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Tuesday, October 08, 2002

By Pamela Gaynor, Post-Gazette Staff Writer

Doctors don't expect to lose their jobs. Almost any one of them can tell you that -- perhaps few better than Dr. Charolette Hoffman.

	Dr. Charolette Hoffman and her husband, James, at their Mt. Washington Psychiatric Services practice on Southern Avenue. "One of the best things about this is I'm in control of my destiny," said Charolette Hoffman. (Steve Mellon, Post-Gazette)

She was one of eight physicians let go in January 1998 when Allegheny General Hospital eliminated 60 positions from its psychiatry department, a third of the unit's total.

For Allegheny General, the cutback was one of many desperate but unsuccessful measures taken to help stave off its parent foundation's bankruptcy.

For the doctors, whose entire training cultivates a sense of social value and an expectation of economic security, it was "devastating," said Hoffman. It was all the more so for Hoffman, who had entered medical school in her 40s.

Pink slips are rarely as profuse among physicians as they became during Allegheny Health, Education and Research Foundation's financial collapse. The state's largest health system at the time, it severed hundreds of physicians, both here and in Philadelphia.

But physician terminations aren't the anomaly they once were either. In recent years, health-care institutions around the country, including St. Francis Health System locally, have been ending employment contracts with physicians, many of whose practices were purchased during a mid-1990s acquisition frenzy.

As the pendulum swings, some doctors have pulled out of medicine entirely, either retiring early or pursuing different careers.

Others, such as Hoffman, have simply gone back to what was the norm for doctors before managed care set off the migration to hospital payrolls: private practice.

For Hoffman, at least, it's a story of renewal. She couldn't have imagined leaving medicine but, having been schooled, on the West Coast at a time when managed care already permeated health care there, she had expected and wanted to be employed at a hospital.

Now owner and medical director of her own practice, Mt. Washington Psychiatric Services, she said she wouldn't have it any other way. "One of the best things about this is I'm in control of my destiny," she said.

The independence isn't without its downside: For her, private practice has been a 24/7 proposition. As the only medical doctor at Mt. Washington Psychiatric, Hoffman, with six licensed therapists working under her, is the only one who takes after-hours call. "I sleep with my cell phone," she said. She also continues to provide services at Allegheny General, though not as a payroll employee.

But heavy lifting is nothing new to Hoffman.

Now 56, she started medical school only 13 years ago, at an age when most physicians are comfortably settled in their careers.

Born to a blue-collar family without the money for a college education, Hoffman began her working life just out of high school, in 1964, as a secretary at the Dairymen's League Cooperative Association's New York headquarters. The following year, the dairy products distributor installed its first computer -- an 8K Honeywell tape operating system, a relic by today's standards. Hoffman took an aptitude test to work in the newly created data processing department, and with the highest marks, got a foothold on the new frontier of office automation, where degrees didn't matter and all training was on the job.

She married while in New York and moved to Los Angeles in 1967 when a new job opportunity took her husband there. After having two sons, her first marriage ended, but her career progressed through a number of higher-paid data processing posts involving more responsibility.

She remarried in 1980, to James Hoffman, who now oversees the business aspects of her growing practice. By 1985, both seemed to have the world by the tail, with lucrative careers -- hers as an applications development manager for Warner Bros.' film marketing operations and his as manager of a corporate consulting unit with IBM Corp.

But Hoffman had always wanted to get her college degree. The midlife reappraisal that goes with turning 40, coupled with the death of her brother, told her, "It was now or never."

With her husband's support, she enrolled as a full-time undergraduate at California State University at Northridge in the fall of 1985.

She was starting her spring term when her husband was diagnosed with kidney cancer.

Exposure to the health-care environment during his hospitalization for surgery inspired Hoffman to consider medical school.

"I definitely wanted to be in a helping profession," she said. "Data processing was intellectually rewarding but not emotionally rewarding."

Some friends thought she was crazy and, at her age, she had her moments of doubt. To test her own mettle, Hoffman signed up for 19 credits in hard sciences the next semester.

Having performed well, she sought other means of motivation -- taping shoemaker Nike's advertising slogan "Just Do It!" on her refrigerator door and keeping in mind singer Cher's motto: "Life is not a dress rehearsal."

In 1989, she entered medical school at the University of Southern California School of Medicine in Los Angeles. Also seeking a change, her husband left IBM in 1990 and began a master's program in health administration there.

To fund their academic odysseys, they sold their house. A fixer-upper when they bought it, its value had more than doubled to $500,000 amid the California real estate boom.

In debt by the time Hoffman got her M.D., they researched cities for a residency program where she could do her training in a more affordable housing market that offered big city amenities in a smaller, less hurried environment.

Pittsburgh filled the bill. She entered Allegheny General's psychiatric residency program in 1993, while her husband found clients as a self-employed computer systems consultant catering to small businesses.

Four years later, in July 1997, the North Side hospital hired Hoffman for its permanent staff. Less than a year later, on Jan. 14, 1998, the ax fell on her department.

It took Hoffman and her husband only the evening of her dismissal to decide independence, rather than institutional employment, was the best course in a profession undergoing such upheaval. James agreed to manage the practice for a year.

Hoffman saw her first private patient less than three weeks later in temporary quarters on McKnight Road, where her practice consisted of herself, her husband and a portable file box.

The same day, they leased a 1,000-square-foot office on Mount Washington, near their home. Following renovations, she opened it three months later.

By 1999, with two therapists working under her -- one full time and another part time -- a part-time clerical employee and her husband, the office was cramped. They annexed and renovated more space, doubling the office size.

The practice continued to expand, requiring additional therapists and support staff.

Late last year, Hoffman and her husband purchased a primary care facility that financially struggling St. Francis Health System had closed.

After a $100,000 renovation, it provided Hoffman both with additional space and an environment that suits the kind of practice she wants to run.

The reception area, with upholstered chairs, tables, trays of cookies and fixings for tea, is meant to feel home like. The therapists' offices, with couches, cushy chairs and table lighting, have the feeling of cozy spare rooms.

Tally, a Siberian husky the Hoffmans rescued from the Humane Society, wanders around the building. They think of her as the "lick therapist."

In Hoffman's view, the relaxing surroundings augment the therapy she and her colleagues do.

She didn't initially expect her practice to get so large and even contemplated going solo. But her husband felt expansion was necessary to achieve the attributes of care Hoffman wanted to deliver and to deal with managed care insurers.

"We pride ourselves in delivering a high quality product in a high quality environment," Hoffman said.

Alone, the paperwork involved with managed care is "overwhelming" and costly, James Hoffman said, though coming from business backgrounds, neither he nor his wife has any quarrel with the concept, which was intended to curb medical costs.

At the moment, Mt. Washington Psychiatric's seven professional therapists have a caseload approaching 600 patients. He said he expected the practice to double in size.

Among other things, expansion has enabled Dr. Hoffman to recruit therapists who specialize either in treating certain mental disorders or in specific therapeutic methods.

As the only physician, Hoffman serves as medical director, seeing some of the practice's patients for therapy but reviewing medication usage for all of them.

The way she's chosen to organize her practice is similar to the way hospitals structure their outpatient psychiatric services.

Hoping to recover some of the personal time she's lost since going into private practice, Hoffman plans to hire a second psychiatrist, part time, in her next expansion, so there's someone to share after-hours call duties with her.

As things stand, even the administrative details of the practice often consume dinner table conversation when the Hoffmans go home at night.