To mix my metaphors lately I've been questioning why I'm beating my head against a while fighting an uphill battle instead of just taking the path of least resistance.
I have realized for some time that in my late 30's I'm already a dinosaur. The numbers of family physicians who provide full spectrum care are dwindling. When I was going through residency it seemed to be everyone practicing obstetrics was stopping. Now everyone seems content handing over their patients to hospitalists and letting go of their inpatient privileges.
Certainly the health care system supports this transition. The current reimbursement system encourages constant production and episodic care, so the most efficient way to make a living becomes staying in one place and cranking through as many patients as possible. Hospitals are constantly enamoured with well paying orthopedic and cardiovascular procedures and are content to hire on hospitalists to meet the specialists needs while they don't shed a tear over the loss their primary care medical staff.
If you ask family physicians why they have chosen to limit their practices to the outpatient world, they will certainly offer many other valid reasons in addition to economic ones. Who wants to take call in the middle of the night when the efforts are not valued by colleagues, the system, or patients? Limiting one's practice may increase the opportunities one has to find that elusive balance between personal and professional life.
So why continue to see patients from the delivery room to the nursing home? To use another metaphor, isn't the handwriting on the wall?