has buzzer lockson the doors.) He sees about 20 patients a day, most of whom show up withoutappointments. "Many of them have been with me since I started,"says Lucks, "back when I used to charge $3 for office visits."

Lucks doesn't send out bills. "If they don't pay, they don't pay,"he says. "I still remember what it was like for poor people in theDepression." Fortunately, his practice income hasn't declined muchover the years because, as he explains, "reimbursement rates I getfrom the HMOs and the insurance companies are more than what I charge myprivate patients."

Lucks has joined a few health plans, but only those he approves of. He'sstill on the staff at a hospital, but no longer sees patients there.

"I take plenty of time to explain things to my patients," saysLucks. "I make sure they understand their problems, and how I planto treat them. I think most doctors don't take enough time to explain things.That's why so many of my patients still come to me."

At 89, Lucks feels fortunate that he's still in good health, which heattributes partly to the fact that he never smoked or drank. He still playsgolf three days a week--on foot, not in a cart--although most of his formergolfing buddies have passed away or can no longer get around the course.In his spare time, he reads and plays the organ, which he took up at theage of 75.

Lucks says he won't think about retiring "as long as I still enjoymy practice. Medicine is still the greatest profession, and I'll keep workingas long as God lets me. But I promised my wife I'll retire at 100."

"For me, medicine is not just a profession: It's a way of life"

Ernest Sears, MD, Houston

Ernest Sears was born and raised in Germany, and got his medical trainingthere and in Italy before coming to the US in 1937. After his residencyin Houston, he opened a solo general practice there in 1940. Except forthree years with the US Army in WWII, he's been there ever since.

At 89, Sears still works full time, including Saturday mornings, withThursday afternoons off. He gets up at 5:30 am, stops at the hospital forrounds, then heads for his office. He usually doesn't get home before 6:30pm. He has cut back his workload, however. He now sees about 15 patientsa day--down from 20--"because I can afford to, and because I like tohave time to talk to them. I spend at least 20 minutes with each patient."

Sears' patients range from toddlers to fellow octogenarians, though mostare middle-aged. He still accepts new patients. Though he belongs to 10HMOs, he resents managed care's intrusions and other annoyances. "Mysecret is that I don't let them defeat me. I still practice the way I want,"says Sears.

"You have to join the HMOs today," he continues, "becausecompanies keep changing plans to get cheaper rates. If you're not in thenew plan, you're going to lose those patients. It's not like the old days,when you got new patients through personal recommendations. Now they pickyour name off a list, because your office is nearby. That's a hell of away to choose a doctor."

In his spare time, Sears listens to classical music, reads medical journals,and takes CME courses. "I like to keep up to date," he says. He'sstill active in his county and state medical associations. And in 1998 hewas named Physician of the Year by the Harris County Academy of Family Physicians.

Since recovering from a recent coronary, Sears now moves more slowly.But he has no plans to retire. His wife, a former nurse, thinks he'd beunhappy if he stopped working. "I have colleagues who retired at 65,"he says, "and one year later you don't recognize them. They spend theirtime sitting there watching the idiot box all day.

"My patients all beg me not to retire. I'm afraid the new ones willbe scared off when they find out I'm 89. After one visit, however, theysay I'm the only doctor who really takes the time to listen to their problems."

With his reduced patient load, Sears now earns less than he used to.But as he explains, "I don't really need the money anymore. I practicenow because I like to, not because I have to. After 59 years, I still enjoyevery minute of my practice. The contact with younger doctors keeps my mindsharp. And I still enjoy the personal relationships with my patients. Forme, medicine is not just a profession. It's a way of life. And it's stillthe noblest profession of them all."

"It's still a wonderful profession"

Lillian Seitsive, MD, Northridge, CA

Lillian Seitsive was born in 1906, the daughter of Russian immigrants.Despite the obstacles facing women in medicine in those days, she graduatedfrom the women's division of the
Medical College of Pennsylvania. During her training, she met and marrieda fellow intern, and both opened general practices in Brooklyn, NY, in 1934.

Throughout her early years in medicine, Seitsive often encountered prejudice."There were very few female doctors in the country then," shesays. "I guess a lot of what I endured would be considered harassmenttoday, but I never paid much attention to it. I just did my work."

When Seitsive began practice, GPs really were generalists. "In theold days, we did everything--far more than FPs do now," says Seitsive."I did obstetrics for 40 years, and I remember charging $15 for a tonsillectomy,or $25 for a brother and sister."

After their children were grown, she and her husband moved to Northridge,CA, near Los Angeles, where they shared offices. He died in 1960. Nine yearslater, Seitsive remarried a widower who helped out with the bookkeepinguntil he died at 88. Her daughter took over the job for 11 years, and thenshe retired. But Seitsive is still going strong. (Her son, now 62, practicesinternal medicine not far away, and a granddaughter attends UCLA medicalschool.) Her only office help now is a woman who's been with her 10 years,and whom Seitsive calls "my girl Friday," because she does everything.

Because of managed care and her own health problems, Seitsive has cutback her practice in recent years to three and a half days a week. She nowsees only five to 10 patients a day, and no longer makes rounds. "Iguess at 93 I'm entitled to slow down a bit," she says. She also admits--grudgingly--toslowing down physically. She suffers from severe anemia, and two years agoshe broke her hip. "I still manage to get around, and I still drivemy own car," says Seitsive, who now walks with a cane. "My familykeeps telling me not to, but I like to be independent."

Although she accepts patients from Blue Cross and Medicare, Seitsiverefuses to join any HMOs. "There are too many regulations, and there'stoo much haggling," she explains, "I can't tolerate all that nonsense.I'd rather do housework." As a result, she's lost many patients. "Theyjoin the HMOs because they feel they have to, or because they think it'sa bargain," she says. "But then they discover it's not such abargain after all because of the restrictions on treatment.

"I don't believe in managed care, and I'm not going to change theway I practice because of it. I'm not going to push my patients throughevery 10 minutes like some HMO doctors do. That's not good medicine. I takeas much time as I want with them. With new patients, I'll spend an houron a history, and another hour for a physical." Seitsive still seessome of her patients from the old days, though there aren't many left. Shegets a few new patients via recommendations, but she admits that "someof them are surprised when they find out I'm 93."

Seitsive's scaled-back practice is no longer very lucrative, but thatdoesn't bother her. "I never made much from medicine, because I nevercharged much," she says. "You couldn't live on what I make now,but fortunately I'm not in want."

In the evenings after work, Seitsive goes to meetings, concerts, or theater.She's on the board of trustees of her hospital, her synagogue, and a nursinghome, and she's active in several religious, educational, cultural, andcharitable organizations. She also attends frequent meetings and seminarsat the hospital, and keeps up with her medical reading. Since she treatedherself to a round-the-world cruise 10 years ago, she hasn't taken any realvacations. Asked what she does in her spare time, she replies, "Sparetime? I don't have any. I'm too busy.

"My children wonder how I keep going. The answer is that I stilllove my work. When I get up each morning, I look forward to going to workand making people feel better. It's still a wonderful profession. I don'tknow what I'd do if I had to stay home."

"With a purpose like this in life, it's reason enough to keep going"

Mack A. Truluck, DO, Ponchatoula, LA

W hen Mack Truluck was 11 years old, he was injured in a boating accident.He had to quit school for a time, and he suffered severe migraines untilan osteopathic physician eventually cured him. "He turned my life around,"Truluck recalls. "I owe my life to osteopathy, and I'm still tryingto pay back my debt. I'll keep doing it until I can't go on any more."

After earning his own DO in 1945, Truluck first practiced in Charleston,SC, then moved to Baton Rouge. At age 65, he decided to cut back, and movedwith his wife to rural Ponchatoula, about 50 miles north of New Orleans.There he built a log home and converted an adjacent hay barn to an office.

At 81, Truluck now practices three afternoons a week and Saturday mornings.He sees about six patients a day and spends at least 15 to 20 minutes witheach one. With new patients, he says, "I take whatever time is necessary."

Truluck's patients don't need appointments. "People come wheneverthey want," he explains, "and I take them in the order they showup. When they're through, they leave their checks or money on my desk. I'venever had a nurse or a secretary. I do it all myself."

Truluck is still a purist among DOs: He does only manipulative treatment."Most osteopaths don't do manipulation anymore," he laments, "andthat's a shame. I don't do any general medicine. If my patients need it,I refer them to family doctors or to specialists."

Truluck refuses to deal with HMOs or insurance companies. "All mypatients pay as they go," he says. "That's the way I've alwaysdone it. If they don't want to do it that way, they don't come. I have somepatients who belong to HMOs, but they pay me out of pocket."

After cutting back on work, Truluck spent much of his free time golfingand fishing. But he's given up those activities for organic gardening, which--togetherwith the physical effort involved in his practice--gives him all the exercisehe needs. It also provides most of the vegetables he and his wife eat. Onweekends, they drive to New Orleans for an evening of dancing.

Truluck's practice brings only a modest income. But as he explains, "I'mnot practicing now for the money. We've lived a conservative life, and I'veinvested well. So I don't really need more money. I practice now becauseI want to help people. When they tell me I've cured their problems, that'sa real high for me, like hitting a hole in one. With a purpose like thisin life, it's reason enough to keep going."

Berkeley Rice. Still practicing after all these years. Medical Economics 2000;1:81.