Generation gripe: Young doctors less dedicated, hardworking?

To some older doctors, long hours, late nights and always being on call were a testimony to their devotion to medicine.

They don't see the same drive in the new generation of doctors.

In a survey of physicians ages 50 to 65, 64% said doctors trained today are "less dedicated and hardworking" than physicians who entered medicine 20 to 30 years ago.

But younger doctors say that's not true. They say lifestyle considerations are shaping how they approach their practices and creating a healthier profession that strives to balance professional and personal lives.

One thing is sure: Older norms of practicing medicine are giving way to newer approaches, but not without some friction.

"There's kind of a loss of what it means to be part of the profession. Being a family physician has responsibility that sometimes extends beyond 9-to-5 and we have to be accountable to patients at other times," said San Antonio family physician James Martin, MD, board chair of the American Academy of Family Physicians.

Some younger doctors say older physicians who grumble about this shift in attitudes are envious.

"Just because younger doctors are getting better at setting boundaries between their professional and personal lives doesn't mean they are less committed. Without those boundaries, physicians risk burnout and being committed -- to a rehab unit," said Douglas Farrago, MD, 38, a family physician in Auburn, Maine.

The new Merritt, Hawkins & Associates survey includes older physicians' views about the next generation of doctors. None of the 436 physicians surveyed said doctors coming out of training are "more dedicated and hardworking" than physicians who entered medicine when they did.

"There is a pervasive cultural rift between many baby boom doctors and Generation X doctors. Whether valid or not, many older physicians see themselves as more wedded to medicine than are younger doctors," Joseph Hawkins, CEO of Merritt, Hawkins & Associates, said in a statement. The Texas-based physician search firm released the national survey in January.

Some doctors say the change in young doctors is in the work ethic, not the commitment level.

"They probably are as dedicated, but I don't think they're as hardworking," said Bob Aldrich, MD, 57, a cardiologist for 22 years who retired three years ago to run an inn in Weston, Vt. "They want to be just in the office. They don't want to be working at night. They want somebody else covering their patients in the hospital."

Women seen as key to shift

A study in the Sept. 3, 2003, Journal of the American Medical Association found that U.S. medical students want careers that provide more control over their personal lives. Match Day figures for 2003 showed medical school seniors increasingly chose residencies in specialties such as anesthesiology.

"At the end of the day, if you can make more money as a dermatologist than as a heart surgeon and go home at 5:00, then only the most ferociously dedicated will pursue heart surgery," said Stuart F. Seides, MD, 56, a Washington, D.C., cardiologist.

For the first time, women made up the majority of medical school applicants (50.8%) in 2003-2004, according to the Assn. of American Medical Colleges. Educators said the influx of more women means more doctors will consider lifestyle issues, such as raising children, when they contemplate career choices.

Family physician Lisa Corum, MD, 38, switched from full-time practice to part-time two years ago after the birth of her son. Working in a group practice in Rock Hill, S.C., allows her that flexibility.

"We're trained that you have to meet the needs of the community. But we're trained to meet your family needs as well," said Dr. Corum, an AAFP board member.

Some physicians said the change in practice attitudes by younger doctors could be good for medicine.

"They may turn out to be better doctors because they may be more healthy emotionally and physically. By leading healthier lives, they may have healthier relationships with patients," said Robert N. Butler, MD, president and CEO of the International Longevity Center-USA, a research organization in New York City.

But others said if doctors reduce hours, that could translate to less time for patients. Who will step in to see those patients, they ask?

"My main concern is fragmentation of medical care in the future. Patients are going to have to get used to shared care with doctors sharing responsibility," said Erwin Stuebner, MD, 59, an internist in Williamstown, Mass.

Using a physician assistant allows family physician Craig Fockler, DO, 34, to get away when he needs to, without disrupting patient care. He said his solo practice in rural Alum Bank, Pa., is a contrast to the practice of a neighboring physician in his 50s.

"He sees patients up until any hour of the day," Dr. Fockler said.

"I'm not going to live at my office, but I'm available to my patients 24 hours per day. I'll be around a lot longer than he will. He's going to burn himself out."