Curbside Consult with Dr. Jayne 4/15/24

I spent this weekend at a class reunion for my medical school. They host a reunion event every year, but the attendees are only invited in five-year increments. It was interesting to see the breakdown of registrations. No one attended from the class of 2019, which seems expected since those physicians are likely still busy with training or are in their first few years of practice and might have trouble getting away. The class of 2009 also had no attendees, but many of the other classes had about a dozen members in attendance. The class of 1974 knocked it out of the park with 31 attendees. The oldest representatives were from the classes of 1954 and 1959, which each had one representative. My class is distinctive because we were the first one to have more women than men. I was speaking with a woman who graduated five years before me (and who happened to be one of my chief residents when I was on clinical clerkship rotations) and she mentioned that she was one of only 20 women in her class. It’s amazing that the university was able to shift the demographic that dramatically in only five years.

The weekend was full of educational events, campus tours, city tours, and several social events. One of the highlights of the week was a scholarship dinner, attended by some of the scholarship recipients as well as those who had donated to class gift funds that provide scholarships. I had three students at my table – one was in his first year of medical school, and the other two were in their third years and were knee-deep in clinical rotations. It was interesting to hear about the specialties they find most interesting and what they might plan to pursue as a career and why. Primary care is at the bottom of the list, at least among the students I talked to throughout the weekend, despite the university moving towards a “zero debt” financial aid program that is supposed to allow students to “follow their dreams without fear of student loans.” It became apparent in other conversations that the university is really pushing for students to go into academic medical careers, which are historically lower-paying than those in private practice.

Although the members of my immediate graduating class know what I do for a living, nearly everyone else I spoke to started the conversation with “Where do you practice?” and I had to explain my career as a clinical informaticist. None of the people I talked to outside of my classmates knew that clinical informatics was a board-certified subspecialty or that you could make a career out of it. Upon learning what I do, several attendees went into some pretty serious rants about how electronic health records have destroyed the practice of medicine. Fortunately, most of the social events allowed me to keep a gin and tonic in hand so that those conversations went more smoothly than they might have otherwise.

Of the members of my class attending, only two are still in full time clinical practice. The rest are either in academic positions where they only see patients one or two days per week, or they are in pharmaceutical or other industry roles where they no longer perform patient care. As someone who is trained in primary care, I’ve had plenty of times in my career where I’ve felt bad about not being in full-time clinical practice – that I’m part of the physician shortage problem. However, looking at what my colleagues are doing, I don’t feel so bad. Even when I’m not seeing patients, I’m generally working on projects that are directly applicable to patient care and helping those on the front lines be able to deliver it in a more seamless way with less burnout.

Speaking of burnout, I wasn’t surprised to learn that the most burned out member of our class is in emergency medicine. She was talking about working during the worst parts of the COVID pandemic and about not having appropriate personal protective equipment. Her comments immediately took me back to being in that same position four years ago. Others in the conversation acted like it was their first time hearing about such things, and it sounds like most of them spent the pandemic doing administrative tasks, performing research, or seeing patients via telehealth. She mentioned the push of private equity organizations into the emergency medicine staffing space and the fact that it’s driving people out of practice. Fortunately, one other class member who happens to be in a specialty heavily impacted by private equity acquisitions (dermatology) took up that charge and spoke about how that transition has nearly destroyed practices in his city. His private practice is a holdout and continues to do well, although he admits they did consider being acquired but felt it would be a bait-and-switch situation.

Our class was about 50/50 with medical versus nonmedical spouses, and in contrast to previous years, only a couple of spouses showed up to all the events. I guess by this point in their lives they figured that listening to their spouses reminisce about graduate school wasn’t the most exciting way to spend an evening, especially when a ticket purchase was required. It will be interesting to see who is still in clinical practice when we meet again in five years, and who has decided to hang up their white coats for good. Speaking of white coats, our school’s students now receive theirs during the first month of school as part of a professional initiation ceremony, complete with the class writing its own oath of professionalism and with many family members in attendance. The students I had dinner with were surprised to learn that we received ours folded up in plastic wrappers from the bookstore, only a couple of days before we went to our clinical rotations. We certainly didn’t have luxurious coats embroidered with our names and “Prominent School of Medicine” logos.

I’m glad those in charge have improved things in the intervening years, but a bit sad that they hadn’t figured it out back in my day. Our alma mater has completely revised its curriculum, integrating clinical experiences very early in the first year and encouraging students to take elective courses in areas they find interesting. Compensation has improved for those teaching, which hopefully means fewer professors that act like it’s a chore. The facilities are top notch, and I wish we had access to advanced simulation labs rather than having to practice certain skills on each other or even patients. It’s nice to see things changing for the better and I wish these up and coming students the best.

What do you think about the future of your profession? How can we do better for the coming generations? Leave a comment or email me.

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