Why the future of medicine is not looking too good

Question: What is the most important thing concerning residents finishing training and looking for a practice in 2011?

a. Feeling of insufficient medical knowledge
b. Health system reform
c. Educational debt
d. Availability of free time
e. Dealing with patients

If you said “d. Availability of free time,” you are either very perceptive and in tune with today’s young doctors or you read an article about this in American Medical News. According to survey performed by Merritt & Hawkins, a physician recruiting company, 48% of newly graduating residents are most concerned about finding a practice which will allow them adequate free time. This is up from 33% in 2008. Only 7% chose availability of free time as “least concerning.”

Insufficient medical knowledge and dealing with patients were concerns of 7% and 2% of the residents respectively. To put some perspective on that, I worry about my fund of knowledge and dealing with patients every day.

Other interesting survey findings are that almost no one wants to practice in a small town and certain “must haves” include geographic location [sic], adequate call coverage/personal time, lifestyle and good financial package. Sixth on the list of “must haves” was good medical facilities/equipment.

American Medical News cites an Association of American Medical Colleges report showing that 28% of medical school graduates owe more than $200,000 in student loans. Despite all the concern about educational debt, only 12% considered loan forgiveness important, a finding with implications for those dreamers who think that loan forgiveness will entice doctors to practice in unglamorous locations.

Does all this bother anyone else? I wonder what people expected? Did they not know that being a doctor involves commitment and self-sacrifice? Apparently not for at least one, as a revealing blogger wrote recently.

The future of medicine is not looking too good to me right now.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • http://bit.ly/gwalter gwalter

    I don’t understand why an infusion of balance and serenity brings cynical feelings? This odds true in many industries.

  • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

    Human beings have the right to try and maximize their free time within the constraints of providing goods and services to others and getting earnings out of it. If, I, as a physician can give enough value of increased health and quality of life to other people by just working 20 hours a week, and still warrant a level of earnings returned that can satisfy my wants, then I can have more free time. If I need to work 60 hours a week to reach a level of earnigs that satisfy my wants, then so be it. So I am free to explore ways to achieve the optimal balance.

    According to the article, the emphasis on “free-time” has changed. It has increased. Does that mean students are becoming more consciously aware of the desire to balance priorities in life? That would be a good thing, in my opinion.

  • civis isus

    The author, like far too many US clinicians, takes as his/her model of “appropriate” physician practice a template contrived in a distant era. Physicians should be “single combat warriors”; health care decisions, indeed people’s health, pivots on their ministrations; it’s not management of care, but the wielding of quasi-magical medical powers that constitutes “real” health care. All of this is outmoded now, and it’s doubtful if it ever held much truth, much value, at any time, for anyone – except the believing clinical community.

    It is long, long past time for intelligent clinicians to admit to themselves, their colleagues, and the public that that model is irrelevant and often outright dangerous to people they would treat primarily as “patients”; that it was never an ideal, but rather an accommodation. Health care can be done much more effectively, and while progress toward that end would take place much more rapidly with physician leadership, it WILL take place whether or not physician leadership materializes.

    • http://twitter.com/#!/CloseCall_MD Close Call

      Civis isus, I’ve read this twice, and I still don’t know what you’re trying to say.  

      “Good” health care comes to a screeching halt when a person does not see the importance of eating well, exercising, having patience (I’ve had this cough for 4 days! Cure me!  NOW!), acknowledging that death is inevitable (stuff this tube down my mom’s throat and make this machine breath for her!  She’s only 88!). 

      In the traditional model of U.S. medicine (which, sorry, is not changing any time soon), this is the reality.  There’s only so much doctors can do.  The rest is up to the patient.  Doctors are not personal trainers or life coaches.
      Most docs (especially primary care docs) know this.  I wish someone would tell the rest of the country.  

  • http://www.facebook.com/profile.php?id=652163311 Thomas Joāchim Garçon

    Misleading headline.

    • civis isus


  • Michael Mcdaniel

    I guess sacrificing most of their 20′s studying, sacrificing  potential earnings they could have made like most highly educated people who waddle into finance, and spend most of their day on gchat and facebook doesn’t count for anything? Besides the fact that they will most likely work 40-60-80 hours a week. There is a difference between free time and 0 free time. As a medical student one doesn’t have this so called free time that others possess. Perhaps doctors are not willing to sacrifice as much as their predecessors, but they have also scarified their autonomy, money and a multitude of other things. It’s time to give them a little break

  • http://abnormalfacies.wordpress.com/ Abnormal Facies

    The fact that this is still the prevailing ideology is essentially why I’m not considering surgery as a career.

  • http://twitter.com/LittlePatient Haleh

    This issue exists in many professions- we also see it in law.  Young students graduating today value balance.  This is a good value.  But to become an expert and a valued professional one needs to devote significant time- by definition a loss of balance- at least for a period of time.  The sacrifice is what leads to becoming an excellent doctor.  I too am concerned with so many who choose to work part-time.  In reality a doctor who has logged in 10 years part time simply is not as experienced as a doctor who has worked more than full time for the same time period.  And experience is a very large factor in contributing to being a truly valued professional- especially in medicine.   I understand your concern.

    Haleh Rabizadeh Resnick, Esq.
    Speaker, Educator and Author of Little Patient Big Doctor

  • http://twitter.com/Skepticscalpel Skeptical Scalpel

    Comments noted. Thanks to all.

    I don’t begrudge anyone their free time. I enjoy my free time too. Maybe I should have expressed this in another way. If your major career concern is how much free time your are going to have, perhaps medicine is not for you.

    • http://twitter.com/dryananderson Daniel Anderson

      Had you ever considered that physicians may have many concerns that they have researched and come to terms with and the issue of free time is the only REMAINING concern they have? That is the way I would interpret this data. However both our opinions are just speculation without a better source of data.

  • Anonymous

    As a health care educator and former Surgical Intern (85-86) who eventually ended up in Pediatric Emergency Medicine I couldn’t agree more. Malcolm Gladwell wrote in his book “Outliers” that it takes 10,000 hours to become an expert in a field. With a 40 hours work week it would take 5 years to become an “expert” physician and most primary care residencies are only 3 years. So, doing the math, it makes sense for residents to have to work more than 40 hours per week. Perhaps the younger generation has become complacent because they feel they can always “Google” the answer. In the US, with our well immunized population, they don’t see or for that matter recognize the diseases of one, two or three generations ago. Although I agree that balance is important in the long run most of mankind’s greatest scientific, artistic, or political achievements came from intense study and hours of goal directed hard work. And for those who say that this model is “outmoded” , you need a little history lesson, or better yet how about a mandatory rotation in a developing country in Africa where you will get to see the ravages of Polio, Measles, Malaria, all forms of cancer untreated, infant mortality from tetanus, vaginal fistulas from lack of obstetrical care, malnutrition, and NOMA (look that sucker up Mr. Google smarty pants).
    It used to be that to go into to medicine you were dedicated to a profession of healing and striving to improve the health of the individuals and the community you served. That’s right, served, medicine is supposed to be about the patients you serve not about you. And the fact that the number one concern of those surveyed was not a. “Feeling of insufficient knowledge” makes me shake in my boots; because the number one thing a medical student should realize when he/she finishes medical school is how f****ing ignorant they are compared to the field of knowledge before them.

    Dr. Julia

    • http://abnormalfacies.wordpress.com/ Abnormal Facies

      “It used to be that to go into to medicine you were dedicated to a
      profession of healing and striving to improve the health of the
      individuals and the community you served.”

      I still see that all around me – I’m sorry the lot of medical students & young doctors you work with seem to have missed the memo. 

      Unfortunately, in life there will be people who don’t act in accordance with your wishes, but this has always been true.  Has every soul who’s donned the white coat been a saint who’s lifted up their community?  I have a hard time believing things have deteriorated as much as has been implied.

  • Anonymous

    I think one of the major reasons for this change in resident thinking is that today, with a much larger middle class, most of the people going into medicine come from families with physicians in them.  Now that many of us have physicians for parents, we know and understand what the costs of no free time are: divorce and not being the most available parent.

  • Adam Tallinger

    The reviewer is concerned with the fact that physician’s are now valuing free time as a top priority in choosing a practice. He alludes to a disregard for the commitment and self-sacrifice required to be a physician. Unfortunately, he misses the big picture. Physicians are not inhuman robots; they are people just like you and I. A commitment to work-life balance does not necessarily mean that less medical care will be delivered. With the consolidation of practices and the increase in the numbers of employed physicians, the doctor can remove the overhead of being a business owner and still practice medicine. It may not be for every physician, but the independent physician has many more considerations that impact free time other than their direct patient care.

  • http://profiles.google.com/jebaronemd James Barone

    Again, my problem is not that I think MDs don’t deserve free time. I believe everyone needs free time. But it’s not about “work-life balance” when your #1 priority when looking for a physician job is free time.

  • http://scepticemia.com/ Pranab

    I think the title is a little hyperbolic and misleading, if anything at all. It just shows that physicians-to-be realize that debts can be paid off, knowledge acquired (if not already), health system never reformed and patients dealt with in general, but once you get stuck in a bad job, well, you are doomed until you get another one. I don’t know how the situation is in the US but back in India, a bad job can mean hell for you. So, I think its not as much of a notion of “if you wanted more free time go be something other than a doctor” but more along the lines of providing a physician recruiting company the data about jobs. I have not read the original report, but I think the very fact that this survey was conducted by a physician recruitment agency means that there is a chance for some confounding to creep in. Like seriously, I would like to provide a phys-recruiter with my job-based worries rather than my knowledge-issues. That is something I would rather talk to my training program director about. Just my two cents!

  • Anonymous

    I actually understand the concern for free/family time, although I don’t think it should be #1 on the list.  What scares me is the apparent lack of concern for adequate medical knowledge, and ability to work with patients.  I have always worried that I didn’t know enough, or that I didn’t deal with a particular patient very well–even after years of successful Family Practice.  These two concerns are what drives me to continue learning and self-critiquing.  Unfortunately, I have worked with recent Residency Graduates, and they simply have not seen enough with their restricted hours(although I am not opposed to humane hours), and that is a concern.  Wanting more free time just out of residency will not provide you the exposure and experience you need in medicine.

  • http://twitter.com/georgebaikal George Baikal

    This survey is depressing and reflects the fears that lay persons have about the motivations of today’s physicians 

    Not an MD

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