November 19, 2018

Is There a ‘Docta’ in the House?

"There’s a big controversy on the Jewish view of when life begins. In Jewish tradition, the fetus is not considered viable until after it graduates from medical school." — Old Jewish joke.

The link between Jews and the medical profession might not serve as a punch line to a joke in the near future, because the Jewish doctor — especially the kind featured in "my son the doctor" gags — is becoming something of an endangered species.

Jewish medical school candidates, who reportedly made up 60 percent of the applicant pool in 1934, dropped to 9 percent in 1988, the last year figures were available. By contrast, 26 percent of all applicants in 1995-1996 were Asian American, a group that represents 4.4 percent of the U.S. population.

Michael Nevins, a New Jersey cardiologist who also studies the history of Jews in medicine, estimates that at the tail end of the 20th century there were between 80,000 and 100,000 Jewish physicians in the United States, comprising between 12 percent and 15 percent of the nation’s 684,414 medical doctors. Jews make up 2 percent of the total U.S. population. If Jewish doctors seemed more ubiquitous than these statistics imply, it is because they are clustered in major urban environments, especially in California and the Northeast.

If it’s true that there are fewer Jews entering the medical field, is it a commentary on the field of medicine — or does it indicate something about the state of the next generation of Jews?

Some believe that declining number of Jewish doctors can be viewed as a step forward: a sign that young Jews are moving beyond stereotype and becoming thoroughly absorbed into the fabric of American life.

But Elliot Dorff, rector and distinguished professor of philosophy at the University of Judaism, sees the downside. For Dorff, whose specialty is medical ethics, fewer Jewish doctors will inevitably mean "fewer people who share Jewish values about medical care."

This might have grave consequences in thorny areas like abortion, infertility treatment, stem cell research and end-of-life issues, on which Jewish doctors instinctively tend to reflect the teachings of Jewish tradition. Dorff believes that for most Jews, whatever their level of Jewish education, the sanctity of life and the sacred calling of medicine are articles of faith. It’s disheartening to think of a future in which Jews no longer hold the health of a nation in their hands.

But medicine as a field of choice has recently declined as a career goal among undergraduates of all backgrounds, said Linda Sax, a UCLA professor of education, who directs the Cooperative Institutional Research Program, which has polled incoming students at four-year colleges nationwide since 1966.

The desire to become a doctor peaked among Jews in 1993, according to Sax, and among all students in 1995. In 1999, 9.5 percent of Jewish freshmen and 7 percent of non-Jews planned to be physicians. In 2002, 7.1 percent of Jewish frosh, as opposed to 6.7 percent of all students in the study, aspired toward a medical career.

Moreover, the future Jewish doctors might not be anyone’s sons. In the last few years, among both Jews and non-Jews, more women than men have set their sights on medicine. A 50/50 gender split is common in medical classes today, and females can outnumber males by as much as 20 percent.

Although Sax’s surveys indicate Jewish freshman are more committed to the field of medicine than the general freshman population, the makeup of today’s medical school classes reveals fewer Jews. This is particularly true in Southern California, where ethnic diversity is prized. USC medical student Ari Isaacson estimates that while 40 percent of the doctors teaching his preliminary medical courses were Jewish, 5 percent of the 160 students in his fourth-year class are Jews.

At UCLA’s highly regarded David Geffen School of Medicine, 5,100 applicants vie for 121 slots. Though UCLA is not allowed to choose students on the basis of race, the school’s dean Dr. Gerald Levey explained that "our demography has changed as California has changed."

"It’s a fair impression that the traditional Cohens and Levys and Goldbergs are going into other things," he said.

The current fourth-year class contains perhaps eight Jews, and about half are of Persian descent. It’s common at UCLA for two-thirds of the class to be non-white, with Latinos and African Americans amply represented. At this year’s graduation ceremony, the new doctors were hailed in 20 languages, reflecting their wide range of native tongues.

In top medical schools as widely scattered as Tufts (Boston), Duke (Durham, N.C.) and Baylor (Houston), the situation is similar. Even in New York City, known for its well-entrenched Jewish population, the number of Jewish medical students has gone down. In Dr. Marian Rosenthal’s 1967 New York University (NYU) graduating class, all but about 30 of the 120 new doctors were Jewish. Today, 23 percent of Joseph Glaser’s NYU classmates are Jews: the rest represent a broad spectrum of whites (29 percent), Asians (24 percent), Indians and Pakistanis (9 percent), blacks from America, Africa and the Caribbean (9 percent) and so forth.

Jews have excelled in the medical field as far back as the Middle Ages, Nevins said. In mid-20th century America, the medical profession offered an unbeatable combination of intellectual challenge, community service and financial reward for bright young Jews.

Social yearnings underpin many medical degrees, said Dr. Gary Schiller, associate professor of medicine at UCLA: "Historically, medicine has been attractive to the sons and daughters of immigrants. It’s a way to rapidly establish yourself in a professional class by virtue of intellect and hard work."

Schiller, from a family of Holocaust survivors, grew up with a sense that medicine is the safest career path, because its skills can be transported anywhere in the world. His grandfather had been a prominent Prague attorney. When the Nazis came, he failed to get out in time, because "he couldn’t transfer a legal career across a border."

Rosenthal said of her contemporaries: "We fulfilled our parents’ aspirations."

Her own parents’ dreams were thwarted by the Depression and widespread quotas used to turn Jews away from medical schools. So great was her mother’s desire for a doctor in the family that she vowed to scrub floors, if necessary, to finance her child’s medical training.

Dr. Jerrold Steiner, who co-directs the Saul and Joyce Brandman Breast Center of Cedars-Sinai Medical Center, is part of a classic multigenerational family of doctors. His immigrant grandfather, a walnut farmer-turned-carpenter, put his daughters to work to help pay for his son’s medical education. Eventually that son had two sons of his own, who were both steered toward medicine.

"Essentially I went into the family business," Steiner said.

He stayed out of his own children’s career choices, and was stunned when his eldest elected to follow in his footsteps. Now his wall bears a photo of father and son performing surgery together; it is inscribed, "To a great surgeon, role model and mentor, and most importantly, a great father. Love, Josh."

But Jewish father/son doctor teams are becoming increasingly rare. Steiner admits that within his own social circle, "I’m the only one whose kid has become a doc."

In fact, in recent years, some veteran Jewish doctors have explicitly dissuaded their children from entering the field.

Their attitude stems from recent changes that have made doctors, in the words of one specialist, "slaves to a bunch of administrators." With malpractice litigation a constant threat, today’s medical professionals feel caught between the lawyers and the insurance companies. And cutbacks in reimbursements mean they no longer command the astronomical incomes that helped make up for expensive schooling and long hours.

Steiner says that today’s young doctors won’t find it easy to afford the perks he enjoys, which includes a home in Benedict Canyon and membership in Hillcrest Country Club.

It’s also true that many young Jews are not interested in medicine as a discipline. Unlike past generations, they face few social barriers in their career choice. For some, the real excitement lies in entrepreneurial fields like business and biotechnology. Others, cushioned by their parents’ earning power, feel free to explore filmmaking and the arts.

Internist Mark Hyman posits several reasons why medicine has become less attractive to young American Jews. Due to changes in family structure, pressure from relatives has far less effect than it once did. Also, as Jews have assimilated into American life, they "no longer feel they are part of an underdog minority that has to prove itself." And the years of arduous training that a medical career demands have little appeal for affluent youngsters raised on instant gratification.

A Los Angeles pediatrician speaks for many in insisting, "This generation’s Jews are Asians." Medical schools today are filled with ambitious, hard-working Asian Americans, not far removed from their immigrant roots. Alan Bienstock’s closest friends among the reconstructive surgery residents at Baylor College of Medicine are second-generation Korean and Indian Americans. Given medicine’s appeal to recent arrivals, it’s no surprise that those Jews who gravitate to medical school are mostly from Russian or Iranian families. Among Middle Easterners, a deeply rooted respect for the profession is part of the allure.

Evelyn Salem is an Iraqi Jew who spent years in Iran before immigrating to the United States. She and her two sisters have six children among them; three have become doctors. Among her relatives, it’s customary for a child to receive a toy doctor kit as a first gift. But, Salem admitted, "The less traditional the families are becoming, the less the kids want to be physicians."

Still, there remain young Jews who view the study of medicine as a privilege. Med student Ari Isaacson is undaunted by the warnings of veteran doctors that the field is not what it was. His reasoning: "I didn’t think I’d miss that control and that money as much as they do. They forgot why they started doing it in the first place."

Dr. Richard Finn, a young oncologist who graduated from USC Medical School in 1997, has hardly forgotten. At 18, he watched his mother undergo treatments for the cancer that ultimately claimed her life. Now he feels honored to be a Jewish American physician, caring for patients of all colors and creeds.

Finn notes that throughout history, "Jews have been isolated, not always by choice." Through the practice of medicine, Jews have a way "to be involved with society, and to give back," he said.

For Finn, medicine remains a profoundly Jewish endeavor, in keeping with the famous Talmud passage: "If you save one life, you save the entire world."