In the essay `Throw Dr. Kildare from the Train`, I wrote that there has been an acceleration in retirements and in retirement planning among local New Haven-area physicians, including both senior members of the Yale Medical school faculty and doctors from the private community. I know from friends and colleagues across the U.S. that this dynamic is playing out in many academic medical centers nationally. Unfortunately, the collateral damage will be severe, with the loss of irreplaceable expertise and experience. The departing muses generally shared a viewpoint of medicine as a calling, and an art, not a corporate infrastructure to be climbed. They also included many of our absolutely best minds and most compelled individuals. Yes, many had alpha-type egos and matching social behavior, but they brought innovation, depths of understanding, fire, and panache to their profession. Who will be left to advise the hard, out-of-the-box, non-formulaic cases that no template protocol can accommodate, once these physicians have left the scene? I do not know. Within modern corporate America, it has become an increasingly common business practice to force out older, often high-functioning senior employees to be replaced by less costly new hires. But this strategy has primary appeal only for short-term accounting. Within medicine, this de facto strategy looks to be a recipe for disaster long-term.

When I was young, medicine was considered to be the top career choice by many, and a very significant percentage of our smartest and most driven students became `pre-meds`. At present, the job of doctor is still generally well regarded, but the profession no longer seems to attract nearly as many star students, particularly compared to finance, consulting or entrepreneurial ventures. The following data, all obtained from published university sources, tell an interesting tale. I would expect that data from many other colleges and universities would tell a similar story. (1) Yale University. Percentage of graduates who entered Medical School: in 1975, 17%; in 2010, 4% (a remarkable decrease, again consonant with similar observations at other `top` schools). In contrast, going into Business & Finance: in 1975, 8%; in 2014, 21%. (2) Brown University. In 2014, 5% of the graduating class went to medical school. In 2011, of graduates entering the work force, 20% went into consulting or finance, and another 10% went to Silicon Valley or technology companies. (3) MIT. In 2014, 6% of graduates went into health or medicine; 50% went into finance/banking, consulting & computer technologies. (4) Harvard University. In 2014, 5% of grads went into health-related fields; 31% went into finance/consulting (and 70% of the graduating class sent resumes to Wall Street and consulting firms). (5) Princeton University. In 2010, about 3% of graduates went to medical school; 36% of graduates with full time jobs went into finance; if you add management consulting, the figure exceeds 60%.

Even a decade ago, we already perceived a profound shift in the medical talent pool. In a 2004 Medical Economics survey, when asked “Do you think the brightest young people are going into medicine today?” 72% of the 7,700 physician responders said No. In my specialty ob/gyn, the percentage was even worse, 82%. Major complaints were a recitative of excessive bureaucracy, not enough reimbursement, medical education debt, and liability. In agreement with the data from the previous paragraph, already by 2004, much of the attrition was due to top students heading to either Silicon Valley or to Wall St, although not yet quite at today’s rates. Why? In a nutshell, they seemed to be following Sutton’s Law for robbing banks, “That’s where the money is.” Charles Lockwood, then chairman of ob/gyn at Yale, felt that nationwide, the quality of candidates had fallen precipitously and that our specialty was “in dire straits.” Lockwood noted that applications and acceptances to ob/gyn training programs by US medical students have dropped to the lowest level in years, a point subsequently echoed by many chairs and program directors across diverse medical specialties. Based on local evidence, this trend appears to be continuing, if not accelerating.