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Helene Pavlov, M.D.

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Will the Doctor Be There When You Need One?

Posted: 10/05/11 04:55 PM ET

July 1 is a special day in hospitals, medical schools and the medical profession in general. July 1 is like Jan. 1 to most. July 1 starts the academic year in health care. It is the first day of internship, residency and fellowship training. For those leaving their trainee status, it is the first day of the rest of their life as doctors. It is the day they start practicing the medical/surgical subspecialty that they spent approximately 10 years training to become competent and confident in after college graduation. The day also marks the end of waivers for loan payback, e.g., loans taken to pay for medical school, possibly college and even intern, resident and fellowship years if stipends did not suffice. July 1 is also the date when they are required to pay expenses for malpractice, licenses, office space and staff -- expenses that are often much higher than earned income during the first year of transitioning to one's "chosen profession."

So, with all that dedication and delayed gratification, why are so many of these young doctors choosing to work part time? The article by Dr. Karen S. Sibert, anesthesiologist, published June 11, 2011 in The New York Times, "Don't Quit This Day Job," was refreshing. She wrote about the disservice of part-time physicians to their patients, to the federal government that supported their training stipends and to their profession. She also stated that this pattern for part-time practice is more common among young female physicians.

When I read this referenced article, it did not surprise me that the author spoke of her grandson. I believed that the author of this article must be someone of the age and generation who understands that a chosen career in medicine is a profession. The generational differences and sense of entitlement in our trainees and newest physicians is something I witness daily.

During the training experience (internship, residency and fellowship), new doctors are trained to expect 10 hours of sleep without work responsibilities. If they are summoned to respond to a patient's needs during the evening hours when they are on call, they are required to calculate when (10 hours later) they can return to work. This 10 hours of downtime is mandated in the name of patient safety and is enforced, even if it means missing an important informative morning conference or patient rounds. If the trainee ignores this mandate, then the training program is subject to substantial financial penalties. As you would suspect, there are oversight agencies with employed people to perform audits and ensure compliance. These policies and procedures reinforce the sense of entitlement and life expectations of our youngest and brightest new physicians.

In the above scenario, while the trainee is not expected at work in the morning after having been interrupted while "on call," the attending physician who supervised the resident/fellow in the middle of the night is expected at work. After July 1, these new "no longer" trainees will discover that the uninterrupted sleep entitlement is over. They will be expected to be at work and to be able to perform. As these young physicians become aware of limited entitlements, many opt to work part-time. They comfortably ask during the interview for a position, "What is the minimum work I will have to perform to keep my job?" I fear that the professional aspect of the profession of medicine is becoming compromised.

As access to health care is being revamped, more patients will be seeking physicians' help, but there will be fewer physicians in number and time available. Being a physician is a profession, a life choice, a dedication to providing quality care to all patients at all hours. These days it seems as if young physicians are being taught to think and behave like hourly workers. They make sure to take every vacation day and sick day they perceive as their due. Teamwork is a word, not a practice; there seems to be a lack of appreciation that when they are not at work, others must take up the workload, as the work does not stop.

It used to be that going to medical school and becoming a physician was a career choice for the most dedicated of students. If these students are willing to work for the "degree" of Doctor of Medicine but are not willing to put in the work expected and required by patient demand, then what is the future of health care, the future prestige for doctors of medicine, and the future attraction of medicine as a profession?

Today, as patients, we want quality, safety, availability and continuity of care. What should a patient expect of their physician in the future? What will be the future definition of a physician?

HSS