I am convinced that the folks in Washington do not understand that primary care is currently an intensely unpopular choice of profession. There have been some massive shifts in popularity of some medical specialties, but the universal theme has been that primary care has waned.

People think it's all about debt burden, but it's not. It's nowhere near that simple. And if you want to prove it to yourself, look at the hospitalist vs the traditional internist. Finding traditional internists (folks who do both clinic and hospital work the same day) are a dying breed heading to extinction. In fact, primary care internists are harder to find in general. And it's no wonder.

Seeing hospital patients in the morning, doing clinic in the afternoons, call every 3 or 4 days, who wants that lifestyle? Compare that to the hospitalist, who is on one week, off the next. A week off is virtually unheard of in traditional practices, but it's the norm for hospitalist work. And hospitalist pays better too.

People fondly remember the days of doctors who do home visits, with a nostalgia entirely unwarranted, and I expect that in our lifetimes, patients will reflect on the days when their regular doctor would see them in the hospital too. But that is going the way of the dinosaurs.

And the true shame of it is that a lot of hospitalists burn out, even with the free time and the extra pay. And that's why I tell people to pick something that makes you happy, because money and lifestyle can't make you happy. It just gives you more time and resources to hate your life.

Match Day

Thursday (today) is the Match. Students found out on Monday whether they have a spot or not, and the unfortunate had to go through the Scramble on Tuesday and Wednesday, and today, everyone finds out their fate. It is a far more ominous day than any other day in medical school.

I have some patients who have children in medicine or are pre-meds, and they are pushing their kids towards subspecialty careers, which makes me sad as an internist. And the thing that I want to tell them so desperately is that there is no price tag on being happy with your job. I could've been paid far more than I'm earning now, but I love my current position, and I don't want more money. I'm happy now.

So, to all your MS4's out there, I hope you don't get what you want, but that you get what will make you happy. And those two may not be the same thing, but when it is, everything else falls into place.

The toll of medical school

My New Year's resolution this year was to get back to healthy living. I spend countless hours talking to people about improving diet and exercise, and ways to change lifestyle to improve health. And it's good advice, and some of my patients are quite successful. However, it's advice that I should probably heed.

Before I started my third year of medical school, I ate healthy. I bought fresh produce. Turkey was my favorite meat. I ran a few times a week. I worked out a lot. I was probably in the best shape of my life. Then came clinicals.

Since that fateful July 1st, my health has gone into a tailspin, because after a 30 hour call, I just didn't have the energy to do anything else, muchless exercise. And every year, I've gotten fatter and more complacent. So I have finally decided that it's time to change. And so I am returning to healthy living.

And I think to myself that medical school has taken a considerable toll on my life. I was physically great. I was mentally stable. I was doing quite well. And as much as I enjoy being a doctor now, it's with the knowledge that I spent so much time taking care of medicine that I forgot to take care of me.

Editorial notes

So, I should note a couple things. I've mostly been ignoring the purpose of tags on posts, but will actually start using them. I will be blogging in 4 main categories: patient care, medical school, first aid, personal life. First aid will be where I dispense unsolicited medical advice. I am hoping that I can start posting once a week, and giving myself some categories will certainly help with that.

EDIT - Make that 5 categories: patient care, medical school, first aid, personal life, and careers in medicine.

All apologies

One of my patients threw a fit. It was really disappointing because I had serious issues with this patient, but this person demanded a personal apology. I did it, and licked my wounds. Truth be told, I don't really care much.

One skill that I picked up in med school during my clinical years was that when it comes to patients, leave your ego at the door. I've had patients yell at me, call me names, disparage me to my face. I just sit there and take it in stride. It's not worth getting angry about.

So apologizing isn't really all that difficult. The only regret I have is that in medicine, the customer is not always right. And it seems like whenever I try to be a good doctor and order tests and medications appropriately, that's when I end up in trouble. And it would be so much easier to just order the needless test, give out the unneeded antibiotic.

But easy doesn't make it right. And the key in all things is whether I can go to bed with a clear conscience.