Ah, youth... It's wasted on the young. Or is it?

"A lot of us feel like it's a really exciting time to practice medicine," bubbles Sindhu Srinivas, speaking for her generation of physicians.

Although many of the leading indicators show that the healthcare system is in crisis, Srinivas believes she and a battalion of young physicians are ready and willing to shape the world in their image. The recent graduate of New Jersey Medical School and former president of the American Medical Student Association admits that, "You hear nowadays in medical school that medicine isn't what it used to be." But she's convinced her generation will make a difference for patients and healthcare in general. "I feel like the future is up to us."

And that's precisely what older physicians are afraid of.

Looking at Srinivas and her "30-something" peers, many of today's established docs see not crusaders, but spoiled brats who don't understand the kind of dedication required to make medicine work, or the way that "real medicine" — the kind untainted by business concerns — should be practiced.

Quietly, in medical groups across the country, youthful cockiness is bumping up against middle-aged despair. The result? Backbiting, stress, and malaise. Generational conflict is eating away at the social fabric of group after group — sometimes revealing itself in arguments over call schedules and comp-ensation, sometimes causing docs young and old to leave their practices in disgust. It's no surprise to learn that such problems often emerge from real differences in what each generation thinks a career in medicine is all about.

The angry generation

For the bulk of active physicians, those who are roughly 40 to 59 years old, medicine just ain't what it used to be. And they're mad as hell about it. Many entered medical school expecting a lucrative career helping others while basking in appreciation from their community and patients. Instead, patients question their diagnoses with data gathered from the Internet, the government threatens to audit their files, they work like dogs, and their income isn't going anywhere.

This change in status is not all in their heads, either. According to the Medical Group Management Association's (MGMA) Physician Compensation and Production Survey: 2000 Report, physician compensation in 1999 rose 3.39 percent for primary-care providers and 6 percent for specialists. Sounds OK — until you read on and find out that, over the same period, physician gross charges leapt 11.55 percent for primary care and 8.51 percent for specialists. In other words, physicians are working harder, but that effort is not being reflected in their pay.

And that's especially tough to take for someone who entered medicine expecting a much better deal. This group remembers what the good old days were, and they can contrast that" with today, observes David J. Bachrach, founder of The Physician Executive Coach in Boulder, Colo. The result, says Bachrach, who has 27 years of experience as a leader in academic medical centers, is a generation characterized by anger.

Hal Patterson, a Denver-based career consultant who works with many disgruntled docs, agrees. "They all come out of residency programs full of spit and shine," he says, "then they just get beat to death. [Physicians] feel just like they're working in an assembly line." Patterson says many of the physicians he works with are contemplating a career change. Some are even throwing in the towel altogether.

According to a recent survey by physician recruitment company Merritt & Hawkins, 37 percent of physicians age 50 or older plan to retire in the next one to three years. Another 16 percent plan to "reduce their workload." And 56 percent reported they wouldn't choose a career in medicine if they had it to do over. Surprised? It gets worse.

Already pushed to the limit, the hard-working middle-aged generation of doctors is also dealing with an older generation ready to cut back their own hours and rely more and more on others to support them in their golden years. Looking for relief, the middle-aged physician might turn to the young, up-and-coming physicians — many of whom insist on taking call only once a week, working a 10-hour day, and collecting a big salary.

The young and the rested

These new physicians, like the rest of their generation, are "more inclined to balance. They want a balance with their personal life. They're more inclined to have the mountain bike, the backpacks — and they want time out of the office," observes Mike Taylor, vice president for marketing at Cejka & Co., a St. Louis-based recruitment and consulting company. "They want good incomes but insist on quality of life," Bachrach agrees.