An essay from 1989.
Some day one of my children will likely ask what I once asked my stepfather, “Dad, do you think I should try for med school?” I feel that it will most likely be our inquisitive middle child, Clayton John (“CJ”). And, when that time comes, what will I say to Mr. CJ?
For many physicians in the past, the answer to this question would have been a resounding, “Yes.” However, I often hear the opposite sentiment being expressed by a disgruntled colleague. And there lies the rub. Why do so many physicians currently feel they would opt for careers other than medicine were they starting over today? Why do so many doctors no longer want to doctor? Therein lies the basis for my projected difficulty in answering Mr. CJ’s question when it likely comes.
From the physician’s perspective, the practice of medicine has undergone revolutionary changes over the past two decades. And these changes are likely to be only the opening volley in a long and bitter struggle between those who provide health care and those who pay for it. Here, I would like to outline the development of a mindset that would abrogate that ancient medical tradition of children following parents into the practice of medicine.
The medical mentality usually takes form during the early school years when the idealistic young human mind begins to grapple with the cold visage of reality. For some of our bright, scientifically-oriented young people, medical school represents the perfect solution to the dilemma of wanting to do something meaningful with one’s life but not being willing to give up one’s chance for the American dream.
First, one must obtain a college degree with very high academic credentials to be competitive for medical school admission. Only 2 to 5 percent of U.S. medical school applicants are accepted for admission. Those who are accepted must find the financial backing to support the four years of financial dependency that medical school brings. However, the transition to medical school can be among the most memorable emotional moments of a lifetime.
The first anxiety of a medical career comes when that brimming idealism of youth grinds up against the highly-competitive gauntlet of classroom medical education. Next comes internship (1 year) and residency (3 to 6 years). These very intense years of on-the-job training can assault the psyche of everyone who endures them to some degree. While a few will become cynical, most will become a bit hardened by the emotional and physical demands of this arduous and long training process.
Throughout their medical training, a young physician is directed toward becoming an independent thinker, a maker of hard, life-saving, or life-taking decisions. They are taught to rely upon their judgment. Medicine is not a world of clean blacks and whites but an ever-changing kaleidoscope of varying shades of gray.
Everything I have described so far is as it was when doctors were happy about their profession. It is not that the educational process has become more difficult. Rather, it is the fact that the framework of medical practice has been rapidly changing during the past twenty years. The increasing cost of health care has insinuated business people between physicians and patients. Patients, as increasingly cost-conscious consumers of medical care, now often question the judgment of their doctors and seek social media and/or legal relief when they perceive a less than God-like countenance in their physicians.
The common theme is that physicians no longer see themselves as the captain of the medical ship. Their medical decisions now have to be approved by an array of corporate, state, and federal non-physicians. The practice of medicine is no longer that simple, intimate covenant between the healer and the infirm. It has now become a complex business transaction in which multiple parties must negotiate a common ground, a ground which can shift at times on a monthly basis.
The physician often sees these changes as threatening vital parts of their lives – their professional autonomy, their position of respect in our society, and their family’s financial well-being. Thus, they begin to question the wisdom of their choice to enter medicine, to begin with, and wonder if they will be able to recommend this profession to their children.
Curiously, physicians often seem to come to this conclusion with little outward discussion of the most basic element that initially led them to practice medicine – the treatment of sick human beings. This part of medicine has not changed. People are still willing to place their lives as well as the lives of their loved ones into their doctors’ hands.
So how will I advise my precious young son when he wants to know what to do with his adult life? I sense that Mr. CJ might be capable of becoming one of our best. And who other than our best would we want for our physicians of the future? If our brightest young minds turn away from the practice of medicine, our society will be diminished with everyone sharing the cost of that failure.
I think by now that you might have a sense of what my answer to Mr. CJ’s question is likely to be. Anyway, what else could I, as a physician/father, want to see my son become — a malpractice lawyer?
Postscript 1: As of January 2019, Dr. CJ became the first-ever board-certified pediatric rheumatologist to practice in the State of Idaho.
Postscript 2: From a 2022 perspective, the above arguments might seem a bit naïve. And, I understand that for some, it might be too late. However, for others who might be on the fence, I say stay. Stay and find a way to fight for medicine. And let the ideals of optimism, positivity, and creativity be among your weapons in that fight.
Richard D. Sontheimer is a dermatologist.
Image credit: Shutterstock.com
