RENEE MONTAGNE, HOST:
What it means to be a doctor in America is changing. The Affordable Care Act is one reason, just one of many factors that have reshaped the practice of medicine. We wanted to get a view of those changes through the eyes of doctors, and Eric Whitney spent time with a father and son who are part of three generations of physicians. He's brought us the story of what they're seeing, and whether they think medicine will still be a good career choice for a fourth generation.
DR. MICHAEL SAWYER: Mike Sawyer. This is my dad, Bob Sawyer.
ERIC WHITNEY, BYLINE: Michael Sawyer is a 43-year-old doctor at Denver Health, the city's big public hospital downtown. He's waiting for me with his father, Dr. Robert Sawyer, just inside the main entrance.
MICHAEL SAWYER: Oh, yeah. Let's go up to the office.
WHITNEY: We head up to the third floor.
MICHAEL SAWYER: All right, man. This is the hovel. It's not quite like the wooden-paneled beautiful doctor's office you think you're getting. Come on inside.
WHITNEY: Denver Health has never been known as a fancy place, but one that's always been there for people in need. Michael's proud to be part of that legacy, which is also a family tradition. His cramped office includes a well-worn futon where he sometimes crashes on long shifts. And on the wall are photos of his father's father, Ken Sawyer, who was also a doctor and died in 1977.
MICHAEL SAWYER: There's grandpa. Here he is operating at CU a long, long time ago, if I'm not mistaken. That's his doctor bag, actually, and that's his microscope over there by John Wayne, in that box over there.
WHITNEY: Wow. Michael also uses his grandfather's desk. He and his dad, who he affectionately calls Dr. Bob, laugh about how someone at the hospital gave him a hard time for that, using unauthorized furniture. He says he knew pretty early he wanted to be a doctor himself.
MICHAEL SAWYER: I remember going to work with Dad, when he'd round, and he'd operate, and I'd sleep in the old surgery lounge. But it was this cool big, leather couch in this cool little room with a huge picture of your grandpa on the wall because it was named after him, and you just kind of go, like, this is what I'm supposed to do.
WHITNEY: Michael is the youngest of seven children, and the only one who became a doctor. He says his father, Robert, never pushed it as a career. Both of them say becoming a doctor is about equal parts you choosing medicine and medicine choosing you.
DR. ROBERT SAWYER: You don't go into medicine just because your dad's a doctor. You go into medicine because it just seems right to you. It's a fit. I mean, had I thought about going into banking, I'd have gone crazy.
WHITNEY: Robert Sawyer, the father, loves medicine so much that at age 80, he still practices one day a week. His ideas about the doctor-patient relationship were formed in part from watching his father, the guy on the wall, practice when Bob was a kid.
ROBERT SAWYER: This was during the Depression. People didn't have much, and it was like they were like part of his family. You know, and they'd bring him chickens and eggs and steaks and stuff like that, rather than pay him. And some of those people, when he died, kept coming to me.
WHITNEY: Robert says the joy he gets from interacting with patients has been the best part of his career. But over the decades, he's watched health care grow ever more complicated and expensive.
ROBERT SAWYER: When I started out, there was only one insurance company, and that was Blue Cross Blue Shield. Most of the people you dealt with on a cash basis, and you worked that out. Then, pretty soon, here comes the insurance companies. Here comes Medicare and Medicaid, and all of a sudden, the bureaucracy is just overwhelming you. You have to ask about what you're going to do. You have to go get permission to do what you think's right. But it was really nice when you could just be able to be a doctor.
WHITNEY: He says the bureaucracy frustrates doctors, because it distances them from their patients. As his son Michael was making his way through training to become a doctor, health care bureaucracy and complexity only grew. He says compared to early in his career, it seems physicians now spend even less time actually practicing medicine. Being a doctor is more stressful now for other reasons, too. The cost of medical school has skyrocketed. He's shocked at the six-figure student loan debt Michael started his career with. Michael says he doesn't try to sugarcoat what it takes to become a doctor when he talks with the next generation of Sawyers.
MICHAEL SAWYER: I have a niece right now who's showing some interest, and is academically very, very bright. But I have a real, very real conversation with these people about, you know, you're going to spend a lot of money. You're going to spend six or seven years of the next 30 years of your life sleeping in a hospital.
WHITNEY: He questions his career choice far more than his father did. Michael's wife is a physician, too. He says while they were still in residency, working crazy hours for low pay under a ton of stress, friends their age were already launching successful careers.
MICHAEL SAWYER: Boy, we could've done something else. You know, would we have been as happy? We don't know. You know, would we be happier? Who knows? But when you're in the thick of it, I think I don't know a doctor my age who doesn't second guess it. You'll like this though, Dr. Bob.
WHITNEY: Leaving his office, though, you can see Michael does love being a doctor. On our way to see another piece of his family's legacy at the hospital, he pauses to show off for his dad. He points out scientific posters tacked up on the walls illustrating particularly tough cases he's worked on.
MICHAEL SAWYER: If you could take somebody - look, dad. That guys (unintelligible) 95 percent of his cells, and by the time I got this guy fixed up, he's (unintelligible) 0 percent.
WHITNEY: Michael talks about seeing a teenage girl he worked on, up and walking around again after a car accident that nearly killed her. He says knowing he helped save her life is immeasurably gratifying.
MICHAEL SAWYER: I've always looked at it as - and maybe it's kind of referenced in that weird little ethereal dream of waking up and seeing your grandfather staring down at you, at your couch - but it's a higher-level calling. You know, I think there's a couple jobs like that, and they would be teachers, and they would be clergy and they would doctors. And you know that what you're doing is absolutely good for the world, and it's a good feeling, no matter how exhausted you are. I mean, I don't know how many days I've gone home after some pretty tragic nights at this hospital and collapsed crying into my wife's arms because it was really sad what happened the night before. And all you can do is, like, you know, at least you were there trying to help.
ROBERT SAWYER: I don't know if anybody could say it better than that. It is a calling.
MICHAEL SAWYER: Make a decision on who's got the right tests...
WHITNEY: We step out of an elevator and through the hospital's glass doors into the cold, but cheerful winter sunshine. Michael and his dad take me to a small brick courtyard near the entrance, where patients and their families can take a break from the noise inside. It's paved with inscribed bricks, which the hospital sells to raise money. Michael's kids had a garage sale, and he told them they had to donate half their earnings to charity.
MICHAEL SAWYER: So, here's ours.
WHITNEY: His 12-year-old son bought a brick.
MICHAEL SAWYER: It says Sawyer Family. Three generations of Denver General, Denver Health Physicians. We were trying to go a little bigger, but the kid's budget couldn't get much more than that.
WHITNEY: It's still pretty cool, though.
MICHAEL SAWYER: Yeah, it's cool. It's great. I mean, you know, we'll see if we can't get it to four here going forward.
ROBERT SAWYER: Yeah, that'd be nice. That would be good.
WHITNEY: Michael and Bob Sawyer don't take it for granted that there will be a physician in the fourth generation of the family. They know exactly how demanding it is. But they kind of hope there will be, because they also know no matter how complex medicine becomes, how enormous its bureaucracy grows and how expensive medical school gets, kids are still going to want to be doctors when they grow up. For NPR News, I'm Eric Whitney in Denver.
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MONTAGNE: And that story is part of a partnership between NPR and Kaiser Health News.