By Brian L. Grant MD

The AMA News reports that many physicians are reducing their hours treating patients and in some cases, leaving or considering leaving the profession altogether.

Some decreased productivity is a result of being employed rather than independent. Morale in many physicians is said to be suffering. The causes can be debated, but the phenomenon is real.

When I entered the profession in the early ’80s, physicians prided themselves on autonomy and enjoyed a great deal of respect. Little did my colleagues and I know that U.S. healthcare was in the twilight of an era of professional control.

We have shifted to a world where the “system” is under challenge by many factors: runaway costs, massive engagement by market driven businesses in the technology, device, and pharmaceutical industries, consolidation of hospital groups, buying of physician practices and many other forces.

Physicians no longer enjoy, by and large, the sense of control and respect that once was their domain. To a degree we may have brought in on ourselves and there have been some decent trade-offs made by some. For example, work-life balance for many has become more important than professional power and pride.

The large number of women who have entered the profession (48% of current medical school graduates) have encouraged new models for women and men in balancing work and family. But to the degree this means fewer hours worked, it is equivalent to less care being provided per doctor working. (For more information on women in medicine, see http://www.catalyst.org/knowledge/women-medicine.)
In order to address the growing physician shortage, many solutions are being considered. This includes leveraging the talents of other professionals, altered delivery models, encouraging more medical immigration (to the detriment of the countries who have trained professionals only to see them leave), and striving towards new delivery models using technology and innovation.

In the end, medicine as we knew it may be history.

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