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It is a known fact, but every generation feels that they had it worst and that other generations have it made.
“When I went to school we had to walk uphill in the snow both ways!”- Every grandparent
I thought that with the constantly-changing medical environment we live in, it would be quite enlightening to have a representative physician blogger from every available generation in medicine plead his or her case on why that particular generation may have been given the short end of the stick.
- I, of course, would represent the Generation X advocate in this cross-platform collaborative effort.
- I thought who better to represent the baby boomer generation than Hatton1.
- I could not think of a more appropriate individual to represent the Millennial physicians than a physician blogger that goes by Millennial Doctor.
- And to get a fresh perspective from the eyes of a resident, who better than to ask Wall Street Physician?
Graciously these bloggers accepted the invitation to participate.
Although there is no right or wrong order to read this posts, it might make sense to go chronologically from oldest to youngest:
I identify myself with the Generation X physicians, having been born in 1971, finishing medical school in 1997, and finishing my radiology residency and fellowship training in 2003.
I have been practicing as a board certified radiologist since that time, logging in over 15 years and counting.
During this time I have seen quite a change in the medical landscape, some changes for the better, others not so much so.
Ahhhh, the medical generation that I am most envious of.
These “Baby Boomer” physicians, which my father was a part of before he died at the age of 50, are widely considered to have practiced in, “The Golden Age of Medicine.”
These physicians were truly “captains of their own ship.”
A physician, based on his or her expertise through years of accumulating medical knowledge, was deemed wise enough to make the appropriate decisions regarding patient care without the need for approval or second guessing by non-medical entities such as insurance companies/HMOs or the government.
Being a physician meant something in these times.
Physicians were treated with the utmost of respect.
My father would often say that no matter what they were doing, nurses would all stand up in respect whenever a physician first entered the hospital wards.
Physician-patient relationships were at an all-time high.
On more than one occasion my father would bring home gifts that patients had brought in to show their appreciation.
One particular gift brings back fond memories.
A patient came to our home and brought a large bag of meat to show his appreciation. I remember my mom saying thank you, these chicken drumsticks look fantastic.
The patient replied, “No Ma’am, these are not chicken, but rather frog legs.”
My mom promptly screamed and dropped the bag.
Although I do not have concrete evidence to back me up, I feel this close physician-patient relationship likely lowered the risk of malpractice claims as well.
This was also the time that pensions were more widely available before corporate America decided it would be financially prudent to shift the burden of retirement to the employee rather than the company.
Social Security benefits for doctors retiring from this cohort were also more robust than current or presumed future offerings and also without the threat of the program becoming insolvent.
The cost of attending medical school and the debt burden incurred from it is considered laughable and pales in comparison to the debt burden subsequent generations have to endure.
Of course practicing in these times presented some unique challenges that subsequent generations did not have to face.
These doctors did not have the vast resources of medical knowledge at their fingertips which the internet now provides me.
If there is something I vaguely remember from medical school, I can refresh my memory in an instant just by “Googling it.”
I remember my father’s office had vast amounts of medical textbooks where they actually served a purpose rather than being more of a decoration as they are in my office.
A radiologist practicing in this time period had far more archaic equipment to utilize in the quest to diagnose a medical condition.
The CT scan was invented in 1972 and the MRI in 1977 but it would be decades later before computer advancements made processing and interpreting these images much easier.
Some truly barbaric practices that radiologists had to employ during this time have gone the way of the dodo bird, such as pneumoencephalogrpahy where radiologists would literally remove your spinal fluid and replace it with air, which, by historical accounts, was incredibly painful for the patient.
The “Golden period of medicine” abruptly came to an end and was perhaps replaced with the Bronze (or should it be Tin?) period as my generation of doctors assumed the mantle.
The relative autonomy that allowed physicians to directly manage their patient’s care without impedance made way to the reign of insurance preauthorizations and peer-to-peer reviews before a medical action would be given the green light (and this was still not a guaranteed outcome)
I know physicians who have spent 30-40 minutes on a phone call arguing why a particular patient should qualify for an MRI (and still be denied).
The “art of medicine” soon gave way to “financial bottom line medicine.”
“The art of medicine was lost when the term evidence based medicine began to be used.”- Hatton1Md
Debt burden from student loans started to rear its ugly head as both college and medical tuition increases far outpaced inflation.
Although the term burnout was first coined in the 70’s, it’s use became more prevalent when describing the plight of the Gen X physicians.
Increasing physician suicide and burnout became topics of hot discussion among my generation of physicians as there was clearly a disconnect between what we thought medicine was going to be going in (based on our predecessors) and what it turned out to be in reality.
Advances in technology carried with it both positive and negative effects.
On the one hand, advancements in radiology made increased efficiency possible with incorporation of systems like PACS (Picture Archiving & Communication System).
Technological advancements in computing also allowed for more data to be processed in a faster time as well as improvements in advanced imaging modalities that provided clearer glimpses into the human body than was ever possible before.
However technology also hit my generation (and the tail end of the preceding one) with electronic health records, which made our jobs feel more clerical, as well as the rise of patient satisfaction surveys/social media movement that made physicians feel like their practice success hinged on Yelp-like reviews.
The Young Guns of Medicine:
They say ignorance is bliss and it may hold true regarding this generation.
On a prior blog post, someone commented that the younger generations may be immune to, or at least can better cope with, the changes that caused so much angst for the Generation X doctors.
The commentator suggested that perhaps there was some sort of “systemization” that occurs with younger doctors who likely never knew about the glory days of medicine practiced decades before and thus became indoctrinated to the current medical climate as is.
This is the first generation of physicians where there was a shift to prioritizing lifestyle.
Whereas preceding generations of physicians wore their personal sacrifices to practice medicine as a badge of honor, this generation did not want to carry that torch.
The rampant spread of physician personal finance/FIRE blogs that occurred during this time helped provide the necessary tools and financial acumen to achieve a lifestyle that is far more tolerable than in the past.
I did not have the advantages these physicians had and had to learn my financial knowledge through the school of hard knocks, making every mistake possible along the way.
As with every generation, there is definitely some cause for concern.
Student loan debt burden is continuing to exponentially rise making the margin for financial error slimmer than ever before.
Declining reimbursements will likely be a trend that continues to plague physicians who, in the past, compensated by increasing their workload, seeing patients like an assembly line (but there is an upper limit to this as there are only so many hours in the day).
Societal programs that these physicians contribute to such as Social Security and Medicare are currently so financially stressed that there is no guarantee that they will ever be able to make use of these benefits when their time comes.
As hospital administrators continue to seek cost-saving measures, there will be a rise of mid-level providers that may reduce or even replace the need for more expensive physicians.
As technology continues to advance, there may be a time when certain specialties (radiology being at the forefront) may be fully replaced by artificial intelligence.
There you have it.
My take of medicine throughout the ages, seen through the eyes of one Generation X physician.
Please take the time to visit the other bloggers in this collaboration and see a perspective from their eyes:
If you are in search of financial help, please consider enlisting the service of any of the sponsors of this blog who I feel are part of the “good guys of finance.”
Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.
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Thanks for coming up with this idea.
I appreciate you agreeing to be a part of it. Hopefully people will enjoy seeing how different generations perceive medicine
What a brilliant concept for a series, my friend! Thanks for this gift.
My only suggestion is we name this the Aluminum Age of medicine, since it seems we won’t be far off from going place to place with our large clattering bags of recyclables as a side hustle to supplement our clinical income.
Many Gen X Docs seem to be making lifestyle a higher priority than we once did, a combination of wisdom and middle age.
I like it Aluminum Age does make a lot more sense. I’m glad it cane together smoothly, coordinating between 3 other sites I thought would be like herding cats, but only 1 minor glitch which is now taken care of (and all links should be working)
You are just full of great ideas Xrayvsn! This series is awesome. I’m Gen X same as you and my experience and observations mirror yours. In my area, I’m witnessing the corporatization and consolidation of health care. Big institutions and companies are gobbling up private medical practices. Instead of being our own bosses, we are now becoming employees and “partners” with large groups. There are benefits and trade offs, but in general I think physicians are losing autonomy. Unfortunately, I don’t think there is any going back to the Golden age. Case in point, the ABR just sent me an… Read more »
Hey MD. Thank you so much for the very positive feedback. It was a struck by lightning kind of moment when this came about (around a month ago). Originally the thought was just an individual post on my perspective of medicine and then the “aha moment” came and figured we have so many physician bloggers out there now, it would be nice to get a representative from each practicing generation to throw in their opinion. Luckily found 3 other very capable bloggers who accepted the challenge (the biggest challenge was communicating between all four of us sharing links to posts… Read more »
Great series, XrayVsn. I’m a millennial, so I’ll give a snippet of from my perspective. Since I’m young and naive, I have only heard of stories about the “Golden Age” medicine. But these stories mean nothing to me since I don’t dwell on the past or wonder how good it could have been had I been practicing 30 years ago. In true millennial fashion, I’m more focused on the here and now in the present moment. Life is good, so I don’t complain. We can only worry and think about what we can control. In reality, I think we still… Read more »
Well said DMF. I do think that is exactly the attitude you need to have these days otherwise medicine will chew you up and spit you out
Not many professions have as stable a job market coupled with a high salary as physicians.
There are still pockets in medicine where you can find a practice and maintain some autonomy. Glad you found yours
I am enjoying the series! It is telling that both you and M have similar concerns about what problems we have in medicine going forward. “The art of medicine was lost when the term evidence based medicine began to be used.” I don’t think this is a bad thing: Science should replace “art” in medicine. We are constantly striving to know what the best answer to any problem is and that can only be arrived at by the process of iterative knowledge generation. Science and the evidence it derives is how we know everything there is to know about disease.… Read more »
Thanks Kpeds for the great comment. I think some of us (at least I do) feel evidence based medicine is slowly degenerating into yelp like reviews from patient surveys and comments. This is what hospitals and insurance companies are now using to justify paying a certain amount of not.
I am all for advancements in medicine based on true scientific evidence supporting a certain course of treatment. But instead we are now hostage to how a patient feels about us
I do agree that patient satisfaction is a terrible quality metric to tie reimbursement to. It is a recipe for disaster and a myriad of unintended consequences await us. It is part of what is driving the opioid epidemic. We made pain a “vital sign” then told providers if you don’t treat people’s pain you won’t get paid, pharma companies misled the public/doctors about the addictive potential of their new fancy opioids and people demanded we treat their pain with them otherwise you get a bad survey and again reimbursement suffers! What a disaster. Incentives matter. But I didn’t follow… Read more »
Thanks for the follow up comment. As far as my confusing statement about evidence based medicine degenerating into a perverse form, I was implying that hospital administrators and other payors are using these satisfaction scores as a major factor in physician pay/bonus. The evidence of effective medicine in their eyes is hinging on the end consumer review. I know of some practices where bonuses are severely cut if you don’t get an average of 4 or 5 star reviews from patients. As you and I know that is a bad way to judge the quality of a medical practitioner. If… Read more »
Yep, many places are using satisfaction scores to influence reimbursement. It is crazy pants. And many institutions try to discretely tell people how to fill out the surveys. They have entire pay lines dedicated to trying to get better survey scores!!!
My wife worked for a while for a practice that used satisfaction scores to effect her base pay! It was very disheartening.
Patient satisfaction scores are replacing a true measure of the quality of care with someone’s perception of their care. These are not the same. At all.
The same trajectory has affected higher education. Students want to be entertained, not work for a grade. Teachers need good student evaluations, so students get high grades but never learn the material. Never learn how to think, how to write.
I got out of teaching and now work in medical research. Much less exposure to the dangers of providing service to “the public.” Now if they would only learn how to drive!
That is an interesting perspective from the world of academia. It seems like you have to do a song and dance to get a good review these days and God forbid you refuse to give patients pain medications (or students a bad grade in your previous case) and suffer their wrath of a bad review. Thanks for commenting.
I made that comment a few weeks ago on twitter. I am not disenchanted with facts and science. The art of medicine takes into account what is ideal but not practical for your patient population and practice type. Sometimes it involves being creative and employs negotiations with patients. It may take a few years to understand. It does not involve checklists and ICD 10 codes.
I read your article in the series after commenting here and got the sense that you meant something a little different than I did when thinking of the “art of medicine” idea. So often I hear people invoke that phrase when they essentially do not know the “best” way to do something. When there is a collection of seemingly equally good (or bad) options with no known “right” course of action. Rather than acknowledge our lack of knowledge and that yes we just need to pick something people say that this is where the “art of medicine” comes in. In… Read more »
Bingo. That’s how I envision it when that phrase comes about (of course I have been told my mind is quite strange and wired differently than others so can’t speak for how others interpret it so you are probably in the majority with your original take on the art of medicine). For me being a physician is more than just taking in data and spitting out an automated response or action. You have to draw in from past experience as well as take the patient as a whole rather than a disease. I loved Millennial docs post awhile back where… Read more »
I feel that quite a lot of medicine will never be amenable to AI. I can see it for figuring out the best chemo protocol perhaps. Some parts of medicine can be run from protocols some simply will never fit in a box. When I hear evidence based medicine I just roll my eyes and carry on doing the best job I can for patients. This does not mean I am anti-science. What is best for the individual may not be best the the population at large. Also if it is frequently an economic argument.
It’s a feeling as old as time. Every generation thinks the previous one had it better in terms of personal freedoms and liberties. History and human development is path dependent, meaning decisions are made based on the history preceding that decision in an infinite cause and effect chain. I don’t see human perspective on this issue ever changing.
Regardless, it’s a fun exercise in this post and one I’m sure you all enjoyed. It was a pleasure to read.
Thanks Riley for the comment and your own insight. It will be one day wild when some generation considers mine the “golden age,” lol.
It was definitely fun to join forces with 3 other doc bloggers from the various generations to do a cross-platform post. With the exception of one hiccup where one post didn’t go live until a few hours later than the rest, it actually went pretty smoothly in terms of coordination.
Glad you enjoyed the efforts of everyone to make it possible. Have a great day 🙂
Thanks for not calling me out by name for my glitch, but I’ll do it now 🙂 This is what happens when I try to post things off my weekly Wed schedule! Thank you again for the inclusion in this collaboration – it was a great idea and fascinating to see different people’s perspectives. My opinions seemed to line up more with yours – perhaps this is because I really should categorize myself as an Xennial rather than a true millennial 🙂 It will be interesting to see what happens to medicine moving forward – there is thankfully much more… Read more »
No worries MD. I’m glad in the end that it all worked out. It was a bit stressful coordinating it where we needed to put links to other posts that until they went live were dead links. Surprised that was the only hiccup to be honest 🙂
You are more than welcome in this project, although I should be thanking you, it was a wonderful post to read (and there was subtle tie in with the frog (both in the writing in my post as well as the Pinterest image at the bottom of my post I used).
OMG the frog legs hahaha ?
I found this article SO interesting; I can’t wait to share it with my husband. When you put it in perspective like that, your generation really has been smacked with a lot of the biggest “growing pains” — in technology specifically — as well as this shift toward patient satisfaction over everything.
It’ll be interesting (well, it’ll be SOMETHING, that’s for sure) to see how healthcare /medicine shakes out now that the landscape is changing. Looking forward to reading the other bloggers’ posts!
Thanks for the comment. Made me chuckle as I read it. Yes my generation has seen quite a change in the medical landscape. Please do read the other 3 associated posts. They are all well written and show a great contrast of how each generation perceives medicine differently.
In the meantime, “you kids get off my lawn!” (me shaking my fist at them angrily
These have been interesting articles! The comments have also been illuminating. I feel like we often gloss over the fact that a big part of the reason for the shift away from physician autonomy lays at physicians’ feet. Not individually, but as a class, we did not police ourselves effectively and there was rampant abuse. In every little hospital I go to, the old nurses remember the local docs admitting elderly people to the hospital for up to a couple of weeks so that the family could take a vacation. $8,000/day respite care, paid for by medicare – hardly an… Read more »
Interesting take High Plains MD. Perhaps we are all suffering for the sins of a few. Shame that a few bad apples ruined it all of that truly is the case.
Even today with this increased bureaucracy people will find away to abuse the system.
Thanks for stopping by. I enjoy your blog as well
I loved everything about this collaborative series. It’s always interesting to see what each generation thinks of each other. I definitely agree with Hatton1 that everyone thinks the golden age was 15-20 years before they started practicing medicine. Thanks for coming up with this idea and organizing the collaboration!
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