own families, fail to form abiding personal
friendships, never develop hobbies or find
the time for relaxation and introspection. As in
other professions, the obsession with
success can lead to one becoming a workaholic
and, in all too many cases, to the abuse
of alcohol or drugs.
Work-related problems may stem from the
combination of long working hours and
the pursuit of excellence, causing physicians to
lose sight of their own personal needs.
They may repress and deny the strains, stresses,
fatigue, and disappointments that are
inevitable with the practice of
medicine.
Patients can make enormous demands on their
physicians, while the physicians
themselves sometimes come to believe that they
are invincible. This feeling is rein-
forced by the fact that they have successfully
surmounted a vigorous and lengthy train-
ing regimen, replete with intense challenges
and often demeaning activities. Further
strengthening the all-powerful feeling is the
success of becoming part of an elite group
where their egos are enlarged by the adulation
of patients, subordinates, and even col-
leagues. Maintaining this status demands
enormous dedication and at times calls for
others to "slow down and take it easy." Holding
onto and even increasing one's mone-
tary rewards can become a major driving force
in professional life and being part of a
"team" or medical group can increase the
pressure for intensive activity.
After many years in active practice, physicians
may find it difficult to retire; the
respect and gratitude of patients can become an
important element of their life.
Retirement may therefore be delayed out of fear
of boredom, the loss of personal satis-
faction and financial rewards, or simply the
fear of finding a new lifestyle. Physicians
who continue to practice after their skills
have begun to diminish risk making decisions
that could be detrimental to themselves, their
associates, and, most of all, their patients.
However, with the changes in the practice of
medicine today, more and more physicians
are retiring at an early age rather than deal
with the bureaucracy, mountains of paper
work, and drop in income.
The changing climate in health care will have
significant impact on the practice and
rewards of the medical profession. It will
challenge physicians to be even more alert to
the potential dangers and require that they
consider their own basic needs and periodi-
cally reevaluate the demands that they place on
themselves and the toll that it takes.
PHYSICIAN REMUNERATION
It is thought by many that the recession of the
1980s contributed significantly to the
substantial increase in the medical school
applicant pool during the following decade.
This is due to the perception that a career as
a physician can ensure economic security.
The prospective physician needs to recognize
that, while the income of physicians-
in-training during post-graduate years has gone
up over the past decade, in reality, other
considerations come into play. New physicians
starting their own practice need to be
concerned with the unknown impact that the
approaching changes in the health care sys-
tem will have. They also need to take into
consideration major overhead costs, such as
those associated with purchasing medical
equipment, malpractice insurance, office
rental, employee salaries, etc. It is therefore
more meaningful to deal with median net
income, as shown in the accompanying graph. It
demonstrates, over the past 25 years, a
similar income pattern for each of the
five-year periods, except at a higher overall level.
We therefore find that there is a steep rise in
income for the first dozen years. It rises
less sharply over the next five years and peaks
between 20 and 25 years, when the
physician is about 50 years old. After a
quarter of a century of practice, income gradu-
ally declines.
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