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Should She Be A Doctor?

Posted Apr 20 2013 2:12pm

Last weekend, after I gave a speech at a public forum about healthcare, a woman came up to the podium and asked me a question. “My daughter was just accepted to medical school. Do you think she should be a doctor?” This should have been the easiest question ever, but was the opposite.

I come from a family of physicians going back more than three generations. It is what we did, what we were. At a family gathering several years ago, I counted at least 14 men or women who were practicing physicians. Three of the fourteen doctors had married medical school classmates, raising the ‘family’ number to seventeen.

Our family believed that the highest calling for a human being was to heal other human beings. So, it should have been easy and immediate for me to say to the mother at the podium, “Of course, your daughter should be a physician. There is nothing better in the entire world!” It pained me not to say that.

A recent Wall Street Journal article written by another physician, more precisely ex-physician Dr. Ed Marsh, expresses several emotions all too common in the community of health care providers: doctors, nurses, and allied health personnel. We are angry, frustrated, and confused.

Prematurely retired Dr. Marsh summarized: “The glow of the personal relationship one might have with one’s patients [the reason we get up in the middle of the night for you] is being [actively] extinguished.” He speaks for virtually all doctors, nurses, and care providers, everywhere, not just in the US.

Dr. Marsh is anything but an isolated case. I too gave up clinical medicine last October, most reluctantly. I love caring for babies and still miss doing it. Forty-to-fifty percent of practicing doctors are now thinking about early retirement.

The national data on provider shortages is clear. From 1995-2008, admission applications to US medical schools fell by almost 20%. Last year there were 110 accredited training positions in heart surgery in the US. Sixty applied. There are roughly one half a million unfilled nursing positions here.

Compared to other nations, the US ranks #1 in spending on healthcare by a very wide margin. In 2010, we spent 17.6% of GDP. Germany, in second position, spent 11.6%.

What did We The People get for all that money? The US is #34 in infant mortality; #40 in population longevity; #81 in hospital beds per 1000 people. The US is #52 in doctors per 1000 people (2.3) but we maintain our top position in lawyers per 1000 people (3.7).

The explanation for the personnel shortages, as well as early retirements like Dr. Marsh and me, was made public many years ago. The #1 dissatisfier of care providers was job environment. Money – lack of it – was not statistically significant. Interestingly, the #1 satisfier of care providers was job content.

Put as bluntly as possible, we love caring for patients and hate the environment or system in which we are forced to do it. This distinction is quite timely in view of a recent Harvard Business Review article titled,  “ The Happiest People Pursue the Most Difficult Problems .”

The author, Rosabeth Moss Kanter, wrote the following. “The happiest people I know are dedicated to dealing with the most difficult problems. Turning around inner city schools. Finding solutions to homelessness or unsafe drinking water. Supporting children with terminal illnesses. They face the seemingly worst of the world with a conviction that they can do something about it and serve others.”

Kanter is both right and wrong. I love the act of caring for sick babies with congenital heart disease. I hate having to fight, threaten, cajole, and sometimes, outright lie in order to get those blue babies what they need.

Twenty years ago, management guru Carl Weick gave us the answer, without knowing it. His classic 1993 paper “The collapse of sensemaking in organizations: The Mann Gulch Disaster” described the “cosmology episode,” where the basic rules of life do not exist, and the world makes no sense.

In a cosmology episode, you throw a ball up into the air, and it never comes down. In a cosmology episode, the sun rises in the south. In a cosmology episode, black is white and red is orange but may suddenly change to green.

In healthcare today, the patient perceives the provider as an enemy: cosmology. What do providers experience? Answer: cosmology episode in the form of roadblocks where there should be wide-open freeways; reasons why they can’t do what the patient needs; and punishment for doing good deeds.

The ball didn’t come down? No sun rising in the east? Provider trying to save you is labeled a “perp” (perpetrator)? Makes no sense, no sense at all! That is the world in which today’s health care provider lives.

No wonder care providers are confused, frustrated, and angry. Wouldn’t you be? No wonder they are leaving healthcare (the system) even though they love providing health care (the service).

(This article previously appeared in American Thinker . It is worth your time reading the comments, especially from other practicing physicians, most of whom have quit, for the same reason as I did. While this is most sad for us as providers, it is [or should be] terrifying for We The Patients.)

What should I have answered the mother of the pre-med student? If you were in my shoes, what would you say?

Note about author: Deane Waldman MD MBA is or more accurately was a pediatric cardiologist who retired from clinical practice saying, “I cannot practice good medicine under Obamacare.”  If you really want to understand what is happening and why, read his forthcoming (July 2013) book, The Cancer in Healthcare.


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