Doctors Seeking Law Degrees to Face Modern Challenges : Professions: Some do it to have something to fall back on as HMOs make inroads in their field; others to cope with an increasingly litigious medical field.

During the week, Dr. Nelson Cunningham spends 60 hours on his feet, dashing from heart surgeries to organ transplants.

But each weekend, the anesthesiologist at Mission Hospital Regional Medical Center in Mission Viejo spends his time poring over law books at Western State University’s College of Law.

Cunningham, 52, is one of a growing number of doctors attracted to law school by the changing face of the health-care industry. Although their reasons vary, many physicians say they are seeking law degrees because managed-care insurance plans have created a more uncertain future for them in the medical field.

A law degree “is something to fall back on,” said Cunningham, the father of eight children. “I’ve always been interested in law and was becoming dissatisfied with the growing bureaucracy in medicine.”

Although no statistics are available on the number of physician-attorneys, experts from both fields said the hybrid profession is growing.

Janet Haynes of the American College of Legal Medicine in Washington, an organization for lawyers and physicians, said about half the group’s 1,600 members hold both medical and law degrees.

“It’s becoming more mainstream,” said Haynes, director of administration for the group.

Dave Langness, a spokesman for the Healthcare Assn. of Southern California, a trade organization that represents hospitals and other medical providers, said the number of physician-attorneys in California may have reached the hundreds.

The increase in the number of physician-attorneys began about four years ago, in the wake of the growth of health maintenance organizations (HMOs). In the past 10 years, the proportion of California patients enrolled in HMOs has jumped from about 15% to the current 75%.

That development boosted the need and financial rewards for primary-care physicians, who are the patient’s first contact, Langness said, at the expense of specialists and private practitioners.

“The old, single, private-practice doctor is an endangered species,” Langness said. “Primary-care physicians now make the treatment decisions. Meanwhile, the subspecialty and private-practice doctors wait for referrals. They no longer control their destiny.”

Kaiser Permanente, the largest medical group based in California, has driven the state to the lead in managed care, Langness said. The group serves a third of California’s insured patients.

Earning both medical and legal degrees is a logical choice that helps diffuse the uncertainty of a changing medical environment, some doctors say.

“Physicians don’t trust contracts,” said Dr. William T. Choctaw, 47, a surgeon in his second year at Western State law school. “A lot of what we do is signing contracts. We physicians traditionally don’t feel comfortable with contracts.

“Knowing how the law works . . . decreases the anxiety and stress,” he added.

This growing number of physician alliances has changed the motives of doctors who are seeking law degrees. In the 1970s, physicians began to attend law school primarily to protect themselves from malpractice suits. Although that still is the motivation for some, the two professions have found some common ground.

John Hill, a Western State law professor, said “Law and medicine are in many ways mutually complimentary. With a new genre of . . . bioethical issues, doctors” must have expertise in both, he said.

Medicine and law are intertwined on issues such as euthanasia, doctor-assisted suicide, surrogate parenting and the use of frozen embryos.

The hybrid professionals often continue their medical practices, and either offer legal advice to patients or pursue arbitration work on the side. Despite their hectic medical work schedules, doctors manage to squeeze in legal studies, breaking weekly medical routines.

“Because the practice of medicine has become increasingly legalistic, physician-attorneys have terrific employment potential,” Langness said.

Choctaw, a Walnut resident who used to spend 80 hours working at his private office and the hospital, has chosen to take on a heavier but more diverse workload. He has won a seat on the City Council, attends nine hours of classes each week, and weaves roughly 25 hours of studying in with his 60-hour weekly work schedule.

“To tell you honestly, I take my books with me to trauma surgery,” Choctaw said. “I’ll read in the lounge while they prepare for surgery.”

Cunningham’s situation is no different. He endures late night emergency calls and still manages to make it to his 8 a.m. law classes Saturday. It’s a rigid schedule, with some sacrifices, he said.

“Sometimes, I’d rather be at my son’s baseball games,” he said. “But the overall goal is to get to a place where I can be part of the solution” in this changing environment.