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From the complexities of medicine in an urban area to a practice in a small town: A St. Petersburg surgeon returns to what he hopes will be a more direct way of helping patients.
By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times, published December 18, 2001
After more than two decades of practicing medicine in operating rooms and board rooms in the Tampa Bay area, Dr. Leslie Pearlstein is heading for the hills. The surgeon wants to rediscover the joy in doctoring, he says, and believes he will find it in a small town in North Carolina.
Pearlstein leaves St. Petersburg this week for Murphy, population 1,600.
Word of his departure surprised many in the community.
"I'm not retiring. I'm not dying. I need a challenge," says the 56-year-old Pearlstein. "You get burned out. There's only so many meetings, so many committees, so many things you can do."
"He wants to hear people's stories" like he used to, says his wife, Reva Pearlstein.
"You want your doctor who comes to your bedside to be happy." Since the decision to make the move, she says, "This is the man that I married, that I fell in love with."
Seated in his office at the Plaza Building at Bayfront Medical Center, the adjacent examination rooms empty, Pearlstein intensely wants his friends and foes to understand the reasons for his unexpected change in direction.
"I'm not doing this bitterly," he says, resting his clasped hands on the desk. The fingers are surprisingly stubby, the skin flaking from sensitivity to latex gloves, a job hazard for many surgeons. He performs from 400 to 500 procedures a year, he says.
"I am feeling guilty. This is my family, these are my patients."
When he moved his practice to the pastel suite of rooms in 1991, Pearlstein intended to stay until retirement. He wanted to concentrate his work at one hospital. Through recommendations from patients and colleagues, about 80 percent of his surgeries were for cancer and diseases of the breast.
"He's a hand-holder," says his wife, "and women in that position need so much support."
"He's wonderful," says patient Dawne Lagergren, a St. Petersburg Realtor. "He's that unique blend of competence and compassion. He came into his office on a Sunday to meet me.
"I'm really sorry he's leaving."
Pearlstein's departure is both a personal quest and a reflection of the frustration many physicians say they feel about the way medicine is practiced today.
Dr. Brad Fishalow, an orthopedic surgeon who roomed with Pearlstein at Johns Hopkins School of Medicine and partnered with him in anatomy class, says he's saddened to see his longtime friend move away.
"He's my doctor. He's my wife's doctor. It's a real loss for the community," says Fishalow.
"It concerns me that doctors are making moves like (this)," he says. "The one expectation you have in medicine is that you're going to go someplace and stay there. We've lost half of our general surgeons in five years. They can make more money someplace else."
It was Fishalow who invited Pearlstein to come to St. Petersburg 23 years ago, to join 17 other specialists and family practice doctors in the Suncoast Medical Clinic group. Pearlstein finished his medical degree and residency at Johns Hopkins, deferring military service during the Vietnam draft. He was then commissioned as an Air Force major and stationed in Shreveport, La., for his two-year hitch.
Reared in Miami, Pearlstein knew he wanted to stay in the South.
When he began his practice in St. Petersburg in the late 1970s and early 1980s, about three-fourths of his patients were covered by Medicare. Another 15 percent had health insurance, says Pearlstein. By the mid-1980s, as managed health care expanded, his physicians' group became one of the first to sign with an HMO, he recalls.
Now he's going to North Carolina, he says, because medicine in Murphy is what it was here 20 years ago.
"It's a community that needs me, and I need them," Pearlstein says. "It's corny, I know."
He will have a solo surgical practice and deal with a single 100-bed hospital. He has colleagues who can tap his expertise, and who will cover for him when he visits home.
Overhead is less expensive: Leasing office space in Murphy will cost $9.50 per square foot versus $25 in St. Petersburg, he says. National figures show overhead for physicians running at 60 percent or more of incomes.
Small towns, adds Fishalow, often do not have HMOs.
Declining payments under HMOs and managed health care plans in the Tampa Bay area have prompted several physicians to seek markets where fees are larger. An estimated one-third of Medicare patients in the Tampa Bay area, for example, are on a managed care plan, which tightly restricts payment amounts to physicians.
Pearlstein says his income has declined 50 percent over the past six years.
To compensate, physicians say they must rush patients through on an assembly line or branch out into cash-only elective procedures such as hair transplants and spider vein removal.
Others simply quit, if they can afford to. The average age of retirement for surgeons, for example, has dropped from 62 to 60, says the Bulletin of the American College of Surgeons.
"When you get paid less than an air-conditioning repairman and you have someone's life in your hands," Fishalow says, "it's not right."
In 2001-2002, compensation for all physicians nationally is projected to increase about 3.7 percent, slightly more than last fiscal year's 3.3 percent increase, says the New Jersey-based Hospital & Healthcare Compensation Report. This year, general surgeons earned salaries averaging $142,000 to $274,000, according to Modern Healthcare magazine's annual survey, published in August.
Pearlstein may be more burned out than most because he has ministered to medicine's politics as well. He was Bayfront Medical Center chief of staff for four years, sat on its board and chaired its quality committee.
"I gained 30 pounds eating chicken dinners" at meetings, he says. "Sometimes I would have seven meetings a week."
In the late 1990s, Bayfront joined with seven other nonprofit hospitals to form BayCare Health Systems Inc. Intended to save money, the arrangement failed to stanch losses of as much as $1-million a month and finally fell apart over Bayfront's lease with the city of St. Petersburg.
The politics of being a doctor and the management left a sour taste, some of Pearlstein's friends suggest. "I think he felt after all he had done someone should treat him a little better," says Fishalow.
Gossip about his departure has been fed by the fact that his wife of 31 years will remain here.
Reva Pearlstein will stay because this is their home, they agree. Employed in bond sales, she needs to be near the couple's aging parents. She wants to continue her active involvement in Congregation B'nai Israel and the Pinellas County Jewish Day School she helped found.
She, or he, will fly back and forth for visits. They have two daughters.
"Some have been mad" about his departure, says Pearlstein. "Some, at the last minute, tried to work out a deal to keep me here. Two-thirds of them say I'm brave -- they wish they could do it."
Pearlstein will be licensed to practice in both states. He says he has no doubts about his new place, nor where to call home.
"This is my home," says the doctor. "This is my life. This is where my cemetery plot is."