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From Residency to Retireme nt tells the stories of twenty American doctors over the last half century, which saw a period of continuous, turbulent, and transformative changes to the U.S. health care system. The cohort's experiences are reflective of the generation of physicians who came of age as presidents Carter and Reagan began to focus on costs and benefits of health services. Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a \"view from the front lines\" both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory. They describe their residency in internal medicine in a large southern urban medical center as a \"siege mentality\" which lessened as they began their careers, in Getting Rid of Patients , the title of Mizrahi's first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi's work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.

From Residency to Retireme nt tells the stories of twenty American doctors over the last half century, which saw a period of continuous, turbulent, and transformative changes to the U.S. health care system. The cohort's experiences are reflective of the generation of physicians who came of age as presidents Carter and Reagan began to focus on costs and benefits of health services. Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a \"view from the front lines\" both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory. They describe their residency in internal medicine in a large southern urban medical center as a \"siege mentality\" which lessened as they began their careers, in Getting Rid of Patients , the title of Mizrahi's first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi's work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.

The time to recalibrate the imbalance between micro and macro social work is now. There is an important initiative in progress, as we will show, to infuse the foundational macro component of our profession into the classroom and field to achieve a more equal footing with its clinical counterpart. This effort reflects and reinforces the understanding that social problems require complex and sustained intervention at all levels of social work practice. It has gained momentum since President Obama's identification as the 'community organizer-in-chief,' along with significant nationwide movements in the past several years, such as the 'Occupy' social protests and immigrant rights actions. In the context of these developments, there is a growing awareness of the relatively small percentage of social work students enrolled in macro methods who will be prepared to actively participate and provide skilled leadership at the grassroots, policy, coalition, and electoral levels (Council on Social Work Education [CSWE], 2012). This awareness was fortified by a recent study of the membership of the Association for Community Organization and Social Administration (ACOSA), where macro faculty reported a problematic level of support from their schools/departments in this area of social work education (Rothman, 2013). Adapted from the source document.

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Background: Children with cancer experience pain and distress due to their illness and frequent medical procedures. Hypno-analgesia techniques effectively prevent and allow pain and distress management in children without any toxicity; however, they remain underutilized because of their cost and the shortage of trained hypnotherapists. We hypothesize that pediatric oncology nurses will change their practice after a four-day training in basic hypno-analgesia techniques, leading to a decrease in procedural distress and pain in their patients. Methods/Design: Six nurses from a pediatric hematology-oncology daycare clinic will be enrolled in this interventional pilot study. The intervention will be a four-day training session in basic hypno-analgesia techniques under the supervision of a certified hypnotherapist. Nurses and patients will be video recorded and evaluated during venipunctures (pre- and post-intervention). Nurses’ mastery of hypno-analgesia techniques will be measured by two external evaluators who quantitatively assess their practice performance on the videotapes. Patients’ distress and pain measures will include self- and parent-reported visual analog scale and Faces, Legs, Activity, Cry, Consolability scale’s assessments by two external evaluators on video recordings. The primary outcome will be nurses’ technique mastery and the main secondary outcome will be the change in patients’ self-reported distress after the intervention. Discussion: We expect that a four-day training of nurses in basic hypno-analgesia techniques will reduce procedural distress and pain in their patients, thereby opening the way to larger clinical trials in various pediatric settings.

In the first four decades of the physicians’ careers, from the 1980s until the 2010s, the health care system changed in both subtle and dramatic ways as has been documented in the previous chapters. These changes had a significant impact on the way they cared for patients and the way they experienced their life and work as physicians within the larger health care system. This chapter presents, first, a brief historical overview of the health care system reform debate that took place over the course of these physicians’ careers (Beckers Hospital Review, 2014). This provides some background for understanding the

Building on the last chapter’s discussion of physician satisfaction and strains during the entry, early and established stages of their career, this chapter looks at the same issues in the physician cohort’s professional lives in the later stages. It focuses on the time when they were more entrenched in their careers until the time when they were at or near retirement, almost forty years after they had been house officers at SAMS. Specifically, this chapter looks at the entrenched (1994–2004), extended (2004–2011), and ending (2011–2016) career phases. Similar to the findings in chapter 3, contradictions and tensions appear

How has the changing climate of medicine over the last several decades, along with the myriad criticisms of the health care system, affected these physicians emotionally? In this chapter, the cohort reveals their vulnerability that is deeper and more personal than elements of satisfaction or dissatisfaction presented in the earlier chapters. This chapter explores the meanings of these physicians’ experiences, which are not typically captured or expressed in physician surveys. The chapter looks closely at their more private feelings, presenting their responses to questions about cynicism, disillusionment, fear of failure, and self-doubt. They were asked whether they have experienced those

The next two chapters examine the overall career satisfaction and dissatisfaction of the physician cohort from the time they completed residency (1979–1980) until they were at or close to retirement almost forty years later. This chapter looks at the overall career satisfaction and dissatisfaction during the entry (1979–1980), early (1980–1984), and established (1984–1994) phases of their careers, while chapter 4 discusses the overall career satisfaction and dissatisfaction at the entrenched (1994–2004), extending (2004–2011), and ending stages (2011–2016). In addition to discussing the doctors’ satisfaction and dissatisfaction as they moved through these phases, to