Should I become a doctor? That question never occurred to me before choosing a career in medicine 50 years ago. Doctors were respected members of society who balanced biology and human compassion with remarkable abilities to help people from all walks of life. If you had a passion for applying science to helping others, there was nothing else you should consider doing. I didn’t, and jumped right into a career as a physician.
Yet today, we frequently hear about the physicians who declare they would not go into medicine again if they could start over. The reasons given include electronic medical records, bureaucracy, insurance company denials, information overload, long hours, declining reimbursement, and family sacrifices, to name a few. We also hear about impending doctor shortages. The Association of American Medical Colleges estimates that in the next decade there will be a shortage of 90,000 physicians. Undersupply issues face primary care and specialties alike.
Is the field of medicine facing a crisis? I actually do not believe it is, and would like to explain why.
Whenever I hear someone complain about declining reimbursement or increasing administrative burdens as reasons why our field is falling apart, I think about something I heard from an anesthesiologist in Prague in 1992. I was there following the Velvet Revolution that peacefully removed the communist government from Czechoslovakia. The country we now know as the Czech Republic was slowly transforming into a democracy. I was with several other anesthesiologists from California, including one particularly outspoken private practice anesthesiologist who was well compensated for his practice and demonstrated that by wearing a very large diamond ring. We will call him Dr. Money.
We visited a public hospital in central Prague and met with the head of a small but busy anesthesiology department. Their resources were limited. Dr. Money seemed appalled by the lack of resources, and in our meeting asked, “So how much do anesthesiologists make in Prague?” The rest of our group shrank in our seats. The anesthesiologist politely responded, “Well, our currency is not easily convertible, so let me describe it this way: all doctors make the same amount of money no matter what their specialty, and we all make a little more than someone who operates heavy construction equipment, and a little less than someone who drives busses in central Prague.” Dr. Money looked appalled and responded, “How do you ever get anyone to become a doctor, and with everyone making the same, why would anyone become an anesthesiologist?” The department head looked confused by the question and quickly responded, “We all became doctors to help other people, and I became an anesthesiologist because the work is interesting and rewarding.”
In that moment Dr. Money was at a loss for words. Our group went on with our visit, but with the renewed understanding that we, too, went into medicine to help others and are (hopefully) fortunate to face interesting and rewarding work.
With that lesson in mind, what will an aspiring physician face today? Gloom and doom, or an opportunity to help people in ways that are interesting and rewarding? I would argue that young people considering a career in medicine in America have one of the greatest opportunities in the history of medicine. Advances in science and technology are happening at a remarkable pace, giving clinicians tools they never had before, tools most physicians who trained in the past never even imagined. New treatments for old diseases are being developed at an extraordinary rate that will improve the human condition in ways former generations never imagined.
It is true that many aspects of our delivery system are broken and need to be fixed. Care in the United States costs way too much for the outcomes we deliver. Inefficiencies abound. So anyone entering the profession needs to be aware of the challenges.
Yet physicians have always faced challenges. Indeed, the profession is known for attracting smart, caring people who love challenges. Think of our predecessors who faced daunting diseases with unknown etiologies, and whose treatments were empiric and frequently ineffective. Even surgeons who knew what needed to be done could not, due to lack of anesthesia and infection control and team members whom our modern surgeons could not imagine a life without.
I am convinced that the opportunities and challenges that exist today can and will continue to attract the best young people to become physicians. If they love science, the tools of modern genomics, proteomics, molecular biology, physics, and clinical pharmacology, there will be endless opportunities to address problems in the human condition through advanced technologies. If they love the social sciences, economics, and human engineering, there will be remarkable opportunities to address care delivery problems through newly evolving concepts like value-based health care, where the focus is on the patient. And information technology, which has been slow to be adopted in health care, will offer opportunities over the next 50 years that will transform care through information exchange and big data in ways we are only beginning to comprehend.
We do need to heed the warnings about shortages of physicians. To be able to help all Americans, physicians of the future will need to do a much better job of delegating health care to other professionals when appropriate. The smart use of nurses, pharmacists, physician assistants, and numerous other well-trained health care providers is essential for the health of our nation. We need to get past the era of the eminent physician who did everything and delegate what we can to our colleagues.
So if I had the opportunity to choose medicine as a profession again 50 years later, would I make the same decision? Absolutely; medicine has afforded me remarkable challenges and satisfactions. I clinically cared for patients in the operating room as an anesthesiologist and in the intensive care unit. I engaged in clinical research in critical illness and organ transplantation. I led and managed a division with three departments and navigated the difficult waters of clinical operations in a major cancer center. I have been able to partner with brilliant colleagues at Harvard Business School who have taught us a tremendous amount about how to redesign our industry. I currently lead a remarkable team of individuals who study value-based health care. I have never had a day in which I did not look forward to going to work and facing the challenges of the day.
We will always need to help the sick. The work is interesting and rewarding. There are challenges that must be met. The clinical conditions that people have and the tools we have to manage them are constantly evolving in ways that create needs and opportunities for the future. Ultimately, I believe, the problems health care faces today will be interesting pieces of history — the way we look back at the challenges faced by our predecessors.