I am one of those fortunate souls who knew my career path from a young age. At seven years old, prompted in part by the passing of my maternal grandfather, I decided that I wanted to be a physician. And I stuck with it – not out of a sense of obligation to my decision, but because the idea felt natural and comfortable for me. By the end of elementary school, I was asking for medical reference books for Christmas and spending time in the evenings taking notes and copying diagrams from these treasured tomes. (Nerd! Yes, I’ll own it.) It seems a bit strange to me in retrospect, as I had no real grasp of the material at the time, but I was inexplicably drawn to it. Attending medical school was a foregone conclusion, and most of my endeavors in my earlier years were, directly or indirectly, oriented to this end.
The impetus for my career goal is honestly a bit of a mystery, as my closest relative in medicine was my paternal grandfather. He was a member of the old guard in medicine – recruited to work on military trains across the US during World War II before he even had a chance to finish his formal medical training. He returned to a small town hospital in southern Mississippi, where he practiced until he was 77 years old because he enjoyed the work and felt a great sense of responsibility to his patients. But he lived over 300 miles away, and I only saw him once or twice a year growing up. I cannot recall a time that we discussed medicine in any depth, and most of what I just recounted about him, I did not learn until he was long passed and I was already a physician myself. My father retired from a lifelong career as a civil designer, and my mother worked administrative jobs in the local school system for most of her adult life. They never applied any pressure for me to enter the medical field, although they certainly did not discourage it.
What brought me to medicine is an enigma, but now, several years out of training, I still believe it was the right choice. I can honestly say that I enjoy my job – perhaps less so when it drags into the occasional 15-hour day, but I cannot envision myself in any other line of work. This may, of course, be due in part to being completely immersed – inundated with medicine for the last 12 years of my life since college. My education occurred in an era of rapid shifts in medicine – work hour restrictions for medical trainees, the rise of the electronic medical record and an increasingly complicated relationship with health insurance and pharmaceutical companies, among other entities. Some say that there has been a changing of the guard. The old-school physician that many still conjure when they hear the word “doctor” is a dying breed. The haughty captains of the hospital (why else do you suppose we still write “orders?”) who eat, sleep and breathe medicine are being replaced by millenials, who tend to prefer shift work and a life beyond the ward. (I was born in 1985, so I believe I’m allowed to say such things…I, too, enjoy having a life outside the hospital.)
Medicine looks dramatically different than it did even 20 years ago. Aside from the obvious cultural shift and imposition of new technologies, ballooning costs have fundamentally altered the way care is delivered. Many in the old guard have been driven out by the change, perceiving it as an aberration – in some cases, even a violation of the sacred Hippocratic Oath. I can see their point. Many days, it feels like delivery of medical care involves a constant clash with faceless powers that hold up hoops and question my medical judgment with little to no knowledge of my patient or my personal abilities. Looking from the inside, the impulse to walk away from medicine is understandable. Even I have had my moments, but I still see the positive impact I have on people’s lives – the relief that comes with an answer they can understand, the triumph of moving past a seemingly insurmountable illness, or even just being present and empathetic when things don’t go according to plan.
These pieces all came into play in establishing Airborne Infectious Disease. I can’t reform the entire US healthcare system on my own, but I can create my own business model that utilizes the best of our current medical system while trying to avoid those burnout-inducing pieces. Electronic medical records may come with a learning curve and the occasional technical difficulties, but they also offer opportunities for cognitive specialists like me to make pretty comprehensive patient evaluations from hundreds, if not thousands of miles away. Rather than fight with insurance companies to justify my treatment decisions, I choose to contract directly with healthcare facilities to provide cost-effective Infectious Disease care to patients. The problems facing our current medical system are daunting, and those of us providing direct patient care have quietly drifted with the current for far too long. We need a lot of small, creative solutions to effect a big cultural shift in healthcare. To my colleagues reading this, I say find a way to make medicine work for you. Don’t resign yourself to working in unsustainable conditions, and don’t walk away from a career that has required such a great investment of your time, money and talents. I gave up thirteen good years to get here, and, fundamentally, I enjoy what I do. Walking away just isn’t an option