Broken Fingers

My son announced yesterday that he wanted to become a doctor, just like his father and his uncle, both of us Internists in Primary Care. He is a hard science type of student; biochemistry major in his junior year, doing elective work in protein molecular biology with a research professor and minor in economics. His future's so bright, he needs two pairs of shades.

My parents came to this country having survived the Nazi death camps. They wanted - no demanded - that I become a doctor. Their reasoning was simple, twisted, but logical. Doctors, even in death camps, were valuable and kept alive to treat slave laborers. That they were also assured a economic living in this country was important, but the key word was always "living".

My father became a furrier. When I would visit him, covered in fur and cotton threads, he would say, "If you become a furrier I will break all your fingers." And he meant it. I chose Primary Care Internal Medicine instead.

We all know the current story with Primary Care. Myself? I got out over a year ago. I am now a Hospitalist. Shorter hours, better pay, way less paper work. No call. No hassle. My younger colleagues, many of them out of training and directly into Hospital medicine, may grumble about the usual conflicts of work, perceived injustices, irritants and pointless rules. They haven't a clue.

So what do I tell my son? Medicine was noble once. Now we 'work to rules' - Medicare, insurance, protocol, formulary, 'best practices.' Our profession's future is being decided, as we speak, by politicians. Will the practice of Medicine, especially Primary Care, resemble anything I am familiar with 20 years from now? Definitely not. Bring on the Nurse Practitioners and Physician Assistants!

I sit with my son over coffee. I see the energy in his eyes. I can almost feel the power of his future. Will he succumb to the Siren's sweet voices?

"Aaron," I said, "if you go into Primary Care, I will break all of your fingers."

- alan berkenwald, md