The Culture of Medicine values orthodoxy. The requirements for getting into medical school are extremely rigid and in no way value aspects of an applicant not easily testable or quantifiable.
Indeed, the various hoops, tests, and checked boxes of getting into medical school seem more designed to weed out renegade, innovative, creative types than to assure a high caliber of applicant.
They select for the correct quality of applicants, not the high quality of applicants.
Medical school admission seems primarily designed to identify individuals who are adept at learning the rules of the game and then driven to win the game. Anyone who questions the game is summarily excluded.
As a cadre, physicians are poorly equipped to resist the Hospital-Pharmaceutical Complex.
We are acculturated to shrink our purview to the smallest area possible. This makes it easier to control all of its aspects, which soothes our control-oriented personalities (also selected for in the admissions process). However, it also dilutes our influence and robs us of seats at the decision-making tables.
Yet, many, if not the majority, of us are extremely dissatisfied at the state of American Medicine. I have written plenty about this. If we are so dissatisfied, why aren’t physicians across the country rising up and demanding change?
We don’t know how to Resist
Physicians spent their high school and college years languishing in libraries and study halls. We didn’t go to trainings in direct action. In residency there are no rotations in “managing organizational change.”
We are so focused on getting the “right” answer, we have rarely had the opportunity to demand those asking the questions defend their choice of question. Give physicians a set of rules to a game, and we fight tooth and nail to prove we can be best.
Ask a group of physicians whether or not the game is just, worth playing, or if the rules should be changed and we just stare blankly back at you. Those questions have no winners, it does not compute.
For sure, we are raising our voices at higher rates than we ever have in the past. Yet, the machine keeps jugging along.
Debt, Competition, and Greed
Maybe it is as simple as too many of us are debt-indentured. The vast majority of us start with $200k+ in debt in our early thirties and then add a mortgage and often some other consumer purchases as well.
Are so many of us permanently debt-indentured to the point where all we feel we can do is just keep our heads down, pay off our debt, and get out?
I slammed my head against the wall for 12 months in my first job. I tried incrementalism from the inside. It was terrible, and when tragedy hit, I didn’t have the stomach for it anymore.
No one ever articulated what we were working towards. What change were we really trying to make?
Of course, I learned no one was trying to make change. They were just trying to make as much money as possible, for the system, and then for themselves.
My partners just agitated for more money for less work with a better schedule without the EMR. Their passion had withered to greed and self-interest, cloaked in the name of patient care.
Effectively, they were still applying to medical school. They were just just trying to win the game.
They didn’t care that the game was corrupt and the purpose of the game was completely divorced from its original purpose.
Or, has this always been medicine? Has medicine always been a dichotomous beast of greed in the name of helping others? Test, cut, prescribe until we are wealthy enough retire to a golf course community?
Have those who couldn’t hold their noses any longer always just left?
Is that our only option, to vote with our feet?
Is There Another Way?
At least in rural medicine, it seems as though all physicians can do is vote with their feet. It seems so dissatisfying to have that left as our only option. Also, as the problems of the healthcare industry are truly national in scope, there are few places left to run.
No real competition for physicians exists because the industry leaders have all embraced the same models which perpetuate burnout. As we are squeezed more and more to “produce,” our time and energy doesn’t allow for resistance and fighting for change.
Normally, it is the young and energetic who push for change. The newest generation of doctors emerges into a field where all their excess energy must be tapped towards getting out from under a debt load. One reasonably measured in fractions of a million dollars.
We debt-laden young physicians have nothing left at the end of the day to offer the fight for change. As such, our voices are largely silent in the national arenas, except of course on the impotent platforms of social media echochambers.
Instead, healthcare “industry groups” and our National Academies usurp the right to speak for us.
Our supposed representatives mostly seem hell bent on protecting or increasing reimbursements for their loudest members, not on making doctoring a fulfilling vocation again.
Surviving the healthcare industry has sadly become our goal.
I certainly hope something or someone comes along as a realistic option to fight for change, but my hope is mostly vestigial. It is a mere remnant of an idealism and passion which seem a bygone memory. Pretty soon, the only place left for our feet to go will be out of medicine entirely.
Honestly, I don’t think I am smart enough, connected enough, nor strong enough to find this other road. I would love for someone to show it to me, though. I would love to follow someone on that journey.
I do not believe I have the strength or skills to lead anyone in hacking a path out of the wilderness we are in. Besides, I have proven myself to be more than content with wandering.
After all, the wilderness is a fine place, we could use more of it.