We Hold These Truths To Be Self Evident

This past week my email account exploded.  Friends, blog followers, and the twitterverse have reached out, all with one question on their mind. 

Is everything alright?  Are you OK?

My answer is a resounding yes.  As I mentioned in a recent post, revolutions come in all sizes, large and small.  They also come in all speeds.  Some coups occur overnight, others are years in the making.  My decisions broadcasted over the web in the last week were nothing if not measured.  I've spent years building a foundation for change.  I've kept my ear to the ground and one finger to the air testing the winds of change.  And change is coming. 

This is as much the end of as journey as the beginning of one.  Years ago, I set the motions in process to develop other revenue streams outside of my office practice.  As those streams have become brooks and eventually gushing rivers, I have felt the pull from deep down inside.

We hold these truths to be self evident...

The dictates of dignity hold that we must believe in a certain innate value in ourselves.  We craft this sense of self in our relationships, in our families, and in our life's work.  The value proposition is not only based on our skills and abilities, but also on our identity. 

At times we give this value to others without monetary compensation.  We invest in a  spouse, children, and friends.  These connections reap the reward of human kindness, love, and companionship and are thus (if one is lucky) paid back in spades. 

We also trade our value for material wealth.  That value may be a skill, or possibly a unit of work.  Long held theories have based the worth of this value on the markets want or need for such a product.  These theories, while much respected in college courses in economics, often forget to take into account the provider of such skills or services.  In other words, only the individual can decide how much he will or will not accept for the value he brings to the world.  In this way these theories are flawed. I can always decide to withdraw from the market. 

To accept a paltry sum for your value is to denigrate your worth, to minimize your individuality. 

The primary care physician of today is accepting less for more and more .  The administrative duties expand: face to face forms, computerized order entry, preauthoriztion, med reconciliation, and the list goes on.

I have reached a tipping point.  I believe my value is worth more than the current system is willing to give.  I can grin and bear it like my fellow physicians, or I can make my stand.

I will not give myself willingly to a system that does not believe in the worth of my abilities.  To do so is to harm my patients as well as myself.  The treadmill of clinical care is currently serving no master particularly well.  

I will not abandon clinical care. 

But I also will not accept what is being proffered me.