Friday, July 22, 2016

Meany - ful Use

Earlier this year I felt great relief when I matched into a graduate medical education program that would allow me to train for three years and at the end, allow me to take a test in which I could earn a board certification in internal medicine. During these three years a great transformation takes place -- a doctor in practice replaces a doctor in name only. After those three years I would spend two years learning how to be an intensive care doctor -- an intensivist. A good portion of my life's efforts for the past ten years had been in the name of this process. I've taken on over $400,000 worth of debt in this process.

"Why do you want to be a doctor?"

This is a question that any pre-medical student hears frequently. I came up with many clever and thoughtful answers (not mutually exclusive) during that time, and over the years since my numerous medical school interviews. At the heart of it all was a desire to have a job where at least an element of "noble" potential remained. Physicians, by no means, have this type of job cornered. A customer service representative that does a good job helping people may enjoy a more noble career than some physicians I've met. I wanted a career which had a high ceiling for this esoteric idea of being noble, and that mixed with the other components of science, medicine and intrigue sealed the deal.

Due to a few personal reasons I've taken a step back and am not in residency. My classmates, for the most part are approaching the end of their first block of residency; their intern year 1/12 complete. I'm proud of them. They are averaging less than minimum wage pay per hour in the hopes of becoming competent enough to truly improve their patient's lives. And, it is not about the money. Physicians will be better off financially than most of the patients they treat. What it is about is being able to use the expertise and years and years of intensive training to practice medicine. Physicians in the United States have given this away, as if it meant nothing. One could argue it was wrestled away, but this is besides the point.

I've been working as a clinical consultant helping physician's deal with a new electronic medical record implementation in their clinic.

The frustration of being handicapped by administrative decisions is apparent.

The bitterness imbued by a bureaucratic machine that scolds physicians for writing pain medication prescriptions per their expert judgment (and makes it an enormous pain in the ass for the patient and amazingly large time sink for the clinic) but ties their compensation to patient satisfaction, is front and center.

The worry for patients that can't afford their medications, procedures, or imaging -- much less their deductibles detracts from the joy of catching a serious diagnosis early or reassuring a new mother.

The disrespect from patients who are frustrated with navigating the inhuman and cold machinery that is American healthcare is understandable, but slowly eroding the will to continue clinical medicine.

I thought I wanted to be an intensivist. I thought I wanted to help the sickest people and respectfully usher the dying and their families through the final phase of life which is waiting for us all. I would be good at it but the price to pay is not something that I'm willing to do.

Instead I am redoubling my efforts in areas that I believe allow for noble efforts that will be supported by me being a fully licensed physician. I started a consulting company aimed at creating education for medical professionals and patients. I wish to write in a capacity which fosters understanding that things are not "okay" and "business as usual" when it comes to medicine in this country. And, yes, it's not all about the money, but I am worried for my family's future when most of my student loans accrue interest at over 8% with a recapitalization of the interest annually. I feel compelled to have one foot in medicine and one in business and that is what I'm doing this year: assuming a businessman pose while re-entering residency a year from now. Oh yeah -- and getting my fat-ass in shape, too.

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