Jacob Goldstein explores the latest demographic shift in the delivery of primary care through his Page One article in today's Wall Street Journal, "As Doctors Get a Life, Strains Show Quest for Free Time Reshapes Medicine; A Team Approach." Goldstein profiles a 32-year old primary care doc who chose to become a hospitalist with well-defined work hours, saying, "My family is as important, if not more important, than my career."
He also interviews an OB and mother of two young children who cites a "controllable lifestyle" as her reason for moving from a five-physician practice to a position as an OB hospitalist with a large facility in Salem, Oregon. The call was killing her ability to spend time with family.
Interestingly, I found no workable solutions for doctors who want to focus more time on their families and who work in non-primary care specialties like orthopedics, cardiology or oncology. In fact, the article quotes a 50-something surgeon who grumbles about "the new guys" who are dictating their schedules instead of sharing the burden of call.
Goldstein makes a subtle point that might easily go unnoticed by readers who are casual observers of medicine, and that point is the physician's paradigm of perspective.
He uses the word "hero' to describe the physician's self-perspective that involves the one-on-one, 24/7, give-everything-for-the-patient mentality that specialists and old-line doctors tend to espouse. He contrasts this with the "me generation" of doctors who seem to slip easily into and out of shifts, turning off pagers, and passing the baton of care to the next doc on duty.
This simple contrast fails to consider one key aspect of the physician mindset: self-actualization through independent achievements. From what I've seen, physicians tend to perform best as leaders above a group, and they tend to compete with (rather than coordinate with) those who are at their peer level. Each physician wants the ability to look at a job well-done and say "I did it."
This fierce independence stands in stark contrast to the culture of teams. Before the field of medicine can continue to evolve in such a way that physicians can enjoy more time with family through more predictable schedules, there will have to be a change in the culture of physicians that embraces a pro-team model for the delivery of all kinds of care, not just primary care. Specialists have families, too, and they deserve a decent quality of living in exchange for a job well done.