DENVER 鈥� Being a doctor in America is changing, in part because of the Affordable Care Act and also because of longer trends in the practice of medicine. Drs. Robert and Michael Sawyer practice at Denver Health, the city鈥檚 big public hospital downtown.聽
Representing three generations of doctors, Michael Sawyer, 43, center, holds a portrait of his grandfather Ken Sawyer along with his father Robert Sawyer, 80, right, at Michael鈥檚 home in Denver (Photo by Barry Gutierrez).
Sawyers have worked or taught here as physicians since the 1930s, so they have a unique perspective on how today鈥檚 challenges stack up against those that physicians have faced in the past.
Anesthesiologist Michael Sawyer is 43, and the third generation physician in the family. He and his father, Robert, head up to Mike鈥檚 cramped office on the third floor.聽
has never been known as a fancy place, but one that鈥檚 always been there for people in need since its log cabin origins in 1860.
Michael鈥檚 office has a well-worn futon where he sometimes crashes on long shifts. His office walls are decorated with photos of his father鈥檚 father, noted surgeon Ken Sawyer, who died in 1977.
鈥淭here鈥檚 grandpa,鈥� Michael says, pointing to a black and white profile of a doctor in a gown and surgical mask at work. 鈥淗ere he is operating at CU [University of Colorado Hospital] a long, long time ago if I鈥檓 not mistaken.鈥� Then he points out several mementos he has of his grandfather鈥檚 work:聽 鈥淭hat鈥檚 his doctor bag, actually, and there鈥檚 his microscope over there.鈥�
He and his father, Robert, also a surgeon, joke about how Michael uses his grandfather鈥檚 desk, much to the chagrin of the facilities managers at Denver Health, who look down on unauthorized furniture.聽 Michael says he knew pretty early he wanted to be a doctor.
鈥淚 remember going to work with Dad, when he鈥檇 round, and he鈥檇 operate, and I鈥檇 sleep in the old surgery lounge,鈥� he recalls.聽 鈥淚t was this cool big, leather couch, in this cool little room with a huge picture of your grandpa on the wall because it was named after him, and you just kind of go, 鈥楾his is what I鈥檓 supposed to do.鈥� 鈥�
Michael is the youngest of seven children and is the only one who became a doctor. He says his father never pushed it as a career.聽 They both say becoming a doctor is about equal parts you choosing medicine, and medicine choosing you.
鈥淵ou don鈥檛 go into medicine just because your dad鈥檚 a doctor,鈥� says Robert. 鈥淵ou go into medicine because it just seems right to you. It鈥檚 a fit. Had I thought about going into banking, I鈥檇 have gone crazy.鈥�
Robert Sawyer is 80 years old, and still practices one day a week. He also knew early on he wanted to be a doctor.聽 He watched his father, the guy on the wall, practice when Robert was still a kid.
鈥淭his was during the Depression,鈥� he explains.聽 鈥淧eople didn鈥檛 have much, and it was like they were like part of his family. They鈥檇 bring him chickens and eggs and steaks and stuff like that rather than pay him. And some of those people, when he died, kept coming to me.鈥�
Robert says the joy he gets from interacting with patients has been the best part of his career.聽 But over the decades, he鈥檚 watched health care grow ever more complicated and expensive.
Dr. Robert Sawyer, 80, left, and his son, Dr. Michael Sawyer, 43, greet each other at the front door at Michael鈥檚 home in Denver. 鈥淚鈥檓 very proud of him,鈥� says Bob of his son Michael who is the only one of seven children to become a doctor (Photo by Barry Gutierrez).
鈥淲hen I started out, there was only one insurance company, and that was Blue Cross Blue Shield,鈥� he says.聽 鈥淢ost of the people you dealt with as a cash basis, and you worked that out.聽 Then, pretty soon here comes the insurance companies, here comes Medicare and Medicaid, and all of the sudden, the bureaucracy is just overwhelming. You have to ask about what you鈥檙e going to do. You have to go get permission to do what you think鈥檚 right.聽 But it was really nice when you could just be able to be a doctor.鈥�
Robert says the bureaucracy frustrates doctors because it distances them from their patients. As Michael was making his way through his training as a doctor, health care bureaucracy and complexity only grew, further reducing the time physicians spend actually practicing medicine.
Being a doctor now is more stressful for other reasons, too. The cost of medical school has skyrocketed. Michael started his career with a six-figure student loan debt that shocks his father. Michael says he doesn鈥檛 try to sugarcoat what it takes to become a doctor when he talks with the next generation of Sawyers.
鈥淚 have a niece right now, who鈥檚 showing some interest, and is academically very, very bright,鈥� says Michael. 鈥淏ut I have a real, very real conversation with these people about, you鈥檙e going to spend a lot of money, you鈥檙e going to spend six or seven years of the next 30 years of your life sleeping in a hospital.鈥�
He questions his career choice far more than his father did.聽 Michael鈥檚 wife is a physician, too. He says that while they were still in residency, working crazy hours for low pay under a ton of stress, friends their age had already launched successful careers.
Dr. Robert Sawyer loves medicine so much that, at age 80, he still practices one day a week (Photo by Barry Gutierrez).
鈥淏oy, we could鈥檝e done something else,鈥� he says. 鈥淲ould we have been as happy? We don鈥檛 know. Would we be happier? Who knows? But when you鈥檙e in the thick of it, I think I don鈥檛 know a doctor my age who doesn鈥檛 second guess it.鈥�
But Michael does love being a doctor. He talks about seeing a teenage girl he worked on up and walking around again, after a car accident that nearly killed her.聽 He says knowing he helped save her life is immeasurably gratifying.聽
鈥淚鈥檝e always looked at it as 鈥� a higher level calling. I think there鈥檚 a couple jobs like that, and they would be teachers, and they would be clergy and they would doctors,鈥� Michael says. 鈥淎nd you know that what you鈥檙e doing is absolutely good for the world, and it鈥檚 a good feeling no matter how exhausted you are.鈥�
But the life and death nature of the work takes a toll, he says.
鈥淚 don鈥檛 know how many days I鈥檝e gone home after some pretty tragic nights at this hospital and collapsed crying into my wife鈥檚 arms because it was really sad what happened the night before, and all you can do is, like, you know, at least you were there trying to help.鈥�
His father gently chimes in, 鈥淚 don鈥檛 know if anybody could say it better than that. It is a calling.鈥�
Stepping out of an elevator and through the hospital鈥檚 glass doors, into the cold but cheerful winter sunshine, Michael and Robert Sawyer walk to a small brick courtyard near the entrance where patients and their families can take a break from the noise inside. It鈥檚 paved with inscribed bricks, which the hospital sells to raise money. Michael鈥檚 kids had a garage sale, and he told them they had to donate half their earnings to charity. His 12-year-old son bought a brick.聽
鈥淚t says 鈥楽awyer Family,鈥� 鈥� Michael reads.聽 鈥� 鈥楾hree generations of Denver General/Denver Health Physicians.鈥� We were trying to go a little bigger, but the kid鈥檚 budget couldn鈥檛 get much more than that,鈥� he jokes.
They pause.
鈥淚t鈥檚 great, we鈥檒l see if we can鈥檛 get it to four here going forward,鈥� says Michael.
鈥淭hat鈥檇 be nice,鈥� says his father.
They don鈥檛 take it for granted that there will be a physician in the fourth generation of the family, they know exactly how demanding it is. But they also know, no matter how complex medicine becomes, how enormous its bureaucracy grows, and how expensive medical school gets, kids are still going to want to be doctors when they grow up.
This story is part of a reporting partnership between and Kaiser Health News.