Physician Demoralization - Notable and Quotable – “The Falling Down Professions”

By Alex Williams, January 6, 2007, New York Times, Sunday Styles Section

“As of 2006, nearly 60 percent of doctors polled by the American College of Physician Executives said they had considered getting out of medicine because of low morale, and nearly 70 percent knew someone who already had. “

“Dr. Yul Ejnes, 47, an internist in Cranston, R.I., said he was recently forced by Medicare to fill out requisition forms for a wheelchair-bound patient who needed to replace balding tires. ‘I’m a doctor,’ he said, ‘not Mr. Goodwrench.’ “

“But in the days when a successful career was built on a number of tacitly recognized pillars — outsize pay, long-term security, impressive schooling and authority over grave matters — doctors and lawyers were perched atop them all. “

“Now, those pillars have started to wobble.”

‘The older professions are great, they’re wonderful,’ said Richard Florida, the author of ‘The Rise of the Creative Class: And How It’s Transforming Work, Leisure, Community and Everyday Life’ (Basic Books, 2003). ‘But they’ve lost their allure, their status. And it isn’t about money.’ “

OR at least, it is not all about money. The pay is still good (sometimes very good). Still, something is missing, say many doctors, lawyers and career experts: the old sense of purpose, of respect, of living at the center of American society and embodying its definition of “success.”

“In a culture that prizes risk and outsize reward — where professional heroes are college dropouts with billion-dollar Web sites — some doctors and lawyers feel they have slipped a notch in social status, drifting toward the safe-and-staid realm of dentists and accountants. It’s not just because the professions have changed, but also because the standards of what makes a prestigious career have changed.”

“This decline, Mr. Florida argued, is rooted in a broader shift in definitions of success, essentially, a realignment of the pillars. Especially among young people, professional status is now inextricably linked to ideas of flexibility and creativity, concepts alien to seemingly everyone but art students even a generation.”

“Indeed, applications to law schools and medical schools have declined from recent highs. “

“The number of applicants to medical school, has dipped to 42,000 from 46,000 in 1997, although it has recovered from a low of 33,000 in 2003.”

“ ‘Students are focusing now on starring in their own creations, their own start-up businesses,’ said Trudy Steinfeld, the executive director of the Wasserman Center for Career Development at New York University. “

“ 'There’s a sexiness to starting something cool,’ she said. ‘Now we have people trying to start a Facebook or a MySpace. You might be working like a maniac, but it’s going to pay off in status. You’re going to be famous, providing something people are going to know and use all over the world.’

“Unquestionably, many doctors and lawyers still find the higher calling of their profession — helping people — as well as the prestige and money, worth the hard work. And the stars in either field are still that: commanding the handsome compensation and social cachet. But to others, the daily trudge serves as a constant reminder that the entrepreneur’s autonomy simply can’t be found in law or medicine.”

“Doctors face pressure. Complaints about managed care crimping doctors’ income and authority over medical decisions are nothing new, but the problems are only getting worse, several doctors said. “

“One doctor responding to the American College of Physician Executives survey wrote: ‘I find it necessary about once every month or two to stay in bed for 24 to 48 hours. I do this on short notice when I get the feeling I might punch somebody.’

“Increasing workloads and paperwork might be tolerable if the old feeling of authority were still the same, doctors said. But patients who once might have revered them for their knowledge and skill often arrive at the office armed with a sense of personal expertise, gleaned from a few hours on www.WebMD.com, doctors said, not to mention a disdain for the medical system in general. “

“ ‘If the topic comes up in cocktail party talk, you’ll hear nightmare stories from people as they’ve gone through the system — ‘they gave me the wrong pill,’ et cetera,’ said Dr. Gregg Broffman, 57, a former pediatrician who is now a medical director of a primary care group in Buffalo. ‘In terms of my own self-esteem, it feels like a personal attack.’ “

“EVEN the language of contemporary medicine has eroded the physician’s sense of majesty.”

“ 'What irritates me the most is the use of the term ‘provider,’’ said Dr. Brian A. Meltzer, an internist in Pennington, N.J., who now practices pro bono on the side, but works full time for Johnson & Johnson’s venture capital division. ‘We didn’t go to provider school.’ “