When Dr. Harrison L. Rogers Jr. finished his training in surgery and hung out his shingle in Atlanta in 1957, he had to go to a banker friend of his family and arrange for $1,000 monthly loans to make it through his first year in practice.
He was able to start paying back the cash advances within about 1 1/2 years and went on to establish himself as a general surgeon. From there, Rogers' career advanced, taking him this year to the presidency of the American Medical Assn., in which he serves as the chief spokesman for the nation's private practice physicians.
Like AMA presidents before him, Rogers came to realize before his election that the year he will spend as the top elected officer of the nation's largest medical trade group will require massive amounts of travel--at least 250,000 miles--and will leave little time to practice medicine. So, also like other previous AMA presidents, he invited a young physician, Dr. Jeffrey Stone, to join his office and absorb virtually the entire caseload until next summer.
Understanding of Generation Gap
What makes this significant is that, in his interaction with Stone and perception of the younger surgeon, the 61-year-old Rogers has developed, he said in a recent interview here, a greater sense and understanding of what could be called the generation gap that divides medicine today--just as it does the rest of American society.
An era has genuinely passed. When Rogers first started practicing in Atlanta, blacks were treated on segregated wards in hospitals that were not air conditioned and where all patients were housed in rooms so dimly lit it was often not possible, he remembers, to tell if they were jaundiced.
One of the first things Rogers discovered in his relationship with Stone, 33, is that--despite a growing gloom-and-doom attitude about the economic futures of young doctors that pervades much of medicine (among Rogers' generation, at least)--Stone will be able to get into practice without having to endure the year or two of economic uncertainty Rogers faced in the 1950s.
The younger surgeon, because he works on call part-time for local emergency rooms and has taken care to cultivate referral sources for patients, will be able to pay his way in practice earlier than his older colleague. This apparently will be true even though there is widely perceived to be a growing glut of doctors--particularly general surgeons.
But that isn't the only discrepancy Rogers discovered between his own experience and Stone's. Rogers said Stone is typical of a new generation of young doctors who simply don't perceive what is happening in their profession in the pessimistic way it is observed by their older colleagues.
Older physicians, Rogers said, mourn what they perceive as the passing of a "golden age" of medicine in which physicians did pretty much whatever they liked and answered to few people for it. But today's younger doctors and medical students, he said, by and large accept what is rapidly becoming a drastically altered medical system in the United States.
While some doctors and medical groups have predicted these changes may play havoc with American medicine and even cause its breakdown, Rogers said he finds in Stone and other young physicians with whom he has regular contact every indication that the new generation of doctors, as a group, will prove resilient and adaptable. Rogers concedes that this is not exactly the picture of medicine painted by many of his contemporaries--or even some prominent members of his own organization--who contend greater government and insurance-industry controls on doctors will bring ruin on the health-care system.
"Young doctors do not look at it (the change occurring in health care) with the apprehension and the fear and the doom and gloom, nearly as much as a lot of my colleagues do," Rogers said. No one pretends the next few years will not be a struggle as medicine, private and public agencies that pay for care and the public at large try to cope with the inevitable change.
But, said Rogers, the pessimism of his colleagues aside, "I think that there is no question" medicine will weather the change and that care will be of better quality for it. . . . It will be better, but it is going to be vastly different."
It is an optimistic assessment, to be sure, and one that defies other predictions heard often in the last five years or so that young doctors will have to struggle to make ends meet and that cost-control pressures will change the systems so patients must accept rationing of certain high-cost services.
While there may be fewer so-called solo practitioners--doctors working alone in private offices--and greater growth in group practice, health maintenance organizations, independent practice associations (which amount in ways to medical cooperatives) and similar institutions, the health-care system here is too dynamic and of too high quality to be compromised by the change, according to Rogers' view.