Readers Remark

Rick Johnson, for HealthLeaders Media , December 13, 2007
Now that we're nearly halfway through the last month of the year, I decided to clear out my in-box. In the process, I figured I'd share with you a few e-mail responses I've received recently. As I noted last week, many readers commented on my columns about generational differences. In fact, I posted a question on this topic on At the time I am writing this, 52 percent of users say Gen X and Y physicians are inferior to previous generations, 27 percent say they are superior, and 20 percent say they are comparable.

On to the mailbag:

I Agree!
From my perspective as a 50-year-old emergency physician who hires new grads regularly, the crop of physicians coming up through the ranks tend to approach medicine as a job--not a career. When they interview they want to know about salary and time off more than anything else. It's disheartening to see.

Michael Christopher, MD, FACEP
Chief of Staff
Emergency Department Medical Director
St. Joseph's Hospital and Medical Center
Phoenix, Arizona

I usually enjoy your columns on, but I must say that the criticism of Generation X and Y doctors by older physicians is just utter nonsense.

The "tradition" and "work ethic" of working 36-hour shifts every few days and being a "doctor" 24 hours a day at everyone's beck and call are based on the silly "macho" attitude developed over the years by doctors, particularly when they were so well compensated for their "selflessness."

Crazy work hours like that are inhuman and help no patients. The fact that more than 100,000 people die every year from medical mistakes, that more than 250,000 people are injured every year because of medical mistakes, that when a patient goes to a U.S. doctor, he/she has only a 50 percent chance of getting the proper treatment, and that there are disparities in medical treatment based upon race/ethnicity, gender, and age can all be linked to these hours and this mind-set.

Times have changed; compensation has changed; the expectations of a father's involvement toward his family has changed; the need for a mother to work while taking care of her family has changed.

Medicine IS a job.

We're not God. We're not even as important as we think we are. If I die, there are numerous healthcare professionals to replace me. Most of what I do can be done by a nurse practitioner, a nurse, or even a tech.

The older doctors have put themselves on a pedestal as if they are part of the most important and indispensable profession in the world. Generation X and Y doctors have gotten over those delusions.

Reality has set in.

Sincerely yours,
C Ghosh, MD, MPH
New York, NY

Don't Forget Pas
I respectfully want to comment on your recent article entitled, Looking Upstream that ran November 8 on In reviewing changes that you feel will hit the healthcare system over the next few years, I actually agree with most. One prediction hit me as being awfully one-sided in its view. That was the one titled "Family Docs Will Step Aside." While I also agree with what you said about that prediction, I have to point out a few other thoughts.

I am a PA who finished my training program in 1975. I have been involved in medical politics for almost 40 years and have lived through many changes to our healthcare system. NPs and, I might add, PAs (whom you omitted), have been providing high quality primary care for decades. There are about 100,000 in the primary care specialties and another 80,000 spread over a large number of other specialties. The fact that we already provide a large portion of primary care to the citizens of our country is not new. We are not interested in "taking over" primary care, just the acknowledgement that both professions are already providing a considerable share of it.

Also, both professions do bring something to the table regarding the future of medical care and what we bring, may in fact, help to save primary care. Why? Because as you pointed out, physicians generally do not want to practice in the primary care specialties any longer. They are making this decision with their feet. Many physicians are looking at medicine's future and seeing PAs and NPs as a solution to a number of the inequities seen in today's system.

We would ask that the larger organized physician groups start to view us not as competition, but as colleagues who want and value a relationship with them where we are given recognition as valuable professionals. We will be glad to give that recognition and support back. All one has to do is read a few articles on the retail clinics where organized medicine has made unprofessional remarks telling patients we will "miss things" or that we don't "know our limits."

Statements like this show that these groups are not ready to provide a comprehensive solution to this mess we call primary care delivery, as they will have to work with and recognize PAs and NPs (as hundreds of thousands of their members do now) to have these changes succeed. They should realize that statements like those only serve to drive away the very groups they need to be closer to.

My last point would be to ask why you see the increasing use of NPs and PAs as a negative? To quote the article, "I'd be especially interested in any predictions that are favorable for healthcare. Those are pretty hard to come by." I think prediction number two is quite positive, and I am surprised that as a health leader it appears you do not feel the same.

Dave Mittman, PA
American College of Clinicians
Natick, MA

I appreciate that these readers took the time to write me--and allowed me to publish their comments here. I'm always interested in hearing what's on your mind. Feel free to write me directly, or you can use the's new "remark" feature below this column.

Rick Johnson is a senior editor with HealthLeaders Media. He can be reached at

Comments are moderated. Please be patient.




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