Saturday, June 9, 2012

Written In Crayon

Doc, what do you think happened?

I stood quietly next the police officer and coroner.  The first rays of sunlight unexpectedly pierced the darkness of the nursing home and illuminated the grisly scene. The patient laid perfectly still on the bed.  His rigid body was pale in comparison to the shockingly red blood that stained everything in the room.  The sheets, the floor, and the nurses call button were all but unrecognizable. 

I winced as I inspected the body.  There were no signs of loss from the mouth or rectum.  The greatest puddle surrounded the dialysis fistula.  I beckoned for the policeman to come over and take a look.  The coroner shook his head in confirmation as he spoke.

It must of been pretty quick, the nurse said it was quiet all evening.

I peeled the gloves off my hands and turned to leave the room.  As physicians, we are often shielded from the untidiness of death.  For the most part, our patients die in hospitals, clean and swaddled in the bosom of our medical machinations.

Of course we experience loss all the time, but until one is confronted with the sudden and incontrovertible proof, we allow denial to protect us from what is actually happening.


In various blog posts, I have written about the extinction of the modern day physician.  Although many agree with my viewpoint, there is a solid argument that I am being overly dramatic.  The detractors say that when you look at the statistics, there is no evidence off mass exodus.  Dissatisfaction may be slightly on the rise, but the physician work force is as strong as ever.

I think the error in such reasoning is that if one is looking for hemorrhage, they will not find it.  The flight of the American physician is much more subtle.  There is no rapid exsanguination, the marrow of a profession will deplete at a much more leisurely pace.

The evidence speaks for itself.  The red headed step children of the profession, the primary care doctors, are the first to leave the room.  Overworked and under payed, the next generation is avoiding this specialty like the plague.  No one denies that what once was respected as the core of medicine, will be handed over to non physician practitioners in the near future.  But as the economic whirlwind of our national debt becomes even more hungry, further cuts will be required to feed the beast.  The number of trainees aspiring to become cardiologists and general surgeons will decline as they become the next to go on the chopping block.

Recent evidence suggests that more physicians are choosing work/life balance over loyalty to the field.  Although the number of phsycians may remain constant, the actual physician hours are declining as a greater percentage of the workforce becomes part time.  Older physicians are retiring early, and younger physicians are choosing shift work and hospitalism over the drudgery of long term care.

And yes, doctors are cutting back clinical hours, taking administrative positions, and becoming consultants.

I believe the writing is already on the wall. 

You can't blame us if we decided to use crayon,

and not our own blood.


CarLoS said...

I´m amazed over the similarities with the present situation here in Europe. But around here, students are already running away from Internal Medicine (Family Medicine is on the black list of careers long ago ...) And because of poor planning and bad politics, young students are going abroad because they have no place in the labor market.

Mark C said...


Sometimes you need a dramatic analogy to make a point... it helps to drive it home.

You are correct to note that IM will be the first of many medical specialties to be reworked into an employed/restricted business model. The writing is on the wall, floor and ceiling at this point.