The business of family medicine

Every day that I walk into the family medicine office that I'm currently assigned to, I'm smashed over the head by the realities of why I could never go into primary care: the business side of medicine.

On the surface, family medicine conjures up warm-fuzzy images of the iconic practice model of a strong doctor-patient relationship that creates a forum for the patient to address all of their concerns and for the doctor to manage the patient's medical problems and prevent future illnesses from coming up. In reality, the whole enterprise is a bit like speed dating: get the patient/date to talk about themselves for a few minutes, drop some one-liners and patient's/date's , give them your number, tell them to call you soon and move on to the next one. Maybe they call, maybe they don't...who cares because I'm gonna see 30 others today.

To continue my god-aweful dating metaphor, the entire venture of family medicine is a bit like the 20-something bachelor's dating scene. You make your game (practice) as attractive as possible by adding on as many bright-shiny things as possible: the bachelor pad (a pimp office with lots of room), the interesting friends (in house cardiologists and endocrinologists), the stylin' wardrobe (custom embroidered white coat) and the reputation ("You should go see Dr. Bostonian, I hear that his 'practice' is enormous. All of his 'patients' that I've talked to have been extremely 'satisfied', but I hear that he his 'visits' are usually less than 5 minutes.") In the background you've got several other things going on...the cougar (the nursing home gig), the druggie (methadone clinic), the groupies (drug reps/speaking engagements) all vying for your time and energy.

Ok, I'm done with the crappy metaphor.

In reality, I've been studying medicine for the past 2 years and I don't have a lick of business sense. There is little-to-no appeal in spending a decade building a practice after all of the hassle of medical training and residency. A lot of people heading into primary care assume that they'll be able to find some doctor that is on the verge of retiring and will just take over their practice...I'm not willing to gamble my well-being on a capital-venture project or some dude deciding to hang it up. I really don't see myself becoming a savvy business person who battles day in and day out to keep his practice in the black by working 3 other jobs so that I can use that money to cover the practice overhead while I wait for insurance reimbursements. It's simply not what I came to medical school to do. I came to learn to practice medicine, not to run a business.


A life more ordinary...

I received the following comment from one of the 2 people who read my drivel:

"Ahem...remember that time you had a blog??
It's like you have a life or something...

It's not that I have a life all of a sudden, it's that I can't find anything interesting to write about and I've had a pretty awesome pneumonia going on for the past week...just to put that one to rest.

So surgery ended last Friday with perhaps the most difficult exam I have ever taken. It was my first clinical shelf exam and being such it was full of long-winded questions with some fairly obvious presentations and lots of medicine questions that were complicated by the fact that I haven't had medicine yet...it was rough to say the least but I passed with all of the mediocrity that has been the hallmark of my medical education

Anyway, I've been on Family Medicine for the past week and it is pretty sweet to be able to sit down with a patient from start to finish, leave at the end of the day with the sun still shining and focus on my non-hospital life again by doing normal person things like buying groceries, sleeping, meeting people for dinner/drinks, and general human life. I was even able to run a few times...that is until I ended up with a cough and a fever that became productive and included bilateral crackles in the lower lobes (God I feel awful). I -gasp- saw the NP at school and she fixed me up with a really nice macrolide and some mucinex without a co-pay or anything and was very nice about adding a few interesting teaching points while I tried to keep my lungs in my chest.

On the navel gazing front, I've decided that surgery is probably not the right choice for a career for me. Having a life outside of the hospital is an incredible thing...I can read, I can eat properly and I can be a nearly complete human being again! So the status quo of EM will be maintained for now.

That's really it...I wish I had something interesting to say. I'll probably not have anything posted for another week or so becaue girlfriend is coming to visit this weekend if I make it until then...I've got a few interesting posts brewing in the back of my mind.