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Perspectives |
1 From the Department of Radiological Sciences, University of California, Irvine Medical Center, Orange. Received December 22, 2000; accepted January 3, 2001. Address correspondence to the author, 18961 Castlegate Ln, Santa Ana, CA 92705 (e-mail: rmfriede@uci.edu).
Index terms: Perspectives • Radiology and radiologists, socioeconomic issues
Is medicine as attractive a specialty as it was 10 years ago? Have the changes in healthcare made medicine less attractive as a profession? Are medical schools losing faculty? Are physicians unhappy with the practice of medicine and expressing this unhappiness to students considering medicine as a career? Many published articles, including my own, have expressed varying degrees of displeasure at the current management of medical practice. But as I have stated before, managed health care is a process in evolution; the management of the practice of medicine in 10 years will be different than that of today. To the incoming student, the primary concern should not be the management of medical practice but the satisfaction achieved in medical practice. Let us start by looking at some numbers.
Articles have been written about the decreasing number of applicants to medical schools since 1996 (1,2), when a total of 46,968 individuals applied to medical school. Since then, the number has declined, decreasing to 43,020 in 1997– 1998 and then to 41,004 in 1998–1999. This represents a 4.7% decrease from 1997 to 1998 and an 8.4% decrease from 1998 to 1999 (2). This does not necessarily suggest that medicine is less attractive. In 1990, there were only 29,243 applicants, so the number had increased markedly over a period of years. In 1996, the ratio of applicants to those accepted was 2.7:1. In 1999, the ratio was 2.2:1, a moderate decrease but not catastrophic. The intellectual quality of entering students did not appear to suffer. In 1998, the mean total grade point average was 3.57 on a four-point scale, while in 1999 it was 3.59. Medical College Admission Test scores for 1998 and 1999 were similar. One dramatic change, of which we are all aware, is the increasing number of women entering medicine. In 1990, women constituted 38% of the entering class, while in 1999 they comprised 45.8% (2). This constitutes an important change in medicine, from a male-dominated profession to one where women are about equal to men at present. Even the decline in the number of applicants has primarily affected male applicants. It is possible in the future that we will see medicine dominated by women with a male minority. The last statistical item of interest is related to the number of faculty involved in medical education. In total, 270,282 individuals had faculty appointments in 1999 (a 6% increase over 1998), with 102,444 full-time faculty (an increase of 4.3% over 1998) (2).
I believe that the fears expressed over the decreasing numbers of applicants and faculty members are unwarranted. Since 1996, we have witnessed the rapid growth of technology, which is dominating the applicant market and has opened new avenues of competition for medical applicants. Bright students attracted by the excitement generated by advances in technology and by the possibility of becoming rich at an early age have certainly decreased the available student pool, but I do not believe it has hampered medicine.
It is hard to categorize medicine as a profession. As a physician, we work as individuals. I hesitate to use the word "noble" to describe our work, and certainly there are plenty of physicians who would not fall into that characterization, but I do believe that for many of us it is noble work. There are not many professions where you deal with human problems and derive tremendous satisfaction from successes and pain from failures. In most cases, you are in control, despite the regulating attempts of managed care; you are the captain of the ship; you make life-saving or, occasionally, life-threatening decisions; you are a huge figure in your patient’s life when he or she is ill.
When managed care became dominant in the middle 1990s, many physicians who were accustomed to a different style of practice became disillusioned with the new innovations. A few retired early, many grumbled out loud, and I am sure many discouraged students from entering medicine. I believe these individuals forgot what the practice of medicine really is: the satisfaction derived from helping other people. Managed care as we know it is transient; medical practice will continue to evolve, and practice 10 years from now will again be different. However, the satisfaction obtained from what you are doing will remain.
Students entering the profession do so for many reasons: (a) the desire to help others, (b) the need for individual expression, (c) the desire for a comfortable life, (d) the need to be considered important and to be looked up to. In the 1960s and 1970s, when physicians were amassing substantial incomes, we were attracting many students into medicine with the primary aim of becoming wealthy. This does not produce the ideal physician; it pollutes the primary purpose of aiding others even when the financial reward is minimal.
Professor Gunn believes that there is something wrong with the medical profession today, which he feels is fostered by the way we select our students (3). Too many physicians who should oppose practices that may be medically or socially harmful to patients remain silent. Gunn believes that this is due to our selection process, which is biased against students who have the traits that would make them good caring physicians. He thinks we need applicants with a broader base in history, philosophy, and literature—applicants who are able to think for themselves on important issues, not applicants who simply score highly on science-based subjects. I believe this makes sense. Too many of our physicians are not concerned with social justice in medicine.
I believe that the financial rewards in the 1960s and 1970s were an aberration in the practice of medicine, just as I believe that our current system is an aberration that will be modified in time. Medical practice will change as our social system changes. In the United States for the foreseeable future, students entering medicine will enjoy a comfortable lifestyle, but they will not amass the incomes of the 1960s and 1970s. Medicine, therefore, will not be the entry point for those desiring to amass a fortune. This may actually be a desirable change; we can assume that those entering are doing so because they like what they will be doing.
As for the future, managed care will change; it is in constant change. Hopefully, we will have a single-payer system. Physicians will be required to be accountable for their acts, as they should be. Accountability will require paperwork and committee work, which many physicians dislike. Annoying restrictions and demands will continue, but, as time passes, I believe that physicians will assume more control over the patient’s treatment. Patients are demanding this. One thing that will not change—the satisfaction the individual will receive from a successful treatment.
Do not discourage your students from entering medicine; it is as close to a divine profession that one can practice on earth.
REFERENCES
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