By Douglas Cassel

Most men lead lives of quiet desperation – Henry David Thoreau

Sometimes even the largest national issues are best understood through the prism of individual anecdote. Over the last week I serendipitously encountered three old acquaintances, at different stages of their medical careers, whose experiences can tell us much about where medical reform is heading. Just like me, their stories may surprise you.

The first hopeful was a junior in college, working to get into medical school. He is a great kid, good grades, board scores and research activities. His resume is solid, if not great. 40 years ago when I applied, he would have had no trouble getting into medical school. Today, his prospects are questionable. Medical school has become enormously popular as a career choice, and applications continue to soar. The quality of the candidates and the admission of women have made the process more competitive than ever, while at the same time, the actual world these graduates will enter is changing. I wonder whether all of these high achievers will be happy in the family practice jobs they will end up filling. Financial incentives, student loans, and decreasing specialty residency spaces will reduce choices substantially. Much of the attraction of medicine has been the challenge and intellectual stimulation encountered in specialty practice, which may not be an option for many. The future for these graduates will not be so much black or white, but a dull grey.

The second doctor I spoke to was a surgical resident finishing his seventh year of post medical school training. (That’s 15 years post high school). Despite all of this training he was having trouble finding a job anywhere his wife wanted to live. Read the rest of this entry »