What will become of the state of health care in this country when large number of "older" doctors leave practice?  

The trend is for this exodus of my generation of physicians to continue unabated over the next few decades.  I saw the earlier version of this phenomenon occur beginning in the generation of doctors that preceded me.  They were literally shocked by the radical changes in medicine, the rise of managed care companies, the government intrusion into the private practice of medicine, insurance companies dictating drugs that could or could not be prescribed, the increasing antagonism, even threatening attitude of patients towards them, the continued threat of litigation and malpractice trials.

Well now it may be my generation's turn.  It's sad on many levels.  After 32 years of practice I truly believe that I am a better physician now than anytime in my career.

I've seen more.  I've been humbled by the inexplicable, unpredictable nature of health and disease. I've been continually amazed by the variability of disease as it affects any one individual.

 I have faced my own personal adversities in life.  I understand from a deeply felt perspective what stress and loss can do to a person's overall health. I recognize the subtlety and difficulty in trying to help a sick human being.  

The longer I practice the more humble I become in the face of human suffering. I understand the relationship between the mind, body and soul.  I fully comprehend how "dis-ease" leads to disease. And am still awed by the variety and variation by which it occurs.

And I, too, have felt the strangling weight of bureaucratic red tape, federal and state mandates, electronic medical records in which documentation is more important than healing, insurance company badgering, patient malpractice claims over unavoidable circumstances, the unfettered, inappropriate intrusion of the state board of medical  examiners over areas they deem their own.

Yet despite the difficulties I have promised myself not to succumb.  To give in is to accept defeat.  I remind myself that this profession remains worthwhile as long as one patient appreciates what I do and can still do. 

So for now I'll let my white hair and my white coat lead the way.


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