Adam E. Klein, MD - West Virginia State Medical Association

Guest EditorialTIMES are CHANGINGCurmudgeon def. - crusty, ill-tempered old man.We all see medicine changing allaround us. Some of these changesare instantaneous and some take awhile. In the thirty odd years sincewe finished medical school thingshave changed in ways we couldnever imagine. Almost all of thiswas witnessed from our billets herein Morgantown where we’ve beenfortunate enough to be perched foralmost all of that time. Of course, thenew technology we’ve seen comeon line is incredible! We rememberthe first CT scanner in northernWV, the year we were interns inMorgantown—1977. Fortunately orrather despite all the new “stuff”our “Art” and the patients haven’tchanged all that much...both stillrequire a caring and available Doctor.One of the best things aboutour kind of jobs, as we’ve cometo realize in the last few years, iswe get to talk to medical studentsand residents—quite a bit. We betwe’ve “been around” well over 3000of them in the last three decades.They are a very bright lot; you’d besurprised what you can learn fromthem, if you just listen. This last fewweeks in one of our offices, one ofus talked to several students thattold us something we’d never hearduntil the last couple of years. Theynow, it seems, are worried abouthow long it will take them to finishtheir residencies. It seems they don’twant to put their lives on hold anylonger than necessary…and they areworried about work hours duringresidency and after they finish. Nowthis latest group we talked to werewomen, but we’ve been hearing thesame thing from the men. By theway, about half the class are womenat WVU—definitely a good thing.But something else is changinghere. On a level much more profoundthan the technological things wealways seem to talk about in piecesfrom places like this. To begin with,the residents and students themselveshave changed. We think they aresmarter than we were. At least ‘booksmart.’ Every year their entranceexam scores go up. And theycertainly have more debt than manyof us did. The average WVU medicalstudent now graduates owing$152,000 , we think we owed $5000when we finished. Students nowopenly admit that potential futureincome modifies their post graduatetraining choices, and who can blamethem with the debt they have?They also come from a differentbackground than us. These kidslikely grew up without a parentin the house that could rememberthe great depression. Very few ofthem are in the first generationof their family to go to college.They are probably smarter thanus in other ways too. There is a lotof talk about “Generation X” or“Generation whatever” but these kidsgrew up in a different environmentthat we did. We’re not sure what thatmeans, but some of these kids talkabout “lifestyle”, a term we neverheard in the context of Medicinefrom faculty, house staff or studentstill a few years ago. When they entertraining, they now have nationallymandated limits on the numbersof hours they work and in someinstances how many patients theycan care for. For the first time we arehearing from newly finished housestaff that the hours they must workare too long in private practice.We thought the “lifestyle” wehad as house officers and studentswas pretty good 30 years ago, someof us think of it as the most fun weever had, but we probably didn’tknow any better. We don’t believeDr. Flink would have recognizedthat term “lifestyle”. He toldus we could go home when thepatients had been taken care of.James E. Brick, MDEB Flink Professor andChairman of MedicineJohn F. Brick, MDProfessor and Chairman of NeurologyWVU School of Medicine6 West Virginia Medical Journal