Next week, my classmates and I will graduate from medical school, an event that instills in me both pride and terror. I’m excited to earn my medical degree after years of hard work and studying. Yet, when I graduate and become a new doctor, I’ll be thrown into a dysfunctional and chaotic healthcare system.
The medical profession is changing rapidly, and many believe in the wrong direction. Every day we learn about alarming trends in our chosen career path. We hear doctors no longer have time to listen to patients and spend their days typing away at computers. We read headlines about hospital networks taking over and Medicare going insolvent, about rising government regulation and insurers telling providers how to treat patients.
This changing landscape has cast a shadow on the medical profession. Physician burnout is on the rise. As many as nine out of 10 doctors wouldn’t recommend pursuing healthcare as a career. Some say medicine has reached a tipping point.
I often wonder what I’ve gotten myself into.
But is the medical profession really losing its identity? Is it changing more so today than ever before? I think we sometimes lose sight of its turbulent history. Doctors have been in my family for the last four generations, and they’ve seen plenty of upheaval.
Two of my great-grandfathers practiced medicine in the early 1900s. At the time, diseases like polio and tuberculosis ravaged the nation. Elderly and destitute patients often died unnecessarily because they couldn’t afford care (Medicare and Medicaid wouldn’t exist for decades). When the Great Depression struck, many couldn’t pay for medical services.
In the 1930s, one of these great-grandfathers, who worked as a general practitioner in Brooklyn, charged $3 for an office visit and $5 for a visit to a patient’s home. When needy patients couldn’t afford those fees, he often accepted baked goods in lieu of payment—or nothing at all.
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The next generation of physicians faced new challenges. My grandfathers were drafted into the military as doctors during World War II, and one of them was wounded serving abroad. At home, our healthcare system suffered severe physician shortages because of the war. As a result, my grandmother was able to enter medical school in the 1940s to become one of the earlier female physicians.
Yet, along with minorities and other women entering the profession, she endured discrimination on a daily basis. For example, patients sometimes refused to believe she was a doctor, and senior physicians demanded to know when she would be getting pregnant.
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By the time my parents began caring for patients, the trials of the profession had shifted once more. In the 1980s and 1990s, AIDS terrified patients and providers as it swept the nation. HMOs sought to contain costs with managed care and patient networks. Hospitals reacted with a wave of mergers to consolidate negotiating power. Physicians were caught in the middle, left to the whims of growing healthcare organizations and losing autonomy in patient care.
Today, the medical profession is still grappling with many of these issues. And my classmates and I face many more ahead, from the incorporation of performance measures into daily practice to our fraught relationship with new medical technologies.
So has medical practice lost its way? I’m not sure. As my own graduation nears, I have mixed emotions on what it means to become a doctor today.
Part of me is afraid. Spiraling costs threaten to upend our healthcare system. Our political leaders can’t seem to work together and to find solutions. I worry about the automation of patient care, the transformation of clinicians into cogs. Doctors old and new are suffering in terms of their mental health, dropping out and discouraging others from joining the field.
But another part of me is hopeful. I see all those tipping points from before, and I have faith my generation will overcome ours as well. I think about the young doctors graduating across the country this spring and the new ideas they’ll bring with them.
It’s a time of great flux and therefore opportunity in American medicine. We can steer our rapidly changing profession in new directions. Rather than succumb to disillusionment, we should take steps to make medical training and practice more humane. We can discover exciting cures and innovative ways to deliver care. With the rise of the Internet and social media, we can advocate for issues that matter to us and stand up for our patients.
Medicine is still a thriving profession. Last year, more than 52,000 students applied to medical school, the largest number of applicants in history. Women now make up roughly half of the graduating doctors in our country, and new medical students come from increasingly diverse backgrounds. Surveys consistently show physicians remain among the most respected professionals by the public.
So while I’m anxious about medicine’s uncertain future, I’m still looking forward to graduation day. It’s such a privilege to wear a white coat, to have the honor to care for patients. I hope we’ll deserve the letters after our names. I hope my generation will change American healthcare for the better.
On May 26, I’ll sit with my classmates on our medical school quad. One by one, we’ll walk up to don academic hoods and receive our diplomas. We’ll read an oath together, inspired by words written thousands of years ago by Hippocrates.
Some things never change.
Nathaniel P. Morris is a graduating student at Harvard Medical School.