Flashback to the 1970s: Was it better to be a doctor then or now?

Imagine it's the 1970s, and chances are you'll conjure up images of long-haired hippies in bell bottoms and tie-dye, and streets filled with war protestors.

A look back in time

If you were a doctor 50 years ago, you may have enjoyed a cigarette or two on the job—yes, that's right, doctors were often smoking inside the medical clinic. Smoking was permitted nearly everywhere 50 years ago: in hospitals, doctors' offices, schools, restaurants, and airplanes.

If you had an MD or DO after your name, chances were good you would be male, as females only made up 5% of the physician workforce by 1970.[1] Today, females account for 35% of the physician workforce. 

Technology advances have had a staggering effect on the evolution of medicine in the last half century. New technology, advances in surgical techniques, and breakthroughs in medications and therapies have all led to better quality patient care.

But today’s doctors also face unique challenges, including staff shortages; staggering medical school debt; increased workplace violence; and mental health challenges, including burnout and higher suicide rates.

Physician compensation in the mid-70s

There isn’t much in the way of comprehensive data regarding what physicians were paid 50 years ago, but a 1988 article published in Health Care Financing Review provides a glimpse into the average physician compensation in the decade.

In 1975, pediatric specialists earned an average of $50,100 per year ($272,500 in 2022). In 2022, the average pediatric salary equaled $242,832—quite a bit lower than their counterparts 50 years ago.

By contrast, general surgeons earned an average of $61,300 in 1975 ($333,400 in 2022 dollars), and in 2022, they averaged $451,489—quite a bit higher.

Student debt: A modern-day burden?

While physicians salaries have stayed relatively flat since the mid-1970s, the price of medical school has risen astronomically. 

According to Education Data Initiative, the average cost of medical school in 2023 is $218,792. In fact, statistics show the cost of medical school has risen by almost $1,500 every year since 2015.[4] With medical education being such an expensive proposition, it’s not surprising that 73% of today’s medical school graduates accumulate debt and owe a median average of $200,000 to $215,000 in total educational debt.

This is in stark contrast to students graduating from St. Louis University's School of Medicine in 1970, who paid tuition fees of about $2,000 per year. Four years of medical school would have totaled approximately $63,000 in today’s dollars. With a cheaper price tag, it’s not surprising that, 50 years ago, many medical students were able to graduate debt-free.[5]

Not only has medical school become more expensive over the years, it’s also more intense, with an admissions process that extends over a 12-month period,[6] and a challenging curriculum that includes learning and retaining more information than in years past. Medical knowledge has grown exponentially, especially in the last 50 years.

The digital transformation

Due to the remarkable technological innovations over the past 50 years, contemporary medicine would appear almost unrecognizable to physicians practicing 50 years ago. The advent of artificial intelligence (AI) in healthcare, leading to personalized medicine and a reduction in time-intensive tasks; the increased focus on telemedicine following the COVID-19 pandemic; and other modern-day marvels all contribute to healthcare's ongoing technological revolution. 

Many doctors agree that these advancements represent only positives for patient care—including Scott Abramson, MD. Dr. Abramson worked as a neurologist at San Francisco’s Kaiser Permanente for 41 years before retiring in January 2020. He spoke with MDLinx about changes that have taken place over the course of his career.

“Prior to [electronic resources like UpToDate and PubMed], doctors would have to look through an overwhelming number of research articles, never being quite sure which ones were the most relevant,” he says. “Now that information can be accessed in a matter of minutes.”

Zoe Quandt, MD, an endocrinologist at the University of San Francisco, California (UCSF) Medical Center, tells MDLinx that the evolution of medical technology presents a mixed bag for both physicians and patients.

“The internet allows patients to go online and research their health conditions, but often the information they find isn’t from credible sources,” Dr. Quandt says. “When a patient has questions about their health, I refer them to websites where they can get solid information, such as the American Diabetes Association.”

Dr. Quandt says that while EHRs allow quick access to patient records, they also have a downside.

"Patients now access their blood test and other diagnostic test results online,” Dr. Quandt says. “This can be problematic when a patient receives test results at 11 pm and panics because they lack an understanding of how to interpret the results.”

EHRs, which were first introduced in 2009, are time consuming for physicians. One study found physicians gave EHRs an “F” in terms of usability, and blamed them for an increased risk of burnout.[8]

Malpractice

Medical malpractice is another contributor to the high rates of burnout seen today. But physicians of the past also suffered under its weight.

During the 1970s, doctors experienced a medical malpractice crisis, seeing large increases in insurance premiums and difficulty securing insurance coverage.[9] Yet the number of cases was much lower compared with today.

A 1977 paper from a professor at Princeton University revealed that, in 1970, 6.5 medical malpractice claims files were opened for every 100 active physicians in the US.[10] The professor notes a study during the period that found only 17% of doctors in Maryland had ever been sued for malpractice during their career. In contrast, the AMA’s 2016–2022 Benchmark Survey revealed that 31.2% of active physicians reported they had been sued in their careers to date.[11] 

The 1977 Princeton paper discusses a survey by the Commission on Medical Malpractice that showed approximately 75% of claims closed were settled for under $10,000, and only 3% exceeded $100,000 (equal to approximately $506,680 in today’s dollars).

Today, the increasing number of suits and settlement amounts has significant consequences for patient care. Dr. Quandt says the increase has led to some physicians overtreating patients and ordering tests that are often unnecessary.

“Ninety-nine percent of the time, physicians are sure they’ve made the correct diagnosis, but if there’s a 1% chance they’re wrong, they often order additional tests as a way to protect themselves against a malpractice suit,” Dr. Quandt says.

The state of mental health

While mental health challenges are nothing new, they have been a growing threat in the past 50 years. Doctors today face increased stress and burnout, especially following the COVID-19 pandemic. 

A 2023 paper from the Joint Commission Journal on Quality and Patient Safety notes that provider burnout is a significant problem at 83% of healthcare organizations.[13]

Due to both the increased conversation around mental health and the higher incidence of mental health issues among doctors, most hospitals are currently in the early stages of developing programs that address physician well-being, according to the Joint Commission Journal. And in 2022, President Joseph Biden passed the Dr. Lorna Breen Health Care Provider Protection Act, named after a doctor who died by suicide, to “prevent suicide, alleviate mental health conditions and substance use disorders, and combat the stigma associated with seeking help.”[16]

The pandemic took violence against doctors and other healthcare workers to a new level, prompting many state legislators to develop policies to protect doctors and other front-line staff. Some states have passed, or are in the process of passing, bills that offer harsher sentences to individuals who assault doctors and other healthcare workers.

Hospital and provider consolidation

Years ago, it wasn’t unusual to see many physicians working in private practice. But today, according to an AMA analysis, the majority of physicians work outside of private practice.[18] The analysis cited rising administrative costs; mergers and acquisitions; and declining pay rates from Medicare, Medicaid, and commercial insurers among the reasons doctors have shifted to work for a practice partially owned by a hospital or healthcare system.

In addition, many hospitals have also merged over the years. As the American Hospital Association notes, these consolidations lead to a reduction in in-patient readmission rates, while at the same time improving certain outcomes and performance measures.[19]

Parting thoughts

While physicians had challenges years ago, the increased demands placed on them, combined with a shortage of physicians and extensive medical school debt, show that the journey to becoming a doctor can prove arduous for HCPs today.

This proves, in part, the need for an increased emphasis from both physicians and hospitals to prevent provider burnout through the practice of self-care.

As a Weill-Cornell Medicine report notes, the core skills of physicians remain the same as they were years ago: talking to patients and providing hands-on care.[22] However, the report also notes there have been significant changes, including a greater emphasis on the need for culturally competent care. 

In addition, the breakneck speed of technological advancements in the last few years are allowing doctors to work more efficiently with patients on disease prevention and personalized treatment plans, meaning improved outcomes overall for patients in the modern era.

Sources

1. Women Have Closed Med School Enrollment Gap; Others Remain. American Academy of Family Physicians. 2023. 

2. Langenbrunner JC, Williams DK, Terrell SA. Physician incomes and work patterns across specialties: 1975 and 1983-84. Health Care Financ Rev. 1988 Winter;10(2):17-24. PMID: 10313083.

3. 2023 Physician Compensation Report. Doximity. December 2022.

4. Hanson M. Average Cost of Medical School. Education Data Initiative. July 12, 2023.

5. Pitlick PT. Our Stories: Journeys of the Class of 1970. Saint Louis University School of Medicine, Spring 2022.

6. Thorndike AN. The roots of burnout start early. See: Applying to medical school. STAT. May 3, 2022.

7. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48–58.

8. Melnick E, Dyrbye LN, Sinsky CA, et al. The association between perceived electronic health record usability and professional burnout among U.S. physicians. Mayo Clinic Proc. 2020;95(3):476–487.

9. LeMasurier J. Physician medical malpractice. Health Care Financ Rev. 1985;7(1):111–116.

10.  Somers HM. The Malpractice Controversy and the Quality of Patient Care. Woodrow Wilson School of Public and International Affairs, Princeton University, Spring 1977.

11. Guardado JR. Policy Research Perspectives: Medical Liability Claim Frequency Among U.S. Physicians. American Medical Association. 2018.

12. Medical Malpractice Claims-Made. Social Inflation and Loss Development Report. Moore Actuarial Consulting, LLC, on behalf of The Doctors Company. 2023.

13. Longo B, Schmaltz S, Williams SC, et al. Clinician well-being assessment and interventions in Joint Commission accredited hospitals and Federally Qualified Health Centers. The Joint Commission Journal on Quality and Patient Safety. April 27, 2023.

14. Matheson J. Physician Suicide. American College of Emergency Physicians. Accessed 2023.

15. Steppacher RC, Mausner JS. Suicide in male and female physicians. JAMA. 1974;228(3):323–328.

16. Dr. Lorna Breen Health Care Provider Protection Act Signed Into Law. Columbia University Irving Medical Center. March 18, 2022.

17. Injuries, Illnesses, and Fatalities. Survey of Occupational Injuries and Illnesses Data. U.S. Bureau of Labor Statistics. August 2, 2023.

18. AMA analysis shows most physicians work outside of private practice [press release]. American Medical Association. May 5, 2021.

19. Fact Sheet: Hospital Mergers and Acquisitions Can Expand and Preserve Access to Care. American Hospital Association. March 2023.

20. Li JMW. Evolution of hospital medicine as a site-of-care specialty. Virtual Mentor. 2008;10(12):829–832.

21. Bastian B, Tejada Vera B, et al. Mortality trends in the United States, 1900–2018. National Center for Health Statistics. 2020. Designed by Bastian B, Lipphardt A, Keralis JM, Lu L, and Chong Y: National Center for Health Statistics.

22. Salnier B. 10 Things Today’s Doctors Need to Know. Weill Cornell Medicine. September 5, 2018.