The chronicle of a lonely do-gooder family doctor who survived.

Tuesday, November 18, 2008

I am out of here...

Well, I did it.

I told everyone I'd wait until the election to make a decision about my future career plans, but in the end it didn't matter. Every day as I drive in to the hospital that sense of dread starts to fill up my stomach and grows stronger until I pull in to my parking space and trudge up the stairs confident I am about to spend another 12 hours doing mostly unpaid work as the agent of a system that utterly fails everyone involved.

I expect headaches in my job. I mean, it's the doctor who is supposed to be the lone hero in the middle of the bureaucratic insurance mess, who is desperately trying to make the system work for the patients, and even once in a while trying to save a life. And it's important work. There are times when families genuinely appreciate the work I do, moments when I feel actual satisfaction.

But those moments are becoming less frequent and the personal cost to me is becoming too difficult to bear. When I approach the end of each year and take stock of what it is I'm doing with my life, I can't ignore the fact that I am working longer and longer hours, doing less and less good for my patients, for a salary that still causes me to sweat the end of the month, hoping I won't have to use credit cards to pick up the short fall of the mortgage and student loan payments.

I love my patients. I mean, I really pour my heart into my practice and try to see the joy I used to know playing an active role in the most intimate, powerful moments in the lives of those I serve. Saying goodbye to them has been truly wrenching.

Despite the hope that the Obama election has given me, I am getting out of the private medical insurance game. The system is totally corrupt, likely unsalvagable. I hope to never go back. I have taken a job at a small community health center, much closer to home, at a reduced schedule, seeing mostly homeless and uninsured patients.

The doctors who work here still have some of that joy that led them to answer the call of medicine. They are dynamic and have an energy about what they do that I have only rarely seen in 8 years of private practice. They are true family physicians who see their patients in the hospital, who deliver their babies, and who help those babies grow up as healthy as they can. That's what I want.

Sure they have bureaucracy and headaches to deal with, but it's not from a system that is financially gouging their patients, it's not from a system that is supposed to be working. There's no illusion that this here is the safety net, the clinic of last resort and no one feels unappreciated.

Going back to The Suitcase Clinic at Berkeley, where I was first exposed to the difference that access to health care could make in someone's life, and extending through my residency at the county hospital here in Seattle, this is the work I have wanted to do for a long time. I just never thought I could do it, and still have a family, and a house, and pay off my loans, and who knows maybe every once in a while pay for a ski holiday. But with a baby on the way, I see myself coming home later and later every day with less and less job satisfaction and I now realize that I can't afford to *not* work in a place that preserves the integrity, the soul of medicine. The paycheck doesn't matter, the work does.

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