Doctors Vanish From View
Harried by the bureaucracy of medicine, physicians are pulling back from patient care
In California, where the cost of living is high, there are shortages of primary-care docs, neurologists, and surgical specialists. "The wait is three weeks to a month to see a pediatric neurologist, and pediatric nephrologists are as rare as hens' teeth," says Harvey Cohen, head of pediatrics at Stanford University School of Medicine. Already, Merritt, Hawkins reports that the average wait for a new patient wanting to see a cardiologist is 37 days in Boston and 22 days in New York. For an obstetrician-gynecologist, the wait is 45 days in Boston and 31 days in San Diego.
Specialty problems. In certain specialties like geriatrics, cardiology, neurosurgery, and oncology, the shortages are projected to be nationwide, even in areas with a high concentration of doctors. Demand for their services will rise as the baby boomers age and develop chronic conditions, but there isn't a corresponding surge of interested students.
Instead, today's med students are gravitating toward nonsurgical specialties with regular hours. In last year's "match" of new grads to postgrad medical residency programs, grads of U.S. med schools filled 97 percent of the dermatology slots but only 41 percent of the family med slots. There were about 2.5 applicants for every family medicine position open and about 14 for every radiology position. The American Association of Neurological Surgeons said last year that demand was vastly outstripping supply and noted that the field isn't perceived by med students as offering a regular schedule or enough personal time. Some specialties may change training to attract more doctors. The American College of Cardiology, for example, is considering whether to trim the current six-year training by a year, cutting out the interventional procedures that aren't done by general cardiologists anyway. That would increase the supply as well as possibly attract candidates turned off by the longer training period.
That's not to say that young doctors are slackers or that no one is interested in the most academic specialties. But as a group, they are thinking very differently about their careers than did their predecessors, refusing to put medicine above family and personal time. One saying: The R.O.A.D. to happiness lies in radiology, ophthalmology, anesthesiology, and dermatology. "There is a generational difference in what we see as important in our careers and personal life," says Jennifer Shu, immediate past chair of the American Medical Association's Young Physicians Section. "Whereas career might have defined you in the past, it doesn't anymore." She and her husband are a good example: She took two years off to have children and now works part time as an instructor of pediatrics and medical director of the nursery at Dartmouth (and writes books in her off time), and her husband is back at school for public health and outcomes research, with an eye toward a career in epidemiology. "I have to take care of my house, my own life, and my son--I make limits," she says.
Statistics show that women--who now make up the majority of med school applicants--work fewer hours than male physicians do. But this desire to have a life is more generational and linked to expectations about what a medical career will and will not provide these days. "It's very clear that all physicians are looking towards having a life outside their medical practice," says Getto of the University of Wisconsin.
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