GenX'er Find They Like Being Doctors

By Ali Shafaie M.D.

It is hard to believe almost 10 years have passed since the first of us left medical school as bright-eyed young graduates, headed for illustrious medical careers. Most of us – perhaps with the exception of subspecialists – have been in practice now for a few yeaars, long enough to know there is much about being a doctor we didn’t learn in medical school, but not long enough to become jaded or bored.

We have been inspired by the older physicians who showed us the ropes in residency and who now mentor us in practice. But as young doctors, we are making our own marks on the medical profession in distinct ways.

We graduated from medical school just as this thing called the Internet was taking off. As we slogged through sleepless nights for measly residents’ wages, others our age were earning millions in stock options and sky-high salaries. Though some, perhaps, may not have had time to notice, in California the World Wide Web was hard to ignore, and there undoubtedly were those who wondered whether we had made the wrong career choice . . . at least until the bubble burst, after which we felt lucky to have a job at all.

Although we may not have made our fortunes in a start-up venture, we’ve been part of the information revolution nonetheless. Growing up, we spent Saturday afternoons playing Donkey Kong at the arcade, and we have been using computers for most of our lives. As a result, our generation is far more comfortable than our more senior colleagues with the increasing presence of technology in medicine. At our clinic, for example, I see young doctors adapting easily to our electronic health record system, while some veteran physicians (though certainly not all) are more averse to it, especially those who still struggle to type with more than two fingers.

We also came of age as doctors in a world where managed care was the norm. Prior authorization, primary care gatekeepers, and other hallmarks of the HMO do not frustrate us as much as they do our older colleagues, though we certainly hate the paperwork as much as anyone. We were taught in school to practice cost-effective medicine, and we feel protecting limited health care resources is an important responsibility for physicians.

We were trained to treat our patients a little differently too, to give them more decision-making autonomy, and to avoid a “doctor knows best” mindset. Younger patients, especially, seem to expect this approach, and it does not surprise us that they do. We enjoy the opportunity to collaborate with them, although even with our training in “patient-centered care,” we occasionally are shocked at how demanding patients can be. My first glimpse of this was the patient who walked out of an appointment, slamming the exam room door behind him, after having to wait a few extra minutes. I’m sure many others have had similar experiences.

Then again, medical school did not teach us many of the fine points about being a “real” doctor. In primary care, for example, physicians may not have fully appreciated the variety of patient issues we would have to address, or how much of preventive medicine is really psychology. Our surgical colleagues may have been surprised by the nuances of operating room scheduling, something from which they were largely shielded in residency.

Time management is another big one: For the most part we did not realize how tough it could be to keep a practice running efficiently. We knew there would be paperwork, but we didn’t know how long it would take to complete. We learned about coding and billing—in theory—but did not truly understand it until it hit us in the face. We are much wiser now.

On the home front, our generation has strong expectations for a work-life balance that lets us spend more time with our families. This mindset is not new, but it seems to mean more to us. Perhaps this is because of the growing number of women in our ranks, but male doctors also seek balance. Especially in the Bay Area, the high cost of living means we often have spouses who must work full-time too, just to afford a house even remotely near the office. Having a flexible professional schedule becomes particularly important in this environment.

After residency, many of us sought work at large group practices that make it easier to achieve a work-life balance and avoid certain business responsibilities. Even so, our professional lives are busy. Rarely is a day off truly a day off, with paperwork, E-mail, follow-up patient phone calls, and myriad other tasks. It is nearly impossible to treat medicine as a 9:-to-5: job; nor do we want to. We chose this profession to help people who expect us to be there when they need us, and we embrace that responsibility even as we seek flexibility in our schedules.

We are concerned that the generation of doctors coming up through training now may have a harder time understanding this philosophy. The current move to limit residents’ hours, although welcome in certain ways, may have the unanticipated effect of making residency feel even more like shift work than it did for us, further distancing future doctors from feeling responsible for their patients. It is worrisome that their transition to professional practice will be more difficult because they did not have it as hard as we did. In this respect, we already are starting to sound like the grouchy elder statesmen we will be soon enough.

After graduation, we dispersed to different cities, specialty areas, and practice types. But there is one thing we still have in common: We are satisfied with our career choice. Medicine is not as lucrative a profession today as it once was, but we understood that going in, and sought out medicine for other reasons. We are grateful for interesting, challenging jobs that let us interact with a wide variety of people.

As one colleague said recently, “Medicine demands so much that you have to love it to survive. Personally, I can’t imagine doing anything different.” Most of us would surely agree. 

Dr. Ali Shafaie is an internist and medical director of Redwood Shores Health Center, Palo Alto Medical Foundation.