For many generations, doctors seemingly had little choice. Work came first. Doctors were expected to live and breathe medicine, spend long hours at the office or hospital, and, when necessary, neglect their families for the sake of their patients. Such behavior was in accordance with cultural norms of the broader society. Leisure time and material goals were traditionally seen by society as unbecoming of a person dedicated to service.
Physicians’ workaholic ways were buoyed by the traditional family structure in America. Anecdotal evidence had long suggested this, but in 1980 Marcia Fowlkes empirically documented the phenomenon. Most doctors delayed marriage and deferred personal gratifications. When doctors did marry, they tended to select wives less accomplished than spouse of other academic or professional men. During marriage, medical wives customarily subordinated themselves to their husbands’ careers. The doctors in this study almost universally indicated that career success was more important to them than satisfaction in other aspects of life, and they typically played only secondary roles in child-rearing and family life.
Physicians’ professional success did not come without cost—particularly for their wives. Spouses had to endure considerable loneliness and solitude. Effects on the children of physicians are not well understood, although there is considerable anecdotal evidence that some children also felt ignored, particularly by unusually high-achieving fathers.
In the 1970s, traditional attitudes toward work and family life among young physicians began to change. A major reason for this was the entry of much larger numbers of women into the profession. Women physicians had traditionally sought a more harmonious balance between work and family life than their male counterparts. In this sense the entry of large numbers of women into the profession likely represented a leavening influence. The effects of the women’s movement ran deeper, however. The feminist movement enabled more women to enter virtually every area of the workforce, not just medicine. As a result, there was a rise in two-career families and a corresponding decline in traditional families, where the stay-at-home wives had long enabled the workaholic ways of their husbands. As the traditional family became less common, an important prop for many generations of doctors became weaker.
A decade later, generational changes also began contributing to new attitudes toward work and personal life among house officers. Members of “Generation X” (born 1963-81) and “Millennials” (born 1982-2000) began entering medicine, and they tended not to share their elders’ preoccupation with work. Younger physicians were not so eager to delay gratification or neglect their families for the sake of a career. They were less career-driven than their parents and grandparents, and they tended to seek jobs that would enable them to attend their children’s soccer games—or even to coach—rather than to provide a high income or big house. Compared with doctors of the silent generation and Baby Boomers, they focused on achieving meaning in life, not just meaning in work.
Beginning in the 1990s, the result was a decided shift in interest among many young physicians toward specialties that allowed greater time for personal and family activities. Fields that became especially popular included dermatology, ophthalmology, anesthesiology, plastic and reconstructive surgery, radiology, radiological oncology, and emergency medicine—all prestigious, high-paying fields with comfortable lifestyles. These so-called “lifestyle” fields all had in common fewer work hours, less night call, more predictable schedules, greater flexibility, and more free time for family, leisure, and avocational pursuits.
At the turn of the twenty-first century, the emergence of “lifestyle” considerations among house officers created considerable consternation among older doctors. Some felt that contemporary house officers exhibited less intensity, determination, and devotion. To the older generation, the lack of complete immersion in medicine was indicative of a less-than-full commitment to being a doctor. They tended to view the desire of many younger doctors to work fewer hours and avoid around-the-clock demands on their time as smacking of unprofessionalism.
However, the rise of lifestyle considerations among residents and young doctors did not represent the “decline and fall” of professionalism in medicine, as some older doctors were wont to maintain. Rather, it represented a natural evolution of the profession, another chapter in the ongoing story of generational change. Indeed, studies demonstrated a strong work ethic and firm commitment to their medical careers among Generation X and Millennial doctors. The main difference seemed to be that younger doctors defined success by their total life, not just by their work, and thus they strove much harder to keep the two in balance.
The early twenty-first century interest in “lifestyle” among residents and young doctors cast into sharp relief the ongoing dilemmas of professionalism in medicine. At the core of professionalism is the ethic that the needs of patients come first. Illness does not follow a clock; service to patients frequently causes inconvenience for doctors. Yet, no one wishes to be attended by exhausted or burned-out physicians either. What is the appropriate balance? These tensions are intrinsic to the practice of medicine, and accordingly they will never go away. Ultimately, each generation must decide this matter for itself, as much each individual physician.
Featured Image: “Doctors with patient, 1999” by Seattle Municipal Archives. CC BY 2.0 via Flickr.