Sunday, October 5, 2008

blogging dogggeral, physician culture, medial students, debt - Physician Forks in the Road

Two roads diverge in a yellow wood
And sorry I could not travel both
And be one traveling long I stood
And looked down one as far as I could see
To where it bent in the undergrowth.

Robert Frost (1874-1963), Road Not Taken (1916)

Doctors are forking one way or another= employment or competition.
.In most markets, physician-hospital relationships will continue to be split along these two separate paths.

Elyas Bakhtiari, “Polarized Hospital-Physician Relationships, Healthleaders Media. September 18, 2008

Individualism lies at the very core of American culture...Our highest and noblest aspirations, not only for ourselves, but for those we care about, for our society and the world, are closely linked to our individualism.

Robert Bellah, et al, Habits of the Heart: Individualism and Commitment in American Life, 1985

For potential future doctors, the decision tree has many a fork,
Decision branching begins in earnest in college,
Should one pick medicine or something with more financial torque,
something taking fewer years and less accumulated knowledge?

But if one wants to be one’s own boss,
Blessed with something called autonomy,
For future physicians that may win the toss,
It beats being just another corporate anomaly.

Then comes four years of medical school,
Where one learns the best and the brightest,
Gravitate towards specialties where higher rewards are the rule.
And results of high technologies one becomes most excited.

Quite often one marries a fellow student,
For women now make up half of medical school classes,
Both spouses are realistic, intelligent, and prudent,
They are no fools, these medical lads and lasses.

Slowly begins to set in a sense of realism,
a feeling there is more to life than sheer care giving,
There’s a palpable fading of humanitarian idealism,
a feeling that creditors and loan officers are not always forgiving.

Residency training and fellowships follows,
Four to six more years of intense concentration.
As deeper and deeper into debt one wallows,
Sometimes with $200,000 of debt accumulation.

Choosing the right residency road is relatively easy,
It boils down to a choice was between primary care and a specialty,
Long hours and low primary care pay makes one queasy,
Whereas shorter hours and higher fees in specialties are practically a guarantee.

Medical students have sharp minds, eyes, and ears,
In clerkships they see primary doctors are frustrated,
They hear from doctors in the field of their many fears.
They know pay for time is low and for procedures inflated.

Finally came another decision branch
Whether to work for the hospital
Or to pursue one’s own tranche,
For many either choice is inhospitable.

In the end many pick the road now more traveled,
The one that offers security, time off, and lifestyle,
The one that keeps income from being unraveled.
The one on the employment side of the aisle.

But others, orthopedists, heart specialists, and others who operate, insert, erase, and replace,
prefer ownership, innovation, and entrepreneurship,
Controlling their hours, expenses, and profits in their own place.
And being masters of their own clinical ship.

In the end, it may come down to tension between physician individualism,
And commitment to an organizational or national cause,
Some say the current economic crisis signals a drift towards progressive capitalism or socialism,
It’s enough to give individual physicians pause.

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