I normally do not publish long direct quotes from other bloggers but this one is so nail-on- the -head that I have to. It is from Dr. Sid Schwab of Surgeonsblog as he talks about the change in how medicine is practiced (including the medical and now surgical hospitalists) and the change in its culture with talk of work-life balance, etc.
... I don't doubt there will always be surgeons and primary care docs willing to sacrifice their personal lives in the name of their practices. But the days of the iron men and women are over, and it's happened in the blink of an eye, in a quarter of a generation. I reject that it's because this is the first generation to value life outside of work, or that they're just selfish. The explanation, I think, lies in the changes that have gone before and around them. The profession is under stress in many areas. To maintain income -- at whatever level -- in the face of steadily decreasing reimbursement, docs must work ever harder. They're increasingly bogged down in paperwork and bureaucratic demands, many of which are predicated -- so it feels -- on the notion that a physician is an thoughtless, careless, and incompetent screwup. (Comments on some of my related posts would seem to confirm that apprehension.) Not a week goes by without a notice from the hospital, the insurers, the malpractice carriers announcing the latest requirements for form-filling, order-justification, chart-polishing. Why, the new generation is asking, knock yourself out in such an environment? "Calling" isn't a word you hear much any more. Other than calling for help.
The notion that you were responsible for your patients made more sense when your decisions were respected and not second guessed by a clerk in Ohio with a check list or a pharmacist assistant in Massachusetts. It made more sense when you were not considered guilty of ( fill in the blank- ignorance,wasteful spending,not following whoever's guidelines, or being "disruptive") and had to prove your innocence. And it made more sense, putting it as bluntly as possible,when you made more money. It made more sense when there was a clear cut sense of your job being a profession, one that was very high in the societal pecking order, than it does when a hoard of watch birds are watching you to make sure you do everything to conform with whatever procedures and practices will maximize the profits of the third party payers or the hospital, not to mention the flagrant hypocrisy of dressing it up as quality measures. As prestige tanks so do pride and ethics and it makes more and more sense to go home after your shift and watch your daughter play lacrosse.
I quoted earlier from another blogger (EM Physician-Back Stage Pass) as he talked about the life of a hospitalist. He said in part :
I guess we're finally coming to realization as a group that medicine isn't worth your happiness and sanity. That it's hardly admirable to subject yourself to abuse (by CMS, by DHA, by joint commissions,by society by medicine) and be absent in the lives of your loved one. Maybe when doctors were respected,autonomous and paid well...but now,not as much.
For many physicians,younger and older ones, for the reasons cited above and more
medicine as a calling is " now, not as much".