Physician takes nontraditional path to practice

By Amanda Mantone Linehan

MALDEN — James Cheverie was nearing 30 when what he calls “an early midlife crisis” hit him.

Though he’d spent nearly a decade teaching science at Malden Catholic High School, he decided his true calling – an unreachable dream he’d long held – was to practice medicine.

“I’d always hoped to be a doctor. It was my childhood dream,” said Cheverie, who now works as a physician at the Malden Family Health Center on Savin Street. “But in the ’80s, medical school was very hard to get into. So I’d kind of talked myself out of it.”

Throughout high school and college, he had considered applying to medical school, but felt he wasn’t among the top-tier, over-achieving students he saw all around him getting admitted to medical programs. So, he settled into a career of teaching high school students biology, chemistry and more. And while he said he found the job rewarding, he couldn’t shake the feeling – watching his own students pursue careers in medicine – that he’d missed his true purpose.

“I was as talented as them, but I didn’t have the right situation,” he said. “I didn’t want to live the rest of my life as a teacher. I wanted an intellectual challenge, and teaching can be very repetitive. I had no mortgage, wife or kids, so I just applied to med school.”

He started studying for the MCAT, lining up references, and trembling at the thought of giving up full-time work – and the accordant lifestyle that comes with a steady paycheck – for the struggles of a penny-pinched student.

“I used to take Rte. 9 from Worcester to Malden because I couldn’t afford the Pike,” he said. “A lot of people thought I was brave, going from making a living to being a poor student. But you just have to persevere. I know it can be done, because I did it.”

He was 32 when he started medical school – “about 10 years older than my other classmates” – and finished in a five-year extended program. He graduated from the University of Massachusetts Medical School in 1996, and has worked at Hallmark Health since 2006, previously working at practices in North Andover, Haverhill and Andover.

“Teaching wasn’t carrying out my life plan. It took a year for me to get ready for medical school, but it’s been worth it,” said Cheverie, who started out thinking he’d become a pediatrician, but “fell in love with family medicine,” which he now practices.

“I’ve told many people it’s never too late to go to medical school. If you really have this dream, you shouldn’t let expenses get in the way.”

Trouble is, Cheverie – both as a career changer and as someone who chose general medicine – is in the minority these days.

Though education options and acceptance standards for second-career medical students have grown in recent years, the number of professionals entering medicine overall – especially general practice, or family medicine – hasn’t followed suit.

Data shows that fewer college graduates are seeking a career in medicine, and of those who do, few are choosing to specialize in the bread-and-butter fields that patients depend on for preventative care, sick visits, birth and overall wellness.

High-paying, low-risk sectors like dermatology and plastic surgery are becoming so popular that residency programs are turning away over-qualified candidates coming from the nation’s most selective and rigorous medical schools.

The reason?

“There are very few dermatology emergencies, the hours are normal, and they make a ton of money,” Cheverie said. “When older practitioners retire, their places are not being filled by nonspecialists or general practitioners.”

It doesn’t hurt that many dermatology practices offer glossy, spa-like facilities, with a never-ending stream of looks-obsessed clients looking for costly elective procedures as an antidote to aging.

Yet, as Baby Boomers age into end-of-life care and require increased management of chronic conditions, the need for general physicians and family medicine practitioners has ballooned.

Even as family medicine centers have become more common nationwide – Malden has two, both of which opened in the last two years – there’s a real risk that the medical community won’t make pace with up-ticking demand from a health-care population that skews older ever year.

Cheverie, and many other doctors, say the balance is nearing a tipping point that could leave waiting rooms overfilled and medical staffs tapped.

“I think what’s going to happen is there will be a shortage in 10 to 20 years,” he said. “Fewer medical students are finding it feasible to go into fields like family medicine because the salary structure is such that it can’t meet their lifestyle needs or loan payments.”

According to a recent study by the Institute of Medicine, physicians who choose dermatology can earn more than $300,00 per year, compared to $175,000 for a general internist. And a 2005 study by health-care staffing firm Merrit, Hawkins & Associates says America faces a shortage of up to 200,000 physicians in the coming decades, as Baby Boomers retire.

“We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably,” said Jon W. Rowe, professor of health policy and management at Columbia University, in the Institute of Medicine report.

A March story in The New York Times, citing a report by the Association of American Medical Colleges, says there are far fewer residency positions in dermatology – 320 in 2007 versus 5,517 for internal medicine and 2,603 for family medicine – yet dermatology is attracting graduates with the highest medical board scores and memberships in medical honor societies.

So what can be done?

Cheverie, reflecting the thinking of many other doctors who have spoken openly and to the media about the topic, says reconfiguring the healthcare system is inevitable.

“I’m not a proponent of universal health care of anything, but they need to restructure it,” he said. “In my opinion, there have to be limits of the amount you can sue a doctor for. There has to be a change in that area.”

He said some doctors he knows have been forced to curtail or close their practices because of rising premiums, malpractice insurance costs and overwhelming loan debts. While doctors “make a good living,” he said, many are hit with so many ancillary costs that salaries take a hit, and new doctors shun all but the most lucrative specialties.

“I think demand will force salaries to go up,” Cheverie said. “There has to be some kind of incentive (to attract general practice doctors). A lot of doctors aren’t happy with the way medicine is today.”

And, Cheverie said, the field could draw more from working professionals who may have been considering a move to medicine. He’s just one example of how it can be done.

“I didn’t go into medicine because there was a shortage (of doctors). I went into teaching because I didn’t think I could do medicine,” said Cheverie. “But to go to medical school to enter primary care, you need good role models. And that concept is changing.”

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