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A Profession on the Edge: New Doctors Face New Day : Medicine: As health reform plans lower expectations, 5 graduates enter a career that's no longer a sure thing.


BOSTON — Their names are Jennifer, Lisa, Coralli, Marc and Wendy. They are five young medical students who were graduated from Boston University Medical School last week--just as President Clinton seems poised to dramatically revamp their chosen profession.

To these newly minted physicians, the deliberations of the Administration's health care reform task force are like the first rumblings of an earthquake that threatens to send giant fissures through the foundations of their lives. Understandably, they are nervous about their futures.

When they entered medical school four years ago, these students were embarking on an occupation that offered them the personal satisfaction of healing people, the professional autonomy to prescribe whatever treatment they deemed necessary and the promise of a handsome income.

Now, as they brace for the changes that would be produced by the President's reforms, they know that they probably are going to have to settle for less money and less professional freedom than they once expected.

And even though they see a need for reform, they are stubbornly resisting Clinton's dictum that the medical profession needs more general practitioners and fewer high-priced specialists. Of the five students, only Wendy Buffett, 30, of Arlington, Mass., aspires to be a family practitioner.

About 15,500 students will graduate from the nation's medical schools this spring, many driven by a humanitarian impulse. Yet most will find themselves saddled with huge student loans to repay and weighed down by misgivings about the direction in which medicine is headed in the United States.

The five students interviewed by The Times expressed the hopes and fears of a new generation of physicians as they anticipate a massive government effort to reform the medical delivery system.

Comfortable, Not Rich

When today's graduates were growing up, most often the local doctor was the person in town with the nicest house and the most expensive car. In 1991, doctors earned an average of $170,600 a year--more than 11 times the national average.

But the President's efforts to cut medical spending, combined with insurance practices that already are forcing doctors into group practices or salaried positions with health maintenance organizations, are causing the students to trim their earning expectations.

"My salary expectations are certainly lower than generations in the past," said Marc Mitchell, 29, of San Francisco, who expects to specialize in internal medicine. "My expectations are to make a living, to be comfortable. But they are certainly not in the realm of hundreds of thousands of dollars or millions of dollars, as in the past."

Yet while most medical students--like Mitchell--will tell you that they expect to earn less than their predecessors, Dick Green, spokesman for the American Assn. of Medical Colleges, said many of them still secretly hope to get rich.

As Green put it: "They say, 'People aren't going to make as much money,' but they are thinking, 'I am going to.' "

No matter what they expect to earn, the students seem to find it necessary to defend physicians who earn big salaries practicing medicine.

"A lot of the time, when people talk about doctors' salaries, I resent it," said Jennifer Lynch, 22, of Clearwater, Fla., an outspoken student who intends to specialize in one of the profession's highest-paying fields, obstetrics and gynecology. "They imply that that's why they are a doctor, to make those salaries. It's not."

She noted that doctors often work 80 hours, or twice the normal workweek.

Even those young physicians who hope to combine work and family see themselves making a better living than most people. One of them is Buffett, a fourth-year student at Boston University.

"I expect, actually, to be able to work half-time and still make about $50,000 a year," she said. "That's in my fantasy. I'm talking about being part of a two-income family."

While these students say they recognize that there will be a growing number of openings for doctors in health maintenance organizations, none of them expressed any interest in working for an HMO, which usually pays less than other alternatives.

Changing Image

As these medical students are keenly aware, physicians are widely being blamed for many of the faults of today's health delivery system. Lynch said she has been disturbed to observe how many people have "a love-hate relationship with their doctor."

"Individuals, when it comes to their own care, love their doctor," she said. "If they are sick, they want you to go the full 10,000 miles to make sure that they are going to get better. If it's their loved one, then do everything you can.

"But when it comes to talking about doctors as a group, we're sort of like the devil. We all charge exorbitant prices. When they talk about doctors as a group in general, we're the evil that needs to be conquered.

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