Being a physician isn't easy.

Here's an article from the NYtimes.

While this doesn't have much to do with geriatrics, I thought I'd weigh in. The premise of this article is that since medical school and residency are subsidized by the states and the federal gov't through Medicare, there is a social obligation for physicians to serve the greater good and put the good of society above individual goals such as family and lifestyle. This is especially true in primary care specialties. And since women are the dominant subgroup of physicians who work part time, women ought to be ashamed of themselves for being so selfish. So says the anesthesiologist who clearly didn't care to meet the primary care needs in the country herself despite her subsidized education. For the sake of brevity, I'll make my points in a list:

1. It is not the job of women medical students to shoulder the burden of the primary care shortage in the US. Physicians should not have to (and I would argue can not) make up for major shifts in specialty choice driven by economics, public policy, the health insurance landscape and specialists like anesthesiologists.

2. Medical school is no more subsidized than any other public school education. Going to a public school is a benefit by working people paying taxes (of which doctors will pay a lot). No one expects those who go to public universities to enter public service in other fields and expecting that in medicine makes no sense. Why not ask it of lawyers? Or MBA types?

3. While residency is subsidized by the government through medicare, I would argue that the residents themselves subsidize their own education by taking a low salary while working long hours and sacrificing much in their personal lives. While the government does subsidize graduate medical education, they also set the rules that resident physicians (who are licensed physicians) can not bill for their services. So the subsidy is really just another way of paying a salary that is justly earned. If the subsidy goes away, then resident physicians ought to be able to bill for their services.

4. Part time women physicians bring incredible balance, perspective, talents to the physician work force that would not be there otherwise. If it was mandated that all physicians had to serve full time for 10 years after residency, I would think that the percent of women physicians would drop and medicine would be far worse off because of that.

5. It is too easy to look at physicians who work less than you and criticize their lack of dedication. As someone who worked as a solo doc, on call 24/7, seeing my patients 7 days a week in the hospital, I could be critical of a shift working anesthesiologist who hands off patients to other docs. How dare she think that transitioning patients between docs is good care? Where is her dedication? Doctors have to quit trying to guess each other's motives and just judge the quality of medicine that is practiced.

6. I would argue that having a healthy private family life is good for professional life.

7. Notice that there is no critique of the quality of part time physicians. If patients want a full time physician then they can select one. If they are satisfied with a part time physician, then where is the harm?

8. Students already graduate with $150,000 debt (average) which grows during residency. This is the reason that out of 20-25,000 medical students, only 90 choose geriatrics. Saying that medicals students are not appreciative of their subsidized education is incredibly insensitive to students who choose not to be anesthesiologist who make 3-4 times what a geriatrician makes ($100,000 to 150,000).

9. The shortage of doctors in this country is a problem of public policy, medical education, not women physician who choose to work part time. Why are women to be blamed for this instead of the men?

10. How is working full time her only metric of what it means to be a good doctor? She has defined it so that she meets the definition and other women don't. But what is she doing to correct the primary care shortage, health care discrepancies, deal with the underserved? No offense to my anesthesiology colleagues, but when I used to round in the hospital seven days a week, go to my office afterwards for a full day of clinic five days a week, go to football games on Friday nights, work in the ER one shift a week, do 200-300 physicals at the elementary and high school once a semester, teach about smoking to 4th graders, do home visits during lunch, attend deliveries at night, see my nursing home patients once a month, work as a medical director of a nursing home and hospice, teach PA students in my office, I felt more like a doctor than the anesthesiologist who worked half my hours but was still "full time." Yet somehow this anesthesiologist sees herself as enough of an ideal doctor to look down on others. Sigh...... I won't even mention some of my doctor friends who are working in rural third world countries. My work pales in comparison to their dedication.

At the end of the day, being a doctor isn't easy. The training asks for enough sacrifices on its own. It's too easy for a doc to criticize anyone working less than them as being lazy and anyone working harder than them as being a workaholic. I knew a doc who said his patients came before his wife. She would get hospitalized for overdoses a couple times a year but he felt if you didn't put your patients first, you weren't a real doctor. I knew another doc who felt if your office wasn't your house (i.e. work downstairs, live upstairs), you weren't a real doctor. This crazy machismo competition has got to end. At the end, if we practice good quality medicine, we should be proud whether it is a little bit or a lot. Just doing that is hard enough.

so much for brevity