Are old school docs cut from a different cloth?

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madchemist89

madchemist89

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Everyone has probably known an older physician who seems to be a reincarnation of Osler or Halsted (the surgical genius not the drug addiction). Are the physicians who are in their late 60's, 70's, or 80's cut from a different cloth, meaning that there is something essentially different about them in comparison to younger physicians, or is there some kind of selection bias at play here?
 
Most physicians go into private practice and never interact w/ students again. They have a family and grow old like everyone else.

Physicians who stay teaching for 40 years are a tiny minority, so yes, they're very different.
 
Yes. They had different training and also a different world more broadly that had a more respected and independent and exclusive sense of what and who a professional was.
 
Are you implying that older physicians are often genius's and younger ones are merely mediocre?

If so I think that's a silly notion to entertain.
 
Are you implying that older physicians are often genius's and younger ones are merely mediocre?

If so I think that's a silly notion to entertain.
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No. There's just something different about them that I can't put my finger on.
 
As noted above, there is definitely a selection bias at play in the types of people who spend a career in academic medicine. There is also the teaching effect that forces them to stay current and stay engaged with students and residents, but the life of an academic center is conducive to growing these types of physicians. Obviously there are many incredible docs in private practice as well, this is just broad stereotyping.

I don't think they are generally cut from any different cloth and I doubt the training they had was any better or worse. You can pull up editorials from the turn of the 20th century and see older docs decrying the state of medical education. You find the same thing in pretty much every decade for which we have literature available. Maybe they're all right, but despite the allegedly worsening training over the last 100 years, we've managed to come a long way, so I refuse to put much stock in the eschatological predictions du jour.

I have noticed one thing in common among the badasses I've encountered: they all continue to read like fiends. These are the white haired docs who always have an article in hand, the IM guys who still take copious notes on every morning report case even though they've been in practice 30+ years. While this also applies to some of the badass surgeons I've met, I think there's an element of physical greatness that sets some of them apart as well. I'm thinking of one well-seasoned vascular surgeon who was very quiet yet wickedly brilliant and absolutely amazing to watch operate. No wasted movement, no hesitation, every cut and stitch flawlessly placed, and every exposure looking like it came straight from a textbook. I think there is some element of physical skill that sets these great surgeons apart from the good ones, just like you see in athletics. I've seen the same thing in younger surgeons too though, so I don't think it's an age and experience thing past a certain point.
 
I mean, the era in which they grew up was completely different than the one we did. This comes with differences in values. I think every generation is a little different than the one that precedes it.
 
Extreme longevity runs in both sides of my family. I could probably be one of those guys taking call into his 60s working 3 or 4 days a week well into his 70s.
But I won't. I've planned, saved, invested and not gotten greedy. If I'm working after 62, something has gone horribly wrong. Or I'm working another year to fund a completely ridiculous retirement reward for myself, like a Ferrari.
They're not cut from a different cloth, they're gluttons for punishment and probably need other interests outside of medicine.
One guy I worked with kept saying, "one more year" and "maybe next year". He had even bought his retirement home already where he spent a few weeks a year. I'm sure you know how the story ends.
Nobody says they wish they had worked more on their death bed. Work until you're in the position that you want to be in for retirement, have a back up plan, and pull the ripcord.

And, maybe I didn't win the genetic lottery after all and it skips a generation. I'm not going to wait and find out.
 
Pacna said:
Most physicians go into private practice and never interact w/ students again. They have a family and grow old like everyone else.

Physicians who stay teaching for 40 years are a tiny minority, so yes, they're very different.
Click to expand...

This is the answer. As a student it is easy to think academic medicine = medicine. But I guarantee those "old school" docs you see have med school and residency classmates who went out into private practice and are just "normal" guys.
 
lazymed said:
Is it work ethic/dedication?
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I would say it's more being greedy enough to milk the system in unnecessary procedures to the point where we now the younger generation takes the fall for it. But in a way that does take dedication.
 
madchemist89 said:
Everyone has probably known an older physician who seems to be a reincarnation of Osler or Halsted (the surgical genius not the drug addiction). Are the physicians who are in their late 60's, 70's, or 80's cut from a different cloth, meaning that there is something essentially different about them in comparison to younger physicians, or is there some kind of selection bias at play here?
Click to expand...
Yes, their cloth is made from silk since they got full reimbursement for their charges for their services. Ours will be made from polyester.
 
IlDestriero said:
Extreme longevity runs in both sides of my family. I could probably be one of those guys taking call into his 60s working 3 or 4 days a week well into his 70s.
But I won't. I've planned, saved, invested and not gotten greedy. If I'm working after 62, something has gone horribly wrong. Or I'm working another year to fund a completely ridiculous retirement reward for myself, like a Ferrari.
They're not cut from a different cloth, they're gluttons for punishment and probably need other interests outside of medicine.
One guy I worked with kept saying, "one more year" and "maybe next year". He had even bought his retirement home already where he spent a few weeks a year. I'm sure you know how the story ends.
Nobody says they wish they had worked more on their death bed. Work until you're in the position that you want to be in for retirement, have a back up plan, and pull the ripcord.

And, maybe I didn't win the genetic lottery after all and it skips a generation. I'm not going to wait and find out.
Click to expand...

The generation who would mostly be dead or in their 80s or 90s now would not have had the same concept of retirement. Taking on a profession was something a little different. When profession =priest/doctor/lawyer. Pillar of community. Not retiring from a calling. Etc. Now we also have a pope who will likely retire...the second one to do so. The world is changing. Different cloth. Different time. Different culture. Can't compare. Not just an academic centre with some mythical community practice beasts of that generation more like folks today

Edit: do far though only retiring from being pope not from being a priest
 
Last edited:
oldanddone said:
The generation who would mostly be dead or in their 80s or 90s now would not have had the same concept of retirement. Taking on a profession was something a little different. When profession =priest/doctor/lawyer. Pillar of community. Not retiring from a calling. Etc. Now we also have a pope who will likely retire...the second one to do so. The world is changing. Different cloth. Different time. Different culture. Can't compare. Not just an academic centre with some mythical community practice beasts of that generation more like folks today
Click to expand...

not all millenials are like that

my dad doesn't plan on retiring and neither do i
 
I wonder how much "lifestyle" was a factor when choosing a specialty decades ago. It seems like it is the most important factor for my 4th year friends.

Some of them even factor in the residency lifestyle.
 
I'd say there's 2 differences. The first and less important one is the world of medicine that molded them. I've met orthos that are in their late 70's that didn't even realize the MCAT was required and who said when they graduated they could pretty much walk into whatever residency program they wanted. The idea of competitiveness in terms of residency was foreign to some of these guys and more than one said they wouldn't have stood a chance getting into ortho today. The amount of knowledge they were required to learn was also a fraction of what we know today, so I'm guessing their curriculum was slightly less rigorous while they were in school. On top of that, society viewed physicians differently in the 60's and 70's. People listened to their physicians and respected them more. Today a doc could do everything right, and still get sued because someone is pissed. I'd say that in general, different societies will mold different physicians, and we are learning and being trained in a very different society than 40, 50, and 60 years ago.

The other, probably more important, aspect of it is the physicians themselves. Most of the guys in their 70's and 80's could have retired a long time ago if they wanted to. They're still practicing because they're passionate about it or see it as their true calling. They love learning and treating people, and would rather be doing that than almost anything else. Those types of physicians do exist in our generation, but they're mixed in with the people that like doing it but just want to do it and retire at 60 or 65. In the older generations, those people aren't practicing anymore and only the gung ho people are left over, so it may seem much more like they're 'cut from a different cloth' when in reality you're only interacting with the people that truly love(d) their career.
 
madchemist89 said:
Are [they] cut from a different cloth, meaning that there is something essentially different about them...
Click to expand...

operaman said:
I think there is some element of physical skill that sets these great surgeons apart from the good ones, just like you see in athletics.
Click to expand...

I don't think men and women are essentially different today (i.e., the World War II generation is not necessarily genetically/morally more virtuous or valorous) but I do think we have the benefit of centuries of historical individuals to admire... over hundreds of years of medicine we see some ridiculous levels of talent.

Like the badasses who cut out their own appendix. Or the Osler or Halsted - we have the benefit of a wealth of knowledge of past men and women to draw inspiration from and in reviewing their lives (like studying Michael Jordan or Tiger Woods) we tend to come to the realization that they have levels of natural ability nurtured by long hours of practice leading to levels of performance we will likely never attain. But they can be our heroes and we can admire them and seek to uphold their legacy.

Goddammit now I need to find somewhere to be sarcastic and bitter this post got way off track...
 
IlDestriero said:
If I'm working after 62, something has gone horribly wrong. Or I'm working another year to fund a completely ridiculous retirement reward for myself, like a Ferrari.
They're not cut from a different cloth, they're gluttons for punishment and probably need other interests outside of medicine.

Nobody says they wish they had worked more on their death bed.
Click to expand...

I think it's entirely safe to say that EVERYONE who knows me hopes that I don't ever retire as I would be miserable in retirement and make everyone's life around me miserable. YMMV of course but I am not a glutton for punishment for being that way. I am me and not alone in this.
 
madchemist89 said:
Everyone has probably known an older physician who seems to be a reincarnation of Osler or Halsted (the surgical genius not the drug addiction). Are the physicians who are in their late 60's, 70's, or 80's cut from a different cloth, meaning that there is something essentially different about them in comparison to younger physicians, or is there some kind of selection bias at play here?
Click to expand...

Yes, they didn't have to worry about being paternalists or misogynists.
 
JP2740 said:
They benefitted from not having jersey shore and honey boo **** as their most viewed shows.
Click to expand...

Or scrubs or greys which a disturbing amount of new docs cite as what they have learned from for how to be a doc in terms of character
 
I
Member 1337 said:
I don't think men and women are essentially different today (i.e., the World War II generation is not necessarily genetically/morally more virtuous or valorous) but I do think we have the benefit of centuries of historical individuals to admire... over hundreds of years of medicine we see some ridiculous levels of talent.

Like the badasses who cut out their own appendix. Or the Osler or Halsted - we have the benefit of a wealth of knowledge of past men and women to draw inspiration from and in reviewing their lives (like studying Michael Jordan or Tiger Woods) we tend to come to the realization that they have levels of natural ability nurtured by long hours of practice leading to levels of performance we will likely never attain. But they can be our heroes and we can admire them and seek to uphold their legacy.

Goddammit now I need to find somewhere to be sarcastic and bitter this post got way off track...
Click to expand...
If anyone cuts out their own appendix...nay even looks at their own medical chart....they will be liable to lose their license. The days of get er done are over. It's all beurocratic 1984 nightmare now.
 
i think so i know a real old school cardiovascular surgeon trained at top undergrad, med school, residency, fellowship. handlebar mustache and everything they were around during a time when they could stomp through the wards and have the waters part before them

now a days doctors are mostly glorified techs
 
Lol patients making their own decisions. Beaurocrats make the decisions develop a protocol and then harass both patients and doctors to fill out five point likert scales endlessly. No independence except in name only. For patients too. Patients don't call the tune if they're not paying the piper.
seminoma said:
I know, right? Patients making their own decisions? Female docs instead of nurses? Psh, what went wrong in society to make things this way?
Click to expand...
 
IlDestriero said:
They're not cut from a different cloth, they're gluttons for punishment and probably need other interests outside of medicine.
One guy I worked with kept saying, "one more year" and "maybe next year". He had even bought his retirement home already where he spent a few weeks a year. I'm sure you know how the story ends.
Click to expand...
Could not have described my Dad better. Part of it is money, yes, but he also does not do anything aside from medicine (he's also one of those people that won't stop talking if you ask them a question because they're that in love with their field). 62 yrs old, and still in love with the OR.
 
RedPhys said:
Could not have described my Dad better. Part of it is money, yes, but he also does not do anything aside from medicine (he's also one of those people that won't stop talking if you ask them a question because they're that in love with their field). 62 yrs old, and still in love with the OR.
Click to expand...

I'm extremely grateful mine (surgeon as well) was never that way.

Not to say that your parent was like this, but as someone in my 30s now I see people even in my own profession who make work such a f-cking priority that they quite literally aren't getting to watch their own kids grow up. 20 years from now no one is going to professionally give a sh-t that you stayed at work until 8 to publish another case report and got home after your five year old is asleep.

/end rant.
//happy fathers day.
 
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