Dueling degrees: Why some doctors are getting a JD
■ As health care issues increasingly reach beyond the realm of medicine, some physicians are finding it helps to also be a lawyer.
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For most people, being a physician or a lawyer is enough. The education required for each degree is demanding and takes years to complete.
Standardized tests along the way require hours of studying and can be stressful. And students in law and medicine programs are traditionally known for being among the most competitive pupils on campus.
But not everyone is satisfied with having just one degree.
No one tracks the number of physician-lawyers in the United States, but estimates are that 1,500 to 6,000 people have MD-JDs or DO-JDs. And the idea of becoming a physician-lawyer is gaining popularity as health care issues increasingly intersect with government, managed care and the courtroom.
"It's a good skill set to have to understand how health care decisions are affected by multiple entities," said Paul R. Mehne, PhD, associate dean for academics at the University of Medicine & Dentistry of New Jersey's Robert Wood Johnson Medical School at Camden. "And if physicians can play an important role in the development of policies, everyone wins."
In most cases, physician-lawyers pursue their medical degrees first and then go back to get their law degrees after setting up practice. But 16 schools offer a combined physician-lawyer program. At any age, the reasons for pursuing an MD and JD are diverse.
Complex managed care structures and government regulations have piqued some physicians' interest. Some want the knowledge of both professions so they'll make better medical malpractice lawyers -- on both sides of the table.
Others want to teach or run hospitals or health care companies. And still others want the legal and medical knowledge to change health policies for the better.
"I realized I was interested in health care issues, not just the science of medicine," said Kermit Jones, an MD-JD candidate at Duke University, Durham, N.C. "I like figuring out ways law can help medicine."
Changing medical policy
Many physicians pursue a law degree because they see practical ways in which legal knowledge can help further medicine's causes.
That was the case with AMA Trustee Donald J. Palmisano, MD, JD.
He got his MD in 1963. Later he would perform surgeries during the day and attend law school at night for four and a half years. He got his JD in 1981.
Dr. Palmisano's motivation: He was part of the Louisiana State Medical Society and became heavily involved in tort reform.
"As a result of many debates with attorneys, I decided I wanted to know more about the law," Dr. Palmisano said. "It's been helpful in organized medicine."
Wisconsin family physician Richard G. Roberts, MD, JD, the board chair for the American Academy of Family Physicians, is someone who earned both degrees a little differently.
Dr. Roberts, a student in the early 1970s when Roe v. Wade and other medical legal issues were in the news, pursued his law degree first and then went to medical school.
"The law seemed to be a way to create social change," Dr. Roberts said. "I still think that is true."
Both physicians noted that having a legal and medical background gives them a unique perspective.
In medicine they learned to think scientifically. Theories were absolute, and medical students learned the accepted ways to treat patients with particular conditions. Medical students weren't encouraged to think creatively, because doing so could get them in trouble as physicians.
As law students, they were taught to think more creatively. Law school challenged them to think on their feet, to give arguments for both sides of a situation quickly. Law students learn that they are in a field that is constantly changing, based on decisions that judges and juries make, and that their arguments can help shape the law.
"It's one of the reasons doctors and lawyers are adversaries, especially in the area of malpractice," Dr. Roberts said. "They have a hard time understanding each other's thinking."
Jones said that in his three years of pursuing both degrees, he's witnessed such misunderstandings, and he wishes physicians could better understand how the law can help them.
"One of the common jokes to me is: As soon as you make a mistake, you can sue yourself," he said. "There is so much more you can do as a lawyer."
Fairer malpractice claims
After years of practicing medicine and seeing how malpractice cases are won and lost, some physicians who go back for law degrees decide that their medical knowledge gives them a unique perspective in the courtroom.
And they decide to stay there instead of going back to the hospital or doctor's office.
For some physician-lawyers, it's about defending fellow physicians from frivolous lawsuits. For others, it is about ensuring that patients with legitimate medical malpractice claims can bring negligent physicians to justice.
Gregory R. Kauffman, MD, JD, of Albuquerque, N.M., practiced medicine for about a decade. The pathologist got his law degree at night and decided to become a lawyer full time.
"I was rather appalled at the medical care, or lack thereof, being rendered to some patients," Dr. Kauffman said. "I was particularly appalled at how things were covered up."
Now he represents plaintiffs. "Good doctors have nothing to be concerned about," Dr. Kauffman said, noting he still has a lot of physician friends. "The only cases I take are the ones that are clear-cut. If there is any justification for what the doctor did or didn't do, I don't take the case."
Robert S. Toth, MD, JD, of Houston, similarly made the leap from medicine to law. He received his MD in 1976 and got his law degree 1981.
When he went to medical school, the emergency medicine and family physician thought he would return to Tennessee to practice medicine. Instead, he decided to go to work defending physicians in medical malpractice cases.
In 1984, he switched to the plaintiffs' side. He takes a small number of cases that cross his desk, the ones he sees as legitimate medical malpractice claims. And when asked, he advises other attorneys on whether a potential client has a legitimate malpractice case.
"The medical training is absolutely invaluable," Dr. Toth said.
"It helps in conferring with the experts and not letting the opposition throw smoke in the face of the jury."
Many physician-lawyers said the malpractice system would be better served by lawyers who have a good grasp of medical issues.
"The legal profession has done nothing to ensure that people who file medical malpractice cases have a medical background," Dr. Kauffman said. "I get lumped in with lawyers who file frivolous lawsuits. ... I personally would like to see something done so there has to be merit to a case before it is filed."
Is an MD-JD right for you?
While many have found dual degrees helpful, some question whether it's worth the hard work.
Edward S. Hume, MD, JD, who practices psychiatry in Syracuse, N.Y., said he does not see anything in medicine that warrants students pursuing a law degree and medical degree at the same time.
Instead, Dr. Hume, who decided to go to law school after taking a law class as the end of his residency, suggests physicians take some law classes and that lawyers take some medical classes if they are interested in health law. Getting a full degree is overkill, he said.
"Having both degrees helped me when I was an administrator and it helped me understand what lawyers are about," Dr. Hume said. "Does it help me in my practice? Nah. Not really."
Others who have received both their MDs and JDs suggest that people considering the second degree should go on to get it if they have a genuine interest in the subject or if they see a way it can help them with policy goals, tort reform or other areas where medicine and the law intersect.
Dr. Hume suggests people who want to do both should get one degree first and then work their way through the second professional school. "People should do whatever they feel called to and get that education first."
Most physician-lawyers say they do feel a stronger calling to either one profession or the other. In most cases -- even if they are spending their days practicing law now -- it's medicine.
"I tremendously miss medicine from time to time," Dr. Kauffman said. "At heart, I still consider myself a doctor first and an attorney a distant second.
"I have the heart and soul of a doctor."