The thing I have realized most during this residency, many others ignored in this piece, is the truly endless ratrace that medicine leads us into. Making the transition into the third year of this confounding experience has highlighted, bolded and caps locked the unforgiving nature of the path I’ve chosen. I realize that I love it and hate it. I struggle with this slow falling sensation while small wisps of happiness, success, and human kindness keep me suspended in animation. This seems like a depressing start to a life long career. The dread upon exposing this particularly necrotic appearing corner of my subconscious was particularly disappointing, silently creeping and unknown. Would I open this and drain out the pus and be relieved or find it to continue slowly festering needing repeated debridement? Or, worst of all, would I find this spreading like wildfire, untamed and requiring more drastic measures?
What am I talking about, right? There is a pleathora of literature, fiction and more studied accounts, of the rigors of residency. However, this is just a passing discomfort. What I have realized is that, all the parts I love about medicine is not what I will be focusing on in future years. There are also many anecdotes and statistics out there now that describe this in greater detail. I’ve been flooded with journal upon journal article citing the more permanent discomfort of being a doctor in this modern age. How many of us suffer decreased payment, sell our souls to the larger health system so we may pay off the $300,000 and mortgage we owe without risking the life and limb of our progeny or forebears?
It doesn’t even seem so bad when you read the articles. True to form we are somewhat optimistic. It seems that many of us make life changes to follow the buck, the cheese that keeps on freaking moving. We buy into the EMR, buy the new treadmill stress test, and learn how to inject botox. We continue to roll our shit up hill so that maybe it will eventually lift us into retirement. There’s something to be said for our willingness to undergo all this change for lack of reward.
The paperwork we don’t have to worry about now because our licenses don’t matter, we will have to in a year or two. The current insurmountable to do lists will be replaced by an equally insurmountable task list. The more patients, the more they will need from us. Attempts at teaching us billing little prepare us for the rejections and the subsequent chase. Even plumbers have to tolerate some late payments. But at least they get paid their asking price. Certainly we wouldn’t want to over charge. But it’s terrible, on even a mock productivity sheet to see that billing $10,000 for the month gets me $4500. We may get these numbers but as of now, it’s still rare to get feedback on how to make that exchange less miserable.
Aside from the injustice of it all, residency doesn’t prepare us for what’s coming. The training, past first year is geared towards team management. Which is great, except if you become a hospitalist and you see and write orders, handle floor pages, and all the family meetings by yourself for half again the number of patients you used to carry. Or, if you go into a practice where you have to crank out some serious RVUs. Or, that all the home health orders come to you to sign and all the tasks and refills, and billing questions. It’s disheartening.
All I wanted was to do some primary care. Care, primarily. I’m sure many of us did. Before I realized the bleak prospects, I still had hopes of establishing a quaint and moderately profitable small group practice. It’s like I’ve just gotten to midmountain, only now realizing that there isn’t a downhill. The odds looking as long as they are, I am sorely tempted to cave and go specialize something pleasant and more lucrative for less stress. Who knows where I’ll end up these next 2 years. Here’s to true optimism that defies logic and maybe finding a rich husband maybe…..
Whistling of Wrens 