THE FATE OF PHYSICIAN PROFESSIONALISM : Changes in the values of the practice of medicine

AZ Medicine, Winter 2008 (Volume 19, Number 4)

Participants were asked to briefly respond to the following questions. “Do you feel there has been a change in the values of practicing physicians? How does your practice of medicine differ from your or others’ earlier perception of the profession? How might the values you apply to your profession effect future physicians?”

As a family doctor of more than twenty years in the military, managed care, private practice, and academia, it has been my experience that most primary care physicians enter the profession with noble motives and high ethical standards. These idealistic doctors, however, are forced to work in dysfunctional, insurer-controlled environments where monetary success is achieved primarily by maximizing patient volumes and minimizing expenses rather than through excellence and innovation. Given the choice between practicing “fast-food” medicine and going out-of-business, they have little option but mediocrity.

What we are beginning to see, however, are physicians, including myself, pursuing alternative payment models. With insurers removed from the equation, we are free to return to our core values of prevention, holism, and quality. In my practice at LifeScape Medical Associates, for example, my colleagues and I establish long-term relationships with our patients and engage in unhurried, in-depth visits. This allows us to know each of our patients as unique individuals, focus upon their “whole health,” pursue innovative treatments, and partner with them to develop appropriate care and positive lifestyles.

It is this return to patient-centered medicine that most represents my underlying values and direction as a physician.

Susan S. Wilder, MD
Dr. Wilder is a Board certified Family Physician. She is the founder and CEO of LifeScape Medical Associates and President of the ArizonaAcademy of Family Physicians.


How many times have you heard physicians blaming patients for what the physician had determined a failure in their treatment? “If he doesn’t quit smoking, drinking and getting fat he will have to find another physician!” “The surgery went great but the patient obviously didn’t do what I told him to do and so now we have these complications.” “She wants me to solve her problems with the insurance company when what I prescribed is not on their formulary. I didn’t develop their formulary and they change it every six months.”

Whatever happened to “the patient comes first” and when did you spend some time with the patient actually speaking with them about their bad habits. Time is all you have to sell but we physicians are not health care brokers and our professionalism is at stake. One of the greatest commandments from God was to love thy neighbor as thyself. Well, we certainly love ourselves; maybe we should step back and realize that the patient truly does come first. That is what has changed in our profession.

[Signed,]
Just a country Doc
Mark Ivey Jr., MD


As a hospitalist, I’ve certainly learned to navigate around the pressures that present with third party players. Hospital goals, and the patients expectations; it sometimes becomes difficult to reconcile these apparently conflicting values. However, it has actually improved my perception of the profession as a whole, since there has been a shift towards an extensive interdisciplinary collaboration with the patients’ best interest being our ultimate motivation. Yes, I do feel a certain loss of authority but there is also less of a sense of isolation. I’m lucky enough to also participate in a concierge medicine practice where many of the time and financial pressures are lifted and I can focus completely on building a relationship with my patients. Hopefully the current heal care system circumstances won’t deter anyone from pursuing medicine as a career. Caring for patient is still one of the most fulfilling parts of my life.

K. Puente, MD
Scottsdale, AZ


Medical students today are no less altruistic, compassionate or driven than their predecessors. Today’s students continue to choose this difficult path out of a trong desire to help people and to serve their community. Unfortunately, these values are not the only considerations for a medical student approaching the end of their training. According to the AMA-MSS Taskforce on Medical Education Debt, 75% of graduating students in 2007 carried greater than $100,000 in debt with an average of $139,517. Given those numbers, it’s no wonder why students of today are choosing to pursue procedure-intensive specialties over the more poorly-compensated primary care specialties. Certainly, specialists are integral to the proper care of patients, but true access to care and cost-containment will never exist in a system devoid of cognitive medicine. Without wholesale changes to not only medical education financing, but also the financing of medical care, debt-saddled medical students will continue to be discouraged from choosing these front-line specialties.

Kyle P. Edmonds, MS IV
University of Arizona
College of Medicine


As a physician who practices Internal Medicine and Geriatric Medicine, my fundamental values have always been centered on a compassionate, comprehensive, individualized approach to patient care. This approach has seen my practice grow and thrive while serving my patients well. However, in the past few years, primary care physicians have been facing increasing hurdles in keeping their doors open.

Decreasing insurance reimbursements, escalating malpractice premiums and skyrocketing overhead have converged to crush many small practices. These forces have also caused a conflict in values for many other physicians, as they have had to sacrifice quality of care to battle the rising costs of staying in practice. Meanwhile, the rest of us have struggled to find another way.

After considerable thought and investigation, I converted my practice to what is known as “concierge medicine” – a direct-pay health care delivery practice. I now accept a limited number of patients who pay an annual fee, allowing me to provide each patient with the personal, comprehensive care that I value while enabling me to continue to afford to finance my practice. The results have been wonderful and have restored my enthusiasm for medicine. My original perception of a career in medicine has finally been realized.

There is room for growth in direct-pay medicine. With the knowledge of this another innovative practice designs, I expect that future physicians will once again feel confident choosing primary care as their lifelong career.

Scott L. Bernstein, M.D.
Scottsdale, AZ


In these last few months of my residency, I can appreciate the many physicians that aparticpated in my training. Physicians of every age, specialty, ethnic, religious, cultural, economic and geographic backgrounds have influenced me. They offered insight into how medicine has changed throughout their careers. An enduring example is a family physician in central Ohio that I shadowed while in college. He had started his practice over a half century before I met him when much of his work consisted of home visits and being paid with produce and pie.

Even though his practice has changed over the decades, his principles had not. Issues like reimbursement and medical liability have undoubtedly changed the landscape of medicine; however, the values of physicians, such as honesty and compassion, persist. Despite all the distractions, the patient remains the primary focus. The sacrifices to become a physician would deter most if not for the tremendous responsibility given to us when our patients entrust us with their most personal possession: their health. Being a doctor is more than a job, it is an opportunity we are given to provide a service to individuals that trust us. Daily I am reminded of my responsibility as a physician to hold to those values I observed in my many physician mentors. In order to maintain these values, physicians must continue to stress their importance to those under their supervision.

Jeremy Slone, MD
Pediatric Resident
Phoenix Children’s Hospital & Maricopa Medical Center

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