I think everyone and their mother has sent me this NYT piece about new doctors’ specialty changes, probably partially because I’m in med school and partially because it has a couple Stanford quotes in it. In a nutshell, it looks like a number of graduating medical students are pursuing medical fields with a more stable schedule–dermatology especially.
In a somewhat more-promising change, I think medical students of my generation also have more of an interest in public health issues as well. We’re aware of the problems in the system, we’ve seen that doctors can only help individuals, but there aren’t enough doctors to help everyone. At our first class of the Community Health concentration, almost 20% of the class was attendance, and almost half the class went to an informational session about MPH degrees from Berkeley. So I guess we either want it easy or we want it really, really rough.
Dr. Wolfe, who’s quoted in the article, attributes the shift to an increased representation of women in medical schools, and that appears to be what the author of the article concludes himself. And while I think it’s definitely a contributing factor, I don’t think it’s so black and white.
One of the reasons I’m active in health care reform is that I think the current system hurts medicine, many times in ways that aren’t easily represented with data or economic projections. First, it’s made doctors less-satisfied with their work, and therefore, more likely to view medicine as “a job,” not “a calling.” The paperwork, the legal risk, and the business management are all sour issues with physicians–if they wanted paperwork, they would have been administrators; if they wanted to be involved in contracts and courtrooms, they would have been lawyers, and if they wanted to deal with payrolls and taxes, they would have gotten an MBA. 30+ years ago, when doctors spent more time seeing patients, and less time filling out forms, it was a more enjoyable job, I imagine. And apparently enjoyable enough that long hours didn’t seem long, or at least seemed more tolerable. But when you start taking the art out of medicine, and stop giving physicians the chance to actually enjoy medicine, of course they’re going to start separating work from home. (Add to the mixture the fast-paced world in which we live, and the conclusion is even more easy to reach.)
The health system has also begun to erode the doctor-patient relationship. When we started to give physicians a financial incentive to provide less care to patients, it created an enormous moral conflict. Suddenly the patient could no longer assume that the doctor was playing on his or her team; maybe the doctor was just trying to make a few extra dollars. And it’s only getting worse. Doctors are still the most trusted professionals in the country, but more people are starting to view them as representatives of the insurance company, purveyors of the Bottom Line, witholders of care, and worst of all, players in the system. People are already anxious about telling doctors their most personal details of their lives for fear it will be reported to insurance companies or later noted as “pre-existing conditions.” When the trust of the doctor-patient relationship is gone, we might as well settle on treating colds and lower back pain exclusively; the patient won’t trust us with anything as personal as an STD when the insurance companies we’re working with deny coverage for dislocated shoulders and childhood asthma (both examples from a classmate who was denied by Kaiser).