Stop Devaluing Your Valuable Medical Education
We exist in a fast food culture in which immediate gratification is a must. Education, in general, is not exempt from this mindset. This devaluation of education is nowhere better exemplified than in the proliferation of online degree mills in nearly all careers and professions. Overpriced schools with truncated curriculums and expedited degrees leading to the illusion of one possessing more knowledge than one actually has. Because the degree implies this is so.
In the specialty of medicine, devaluation of our expertise is prevalent. We are told that others with less or different training than ours can do what we do. Some of us question whether it might be more wise to advise others interested in the medical profession to choose another discipline within the health industry that will enable one to spend less money, less time in school and graduate with the potential to earn more income. I understand this sentiment completely. My perspective differs however. I want to bring us physicians back home. To remind us who we are, why we chose to do what we do and that it was, and is, indeed worth it. Take a seat.
I entered the medical profession because there was nothing else I wanted to do. Nothing. I knew it would be expensive, but I also knew the return on the investment would be great. The return was not just about compensation, it was about knowledge and my ability to use that information in ways unforeseen at the time. It was about the expertise I would soon possess to practice my craft. You see, I love being challenged. This love of being tested has never changed during my entire career.
No one can do what we can do…no one. They can only impersonate. My mechanic has 60+ years experience. Sure, I can work some on my car, but I will never know what he knows. And I know it. But I can imitate. And somewhere, I could find someone naive enough to allow me to work on their vehicle for a price, I just need to sell myself. And I’m an amazing saleswoman. However, I would never do this because I have a conscience.
It is so, so important to remember that we are the masters of our domain. Regardless of political correctness and accusations of arrogance, our proficiency cannot be ignored or denied. Attempts are made to demoralize us by belittling our education as foolish when we could have done less for more(supposedly). We cannot fall prey to that and give up. Why? Because it is simply not true.
For those of us who were present during the beginning of the AIDS crisis….have you forgotten that it was the primary care physicians in the community who rang the first alarm? They knew something was not right. They knew what they did not know. And they blew the whistle. Let’s also not ignore the multiple inventions and discoveries by physicians…Joseph Lister and the introduction of the antiseptic technique; Jonas Salk and Albert Sabin’s individual discoveries of the polio vaccine; Charles Richard Drew and his development of blood preservation in what we now refer to as blood banks; Patricia Bath, the first Black female physician to complete a residency in Opthalmology and her invention of the Laserphaco Probe for cataract treatment; Gerty Cori, the first woman to earn a Nobel Peace Prize for Medicine or Physiology when she discovered the enzyme responsible for the catalytic conversion of glycogen to glucose(remember that cycle from med school?)…and the list goes on. I am honored and humbled to be amongst such illustrious peers.
OUR PLACE IS IN MEDICINE. We have earned it. We are the leaders; we must own it unashamedly. What I find most abhorrent is the possibility that brilliant minds may fester and future innovations remain undiscovered because we physicians were too practical. I have no desire to encourage those who come after to take the path of least resistance because it is cheaper and easier. By doing so we ensure mediocrity in medicine. I want to inspire them to pursue excellence. It was never about the money for me…I will always make money. We, as a group, have the ability to mount a crusade against the overwhelming costs of medical education, and we will. It just won’t be at the expense of our education. The mind…the mind…the incredible mind….what a terrible thing to waste. Becoming a physician, waste we did not.
I am new here, but I’ve been in practice since 1988. I am curious why I do not see our specialty societies being held accountable for the misery and dissatisfaction in primary care. Are they not our medical unions? Do we not pay dues? Why is it ok to link rvu production- which is procedure biased- to compensation in primary care? Isn’t it an absolute conflict of interest for hospitals to own primary care practices, when they make money by admissions and quality care means avoiding admissions?
Why is it permissible for the AAFP to debate food deserts at their annual conventions and not FP compensation-work loads, rvu returns, etc. Although compensation is not the entire answer for dissatisfaction, it certainly plays a role.
Um, when I was treating a patient years ago, he looked at me and asked “Did you learn this in the service?”
And there you have it…
God bless you, Dr. Newman, for your dedication and sincerity.
As for me, I’m done. Every part of me is checked out, except the part that deposits the paycheck. I will fulfill my ethical and professional obligations, but the second I see a hole in the fence, I will run through it, and all you will see is my pink behind disappearing into the brush outside the wire.
I will never discover the cure for cancer, and every time that I have a patient encounter in which I am told that I am a great and caring physician, and that there are none left like me, I am actively disobeying the dictates of my employer and risking punishment, for wasting precious time with a single patient, when I could be generating revenue for the practice.
I can not be rid of this horrible profession fast enough.
What a shame to be so miserable. What a waste.
This is not on the profession. It is on you.
Hold up Rick. I have swatted the ball back and forth with Lance, and he knows his topic. The only time he pisses me off is when he beats me to comments I should’ve made but didn’t think of quickly enough. Lance is honest and direct. He doesn’t need me to defend him, but I have appreciated his remarks for the past decade, and I can tell that he has earned his opinion.
You might want to listen and learn.
Hi Rick.
Agreed: It is a shame.
Had I stayed with either of the two solid city jobs I had before getting the crazy idea to go to medical school, I’d have a smaller income, but much less debt, and I’d be retired now, with a pension, rather than looking at working for the rest of my life (unless I win the lottery or knock off a bank).
Unfortunately, just before the boom really dropped on Medicine, way back in the nineties, I believed the BS spouted by the medical schools, JAMA, and the like, about autonomy, fulfillment, professionalism, etc. I spent a tremendous amount of time, money, and effort preparing for, then completing med school and residency, only to utterly fail in my goal of having a small, no-insurance medical practice (incurring further debt), when there just weren’t enough patients to support it. Now, I have no choice but to work for “The Man,” where my every move (and probably keystroke) is scrutinized, where I have little choice regarding the type of medicine I practice, and none at all over all of the little things I looked forward to designing myself – decor, lighting, equipment, EMR (or index cards), staff, hours – you know, every single aspect of my working day, which is, and has been, completely dictated by someone else, just like coming to work in a call center or a factory. I’d love to do what Doug is doing, but I picked the wrong time and place to try it, and I have no resources left to try it again.
So, yeah, it’s a shame that a highly trained and qualified professional at an age when most people are thinking about their retirements, has to go to a miserable, fluorescent-lit building every day, punch a clock, cater to imbeciles, fear that any word can be taken as the basis for a patient complaint, and, when he does try earnestly to provide the best care possible, be “talked to” about his “productivity.”
I’m glad you’re happier in your job.
Points taken, Lance. Thanks.
Hey Lance. I truly feel your pain. I did work “for the man”. I worked for 2 competing hospital systems. When I tried to leave one hospital and join the competing system I was sued. I practiced with the King of Medicine. He taught me a lot. We battled the system and fought the good fight. 1. The only take away 25 years later is screw them. You are expendable to them. They will replace you in a heartbeat with a mid level. 2. Work for yourself. The system is screwing physicians. As you know they devalue you and your skills. They continue to hire replacements that are significantly less qualified. They don’t care. You have to break the shackles. I was soo burnt out until I quit the madness. Make a move, to private practice/DPC, you will never look back.
Thank you for your comment.
I am dedicated and loyal, to my patients and to myself. Not to any employer. When I wrote this “Letter to my colleagues”, it was as a result of the number of comments I had read in various forums in which they not only felt devalued, but were also being displaced or replaced by cheaper labor in the interest of profit. I wanted to remind them(us) that despite how the corporatization of medicine has destroyed the practice of medicine, it hasn’t changed our training, our skills or our education. It doesn’t have to negate our purpose or our oath, unless we allow it. I made the decision to go part-time 8 years ago. Although it hurt me financially, I do not regret my decision. Working in a metric-driven system was incongruous with my ethics and integrity. No one forgets their integrity/ethics, they relinquish it. I wasn’t willing. My specialty is EM. Similar to you, I spent time, not only interacting with my patients(I’m emergency medicine), but treating them the way I saw fit, knowing that it was a matter of time before I was terminated for practicing in a humane manner. I would get the same compliments, patients expressing how grateful they were for the wonderful care I provided and for listening. And I would have to tell them that if they ever came back to that ED, I most likely would not be there because I would have been terminated for doing exactly what I was doing, providing quality care and a quality experience. That is not rewarded in medicine. I had reached the point that I decided patients needed to know that physicians do not support the fast-food model of medicine, the C-suite does. So they would stop blaming physicians for all of the ills(pardon the pun)that have befallen medicine.
I left EM 1.5 years ago and will never practice it again in the U.S. Between the metrics and the increase in mid-level providers for whom I was forced to become responsible, it just wasn’t worth losing my peace of mind or license. I now work in correctional medicine. I don’t have to deal with the aggravation of metrics, I function autonomously and the inmates are very appreciative. I know I’m making a difference. That feeling trumps everything negative I felt working in corporatized medicine.
Good job! You offered a good “ long game” take.
Natalie, I thoroughly enjoyed your commentary. I agree physician education although lengthy, exhausting and expensive is critically necessary to provide the breadth of knowledge and experience to provide competent physicians as we transition to independent practice. No other clinician can provide the care and expertise we can despite what the media and lawmakers purport. A physician’s mind is invaluable.