Today's Lesson: Switch Specialty

By Amanda Bower

Martin Palmeri has changed his mind before. Until his fourth year of college, he was planning a career in investment banking. But one afternoon, while volunteering in a North Carolina medical clinic, Palmeri realized that he was much happier in the hospital than in economics class. Palmeri was drawn to obstetrics and gynecology, he says, for the "emotion and passion" involved in delivering babies. "It's tremendously rewarding."

Or so he thought. Last year, his third at the Brody School of Medicine at East Carolina University, Palmeri, 28, began investigating what he calls the "litigious juggernaut" of ob-gyn and decided the risks of the specialty were greater than its rewards. He's not alone. More than 10% of respondents to an informal poll on the American Medical Student Association website say they have switched their intended specialty because of the rising cost of malpractice insurance. An additional 36% are considering a change for the same reason. In the first round of the process that matches medical-school graduates to most residency programs, 30% of positions in ob-gyn and 20% in E.R. medicine went unfilled by this year's U.S. graduates. (Most spots were ultimately taken by foreign-school graduates and U.S. students who did not get their first choice.)

Palmeri did his homework before giving up on ob-gyn. He attended a workshop held by the American College of Obstetricians and Gynecologists, at which he heard alarming stories of physicians turning away high-risk patients for fear of litigation, or losing their practice because of skyrocketing insurance costs. Palmeri then observed the civil trial of a Wilson, N.C., obstetrician who was sued after the plaintiff's baby suffered neurological damage during birth. The doctor claimed that the plaintiff had refused to have a C-section despite his insistence that a vaginal birth would endanger both mother and baby. The plaintiff claimed she had received no such advice. Palmeri says he was disturbed to see that "the trial focused on the poor outcome and not on what the physician actually did." The jury was hung, and the doctor--who says he had to pay at least $30,000 in office overhead while he earned nothing sitting in court--settled the case. His insurance premiums jumped from $22,000 in 1998, the year he delivered the baby, to almost $70,000 this year. "I just couldn't imagine having to go through what he did every couple of years," Palmeri says. He's now considering radiology.

Professional groups for high-risk specialties are concerned about the loss of people like Palmeri and Peter Chien Jr., a New York University medical student who contemplated orthopedics but is opting for dermatology, a less litigious field. Perhaps even more troubling, a quarter of final-year medical students polled said they would not study medicine if they started their education over. Thankfully for his patients, that's a change of attitude Palmeri hasn't shared. --By Amanda Bower