It's easy to accuse doctors of indifference when you're sitting in a waiting room after having waited weeks to get an appointment. But doctors tell us that-with insurance and malpractice issues, difficulty in recruiting doctors to the region, and demanding, unrealistic patients-practicing medicine today is just as frustrating. Five local physicians sat down with us recently after a long day of treating patients to discuss what it's like on the other side of the examination table.

Moderated by group publisher JEFF LAWENDA.

Solo practitioner DR. MARGUERITE BARNETT is board certified in both general and plastic surgery and is president of the Sarasota County Medical Society.

DR. BRAD LERNER practiced internal medicine with First Physicians Group of Sarasota and served as the chief medical officer of the group until Oct. 1, when he left to open up his own concierge-style family care practice.

DR. CHARLES LOEWE is CEO of Center for Digestive Diseases and Center for Endoscopy and Surgery in Sarasota, which includes three physicians.

Sarasota neurologist and solo practitioner DR. J. TERRY PETRELLA is medical director of the Florida Gulf Coast ALS Centre and The Muscular Dystrophy Association of Sarasota and assistant clinical professor of neurology at the University of South Florida School of Medicine.

Bradenton urologist DR. MARK WEINTRAUB is president of We Care, a statewide program that provides medical aid to people who don't qualify for any financial assistance. He is also a delegate to the Florida Medical Association.

JEFF LAWENDA: What are your biggest challenges in running your practice?

DR. PETRELLA: Finding professional, quality-driven people who have a sense of loyalty and are willing to work in an ethic commensurate with my own. It's not easy.

DR. LERNER: The folks we generally would hire can't afford to live here. Even the physicians we would hire can't afford to live here anymore.

DR. BARNETT: I went into medicine very idealistic; I wanted to help people. The closest I've ever gotten to fulfilling that pure practice of medicine was when I was in the military. I didn't have to worry about reimbursement and collections. About six years ago, Medicare, the primary source of payment in this area, announced it was cutting reimbursements. At the same time, I have to come up with close to $50,000 just to pay my malpractice insurance. So I decided to limit my Medicare patients and gave up a good deal of my reconstructive work. And now I select patients on the basis of risk. Because we all know that bad outcomes can occur even if you've done the best job.

LERNER: The most frustrating part of running my primary-care practice is the inability to keep up with demand. Sarasota is incredibly underserved in primary care. You're seeing more patients in a day, more who are older and sicker, and [you're] doing more paperwork, while patient demand continues to grow.

WEINTRAUB: We're under attack on many fronts: the government, the insurance industry and the legal profession. We have to do so many things that have nothing to do with taking care of our patients. Once upon a time a medical record was a medical record. Now it's more a legal record. Many of my colleagues are trying to figure out how to get out of medicine early. National data shows a decreasing pool of people going to medical school. I wonder how long it's going to be before the quality of people getting into medical school is decreased.

LAWENDA: Have any of you ever thought of leaving medicine?

LERNER: Yes.

BARNETT: Yes.

WEINTRAUB: Yes.

LERNER: I've spent the last 11 years both as a physician and as CEO of a 50-or-so physician group, and I decided I didn't want to do both. I decided I enjoyed most being a doctor, but I didn't want to be a full-time doctor in the traditional sense. So I've opened a small, concierge, boutique-type practice. It's not a solution for the masses or the industry, but it is a solution for me.

LOEWE: I'd like to be a plastic surgeon based on the reality shows now. The money is in plastic surgery, cosmetic dentistry and dermatology.

BARNETT: The grass always seems greener on the other side. You have to deal with people who come in want to see the lawyer because you've left one little crease on their cheek.

LAWENDA: How general is the level of disappointment among physicians?

LERNER: I think it is widespread. You're going to have to wait for a whole new generation of physicians who have different expectations than those sitting in this room, who probably straddle the old and the new way.

We have been searching for two physicians for the past year. Nobody's going into primary care because they work too hard and don't get paid enough. Many are going into a new field, called hospitalists, people who do shift work at the hospital and don't go into the traditional private practice. And the cost of opening up a practice and buying a house here is very expensive, particularly compared to the reimbursements. We are in a Medicare-based community. Medicare is one of our worst payers and pays worse here than on the east coast of Florida. So a new physician can move to the east coast and earn significantly more and probably spend the same or less to live.