Diminished commitment can be traced to profession's diminished rewards

Regarding "Younger doctors less dedicated, hardworking?" (Article, Feb. 2):

The generational dispute detailed in your article is at least as old as Moses, who noted with dismay how the young quickly forgot the sacrifices of their elders. However, your article did not delve far enough into perhaps the root cause of the diminished commitment to long hours, which is the diminished reward for one's efforts.

Doctors entering the profession are at a gross disadvantage compared with their forebears. They are expected to incorporate every medical advance in the last century into their knowledge base; the phrases "I don't know" or "We can't do anything for you" are not in their vocabulary.

They must be specialists in charting, coding, billing and social services, in addition to knowing something about the heart or a similar organ. Their patients read medical textbooks, the Internet and even their own charts and often argue with them about the diagnosis and treatment. (As a result a patient interaction that used to take 10 minutes, with time left over for chatting about fishing or the relatives, now takes 30, including coding and dictation.)

If they like to do procedures, they may make a lot of money. However, if they decide they would rather provide primary care instead of wielding a knife or a catheter, they can look at a salary that will make it hard for them to pay off their average $109,000 medical school debt. They can look forward to a high risk of litigation and ever-rising malpractice premiums.

An alphabet-soup of regulatory agents -- CMS, HIPAA, OSHA -- will continue to intrude on their practices.

Computerization will promise greater productivity for you but actually will lead to frustration and increased distance from patients.

I could go on and on. The older doctors quoted in your article came of age during a golden era of medicine when physicians worked harder but received more rewards, particularly the deferential acknowledgement of their patients and the public at large.

The wonder is not that young doctors don't commit themselves more to hard work and sacrifice. It's that they don't all give up medicine at an early age to run inns in Vermont.

Jeffrey S. Sartin, MD, La Crosse, Wis.

Editor's note: Dr. Sartin is a 42-year-old infectious disease specialist.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/02/23/edlt0223.htm.