Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 24, 1990 TAG: 9006280660
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LOW MOOR LENGTH: Long
The shoes, laced and tied, are flattened at the heels from the incessant wear and tear by their owner, Dr. Michael Lassere. Lassere slips on the shoes whenever he has a baby to deliver. This night, Lassere will pull the shoes on and off four times.
Lassere will end up spending the night in room 340, a patient room that has been converted into an "on-call" room for obstetricians. But he does not know this when he picks up the phone and dials home.
He tells his wife, Jeannie, that he won't make it for supper after all. He's waiting for an anesthesiologist to arrive so he can do a Caesarean section. And there's another patient in labor who could deliver any time.
"I'll try to get home as soon as I can," Lassere tells his wife. "I love you."
The pressures that come with being one of two obstetricians in the Alleghany Highlands has taken a toll on Lassere's wife and two young daughters, the 35-year-old physician acknowledges. "It's hard on them. They've been very patient."
Occasionally, he's spent three consecutive nights at the hospital delivering babies. "I can pretty much count on spending at least one night a week here," he says.
In a few months, however, Lassere and his family won't have to endure such a frenetic schedule. After nearly five years of delivering babies at Alleghany Regional, Lassere decided last month to call it quits. He told patients who would deliver in December or later that they would have to find another obstetrician. He was going to limit his practice to gynecological services only.
When Lassere announced his decision, the area's only other obstetrician decided she, too, would have to give up obstetrics until another doctor could be recruited to deliver babies.
"I don't want to hate my job," Lassere says. "When you get to the point you don't enjoy what you're doing, you shouldn't do it. It's gotten to that point with me."
Lassere isn't alone. Nearly one-third of the obstetrician-gynecologists and family practice physicians in Virginia who have delivered babies have given up obstetrics, according to a report released late last year. The median age of the physicians who had dropped out was just over 40.
"As increasing numbers of physicians give up this specialty, those remaining develop larger and larger practices," the Medical Society of Virginia report said. "As a result, many of Virginia's practicing obstetricians, particularly those located in smaller and more rural areas, maintain grueling schedules, and are practicing at, or near, capacity."
Lassere, relaxing for a moment in the yellow vinyl easy chair, can't point to any one reason for his decision. "I'm really burnt out," he says. "I crave a respite."
A moment later, Lassere gets a call. The anesthesiologist has arrived. The patient is ready. Lassere grabs some green scrubs - medium-sized - off a metal clothes rack and slips them on. He eases into his brown wingtips and scurries down a flight of stairs to an operating room. Forty-five minutes later he is back. An 8-pound, 10-ounce baby boy and his mother are doing fine.
Lassere strolls down the hall to check two other patients. One is munching on junk food and smoking cigarettes. Lassere doesn't think she'll deliver any time soon. The other is further along and could deliver any time. Lassere is just glad the time didn't come while he was doing the Caesarean.
"What happens if two patients are critical at the same time?" he asks. "There's only one of me. I can't be at two places at one time."
Six years ago, as Lassere entered his last year of training as an OB-GYN resident, he was flooded with job offers. His colleagues couldn't believe it when he told them he was going to a rural area and open a solo practice.
"People told me I was crazy," Lassere recalls. They told him he would be working harder and making less money. They said he wouldn't be able to take the stress.
"In retrospect, I think they were right," he says.
When he arrived in Alleghany County, Lassere was full of ideals and living in the past. He pictured himself becoming the type of obstetrician that Dr. Leon Gillard had been.
Gillard was one of the senior physicians who trained Lassere and other residents at Louisiana State University in a rural satellite clinic in the town of Lake Charles. Gillard, a solo practitioner, became a hero and role model to Lassere, who had grown up in a small town in southern Mississippi.
Lassere took an immediate liking to the small-town friendliness and nurturing atmosphere of Clifton Forge. He loved the mountains and the outdoor recreational opportunities. He and his wife rented an old, roomy house and joined the Appalachian Trail Club. Later, they would buy 85 acres bordering the national forest in the tiny community of Rich Patch and put up a double-wide trailer while they saved money to build their dream house.
But Lassere soon discovered he had no time to hike or enjoy the outdoors. He realized his two daughters were growing up without him.
When Lassere arrived, five family practice physicians and another obstetrician were delivering babies in the area. A few months later, the five family practice physicians - blaming rising malpractice insurance premiums - stopped. Lassere and Dr. Beulah Roblete, who had arrived in the area 12 years earlier, found themselves totally responsible for the 350 to 400 babies born each year at the hospital.
It didn't take long for Lassere to confront the gap between his dreams and reality.
"It's a kind of chronic stress," Lassere says. "Too many hours, too many responsibilities and a growing realization there is very little hope the situation will get better."
One major cause of stress, Lassere says, is the inability of a small, community hospital to live up to public expectations.
Patients seem to believe that all the technology and services available in a major regional teaching hospital also will be in a 176-bed facility like Alleghany Regional, Lassere says. They expect an anesthesiologist to be available on premises around the clock. They expect operating room nurses to be in the hospital if an emergency Caesarean section is done at 2 in the morning. They expect the latest diagnostic and monitoring equipment. They expect pediatricians and neonatologists to be immediately available.
The reality is different. "It's almost impossible to provide those services in a rural community hospital," he says.
An added pressure is the growing number of women who simply "drop in" at the last moment to have their babies. These are women who have seen out-of-town doctors for their care or who may have had no prenatal care at all and simply show up at the hospital ready to deliver a baby. Lassere has never seen them before. He has no clue about their medical histories or potential problems. In five years, he estimates he's seen well over 100 patients in this category.
The doctor-patient relationship has become more strained, Lassere says. "It's like there's an assumed adversarial relationship."
It's not unusual to have patients who take notes on everything, write down the names of everyone they see and demand certain tests, Lassere says. Patients have the attitude that if they don't deliver a perfect baby, it's the doctor's fault. The physician has been reduced to the role of a well-trained repairman.
The threat of a malpractice suit "is always in the back of my mind," Lassere says. A successful suit, he knows, could mean financial ruin.
The cost of malpractice insurance is part of the aggravation that comes with being an obstetrician. Lassere's rates will drop dramatically when he limits his practice to gynecological services only. Yet the cost of insurance by itself is not a determining factor in his decision to give up obstetrics, he says. Indeed, rates in Virginia - which had ranged from $26,000 to $43,000 - dropped by 25 percent in recent months.
A year and a half ago, Lassere decided that the local caseload of obstetric patients was too much for two doctors. At that time, hospital officials had been trying more than a year to recruit another obstetrician. Lassere figured he'd give the recruiting process a little more time.
But as the months dragged on, the practice of obstetrics became less and less satisfying. He found himself not having time to devote to his office practice and his gynecological patients. Lassere has a strong interest in using the laparoscope - a thin, lighted tube - for diagnostic and minor surgical procedures. Trying to schedule those around the unpredictable arrival of babies proved nearly impossible.
"If you have a group of doctors, you always have one guy to take care of non-scheduled things," he says. "In a practice like this, that's not possible."
Some days are better than others, Lassere says. But there is no respite when the bad days pile on top of each other. Airline pilots, he says, are grounded after flying a certain number of hours. Lassere was beginning to feel like he would never be allowed to come in for a landing.
"I just made the decision this was not the way I wanted to continue my life. It's more than just a career at stake. It's your life, your family," he says. "I think I gave it a good shot. I feel good about the decision. Enough is enough. You have to move on."
by CNB