Like Father, Like Daughter? Not if I Can Help It

-#include virtual="/time/2006/includes/haig.txt"-->Intense and beautiful, kooky and wise — these are terms that come to mind when I try to describe my teenage daughter. Perhaps most fitting is the word"free" — her mind is fast, strong and unfettered. She has a heart for the suffering and she can do the science — but I'm scared of leading her into my world, pushing her even just a little, into the devouring vortex of medicine. And I know why. It's because she's so free.

Both my parents are doctors. Three of the six guys in my department are doctors' kids. I don't know if this statistic is kept by any of the agencies, departments and commissions set up to monitor, regulate, police or control us, but a lot of today's physicians are physicians' children. But I think that's about to change.

Not that the biggest picture has changed. It's still so easy to fall in love with the raison d'etre of one's own father or mother. Medicine is undeniably a mission, a calling. Yet young people must feel it — each somehow attracted to his or her specialty, one's own nook in the grand house of medicine. I still know I did.

My field is very broad. An orthopedic surgeon can spend his or her day casting babies' club feet, sewing an artery whose cross section is smaller than the dot on this i or hammering a foot long chunk of steel into someone's thigh bone with a (sterile) five pound maul — all in the name of good will toward man. Our patients generally get better and the uniquely orthopedic interaction of science and humanity makes for a great richness of experience in our everyday lives. Ask any doc — ortho is fun. And while not much of a relativist, I can imagine that docs in other specialties love their fields as well — though maybe not all ("ah, the romance of ... nephrology?").

Still, a question doctors my age ask each other all the time is, "Are you steering your kids into medical school?" The answers are quite often bitter, sometimes wistful — and usually negative. Partly this is not just a doctor thing. No father wants his kids to suffer, his boys to miss the good times, his girls to be toughened and, yes, coarsened, by the vulgar realities which nonetheless shaped him. Largely, though, the answers are "medical" ones and they revolve around two factors: first, that it seems a kid who can get straight As in a hard course of college study and 'delay gratification' for the ten years or so of training, can go into business and make a lot more money doing a lot less work than their medical parent does. And second, many docs simply don't want their child to "put up with all the sh—." Its the freedom issue — in more prosaic terms,

"They make you feel like a convict" is what doctors say about the people, commissions, agencies and departments we must answer to, every month, for the rest of our lives, or be stripped of the right to practice medicine (as well as the ability to earn a living). Every doctor lives under continuous scrutiny from federal, state, hospital, insurance company, specialty board, medico-legal, and professional conduct organizations. Hundreds of pages of forms must be filled out, hundreds of thousands of dollars spent, hundreds of hours of study and examination must be completed every year — just to stay in practice — and that's after Board Certification, a process at then end of ten years of intense training, study, work and examination.

Each of these burdens is placed on the doctor in the name of "protecting the public", but everyone in the medical business knows the plain truth: that not one of these actually helps us treat patients, not one makes us better doctors. You become a better doctor when you notice patterns, when you get out of your own way enough to hear real complaints and treat them. You might scrub in with a friend who does a new procedure, go to an interesting course (the good ones often don't give CME — mandated continuing medical education — credits) or you might become a better doctor in your room at night with your old books that you see in a new light because you've seen a certain case that day. Every doctor knows this: however it happens, professional growth does not take place via "administrative compliance." The public is not protected at all by these things. What they do protect is the livelihood of an entire class — the millions who make their livings in the public and private "administration" of American medicine. Do I want to feed my little girl to this beast? I don't think so.

Following in a parent's footsteps, knowing firsthand the unusual life of a doc and stoking the early fires of a developing superego with such high octane respect and responsibility that scarcely any other human endeavor seems worthy — this is the psychology that makes doctors' kids into doctors. There are, quite honestly, many in my field of surgery who will work for any salary — some would literally pay to do it. They can derive satisfaction from little else, their self-concept is utterly enmeshed in it and doctor's children or not, they will be doctors in the next generation. Today they make up, by my guess, about 10% of us. Wish them well for they will be the only ones to take care of us if we have a hard problem when we get old.

The 90% who can't conceive of life not-as-a-doctor are on the verge of being replaced by a bunch who don't seem to mind the bureaucratic stuff — the 9 to 5 docs. Hard problems do not attract them. Sub specialization, cost-effectiveness and "compliance issues" will increasingly dominate their professional lives and they will deal well with an enlarged para-medical industry and hospital bureaucracy.

And we will probably still have the "at least you know you won't starve" immigrants and the upwardly mobile "my son, the doctor" crowd. And still just maybe this daughter of mine — not that I would push her, you see, but she did so well this summer in anatomy camp ...