I keep hearing that back in the 70s-80s was the "golden age of medicine", that doctors were paid really well and lived really well, but now medicine "is not worth it". What exactly happened?
First, I agree with others that you have to be a little cautious about buying too much into the "Golden Age" dogma with regards to any profession. A retired pathologist who started practicing in the 1960s once told me that when he declared his pre-med intents, his family internist told him, "Don't do it! They just passed this thing called Medicare not too long ago. It's going to completely ruin medicine. Complete socialism."
Now one could argue that where we are at now is in fact the long, drawn out conclusion of the internist's warnings. But as you can see, the 20-30 years following this internist's warning--and the vast majority of the pathologist's career--were in the supposed "Golden Age of Medicine."
Personally, I witnessed a similar "Golden Age" caution from my father, who was a commercial airline pilot, with Pan Am for much of his career--until they went out of business. Most pilots from his era (starting in the 60s and 70s) will agree that the Golden Age was back then and that the 80s marked the beginning of the end of the airline industry. Having seen my dad's work schedule, autonomy, and general annoyances associated with the job increase--along with pay decrease for younger pilots--as he progressed through his career, it does seem to me from the outside looking in that there may be some truth to their claims. But I also know many young pilots who are in the profession and still love the job, even if they do sometimes complain about the pay when starting out, the lack of security with any given airline, and onerous security requirements.
Overall, the airlines used to be flush with cash, security was minimal, and they competed on service and convenient routes--not on price. So whereas there used to be an expectation that you would stay at the same airline your whole career, make a ton of money upon retirement, enjoy free travel for you and your spouse until death, stay at 5-star hotels when on trips, and get great catered food in the cockpit...things are now different. Pay is much less when adjusted for inflation, bargain hotels aren't uncommon for domestic flights, free travel is a bogus fringe benefit since almost all flights are near 100% full, and meal service doesn't even exist in most flights. And of course there's no more waltzing through the airport in five minutes, leaving the cockpit door open the whole flight, inviting kids up to the cockpit to check things out. Now you have to barricade yourself in for fear of a cockpit invasion.
One could certainly say medicine has had similar changes since the 60s. Nearly every specialty is having to justify their worth. Patients expect much more autonomy and won't immediately acquiesce to authority as in decades past--some might say justifiably so. Insurance companies and Medicare nickle and dime physicians left and right, always looking for a way to deny payment or bargain down a price. Brief notes and dictation have gone the way of physicians spending hours on a daily basis typing notes optimized for billing and bureaucratic compliance. Med school tuition and resulting debt has increased many times greater than inflation--and the increase in physician salaries.
The screws have been tightened on many fronts. As others have correctly mentioned, this has been a common theme among many industries in the United States over the last half-century. Could it be just the obvious conclusion of a country that went from being flush with cash and the only major functioning democracy post-WWII--now with increased competition from around the world, increased debt, and an increasingly old, sick, and non-working (i.e. longer retirement period) population? Medicare was never intended to support people several decades of their lives, and employers are increasingly unable to pay for a medical system that is filled with expensive technology and pharmacology. Things were a lot different when a CT scan was considered high-tech and the most expensive drug was an antibiotic.
Patients are living longer and becoming much sicker, but we're still offering aggressive care all the way to the end of one's life. And with new chemotherapy agents, robotic surgery, and everything else available, patients and their families are demanding these therapies. The question is who will pay for them?
As some have suggested on here, so-called mid-level providers are part of the equation, but I don't know that they're a driver of the decline of the "Golden Age" as much as a symptom. Physician training is long and expensive, and the resultant commiserate compensation is expensive. I think it's more an issue of more people living longer and demanding top-notch care, but there just isn't any sustainable way to pay for it all. I'm not sure we can expect that every single patient in the country--regardless of their employment status, ability to pay, etc.--can go in for a half-hour visit with a primary care medical doctor every year. Obviously, the trend has already moved away from that reality except for those willing to pay for it out of their own pockets.
Regardless of all of the above, I would suggest that for those still in the pre-med or medical training phases, I still think becoming a physician is a great career choice in the United States...
if you want to be a physician. I would never recommend it solely for financial security, "getting rich," or for prestige or status. It will still provide the first, sometimes the last...but "getting rich" by way of practicing medicine is increasingly difficult--if it ever way easy. And if your primary goal is making the most money possible, you will be miserable through all of the many years of training learning about medicine, physiology pathology, and treating patients--and not actually making any money.
I always say that I see absolutely nothing wrong with smart, talented students expecting to make a good, upper-middle class income from a career in medicine. After all, most would have been fully capable of going into similarly paying jobs in law, business, engineering, and other fields. But at some base level, you actually have to enjoy learning about the science and practice of medicine. And with the exception of a few medical specialties (e.g. pathology, radiology), you need to enjoy working with patients.
Finally, to address concerns about whether or not a mid-level degree would be a better bet, I think this is a very personal question that everyone must answer for themselves. If you desire a much shorter training period, less debt (in general), and less responsibilities and a more traditional and flexible working schedule after training (i.e. easier to get a 40-hour, regular schedule than the usual 50-60 hours per week most physicians work)...then perhaps looking into becoming a physician assistant, nurse practitioner, nurse anesthetist, anesthesiology assistant, perfusionist, etc. is for you. But if you know that you will absolutely not be satisfied unless you have the broadest, most in-depth, and most comprehensive understanding of human physiology and pathology--encompassing all fields of medicine and not just your area of expertise--then think twice before ruling out becoming a physician.
To sum it up, maybe the "Golden Age of Medicine" is over. But for the right person, it's still a good time to be a physician. You just have to have the right expectations about what you're getting into. I think most of my colleagues just getting into practice in the last few years never had many of the expectations that many retiring docs bemoan the loss of. So is the field different? Definitely. Is it worse? Not necessarily. Most younger docs are also going to be far less likely to work 60-80 hours per week with virtually no time off throughout their entire practicing career.
Good luck!
