Editor's note: This post was picked up from www.thehealthculture.com.
Sandeep Juahar, who wrote an excellent warts-and-all account of his medical education in Intern: A Doctor’s Initiation, is now old enough to be having a midlife crisis. In a recent New York Times essay, he may or may not have been projecting his own current feelings of disillusion onto the entire medical profession. He writes about the sorry state of medical practice today. (emphasis added)
Managed care was supposed to save American medicine by stemming the rise in spending initiated by Medicare. It failed to do that. Instead, it did away with the kind of medicine that made people want to be doctors in the first place.
In the last four decades, doctors have lost the special status they used to enjoy.
Physicians used to be the pillars of any community. If you were smart and sincere and ambitious, the top of your class, there was nothing nobler you could aspire to become. Doctors possessed special knowledge. They were caring and smart, the best kind of people you could know.
Today, medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future.
Juahar goes on to say that managed care is not to blame. Doctors have abandoned their professional ideals.
In the mid-20th century, physicians were among the most highly admired professionals, comparable with Supreme Court justices. … Depictions of physicians on television were overwhelmingly positive. Doctors were able to trade on this cultural perception for an unusual degree of privilege and influence.
Organized medicine used this influence to try to defeat nationalized health insurance plans like Medicare, seeing them as an attempt to undermine income and autonomy.
Salaries skyrocketed after Medicare. But doctors came to be seen as "bilking the system." "Doctors … were helping each other game the system; the operative phrase was 'I'll scratch your back if you scratch mine.' "
Satisfaction with choice of career plummeted. Only 15% of physicians questioned their career choice in 1973. In 2001, 58% said their enthusiasm had declined in the past five years, and 87% reported a decrease in morale. 75% said medicine was no longer rewarding or was less rewarding than it had been.
[P]erhaps the most serious downside is that unhappy doctors make for unhappy patients. Patients today are increasingly disenchanted with a medical system that is often indifferent to their needs. There has always been a divide between patients and doctors, given the disparities inherent in the relationship, but this chasm is widening because of time constraints, malpractice fears, decreasing income and other stresses that have sapped the motivation of doctors to connect with their patients.
Juahar claims the reason both doctors and patients are dissatisfied with the current state of health care is that the medical profession has abandoned its core ideals. But there's another explanation.
It's true that the practice of medicine changed considerably after Medicare and the introduction of managed care. But the statistics that document dissatisfaction come from doctors who entered the profession with one set of expectations, only to find the game had changed. New generations of doctors begin their practice with their eyes wide open. It's a bit premature to say that becoming a doctor is no longer a noble aspiration.
Andrew Wakefield: The integrity and validity of science
The physical exam and society’s regard for physicians: A history
Candid comments from the medical profession
Marcus Welby vs. the specialists
Should doctors work weekends?
The art and science of medicine
Physician as lone practitioner
The esteem of the medical profession: Then and now
The doctor/patient relationship: What have we lost?
Sandeep Jauhar, M.D., Out of Camelot, Knights in White Coats Lose Way, The New York Times, January 31, 2011