Physician, Raiter Clinic, Cloquet Years in practice: 52 Medical degree: 1959 (University of Minnesota) What aspects of medical practice have surprised you (in good and/or bad ways)? (a) The rapidity with which the insurance industry took over the practice of medicine, beginning in the late 1960s. It is now virtually impossible to survive on fee-for-service. (b) The advances in technology, diagnostic and therapeutic. In 1957, the bubble oxygenator was being used for the first time; now it is routine. Radiation therapy was administered using vacuum tubes. Digitalis leaf was still being used. Penicillin was being augmented with more and better antibiotics. Since then, through basic science, ongoing increases in knowledge of physiology, down to the molecular level, have improved therapeutics. (c) The technological advances have come at a price. One unexpected and disturbing consequence of the advancement in knowledge and technology has been the rise of subspecialties, to the detriment of general medicine practice. About 40 years ago I saw a cartoon depicting an office door with the legend, “Dr. John Smith, Specialty: Side effects.” Then it was a joke; now it’s for real. (d) We have become so technically oriented that Mrs. Jones has become “the gall bladder in room 3.” We are struggling to retain our sense of empathy with our patients, largely for economic reasons. It costs to have the machines and the special drugs, and we can’t afford them without seeing more patients and shortening appointment times. What were the most important factors for you in choosing a medical specialty? Both of my parents were practicing physicians. I grew up getting dinner-table M&Ms, so it was only natural to step right in. I did preceptoring in the St. Luke’s (Duluth) Pathology Department during summer breaks in college and got grounded in basic anatomy and pathology. I joined my parents’ general medical practice, Puumala Clinic, in Cloquet in 1960, and worked there until the practice closed in 2005. Since then I’ve practiced part-time at Raiter Clinic, also in Cloquet. What was your debt upon graduating? Thanks to my parents, I emerged from medical school debt-free. How has the culture of medical practice changed since you began practicing? (a) The increased acceptance of women into the medical profession has been great. In 1930, my mother was among six women in her class at the University of Illinois College of Medicine. In 1956, there were six women in my class (including my wife, Barbara) at the University of Minnesota. Our three-doctor clinic employed two women physicians—my mother and, later, an RPAP [the U of M’s Rural Physician Associate Program] student who had trained at the clinic. Four of the 13 family physicians at the Raiter Clinic are women, and this number will certainly increase. (b) With the technical advances, the cost of examinations, and the ancillary staff needed to run a large medical group, the physician’s ability to sit down with a patient and find out what is really bothering the patient has been reduced to a waiting-room checklist. The 15-minute office visit is not satisfying. I fear that we are losing the art of medicine; instead of a profession, it has become a job. (c) The shift away from general medicine toward subspecialties reflects a major cultural shift in medicine from 50 years ago. In part, this has occurred in response to the increasing use of midlevel practitioners in place of family doctors; in addition, the six-
digit debt that medical students now typically incur sends them to advanced, more lucrative training. This cultural shift bodes ill for the medical generalist. A light at the end of the tunnel is the advance care directive. It will help protect our resources, enabling us to provide them to those who will benefit the most. What advice would you give to physicians entering medical practice? Get a full, rounded basic medical education and general internship before you enter specialty training. I think you’ll have a better understanding of the humans you are dealing with. What, if anything, would you have done differently in your career? I would have done nothing different in my career. I wanted to be a general doctor and, more than 50 years later, I am still doing that.
Paul Waytz, MD Physician and Partner, Arthritis & Rheumatology Consultants, Edina Years in practice: 32 Medical degree: 1974 (University of Illinois–Chicago) What aspects of medical practice have surprised you (in good and/or bad ways)? I have been in private practice for 32 years and have been amazed by the quantum leap in technology and availability of advanced diagnostic tools. Is what I have witnessed in the past three decades any different than the replacement of horsehair with synthetic suture material? Perhaps these observations answer both the “good” and the “bad” aspect of the question. PROFESSION to page 12
Telephone Equipment Distribution (TED) Program
Ricard R. Puumala, MD
Do you have patients with trouble using their telephone due to hearing loss, speech or physical disability? If so…the TED Program provides assistive telephone equipment at NO COST to those who qualify. Please contact us, or have your patients call directly, for more information.
1-800-657-3663 www.tedprogram.org Duluth • Mankato • Metro Moorhead • St. Cloud The Telephone Equipment Distribution Program is funded through the Department of Commerce Telecommunications Access Minnesota (TAM) and administered by the Minnesota Department of Human Services OCTOBER 2012
MINNESOTA PHYSICIAN
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