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GENERATIONAL
early age. I saw my first C-section when I was about 12 years old
(commemorated by a brief syncopal episode), and gradually be-
came very familiar with the sights and sounds of various health-
care settings. For summers in high school, I worked as an O.R.
scrub tech, cleaning and learning how to setup operating rooms,
helping sterilize instruments, and occasionally holding a limb or
retractors in a particular position during a procedure. I found
medicine interesting, but all this exposure to it still did not quite
convince me that it was the right profession for me — a feeling
that lasted through my college years in Austin.
Both of my sisters were very motivated students, and seem to
have more readily absorbed my parent’s medical aspirations for
us into their own. They predictably progressed from high school
to college, to medical schools, to residencies and fellowships. Ap-
parently, I was a slightly harder nut to crack. Despite all the same
medicine exposure growing up (there are pictures of my sister and
I dressed in full surgical garb for Halloween, when we were 11
years old), it wasn't until after college, when I was volunteering
at a WHO sponsored polio-vaccination & preventative health ef-
fort in India, and personally witnessed the vast numbers of people
who desperately needed quality medical care, and I saw firsthand
how much of a difference dedicated physicians could make —
that's when my interest in medicine was piqued, and when I se-
riously began considering it as a profession.
Unlike my parents who had very little growing up, I had every-
thing a child could ask for. My circumstances and perspective were
different from theirs in that I wasn't driven to look for professional
opportunities to better my socioeconomic situation, which thanks
to my parents, had always been quite comfortable. Even though I
had spent a good amount of time exposed to hospitals and clinics
in the U.S., it took participation in an often chaotic public health
effort in dusty streets on the other side of the world, to reveal to me numerable variables make predicting the future of healthcare very
a previously unknown kind of personal satisfaction that came with
working hard in the service of others health needs. This contentment
and the associated intrinsic happiness it kindled in me, is primarily
what drove me to become a physician.
Now as an employed internist in a hospital-based practice in
San Antonio, I have a reasonably good work-life balance. I am
not perpetually on call, don't spend much time on administrative
or financial issues, and work in the hospital every other week. The
demands and complexities of hospitalized patients can be exhaust-
ing, and the time off helps us recharge and be more empathic
caregivers when we're back at the hospital. One of my sisters be-
came a radiologist and is employed with a large hospital system
in Houston, and the other became an ophthalmologist and is em-
ployed with one of the largest retinal specialist groups in Chicago.
These are different models of medical practice then my parents
PERSPECTIVES
knew. Medicine has evolved into more of a team sport, with
physicians now being just another member of an ever-expanding
team. Increasing expenses, frequently burdensome insurance re-
imbursement requirements and progressively stringent quality
metrics are forcing physicians to abandon their private practices
and turn towards employment with large hospital systems or com-
panies. Many of the requirements of modern-day medicine are
forcing the physician to, bit-by-bit, spend more time in front of
a computer screen than with patients. In spite of all this, I usually
walk out of the hospital still feeling that sense of fulfillment in
service to those in need. As long as I feel that, I will continue to
practice medicine.
However, will my wife and I encourage our children to be third
generation physicians? At this time, I just don't know. There will
always be a need for healthcare and physicians, but I want our
children to be happy and satisfied in their careers. At the rate that
medicine is changing, the role of physicians in the next few
decades is yet undefined. Clinic based physicians will have in-
creasing regulations and restrictions by insurance companies on
diagnostic tests and therapeutic interventions. To meet increasing
hospital demands, telemedicine doctors or even medical robots
may be increasingly used to triage patients in the emergency de-
partment and round on them in the hospital, and even perform-
ing routine surgical procedures. All this in the context of the
intensifying needs of an aging, severely chronically ill, and often
litigious patient population who are in an already resource-
strained and cash strapped health system. In these circumstances,
would physicians still be able to deliver the standard-of-care, ev-
idence based interventions we were trained to do, or will they be-
come more data analyst/resource conservators, continuously
having to compromise medical decisions for the sake of what cor-
porate employers or insurance companies will authorize? The in-
difficult. I think most of us tend to hope for the best, but prepare
for the worst.
As Charles Darwin himself noticed 150 years ago, a key char-
acteristic to the survival of an organism is constant striving. I
don't dress my kids up in doctor outfits, and our family meals are
not like signout rounds at work. My wife and I simply try to en-
courage our children to find a job which creates that same feeling
of deep-seated happiness that I stumbled upon while doing simple
rural public health service those many years ago. As long as our
children work hard at what they love to do, I think that whichever
professional path provides them that strong sense of personal sat-
isfaction, their raison d'etre - that would be the one we would en-
courage them towards.
If it turns out to be medicine, great. If not, great.
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