WRITING in The American Thinker, Joel Levine examines “the coming indifference of American medicine.” The medical profession, he argues, has been transformed from a field imbued with heroic self-sacrifice to one characterized by a clock-punching mentality. The result is worse patient care.  As has been discussed here before, a major cause of this transformation, only obliquely referred to by Levine, is the large-scale entry of women into the profession. Today’s physician, Levine writes, virtually “advertises [his] fragility.” But why? Levine won’t come right out and say it. The entire culture has  changed because the doctor is more likely a woman.

Levine writes:

Thirty years ago, the training and practice of medicine was deeply rooted in “inherited” values as much as craft. Physicians were in a noble discipline recast into paladins protecting society, even a bit of its soul, against an implacable adversary. Training was both arduous and flawed (inflated egos and autocratic mice that roared) but with a central purpose. When done well, doctors successfully confronted their most difficult internal challenges, fear of the power of illness and the willfulness to make important decisions when the consequence was uncertain. This “old” medical culture was best expressed by a single term: “My patient.” It was as far from provider and client as you could possibly get. “My patient” conveyed both bond and responsibility.

We are about to burn the bridges to this tradition from both ends. Resident physician work rules mandate the numbers of hours and/or hours per night with severe penalties for even minor violations. Doctors care for fewer patients and surgeons operate less often. We have flipped from when doctors were mythologized for being strong to a system that all but advertises their fragility. A quick visit to the kitchens of Michelin-starred restaurants will show that the hard work that aspires to mastery over mere competence still remains a feature of that pride-filled profession.

Levine refers to a recent piece in The New York Times on the growth of shift-work in medicine, but he doesn’t mention the main point of that editorial. These changes resulted from women physcians trying to balance home and work. For all the vaunted compassion of female physicians, the pursuit of radical equality has brought about a decline in medical care, not the imagined improvement. It is the female doctor who wants most of all to go home. In a previous entry here, reader James N., a physician, wrote:

There have always been women doctors, of course. But, to achieve excellence, they surrendered some important things that normal women never would. When normal women flooded into medicine in the 1970s, we were told that they would be just as good – no, that they would be better – than the men. Better because, in addition to being intellectual equals (true, in a certain sense), they were also compassionate and caring.

The actual consequences of the decision to admit normal women to medical school have been very significant, but the most profound changes are yet to come. 

The entire job has had to be redefined to suit the normal woman. First, training shifts had to be reduced from 36 hours to initially 24, and now 16. This means that one never has longitudinal responsibility for one’s patients, and that one has to learn to “sign off” before one learns what the recipient of the sign-off needs to know. 

Next, the hours worked in a week necessary to define “full-time” performance had to be reduced. Male internists who had their own practice typically worked 65-70 hours per week, for many years. New hires in Internal Medicine work 38 hours a week, or less. This creates tremendous shortages of primary care physicians at a time when demand is increasing. 

Extended absences from practice have become normal, even laudable. This virtually requires structured employment of doctors, as opposed to private practice. 

The most important change is yet to come. Physicians are not leaders, not on top of their game, until their mid 50s, and their leadership roles extend to ages 68-70. One learns from one’s patients. By the time a male physician is a leader, he has had tens of thousands of patient encounters. The female physicians who, in their 30s and 40s, worked half as much or less than their male colleagues have been deprived of thousands of cases, cases which were necessary to fit them for leadership.

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