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Letter to the editor

July 2011

What does it mean to be a passionate and dedicated physician? That question now seems to be more frequently debated, given the confluence of changes in medicine that continue to make Marcus Welby, MD, a distant memory.

First, physicians increasingly no longer own their own practices. Second, even if they do, all the bureaucracy inherent in ownership has created a palpable disconnect between the love of practice and the actual practice of medicine. And third, many doctors going into medicine are looking from the get-go for a field that offers them the ability to work less than full time.

Why are more doctors in general and hospitalists in particular opting for part-time work? I’m often pondering such things while pouring milk into my Fruit Loops each morning. Over one such fine breakfast, halfway through my bowl of sugar and other artificial flavors, I noticed an editorial by Dr. Karen Sibert, an accomplished anesthesiologist. While I risk taking it out of context from the full editorial, here’s an excerpt:

“I’m a doctor and a mother of four, and I have always practiced medicine full time … Today, however an increasing number of doctors, mostly women, decide to work part time. This may seem like a personal decision, but it has serious consequences for patients and the public. It’s fair to ask them – women especially – to consider conflicting demands that medicine and parenthood make. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.  Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work.”

Wow. Maybe in the future, instead of taking the MCATs, we can just all get sterilized. In all seriousness, I do get the point – I think. If you choose to be a doctor, you better be “all in.” Ours is not a field for those who seek balance in life. With great responsibility comes great sacrifice.

Well, so much for vacation, and forget about that second kid. While I certainly don’t begrudge those who are willing to completely their life to their job, I do resent the idea that those who do not are somehow less of a physician. The idea that part time is inferior to full-time is, of course, ludicrous.

I don’t think I have ever written a letter to an editor; this is as close as I will come via my blog, so there is no stopping me now. Said letter would question the idea that we are somehow responsible for a health care system that has traditionally made it exceedingly hard to be anything but a person with few responsibilities for child care or other non-job related duties.

As Dr. Sibert wrote, “In a perfect world, hospitals could [set] up child care centers. In the meantime we can only depend on the doctors’ own commitment to the profession. What? We can and should expect doctors to reject the idea that they owe the profession more than compassionate and dedicated care to their patients. We aren’t indentured servants. If we wish to work less, the only retribution we should expect is a concomitant decrease in pay.

We all want dedicated doctors. By and large, people who provide care are some of the most committed people you will ever meet. However, this dedication is increasingly delivered within a shift or limited workday.

Those shifts when tallied up may equal 20 hours, 40 hours, maybe even (still) 100 hours a week. It is what you do in those hours that counts, not how many you work.

Which leads me back to what I found to be the editorial’s central premise: the notion that if you aren’t fully committed, you aren’t committed. Dr. Siebert offered one aspiring physician who envisioned a family the following advice on work-life balance, “if want to be a doctor, be a doctor.”

Good grief. If you want to be a doctor, absolutely be a great doctor. And if you decide to be a great doctor who works two days a week, fantastic, be that great doctor two days a week. Again, no one should assume that the doctor working 20 hours has less of a capacity for empathy and compassion than the doctor who has embraced his or her “calling” by working 100 hours. In fact, many might rightly argue just the opposite.

In my mind, there is no better job than one that allows you both the intellectual stimulation of being a physician and the ability to use that knowledge to help people. The road to this professional achievement is full of long, hard work, and it requires substantial financial and emotional sacrifice.

But when you end your formal education, your duty is to the individual patient. You aren’t some widget produced by the medical educational system that now must produce 80-hour workweeks or prove defective. Whether you treat one patient with compassion or one million, there is nothing more honorable than being a dedicated physician to each patient you treat. To think otherwise is to reject many of the very professionals our health care system desperately needs.