The Changing of the Guard
by Teresita Bacani-Oropilla, MD

Circa 1980, fortunate circumstances involved me in the training of medical students and psychiatric residents. Observing these young individuals blossom into full-fledged professionals has been another fulfilling chapter in my life as a physician.

As early as the first year in medical school, most students have their eyes and hearts open to what kind of specialty they eventually will practice. In their rotations, they evaluate their proctors as they make their rounds. Do these teachers help people? Do they like what they are doing? Are they worth emulating?

They are very sophisticated, these young ones. They are not as trusting nor starry eyed as my generation was, whose broad aim was "to serve humanity" and expected that whatever their choice, they would do well. Having heard of, and raised in the realities of managed care, these budding doctors carefully choose their options. Most of them are burdened with loans. Their choice of residencies is not only based on the quality of their future training but also on the economic returns of the present and the future. They consider life styles, whether they will have the inclination or the time to practice their chosen field in the manner they want to, and raise families besides. They plan on where they want to settle down, and even consider a time line on when they might want to retire. They would rather not leave much to chance.

In a litigious society, they have been taught to be wary, to document their activities and to pay attention to malpractice coverage. Buffeted by rising costs of practice and interminable paper work to claim remuneration, they have had to hone their business acumen. One would almost suspect that the enthusiasm and anticipated joy of practicing medicine would be wiped out by then. Having expended their energies on non-medical endeavors, it is to their credit that they still have the vitality to do their doctoring and render compassionate care to their patients.

At a recent conference for psychiatrists, it was gratifying to see a parade of former students and residents forming the bulk of attendees. Confident, self assured, and matured, they now occupy positions of importance in the psychiatric hierarchy. They have become the bulwarks of inpatient, outpatient, and community care. They have branched into forensic and academic medicine. Some have specialized in drug addiction, or the care of children and adolescents, and the geriatric population.

They may not completely agree nor approve of the way they are constrained in their practices, but like resilient reeds, they have bent with the winds of change. On them now lies the fate of our mentally ill. By their diligence and advocacy, so will others in the future. They have arrived. That really makes the older generation proud.

Back to Newsletter