Young physicians: Don’t repeat my generation’s mistakes

My generation of physicians was much like yours.

My were also “the best.” We’d risen to the top of every academic pyramid: middle school, high school, college. We could be anything we wanted to be.

We chose medicine, partly for noble reasons. Our bodies were wondrous and we got to help people. But also for some not so noble reasons: the money was good, everyone would look up to us, and we’d never have to deal with the compromises and corruption of business. After all, who would ever put a price tag on life and death?

So we also put in our seven or more years of sleepless nights and accumulated mounds of debt. No problem: The endgame was a lifetime of respect, doing good for society, and financial independence.

Our cloistered academic training reinforced our sense of superiority and uniqueness. We emerged feeling we were chosen, exempt from the rules of the outside world.

Then we entered practice and reality struck in so many ways.

First, our patients often fought us. They wouldn’t lose weight even if the alternative was insulin shots. They wouldn’t stop drinking even as their skin turned sallow. They wouldn’t stop smoking even when we outlined that dreaded spot on their chest X-ray.

We’d imagined a life filled with satisfying “saves.” Instead, we woke up every day to a continuing ever eroding holding action.

Second, we get bored. Most of our day was spent reassuring patients, taking blood pressures, and taking care of paperwork. Daily practice lacked the intellectual excitement we’d expected.

The money was good; the respect was good … but in our hearts the prestige felt out of sync with the mundane nature of our work.

Third, medicine suddenly became a business, and that changed everything.

Nobody cared about our life and death stakes anymore. The “suits” only cared about how much you made them, how much you cost them, and how easy you were to replace. And we knew deep down, we too often could be replaced. It had been a long time since we’d practiced at the top of our license.

Suddenly men in cubicles were telling us how long our patients could stay in the hospital, what medications we could prescribe, and most galling how much we’d be paid. We’d never been treated in such a heavy-handed manner.

We asked ourselves, “What happened?” We were always the smart ones. Suddenly our peers who failed academically were telling us what to do. We couldn’t admit that they often had other skills we might have lacked: risk-taking, questioning authority, the ability to inspire others. In this new ugly business of medicine, those qualities now reigned supreme.

So we entered the grieving process.

First, denial. (“My world is not going to change. I’m the one saving lives. My patients will never allow this to happen.”) Then, anger. (“I’m going to quit the profession!”) Then, bargaining. (“OK. I know I may have abused my authority when I was in control, but I’ll be better if you give me another chance.”) Then, depression (“I was the best. Why did they change the rules?”) And finally, resignation. (“Just a few more years and I can retire.”)

Almost every doctor of my generation is now working through various stages of this process. Almost none of us have recommended the profession to our children.

Personally, I don’t blame my generation for feeling betrayed. I blame an academic system that taught us having a knowledge base could somehow bypass the give and take, compromises, and people skills of almost any other profession. I blame a system that taught us being the best meant the best at taking tests.

It has been excruciating to watch my generation of physicians pay the price for these false promises.

All we can do is pass down this moral: Make sure your generation of physicians is better served.


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