'I'll just do my job'

For the last 20 years, I've made it a point, whenever I met someone new who I discovered was a doctor, a lawyer, a minister, or some other kind of "professional"-and as often as I thought it was polite to do so-to ask quite simply: "If you had it to do over again, knowing everything you know now, would you still go into this profession?"

And I've been stunned how many times the answer has been quick and direct: "No way!"

Especially among physicians (and nurses), if I've heard it once, I've heard it a hundred times: "If I could go back and actually help people with their physical problems, I'd love it. But to spend half my life filling out forms? Probably not."

Then I read that as early as 2006, nearly 60 percent of doctors polled by the American College of Physician Executives said they had considered getting out of medicine because of low morale, and nearly 70 percent knew someone who already had. Does anyone imagine that the statistics have improved over the last four years?

And does anybody remotely believe that such statistics will do anything but get much worse over the next few years? The name of the game when the federal government moves in with more oversight is what you might call "nuisance monitoring." It has yet to enhance the passionate practice of any occupation known to humankind.

So I've made it a point over the last few days, since the passage of Barack Obama's infamous healthcare bill, to inquire personally of a number of my friends and acquaintances who are doctors about what they think the next few years hold for them. It's not a heartening picture.

Noteworthy in their responses is the total absence of complaints about how life is going to get worse for them as individuals. Their main worry is for the lives, care, and peace of mind of their patients.

"Here's the bottom line," one family doctor told me-summarizing well what I heard from them all. "I will soon be asked to see more patients every day-and I already come home exhausted and sometimes uncertain whether the diagnoses I've reached and the treatment I've prescribed is right on. I don't like the thought of coming home even more weary-but I especially don't like the effect of that on my patients.

"And I will be paid less for that increased work load. Congress has already dictated that, chopping Medicare and Medicaid payments in order to pretend that the whole system works financially. I think a lot of people would be surprised how relatively little a family practitioner earns-typically in the low hundreds, and that's against a background of galloping costs for maintaining an office, for malpractice insurance, and for repayment of huge personal debt for an outrageously costly medical education. Of course, I appreciate a decent, although I don't think lavish, income. But if doctors' pay keeps shrinking, so will the number of young men and women committing themselves to the profession. And then the squeeze for service will get much worse.

"All of which means," my friend concluded, "that rationing will become a necessity. In one sense, I guess we've always rationed healthcare-and it's true that the wealthy have enjoyed the assurance that they will get the very best. But in our system in recent years, very few, even among the poor, have gone without healthcare. They may have had more anxiety, they may have delayed going to their doctor, and so on. And there are some ugly cases, I know, where people have actually died because they didn't know where they could get care. But that hasn't been the norm. Now we're headed, sure as you know anything at all, for a system where the government-or one of its thinly disguised agents-will be making all those decisions.

"In one sense," my friend said wistfully, "I suppose all those developments might even take a little pressure off me. I'll quit worrying-the way any bureaucrat quits worrying. I'll just do my job."

But I doubt if that's the kind of doctor most people are looking for. I doubt if that's the kind of calling most young men and women first felt when they chose to go into the field of medicine. I can't remember when I heard a kid say, "When I grow up, I want to be a bureaucrat." If you have a question or comment for Joel Belz, send it to jbelz@worldmag.com. To hear commentaries by Joel Belz, click here.