Monday, September 1, 2008

Hard Decisions

So, in the face of a new addition to the family my thoughts have turned somewhat to the future. As impossible as it seems, I am only a little less than 2 years from having a 'real' job (with an accompanying very "real" school debt). What, then, to do when I grow up? How to put food on the table and pay the bills?

This has been a long struggle for me for a variety of reasons. For those of you who know me at all, you are very well aware that I absolutely detest residency and as an extension, Internal Medicine, and as an extension of that, doctoring as a whole. I think it is a field that is full of false promises, that attracts those who want to care and the prevents them from doing so, at least in residency. The inhumane hours, workload, ever-increasing oversight and decreasing compensation for same (not that you see any of that in residency) saps even the most optimistic of all humanity. I myself have wished all my patients dead just for a few extra hours of sleep, and that is a literal statement, not an exaggeration. This darker side struggles against the light and caring I found in me long ago in a far off land, and lately it's the dark what's winning the battle. I also struggle with the same problem Glenn Walker faces--at what point has the job taken over? Where is the balance between family, self, God, and work? Should I give the best of my effors at the job, or should I save that for some other aspect of my life? Have I wrecked my own hopes on the ragged shores of doctoring?

I think, in the end, it comes down to what I can tolerate. After much thought, about the only time I seem to enjoy doctoring is when I have the TIME to do the job the way I see fit. This is, of course, the antithesis to what modern doctoring is about. Certainly there is no place for proper care in the outpatient setting, what with appointments scheduled every 15 minutes even for the most complex patient. This rules out essentially every speciality except possibly critical care and hospitalist work. Fortunately, I don't mind those two as much, and that's probably where I will end up, for a while at least. I suspect that at some future point my own sanity will require that I leave medicine as a field and find something else.

One other note--it's very hard to try and make decisions about what you want to do as an attending physician when you are in the midst of residency. Residency programs come with such a high added burden of pure chaos that it's nearly impossible to gauge what your life will be like without 7 additional hours (that's an average, some days higher, some lower) of garbage of questionable utility. What could I do with an extra 7 hours per day? It boggles the mind.


Claudia and Glenn Walker said...

So you're telling me residency isn't better?! Ah, man! :) Just kidding, and thanks for the insightful post. I have a lot of conflicts, but thankfully I love surgery and hopefully it'll work out. I still wonder almost every day if all this is worth it, and continue to hope it is. I believe it will be, but I'm with you: the hoops and struggles of going through medical school and residency are a cost that feels just too high to pay. The system's just not right, but the end result will hopefully be enough.

jaredski said...

Call me a foolish optimist, but I think there's a place in medicine for even you. Granted, my residency (pathology) was much more reasonable with the hours, so that may account for my optimism. But I think in any specialty, if you want to work less hours, then you should structure your work that way. If you want to make huge money then you'll have to work insane hours, but if you're content to make a more modest amount I would think you could find something to suit you.

One example is a friend from med school who quit residency with 3 months left because he was disillusioned, as you are, with the system (and had a fight with his program director). He started his own family med clinic focusing on osteopathic manipulation, acupuncture, and alternative remedies. Whatever you think of its scientific value, you can't deny that he's serving a niche clientele, working for himself, and enjoying his life.

Good luck with the hard decisions. If you can just survive the residency, I think things will get better. You'll have the freedom to do what you want.

Anonymous said...

I'm 3 years away from finishing my radiology residency and I'm pretty sure I'm going to quit. No matter how you spin it, I have just come to the conclusion that I dislike it and cannot see myself doing this for the rest of my life. Certainly, there's something to be said for holding onto a job for the sake of practicality, but at the same time, I can think of few things worse than dedicating such a huge chunk of life to something that makes you unhappy. As doctors, we have many career options, moreso than we realize. You, in particular, who will have finished residency will have many opportunities to explore other careers -- whether in finance, health care services, entrepreneurship, writing/journalism, medical advisory, etc.

It's great that you've made the realization so early on. Now you're in a great position to design a career that you want! Good luck.