A couple of interesting posts in DB Rants and Panda Bear recently regarding the nature of what it means to be a doctor. Specifically in the DB piece, I was surprised by the vehement responses from medical students and residents defending lifestyle and monetary compensation as legitimate guides to specialty choice. Now mind you, most of these posts were well written and carefully thought out. Diminishing reimbursement, long hours, and lack of respect were all cited as sources of disillusionment and justification for younger physicians to pursue opportunities in fields more conducive to a) better earning power and b) more flexible hours and improved lifestyle. Applications to primary care and internal medicine have tailed off. General surgery became a much less competitive field over the past ten years as numbers of interested fourth year students decreased (attenuated somewhat by the recent implementation of work hour reform). The best and brightest of our medical students, the AOA bunch, are gravitating toward specialties like dermatology and radiology and I wonder if this is something to be concerned about. There is a sense of entitlement found in recent medical graduates that I find a little shocking. The thinking goes, "I busted my ass, got the top grades, made AOA, racked up $150,000 in debt, now it's time for a little retribution. Why should I slave away as a 'provider' for some mega-corporation HMO that seemingly randomly denies payment for this or that procedure/admission/test?" Compelling argument indeed. But an important detail is conveniently omitted; no one forces anyone to be a doctor. There's plenty of ways to make a bundle of money and have weekends off. Manage a fund. Become a broker. Run a 4.2 40 meter dash. I don't think medicine is supposed to necessarily be a default pathway for "really smart" kids who happen get high scores on MCAT's. We live in a meritocratic society, I understand that. But I think you compromise a core principle of medicine when practitioners see the job more as a reward for high achievement, rather than a privilege to be treated with humility and respect. A classic quote that killed me: "Ultimately, medicine is a job." If medicine is simply a job, a way to kill some time between the hours of 8 and 5, then I think we're all in trouble.
The whole concept of "just a job" fascinates me. It used to be, man's identity was intimately tied up in his caste or profession. Warrior classes, the clergy, the nobility, merchants, even the peasant classes. As a surgeon who trained just before the era of work hour reform, I'm a little biased, but truly, how can I honestly separate what I do every day, all day, the rest of my life, from who I am? I am a surgeon. It's a big part of who I am. I spent almost twenty years in school training for this. I spend the bulk of my waking hours thinking and doing surgery, taking care of patients. Not that I'm a one dimensional automaton. I have a wife. I read voraciously. I watch too much sports. I work out. I mean, I live a pretty regular life. But if one's self identity isn't dependent to some extent on what one does for a living, I don't know what else is left. Are you "that guy who's married and has two kids"? Or the woman who "likes to paint reprints of Cezanne on the weekends"? I think a cursory review of human history demonstrates that only recently have we considered those who "define themselves by the work they do" as somehow pathologic and subhuman. "It's just a job" denigrates all those conscious hours one expends during the day as mere frippery, an unessential, meaningless experience. One reason for this may be the way the workforce has changed. Factory jobs are gone. Agriculture long ago ceased to be a viable occupation for the average person. Most people are employed in the service industry, or involved in sales/marketing of mass-produced merchandise that they really could care less about. Is it any surprise that someone who sits in a halogen soaked cubicle all day hawking widgets would rather define his or herself by something other than "paeon of giant corporate conglomeration"? As a surgeon, as any physician, that isn't an issue. I'm lucky enough to be involved in an occupation that allows me to help people directly, every single day. It isn't "just a job". To consider it as such would be disrespectful to all the patients who come to me seeking to be made well again.