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!” says every grandparent
I identify myself with the Generation X physicians, finishing medical school in 1997 and my radiology residency and fellowship training in 2003.
During this time I have seen quite a change in the medical landscape, some for the better, others not so much so.
My predecessors
The medical generation that I am most envious of.
These Baby Boomer physicians 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.
Physicians were treated with the utmost of respect.
Physician-patient relationships were at an all-time high.
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.
Some truly barbaric practices that radiologists had to employ during this time have gone the way of the dodo bird, such as pneumoencephalography where radiologists would literally remove your spinal fluid and replace it with air, which, by historical accounts, was incredibly painful for the patient.
My generation
The Golden Age 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).
The art of medicine soon gave way to the financial bottom line of medicine.
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 ‘70s, its 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 and 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 that may hold true regarding this generation.
There have been comments 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 because they never knew about “the good ol’ days.”
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.
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.
“Xrayvsn” is a radiologist and can be reached at his self-titled site, XRAYVSN.
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