Would you tell your children to eliminate the practice of medicine from their list of potential career paths? It’s not a question I ever needed to consider. Although my three children are bright and have a good work ethic, none of them considered becoming a doctor. At least if they did, I wasn’t consulted. Two of them have always been squeamish about body fluids, and that was probably a deal breaker for them. It certainly wasn’t because I complained about my job. I don’t recall ever grumbling about being a pediatrician. Although my considerably less-than-perfect attendance at dinner and their sporting events may have prompted them to seek a more family-friendly profession.
In a recent column, Dr. Allan M. Block wrote a piece titled "Why I’m happy my kids don’t want to be doctors"(January 2014, p. 16). In his sad-but-true commentary, he imagines how uncomfortable it must be to leave medical school with nearly a quarter of a million dollars in debt, a burden that must affect how young doctors choose what and how they practice. While none of us planned to practice rogue medicine, Dr. Block also bemoans the fact that "people who know nothing about medicine try to tell us what we can or can’t do."
Is his commentary merely a burnout candidate’s last rant before the flames reach his vital organs? Or, is he speaking for the many physicians who have worked long enough to realize that the practice of medicine has moved perilously close to the point where the cost/benefit ratio has tipped to the "it-isn’t-worth-it" side?
While none of my children sought my opinion on medicine as a career path, scores of my patients have shared their dreams of becoming physicians. Whenever this has happened, I egotistically hope that in some way I may have served as a positive role model they wish to emulate. But, I have learned that there are usually more potent motivators lurking in the background. While still puffed up with undeserved pride, I also assume that they are asking for my opinion on their plans . . . which of course they are not.
I ignore the obvious and offer, "Well, it may not be as much fun as it was 20 years ago, but being a pediatrician is still a lot of fun." Of course, this begs the question, If I were in their shoes today, would I apply to medical school?
Hesitant to throw too much cold water on their enthusiasm, I am sure to reassure them that I think they would make wonderful doctors. But, I add that becoming a physician is a long and expensive process. I hope that they are still listening when I add, "You know that nurse practitioners and physician assistants get to do almost all of the cool things I enjoy the most about being a pediatrician, . . . and the training is certainly shorter and less costly."
Of course, choosing either of these nonphysician career paths will rob their parents of the opportunity to introduce them at cocktail parties as "Our daughter, the doctor." But, the trade-off is that they will be more likely to be content with their jobs.
While my observations may be good advice for some of my patients, it leaves unanswered what to do about the malaise that hangs over Dr. Block and many of our colleagues. Educational debt has robbed some young doctors of their entrepreneurial spirit. Pressures from the government and third-party payers have nibbled away at our autonomy. And, the threat of malpractice action has smothered many of us in a blanket of fear.
Even in the face of all this gloom, if one of my grandchildren told me that they really wanted to be a pediatrician and expressed no interest in the nurse practitioner option, I would be candid in describing the erosion that has occurred over the course of my career. But, I would challenge them to tell me another job that could offer them even half of the opportunities to feel needed and appreciated that I have enjoyed. Hopefully, at least some of the frustrating downsides of medicine today will be reversed by the time they enter practice.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including "How to Say No to Your Toddler." E-mail him at pdnews@frontlinemedcom.com.