It's worse to be a chemist--and other responses to unhappy physicians

Yesterday’s post, trying to reconcile heartfelt physician concerns about the evolving practice of medicine with data suggesting more students than ever are pursuing medicine as a career, clearly touched  a nerve,  drawing  a range of thoughtful responses, many from Twitter.

I was encouraged by the number of doctors who wrote that on balance, everything is (still) (pretty) awesome.   It was especially heartening to hear this view from front-line physicians, like my former colleague Jamie Beckerman (“As a front-liner myself, I couldn’t imagine doing anything else. I love it every day.”) and UCSF internist and researcher Urmimala Sarkar, “There IS something special and unique about medicine. Lucky and grateful in #primarycare!”

Some academic and policy-oriented physicians, such as Ashish Jha and Aaron Carroll, were if anything, more emphatic.  Their basic perspective: physicians have it really good and should stop whining.

On the other hand, some thoughtful critics noted that many of those most enthusiastic about medicine aren’t doing it all of the time.  Perhaps these “part-time” docs (or worse, folks like me who are now non-practicing docs) can idealize and glorify medical practice precisely because they’re not in the trenches, fighting the battles every day.  (I’d like to think I’m reasonably attuned to current concerns – see herehere.)

Some critics also suggested that prospective med students and young trainees may not really know what they’re getting into (“Applicants don’t know any better,” one respondent grumbled) – or might not hear the advice they receive.  “Every Dr I know says they wouldn’t do it over again but they ignored the same advice as students,” tweets biologist Ken Fortino .  Moreover, as VC and physician Justin Klein points out, “It’s hard to appreciate the nature of the job until you do it.”

The always-thoughtful (and fellow Forbes physician contributor) Ford Vox (see this recent gem) pointed out that physician satisifaction may depend a lot on where you’re working – and of course he’s right.  My current PCP, at One Medical Groupseems far less harried than my previous PCP, and tells me that a key reason she joined One Medical was precisely for the opportunity to practice medicine in a fashion that’s less rushed and closer to her original ideal.  The opportunity for a more fulfilling practice is a draw not only for traditional concierge practices (or concierge-light practices like One Medical), but also for innovative primary care practices such as Rushika Fernandopulle’sIora Health.  While happier physicians are likely to result in more satisfied patients, this may not inevitably translate into improved outcomes (a disconnect this recent Onion story wryly observes).

The need for perspective was suggested by UCSF physician-scientist Ethan Weiss: “I think being a doctor is still great. It is being a scientist I am worried about,” and even more poignantly by former industry chemist John Tucker: “The bloodbath among my peers in recent years has probably made me excessively intolerant of the complaining.”  As VC Nimesh Shah nicelysummarizes, “versus the avg working American it’s still a well paying job with exceptionally low unemployment.”

Perhaps my favorite response was from AliveCor founder and cardiologist (and my 2013 Digital Health Entrepreneur Of The Year) Dave Albert, who notes that his wife “works 4 proto-ACO, gripes about Epic & loves being a doctor” and“our MS2 [second-year medical student] son heard all the horror stories. Picked medicine (probably IM[internal medicine]) over Investment Banking.”

Perhaps there’s hope for medicine’s future after all.

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David
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