Like most primary-care physicians, Dr. Gregory
Bazylewicz's job keeps him busy. His medical office
is in Manchester-by-the-Sea.
News staff photo/Jonathan M. Whitmore

General practice is a growing specialty

By MARY K. FITCH

News staff

Dr. Maury McGough's typical day goes something like this: She'll see about 20 of her 4,000 patients, talk to others on the phone, call insurance companies, conference with doctors, and do lots and lots of paperwork.

The only thing she can count on in her fast-paced Salem office is a hectic, 60-hour work week. McGough, an internist with Harbor Medical Group, says it's all part of the deal when you decide to become a primary-care physician.

"You don't go into internal medicine to make a lot of money, get out every day at 4, and play golf every Wednesday afternoon," she says.

McGough is a generalist, once considered the bottom of the medical community's physician hierarchy. Not anymore. There's a renewed respect for generalists as HMOs bring them to the forefront by wooing primary-care physicians, the gatekeepers of managed health care.

Primary-care physicians are usually internists, family practitioners, pediatricians and sometimes obstetrician/gynecologists. Today, some 30 percent of the country's 720,000 doctors are generalists, according to the American Medical Association.

"You go into internal medicine because you genuinely like people, you care about people, and you want to help," says McGough, a 43-year-old mother of three. "There aren't any other jobs like it."

HMOs hire primary-care physicians to handle most of a patient's care — from a sore throat to a suspicious lump — referring them to specialists only when advanced treatment is needed.

On average, each primary-care physician has 2,500 patients. The doctors say it's manageable because most patients don't schedule regular checkups and many don't visit for years.

"I don't think people would be happy to know that's how many patients a doctor can have," says Dr. McGough, who has about 4,000 patients. "But I know my patients for the most part. It's good record keeping."

Growing demand

The greater role of primary-care physicians under managed care has had a predictable effect on the medical community: After years of favoring the specialties, more doctors are choosing to become generalists.

That's quite a change from past years, when the vast majority of the 16,000 medical students who graduated each year chose specialty residency programs such as surgery, dermatology and cardiology.

Medical students often were drawn to specialties where they had higher pay, better hours and more prestige than generalists.

Specialists earn $250,000 to $300,000 per year, according to the American Medical Association. Generalists average between $150,000 and $200,000.

Despite the difference in pay, more and more medical students now are opting to pursue careers as generalists. In 1996, 54 percent of med-school grads chose a residency program in that field. That number edged up to 56 percent this year.

Deborah Harrington, 27, is one Beverly Hospital family practice resident helping to bump up that number. She plans to go into a group family practice when her training ends in two years.

As a child growing up in California, Harrington was inspired by her own family practitioner and his skill in treating all different types of people of all ages. And, Harrington says, she likes science and people so medicine was a natural career choice.

There's also more work for generalists than specialists, partly because HMOs need generalists to serve as primary-care physicians, Harrington says. She knows anesthesiologists, pathologists and radiologists who are unemployed. She figures the growing demand for generalists will likely land her a job soon after her residency.

When she does, she expects to earn about $100,000 a year. It may not be as much as specialists, but Harrington says it's enough to cover her $2,700 monthly student loan payments.

She also knows she'll be working long hours when she enters family practice. But like Dr. McGough, Harrington says she doesn't mind. "I kind of like working," she says with a shrug.

Dr. Gregory Bazylewicz, a 47-year-old family practitioner, shares that work ethic. His days start around 7 a.m. at Beverly Hospital, checking X-rays, reviewing lab reports and visiting patients. Sometimes, he'll squeeze in a meeting. By 9 a.m. he's back in his office that occupies the ground floor of the Colonial Manchester-by-the-Sea home he shares with his wife and four children.

He sees patients all morning and all afternoon. Some afternoons he sees homebound or nursing home patients. Between 5 and 7 p.m., he finishes his visits and paperwork.

Often the work doesn't end there. He's on call one night a week and one weekend day a month. The calls come at all hours of the day and night, from patients worried about a baby's fever and from nurses asking about treatments for his patients in the hospital.

In all, Bazylewicz puts in 65 to 70 hours a week. "I don't think calm is how anyone would describe my office," he says.

He says he knows that family practitioners don't carry the same high prestige or salary that neurosurgeons, cardiologists and other experts have. But, he quickly adds, the job is right for him.

"Everybody in this field gets tired and we sometimes we have a particularly demanding group of patients," he says. "But it's still the patients who give me the most satisfaction."