My understanding is that several things had not happened which have served to decrease job satisfaction among physicians.
***Please note that I am about to list some things that are bad about the profession of medicine. Any of you who don't want to hear any more bitching from us whiners due to our stupidity and laziness should bail out now.***
Managed care, and I include CMS in that, demands a huge amount of paperwork, justification and administrative overhead to get paid. Back in the day this was not as bad. Many physicians who had to deal with this as it evolved felt it was a blow against their judgement and autonomy because they had to justify everything they did. That is true but the rest of us are just used to it now.
Medical Malpractice was not the life sucking beast from Hell that it is now. You could really only get sued if you really screwed up and then only for real damages, not for the Power Ball.
People didn't expect medicine to fix every aspect of their lives. Now the ads tell people to go to a doctor for everything from feeling sad to being fat to can't get an erection. Had a patient in the ED the other day who came in by ambulance for "I feel tired." Everyone came out of that encounter unhappy.
People used to see doctors as professionals. Now we're just the functionaries who deliver the govt. mandated entitlements. To the typical Medicaid patient who comes to the ED every month to get a refill for whatever I'm no different than the clerk at the Social Security office.
What was the average med school debt back then? Less than now I'll wager. If money/time was an issue you could go the usual route and do an internship and hang up a shingle. No residency unless you wanted to specialize. Good luck going that route now.
All these things combine to limit your ability to practice medicine. In the olden days they could really try to figure out what was wrong and try to fix it. If they thought something was really nothing they could treat it like nothing without the threat of the massive lawsuit. They knew they'd get paid so paperwork was a non-issue. You wrote in the chart to remind yourself what was going on later, not so some bean counter could code your work or decide if you should be paid or not.
Were the "good old days" perfect? No. Were they better. Maybe not. But they just didn't have to contend with some of the things we do today.
to add... there were plenty of things that weren't known or had no treatment "back in the day." i had an older physician a few months ago tell me that in the past, there was little to do for patients, but the doctor was there at the bedside. the doctor was there to see the patient and family through it. today, there is more potential to do something, there are more things available, but the doctor isn't there as much at the bedside holding the patient's hand... depending on how you look at it, that's either a good thing or a bad thing.
i have attending's who trained in the 1970s... when there was no ct scanner, there was no mri... they didn't know what hiv was.... didn't know what hepatitis b or c was... the only antifungal's was amphotericin b in it's lipophilic or non-lipophilic form... no mrsa... hell, the double helix structure of dna had only been known for a decade... ace inhibitors were only just in their infancy... even into the 1980s, we didn't know some of what we know now, as even cardiologists who trained then will tell you that they used to think beta blockers early in an mi would kill a patient.
and back in the 70s, they used to admit patients for routine physicals and labs... so rather than the stage 4 breast cancer status post radiation chemotherapy who presented with an undetectable white blood cell count and neutropenic sepsis (like i just admitted 30-40 minutes ago); they'd admit the 45 year old gentleman in need of an h&p, and some basic labs.
patients are sicker and more complex than they were then. 1977, that patient i admitted tonight was likely dead... 30 years later, she's got a chance.
so, i imagine that admitting patients who weren't terribly complex, or admitting patients who were on death's door without a chance to do anything, and without the expectation of the patient or the family that a miracle be pulled off was a bit easier than many of the patients we see these days. throw in higher reimbursement, little questioning from insurance companies/hmo's/medicare about the care of patients, more autonomy and it's easy to see why the "heyday" really was that cool.
Did that really change? 
