Last week I had lunch with a friend. Then I listened to someone being interviewed on NPR. In a twisted kind of way, the two things got me thinking about primary care.
My friend is a family doctor in a large multispecialty practice. From the outside he appears happy. He has lots of patients, works hard, and is well compensated (compared to other primary care docs). He believes he is giving good care to his patients, but he is constantly running over an hour behind because he likes to make sure his patients get the education they need. His group is willing to listen to the individual providers and work with them to make things better, and he loves the collegiality of the larger system. But sadly, he feels like he has lost his calling. Although he readily admits he could forsee continuing on in this manner until retirement at age 65, he no longer feels passionate about what he does. Financial reimbursment insanities have forced the scope of his practice to narrow to a point where he is doing nothing but geriatrics. He likes geriatrics, but he longs for the generalist vision he initially fell in love with but feels he can no longer attain. After all, there is not enough time to do simple dermatologic procedures when a derm referral is readily available within the group. He has done hundreds of vasectomies, but cannot continue these because in our state, doing one/year pushes the malpractice premium to that of a urologist, so he cringes every time he sends one of these to the urologist down the road. He loves the idea of Family Medicine but admits that if a med student rotated with him, they would not choose family medicine as their calling. There is no more edge, no more variation. Everything has become somewhat vanilla with no spice.
Then I listened to an interview on NPR where an author was discussing her book. The interviewer asked if she was afraid of publishing her views knowing some religious groups would find them offensive. She stated something like she is a writer. She has to write. She cannot be worried about what others might think because if she did not write, she would cease to exist. (Ok, that was totally my take and not the actual transcript. Suffice it to say, her passion was palpable).
So, I could not help but wonder what happens to the passion of most primary care docs. We all had the passion of that author at one point. We all remember the first unusual diagnosis, the first procedures, the fear of leaving the shelter of residency, and the excitement of spreading our own wings and doing our own thing. During that time, we too were passionate. What happens? Do we become like dogs in our own Skinner Box being inundated by random insanities until we succumb to learned helplessness? If we told the author she could only write about noncontroversial topics, would she lose her passion and desire to be an accountant instead?
Life without passion is not something I am willing to resign myself to. I have to believe we can change the system so those of us who are passionate can continue to be so for years to come and those whose passion has been lost in the ashes can potentially be rekindled. Doing this is essential for our lives and the lives of our patients.
John Brady, MD, FAAFP
Newport News, VA