Medicine – great job, no room for imagination

So finally after two years of painful examinations and sitting in the classroom, my schedule is finally my own . . . sort of . . . Board exams which are coming up in June are around the corner and there is STILL that sense of something hanging over you, something foreboding, another test, another milestone ahead that we must reach, whether its by running, walking or crawling . . .

Its easy to buy into the myth of the “promised land” in medicine. It is easy to admire those urologists, dermatologists, anesthesiologists, radiologists with their tidy little salaries and the “perks” that they have to do what they “love” and ONLY work 60-70hrs a week. After all, if one were to be paying $50k a year in tuition, it BETTER be for something right?

Yet as I sit here procrastinating in the library, I came across an article about Al Gore and the freedom he has now that he is not in politics to be on the board of a private equity company, give presentations about global warming, advising Apple and Google on their business strategy and as usual it reminded me of all the other things in life one misses out on when one enters this profession, or should I say this priesthood that is medicine. In fact, as you look at the average life of a physician, the objective really is to have a stable, well paying, prestigious and interesting job around which the rest of your life is supposed to orbit. When I compare this to the life I would choose to live if I were not in med school, it lacks the spontaneity, the imagination that I think defines who I am. I want to be able to fly to Nice for Cannes and connect what I learn about human nature there to setting up a agricultural project in Burundi, visit my familiy and friends in Taiwan and Japan on the way back to the states for a business meeting while finishing a few interesting books and eating some good meals along the way.

What is the problem with medicine? Its not just the hours in medicine that really prevents physicians from living a life like this, its the culture which replaces the room for imagination and creativity with patriarchy. Ever since the first day of orientation, my life has been planned out, circumbscribed, and micromanaged for me. You are expected to respect a hierarchy. There is an attending physician and below him (sorry ladies, most physicians in positions of authority are still male) a resident and below them an intern then there is the medical student who gets all giddy when they get to do ANYTHING of significance. Within this culture, it is no wonder people are leaving medicine. I heard recently from Dr. B that 3-4% of medical students in the country enter medical school with NO INTENTION of practicing medicine. In fact, I would argue that once training is over, that number is doubled. Take our graduating class of MD/MBA students at DMS this year. 4 out of 6 are going into consulting or banking and to be honest, if some of the other DMSers that did not have exposure to Tuck and the possibility of doing anything OTHER than medicine were properly exposed, I could see 20% or more of the graduating class going into a non medical profession. I think the reason is clear, the cult that exists in medicine really turns away the most imaginative and entrepreneurial individuals that enter medicine. How does this impact patient care? Well it has certainly narrowed the role of physicians to one of being bystanders. I would argue that most of the profound decisions and innovations occur outside of the purview and even peripheral vision of physicians.

Things like new drug or new device discovery, health management and organization building, health care policy, things that really impact the way health care works is done by non full time clinicians (the business execs, consultants, entrepreneurs and inventors may have MD behind their name but generally do not practice medicine). THEY make the real important decisions in medicine, NOT physicians who are mere bystanders in the process

Wow what a rant, I guess procrastinating is really getting to me . . . . anyway better continue this another time before I fail boards.