More Physicians Say No to Endless Workdays

My brother tried hard to get home, but work always got in the way, Dr. Dewar said. Even on Christmas morning, they would must wait to open our presents until Dad was done rounding at the hospital.

HONESDALE, Pa. Even as a girl, Dr. Kate Dewar appeared destined to inherit the small-town medical practice of her grandfather & brother. At 4, they could describe how to insert a pulmonary catheter. At 12, they could suture a gash. & when they entered medical school, they & her brother talked eagerly about practicing together. But when they finishes residency this summer, Dr. Dewar, 31, won't be going home. In lieu, they will take a job as a salaried emergency room doctor at a hospital in Elmira, N.Y., six hours away. An important reason is that they prefers the fast pace & fascinating puzzles of emergency medicine, but another reason is that on Feb. 7 they gave birth to twins, & they cannot imagine raising them while working as hard as her brother did.

Dr. Dewars alter of heart demonstrates the significant changes in American medicine that are transforming the way patients get care.

For plenty of years, medicine has been dominated by fiercely independent doctors who owned their practices, worked night & day, had comfortable incomes & seldom saw their families.

Indeed, emergency room & critical-care doctors work fewer hours than any other specialty, according to a 2008 document from the federal Department of Health & Human Services.

But with six children, Dr. Dewar wishes a life different from her father's & grandfather's. So in lieu of being an entrepreneur, they will become an worker of a massive corporation working 36 hours a week  half the hours her brother & grandfather worked.

Her decision is part of a sweeping cultural overhaul of medicines traditional ethos that along with wrenching changes in its economics is transforming the profession. Like Dr. Dewar, plenty of other young doctors are taking salaried jobs, working fewer hours, often going part time & even choosing specialties based on relatives reasons. The beepers & cellphones that one time leashed doctors to their patients & practices on nights, weekends & holidays are being abandoned. Metaphorically, medicine has gone from being an individual to a team sport.

For doctors, the changes mean more control of their personal lives but less of their professional ones; for patients, care that is less personal but, as studies have shown, more skilful.

Older doctors view these changes with considerable ambivalence, among them Dr. Dewar's 90-year-old grandfather & 61-year-old brother, although both supported Dr. Kate Dewar's decisions & were thrilled about the birth of her twins.

My son & I had deeper feelings for our patients than I think Kate will ever have, Dr. William Dewar II said over lunch at a diner in Honesdale, about 30 miles northeast of Scranton. Chewing on a club sandwich, Dr. William Dewar III gestured toward the diner's owner, who had greeted them deferentially.

In a separate interview, Dr. Kate Dewar said that treating chronic conditions like diabetes & high cholesterol  a massive part of her father's every day life  was not that fascinating. They likened primary care to the film Groundhog Day, in which the same boring issues recur endlessly. Needing constant stimulus  they e-mails while watching TV  they realized they could not practice the medicine of her forebears.

Ive had six generations of his relatives under my care,they said as a waitress brought his usual Diet Coke without being asked. Kate will seldom have that.

Her attitude is part of a gradual distancing between doctors & patients. Doctors were one time revered, but a host of intermediaries  insurers, lawyers, the Net, growing patient needs & expectations have intervened, to the point that plenty of patients now see doctors as interchangeable. More youthful doctors are deciding that the personal cost of being at their patients beck & call is high, while acknowledging that teams of doctors can offer a higher quality of care. So they are embracing corporate, less entrepreneurial & less intimate roles in part for the uninterrupted relatives time they bring.

I like it when people get better, but I'd it happen right in front of my eyes & not years later, they said. I like to fix stuff & then move on.