Why Lawyers and Doctors Get Depressed

This article in the NYT speaks clearly about professions I know something about.

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January 6, 2008
The Falling-Down Professions
By ALEX WILLIAMS
YOU can’t say law firms aren’t trying.

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“The older professions are great, they’re wonderful,” said Richard Florida, the author of “The Rise of the Creative Class: And How It’s Transforming Work, Leisure, Community and Everyday Life” (Basic Books, 2003). “But they’ve lost their allure, their status. And it isn’t about money.”

OR at least, it is not all about money. The pay is still good (sometimes very good), and the in-laws aren’t exactly complaining. Still, something is missing, say many doctors, lawyers and career experts: the old sense of purpose, of respect, of living at the center of American society and embodying its definition of “success.”

In a culture that prizes risk and outsize reward — where professional heroes are college dropouts with billion-dollar Web sites — some doctors and lawyers feel they have slipped a notch in social status, drifting toward the safe-and-staid realm of dentists and accountants. It’s not just because the professions have changed, but also because the standards of what makes a prestigious career have changed.

This decline, Mr. Florida argued, is rooted in a broader shift in definitions of success, essentially, a realignment of the pillars. Especially among young people, professional status is now inextricably linked to ideas of flexibility and creativity, concepts alien to seemingly everyone but art students even a generation ago.

“There used to be this idea of having a separate work self and home self,” he said. “Now they just want to be themselves. It’s almost as if they’re interviewing places to see if they fit them.”

Indeed, applications to law schools and medical schools have declined from recent highs. Nationally, the number of law school applicants dropped to 83,500 in 2006 from 98,700 in 2004—representing a 6.7 percent drop between 2006 and 2005, on top of the 5.2 percent slip the previous year, according to the Law School Admission Council.

(Maybe they’ve been talking to actual lawyers. Forty-four percent of lawyers recently surveyed by the American Bar Association said they would not recommend the profession to a young person.)

The number of applicants to medical school, meanwhile, has dipped to 42,000 from 46,000 in 1997, although it has recovered from a low of 33,000 in 2003.

Students are focusing now on starring in their own creations, their own start-up businesses, said Trudy Steinfeld, the executive director of the Wasserman Center for Career Development at New York University.

“There’s a sexiness to starting something cool,” she said. “Now we have people trying to start a Facebook or a MySpace. You might be working like a maniac, but it’s going to pay off in status. You’re going to be famous, providing something people are going to know and use all over the world.”

Unquestionably, many doctors and lawyers still find the higher calling of their profession — helping people — as well as the prestige and money, worth the hard work. And the stars in either field are still that: commanding the handsome compensation and social cachet. But to others, the daily trudge serves as a constant reminder that the entrepreneur’s autonomy simply can’t be found in law or medicine.

“We’d all seen the visions, watching ‘L.A. Law,’ or ‘Ally McBeal,’” said Catherine Kersh, 32, a former litigator at a large firm in Los Angeles. “It did seem glamorous.”

Reality, she quickly learned, was different. Ms. Kersh recalled a two-week stretch in which she and a team of associates were holed up in a conference room with 50 boxes of documents. Every day, for 12 hours, they fastened Post-it notes to legal briefs.

“You look around at the other associates, trying to remind ourselves, why did we go to law school?” said Ms. Kersh, who now works for a nonprofit group that administers scholarships.

Many young associates, she added, spent their lunch hours making lavish purchases on NeimanMarcus.com, just to remind themselves that what they did counted for something.

Life, in fact, was less like “Ally” and more like “The Practice,” where lawyers work like dogs in a thoroughly unglamorous setting.

Nor does hard work guarantee success. “With law firms merging, fewer people are making partner,” said Carolyn Elefant, a lawyer in Washington who writes for Law.com, a legal news and information Web site.

In 2005, the number of equity partners at law firms grew by 2.5 percent, compared with 4.5 percent five years earlier, according to a study by Citi Private Bank. And even if you make partner, the work doesn’t lessen.

“Partners now are often billing as many hours as the associates, because of the enormous growth of law firms,” Ms. Elefant said. “There’s a huge overhead. The demand for global practice means many partners having to be available to clients around the clock.”

As firms demand ever more billable hours, said Lawrence J. Fox, a partner in the Philadelphia office of Drinker Biddle & Reath, lawyers find less time for pro bono work — the very thing that once gave them a sense of higher calling. Increased competitive pressures also mean that young associates are often locked into arcane sub-specialties, like pharmaceutical product liability.

Doctors face similar pressure. Complaints about managed care crimping doctors’ income and authority over medical decisions are nothing new, but the problems are only getting worse, several doctors said.

“Remember the ‘I Love Lucy’ episode in the chocolate factory?” said Dr. Ejnes in Rhode Island. “That’s what a medical practice is now like. They keep turning up the speed on the conveyer belt, and before you know it, you’re stuffing chocolates in your pockets.”

One doctor responding to the American College of Physician Executives survey wrote: “I find it necessary about once every month or two to stay in bed for 24 to 48 hours. I do this on short notice when I get the feeling I might punch somebody.”

Increasing workloads and paperwork might be tolerable if the old feeling of authority were still the same, doctors said. But patients who once might have revered them for their knowledge and skill often arrive at the office armed with a sense of personal expertise, gleaned from a few hours on www.WebMD.com, doctors said, not to mention a disdain for the medical system in general.

“If the topic comes up in cocktail party talk, you’ll hear nightmare stories from people as they’ve gone through the system — ‘they gave me the wrong pill,’ et cetera,” said Dr. Gregg Broffman, 57, a former pediatrician who is now a medical director of a primary care group in Buffalo. “In terms of my own self-esteem, it feels like a personal attack.”

EVEN the language of contemporary medicine has eroded the physician’s sense of majesty.

“What irritates me the most is the use of the term ‘provider,’” said Dr. Brian A. Meltzer, an internist in Pennington, N.J., who now practices pro bono on the side, but works full time for Johnson & Johnson’s venture capital division. “We didn’t go to provider school.”

Making the erosion of cachet more acute is the fact that unlike law schools or medical schools, flashier industries recruit heavily on top college campuses, said Lauren A. Rivera, a sociology graduate student and an instructor at Harvard who studies career choice among students.

“Investment banking and consulting firms have a huge presence; they’re barging in from before first day of classes,” Ms. Rivera said. “The messages they convey appeals to every undergraduate fantasy: this is a continuation of prestige education, this is the only valuable way to finish your education. You’ll work with the smartest people and the most exciting, high-profile clients.”

And then there is, yes, the money issue. Or rather, money envy. Associates at major New York firms often start at $150,000 to $180,000, said Bill Coleman, the chief compensation officer at Salary.com, a company that tracks income statistics. Partners at the country’s biggest 100 firms took home an average of $1.2 million in 2006, according to American Lawyer.

Hardly small sums, but for many senior investment bankers, bonuses and salaries this year will average $2.25 million to $2.75 million, according to Options Group, an executive search and consulting firm.

Doctors rarely approach such heights. While income varies widely, a typical physician might earn $150,00 to $300,000, according to Salary.com data. A surgeon might make $250,000 to $400,000; hot-shot surgeons can earn $750,000 a year, and superstars over a million dollars.

But absolute numbers are not the only issue, Mr. Coleman said.

The professions still largely award income in the traditional sense — a set, orderly progression, over the course of decades. Careers in more entrepreneurial industries like hedge funds and private equity firms follow the sky-is-the-limit model of the entertainment industry, the Web or professional sports.

Kevin J. Delaney, a sociology professor at Temple University who has studied the culture of hedge funds and private equity firms, said executives there “love the idea of being responsible for their own fate.”

They’re going to make a million or lose a million based on the trades they make,” he said.

Many firms are so small, he added, that “you go there, it’s one floor, and 10 people sitting around the room, six of them making millions of dollars.”

This star-system mentality is particularly attractive to college students, many of whom were reared with the ’80s philosophy that every child was a potential superstar, Mr. Coleman said. And they want immediate rewards — not exactly the mentality that will fuel a student through years of medical school, a residency and additional training for a specialty.

“Their attention span, everything, is instant feedback: quick, quick, quick,” Mr. Coleman said. “Apprenticeship, these kids don’t want to do it.”