For decades, we’ve been witnessing a pattern of retrograde evolution in the healthcare system. I recently asked a colleague, Dr. Richard Reece, a retired pathologist and a prolific writer, about the main changes in the healthcare system between now and when he started practicing in 1965. His answer is below. (It’s important to note that not all the changes have been bad, as exemplified by the increasing number of female physicians).

Differences:

1. Loss of physician autonomy
2. Loss of morale
3. The physician shortage
4. Unaffordable costs
5. Higher indebtedness
6. More women physicians
7. More cynicism
8. The sense of crisis
9. More a feeling medicine is a job not a profession
10. More realism and pragmatism
11. No Internet
12. Less prattle about performance, quality, outcomes, and value
13. More group and corporate practice

Similarities:

1. We’re still attracting bright young people, we’re still healers, and we still yearn to be independent autonomous decision makers.

Filed under: Health Policy