From every direction, the practice of medicine in the U.S. is under attack. If one were to believe the headlines, the American health care system is populated by insensitive, selfie-shooting, Medicare/Medicaid-cheating, inefficient, and ineffective physicians grappling with an over-regulating government, predatory insurance companies more concerned about profits than the health of their customers, and a legal system that more often confuses a bad medical outcome with actual malpractice. Morale in medicine may never have been lower among physicians than it is currently. Studies have demonstrated that few physicians are positive about the future of their profession, and the majority do not recommend medicine as a career choice for young people or their children.
I have always wanted to be a physician. It has always seemed that it was the “family business”. With a grandparent, uncles, cousins and a father in health care, did I exercise “free will” when I accepted admission to a six-year medical program at the age of 18? One could argue, maybe not! However, on the eve of starting medical school, I affirmed for myself that it was what I wanted to pursue. I have never looked back on that choice with regret despite the ups and downs of this noble profession. To answer my self-imposed question, what I love about medicine are the unique opportunities it has given me. Caring for others, educating trainees, a collegial bond, and the intellectual challenges have sustained me through difficult times.
As a physician, we have a unique responsibility and a privilege. It is called the doctor-patient relationship. I have always viewed this privilege as earned through years of hard work. Inherent in our profession is the acknowledgment that those we care for are suffering. The Latin root “patiens,” from “patior,” is to suffer or bear. I can’t stand it when some try to use the term client in its place. My automobile mechanic has clients. I have patients. We share an intimacy of information and emotion with patients that few other professions allow. Other than maybe members of the clergy, no one else is privy to the closely held secrets, pains and distress of our patients. We often have the ability and need to heal not just the body but also the spirit of our patients. At the end of the day, it is just one doctor-one patient, linked together in a sacred relationship. I don’t think any other field would provide the same opportunity. The more we give, the more we get.
Sadly, the pressures on physicians are increasing while economic reimbursement is decreasing. The amount of debt accrued by medical students is astounding. In a study by the AAMC, it was noted that the median educational debt of all students was $180,000. Including interest payments, the total repayment could approach half a million dollars. Considering the length of time in post-graduate training as a resident or fellow varying from 3 to 7 years earning a modest income while working long hours, the opportunity cost of not being able to earn a higher income and start saving for retirement is a real economic hardship.
Medicine has attracted the best and the brightest historically. Given falling reimbursements, increased debt, and outside pressures, people contemplating a career in medicine may not make the equation that the personal rewards that a medical career can give balance against the decreased economic benefits. That will be a regrettable day that is probably already here. To save medicine, society will have to absorb the cost of medical education in some manner as it did the cost of postgraduate training with Medicare. Those that choose the profession in the future may actually be more dedicated and value the non-monetary reimbursements more than the financial. Hopefully, they will be just as capable.
Gary B. Nackman is a surgeon and owner, NJ Vein Care.
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