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April 13, 1998

Where Have All the Flowers Gone: Where Is the Joy in Medicine?

Arch Intern Med. 1998;158(7):693. doi:10.1001/archinte.158.7.693

THE 20- AND 30-somethings in our profession have already given up on this essay. "Another one of those what-it-was-like-in-the-golden-days-of-medicine articles." I can hear them saying it now. Hopefully, they will read a bit further, because although this essay contains some nostalgia, its message has nothing to do with the "good old days."

The structures that built American medicine to its current preeminence are crumbling; many have already turned to dust. The National Institutes of Health's "pay-line" hovers below 20%; clinical revenues have crashed thanks to the brokers of managed care; subspecialty medicine—the bastion of medical advances for the past 35 years—cannot convince US-born residents to join its ranks; and department chairs are dying, retiring, or taking lucrative positions in industry. On all sides one hears sobs, moans, and cynical remarks. Where indeed have all the flowers gone; where is the joy that used to inspire our profession?