A physician walks into a clinic and is greeted by a receptionist. The physician proceeds to put on his white coat and introduces himself to the first patient. After asking a few questions, the physician conducts a short checkup, afterwards writing the patient a prescription in hopes of restoring him to good health.

When posed with the question "What comes to mind when you think of the role of a physician?, " most people would provide an answer not altogether different from the situation mentioned above. The truth is, however, that a great deal more is asked of physicians nowadays which reaches beyond a simple one-on-one relationship with the patient.

Besides patients, physicians have to interact with insurance companies, lawyers and court officials in the case of mal-practice cases and limited resources. In addition, medicine is no longer about the doctor receiving a handsome paycheck in return for his services. For instance, a group of pediatricians in Kansas City, Missouri filed a lawsuit in 1998 against a healthcare organization for unfair underpayments [1]. After carefully examining financial reports, these physicians discovered manipulation of numbers not in their favor, which resulted in lower reimbursements for the physicians' up-front costs.

Increasing malpractice insurance rates continually threaten to compromise a large portion of the doctor's pay. Physicians throughout the country are forced to stop practicing medicine because insurance costs are high while malpractice coverage is insufficient. For example, an Illinois neurosurgeon lost a civil case where the plaintiff was awarded $5,000,000 and may have to declare bankruptcy due to grossly inadequate insurance coverage [5]. Being a doctor is risky and compromising one's financial stability and furthermore, professional reputation, may be a possibility.

The reality is that physicians are trying to survive in a three-way struggle involving health care companies and patients. They have to deal with paperwork for contracts and claims while trying to heal patients, and sometimes, they are forced to make decisions that do not make patients a number one priority. They also need to worry about covering their costs while still making a living.

However, physicians are searching for ways to gain greater power, including joining physicians' unions [4]. Recently, CBS's 60 Minutes featured a New Jersey family who discussed their struggle to continue their roles as physicians [6]. The father compared his past successes, prestige, and overall content with the profession with his children's present problems of surviving financially. This family of physicians believed that they could not continue unless change takes place. As a result, they have joined fellow physicians and taken part in protests to make federal authorities aware of the injustice that physicians face. A key goal is to cap the amount of money awarded in civil cases.

Also, a few state legislative committees are already addressing medical liability. Lobbying groups and medical organizations in Texas are trying to reduce the amount of frivolous claims and limiting monetary rewards for mental pain and anguish in response to many high profile cases [2]. Even President Bush's proposal to reform medical liability has been progressing as the House of Representatives, which has passed legislation capping awards in civil cases to $250,000 [3].

Overall, our government has started to show signs that physicians' concerns will not be overlooked. This progress gives hope to current and future physicians that their profession will return to better days.

Adarsh is a third-year student majoring in Biology. He aspires to enter the field of medicine.

How does this all affect the next generation of physicians? Here is what Joey Veloso, a prospective medical school applicant, thinks about the issues facing today's physicians.
Q: What do you believe are the downsides to becoming a doctor now compared to thirty years ago?
A: They have lost a lot of prestige. Many patients don't respect doctor's decisions as much as before and question their advice. Also, physicians are making a lot less money these days. HMOs keep on dropping their coverage amount, which leads patients away unless physicians drop their rates. If this continues, then physicians will have a difficult time making a reasonable salary.
Q: Based on your first point, do you think the relationship between patients and physicians has declined?
A: Well, the focus is not just on fixing the problems of the patient anymore. It's also about making sure nobody can point fingers later on. Everything on the [insurance coverage] checklist is done even though a doctor may think a test is not necessary. Basically, the patient can become the doctor's worse enemy if something goes wrong. This takes a physician away from comforting and patients towards being distrustful. I think this all comes from today's culture and laws allowing people to financially cripple someone else when they make a mistake.
Q: So how does everything that you have told me affect your future goals of becoming a physician?
A: I still will apply to medical school. I think that physicians will rise up to challenge of the forces holding them down. If the current generation of physicians does not, then I know that my generation of physicians will unless they want to risk unemployment. I believe forming a strong political voice will change things.