Don’t worry, your kids will make excellent physicians

Joseph E. Scherger, MD, MPHMuch has been written about whether physicians in practice would recommend that their children pursue a career in medicine. The 87th Annual Physician Report by Medical Economics shows only 40% would. 

However, medical schools and residency programs are growing rapidly and have plenty of applicants. Are these future physicians going to carry on the traditions of being a physician, with selfless devotion to the care of patients? Will they work hard enough?

As someone who teaches medical students and residents on a regular basis, I see this next generation as dedicated to patient care. I regularly see them “going the extra mile” for patients. However, they also want a balanced life with family and personal interests and are not interested in playing the role of the “always working” physician.

The practice of medicine is changing. The complexity of the work for both individuals and populations has become much more complex. For the entire history of medicine until recently, physicians reacted to demand. They cared for patients when they become sick.

Today physicians are called upon to provide comprehensive preventive medicine and to manage a variety of chronic illnesses. The population being served is expected to have excellent health outcomes. This work goes beyond what one physician can do. It requires a team approach.

In the 1997 movie “As Good As It Gets,” an HMO is bashed for not caring for a child with asthma. The traditional pediatrician makes a house call and saves the day. Internist David Lawrence, MD,  former CEO of Kaiser Permanente, took umbrage at this portrayal. In his 2002 book, “From Chaos to Care,” Lawrence describes how well-functioning teams are able to greatly improve the care of children with asthma compared with scattered private practices using different medical records and having poor communications.

The next generation of physicians will still be caring for patients and preserving a trusted doctor-patient relationship. But they will be part of a team of providers and support staff all doing the work of keeping a population of patients as healthy as possible. In many circumstances, a physician will be the leader of this team. In other settings, the physician will be the clinical expert with the most sophisticated training. The next generation will take on executive roles in the care of a patient population.

To many physicians in small practices, this will seem like a different world. To the young generation this should be exciting and rewarding, and they will look back on 20th century medicine as primitive. With the training and responsibility of physicians in organized team settings, they will be well paid.

Speculation about the next generation of physicians may be interesting, but we should not be concerned. Plenty of bright young people are entering medicine and their roles will be highly valued in the quality healthcare delivery systems already in development. Some will choose to practice alone in a concierge or direct primary care setting taking only cash payment, and they will provide good care to a limited number of patients as long as they have access to the resources necessary for modern high quality care.

Today’s physicians would be wise to encourage their children to pursue a career in medicine.