Physicians - The Triple Decker Sandwich Generation

Bring me a slice of meat between two slices of bread.

John Montagu, 4th Earl of Sandwich (1718-1792), to his servants, thus the sandwich was born

March 5, 2012 - No doubt you’ve heard of the sandwich generation. These days it’s all the buzz. It consists of a generation of people who care for their aging parents while supporting their own children.

Physicians are part of a three-decker sandwich generation . They are caught between four slices of people with human fillings in-between.

• The first slice are themselves. Like other Americans, physicians are aging. Physicians, faced with declining reimbursements and rising costs, have to take care of themselves, pay off their educational debts, educate their children, and take care of their aging parents. They must also decide whether to stick with private practice or acquiesce to government mandates, which, in the minds of some physicians, threaten their independence and clinical liberties.

• The second slice are parents. They sacrificed for their physician children, now physicians must sacrifice for them. Do physicians arrange for them to move closer to them ? Do they use their knowledge to arrange the best care for them? Do they instruct them how to stay healthy longer? Do they use technologies like Skype to stay in closer touch? Do they pay for their care?


• The third slice are younger physicians. If physicians are to stay in practice, they need to recruit younger physicians. But young doctors are a different slice of bread. They prefer to work for others. They prefer a balanced life style to 60 hour weeks that were common in older generations of physicians. Young physicians tend to be risk-adverse. Many prefer secure incomes to pay off their educational debts and malpractice premiums to the financial unknowns of private practice.

• The fourth slice aging patients. Out of loyalty and personal relationships, most physicians will keep our current Medicare patients. But what about the 78 million aging baby boomers now entering Medicare? Do physicians accept them as patients, even if accepting them means they can’t afford them and still meet their bottom-lines? Do physicians tell them the federal government has their best interests at heart as it cuts $575 billion out of Medicare to save Medicare for the next generation? Do physician s turn to other practice models, to technologies, and to online solutions to become more efficient?

Whatever physicians do, wherever they turn, they will learn there are no easy answers to the dilemmas of aging. Physicians' humanity is bound up with others. They are humans together in an aging world.

Sandwich is a verb as well as a noun. It means to fit two or more people together in space or time.

Tweet: Medical care is a human three-decker sandwich, and physicians are an ingredient of each layer, binding the sandwich together.