A Difficult Time
My Journey in Medicine	by Jerry Sobieraj, MD © 2001
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Chapter 1: The Sunday Globe

Painstakingly, slowly, I turned the pages. The urge to scratch my nose felt strong, but I couldn't bear to see those dreaded ink smudges on my face. The bigger the newspaper, the more ink I'd get on my hands. Since I was reading the Sunday (Boston) Globe, which was always big, the ink was particularly problematic. Big also meant in this case, that it was filled with a large Classified Section. That, of course, was the point. I generally didn't read the paper to get news, for that, I preferred to listen to the radio. But I wasn't interested in news. I wanted the largest Want Ads section possible (I wasn't on line yet, and hadn't heard of jobs.com, the Monster Board, etc.).

After I set the paper down, I rinsed my hands and sat down quietly. I couldn't believe I felt the need to peruse the Sunday Classifieds. Yet, the thought of continuing on in Medicine for another month, let alone another year, seemed unbearable. Going to and from work hundreds of more times was too much to countenance.

Yet, how could this happen? I had believed my career in Medicine would be interminable only a decade ago; now it all appeared for naught. It wished I could "declare victory and go home", as Bob Dole had done during his tenure as Senate Majority Leader. Instead, it was time to declare defeat and look at other options. That was my reality.

The Want Ads were not very inviting. Though some ads appeared to be a good potential fit, when I decided to answer them, not much happened. Often I wouldn't hear back, and would begin to wonder, "Did my letter get lost in the mail?". Most of my rejections were in the form of no response. When I was ignored it was hard to know where I stood in the eyes of prospective employers. I had a lot of education and had acquired many skills, yet none of this seemed marketable.

The few responses I did get were not particularly encouraging. They would tell me my CV (curriculum vitae, which is Latin for resume) looked great, but not quite what they had in mind. Well, when I read the ad it sure made me feel I was appropriate for the position (at least enough to take the time to write a letter). What happened? Why didn't anyone want to hire me? I surmised this was the result when one tried to transfer one's skill set to what seemed like a reasonable alternative (e.g. consultant, health educator, etc.)

I had believed that becoming a physician wasn't just a job, but a career, a lifetime of growth and opportunity. Yet my inability to shift to a new career in the health care industry made me feel about as bottled up as an older person who hadn't had a bowel movement in a couple days, and didn't know what to do next to get things moving. What was I supposed to do? Sure, I had letters after my name. Yet outside the medical marketplace, I was an entry level 'commodity'. I felt that if I had applied to McDonald's the next day, I would have been put on the grill.

I've been asked, as have most physicians nowadays, "Would you do it all over again?". I have thought back to my interest and zeal of youth, and didn't see how I could have ended up elsewhere. Maybe if I had come from a more established background (established in terms of upper crust society), I would have developed more options during my post-secondary education. Yet I never realized how pinned in I had become until I began to look outside Medicine.

I had become a primary care physician. I was a revenue generator. In the eyes of my employer, I had an expected productivity and associated costs. I had to cover my costs in order to make myself valuable to my organization. Based on current compensation rates for seeing people in an office setting, my productivity demands precluded me from having adequate time to address all, or even most of the issues of concern to my patients. I tried to be understanding and cover as much as possible. I knew they had to wait at least 3 months to get an appointment to see me again. As a result, I was always running late. Well, how could I stay on time when I only had 20 minutes to talk to a patient who might well pull out a list of 5 questions from their pocket when I entered the room. I knew I was fortunate to have 20 minute appointments versus the 10 minutes I often heard about in news stories (but didn't know if they actually existed). However, it generally took me 30 minutes to cover a patient's issues in sufficient detail, so we both left with a better understanding of what needed to happen to manage their medical problems effectively.

Was it too much to ask for this kind of time to talk to my patients? My boss seemed to think so. I could ask for less money, for changes in my schedule, for whatever else I wanted, but the bottom line always seemed to be the same, productivity. I was required to see more patients, as revenues never seemed to meet the institution's expectations.

What was wrong with our health care system? Health Maintenance Organizations (HMOs) often took the rap. The high cost of drugs was another target. Surely, some of this was deserved. Yet I felt the problems in health care extended well beyond their borders. I believed it was time that we, the doctors, started shouldering more of the blame. We were the ones who saw the patients, and if we ultimately took a stand that it was important to be able to sit down and talk to people so that we could better understand their issues, we could make it happen.

In January of 2000, a colleague of mine, who was usually incredibly busy with his part time clinical practice, saw a couple of my patients for urgent visits (related to upper respiratory infections). When I noted he had seen them, I sent him an e-mail thanking him. He said it was not a problem, as a new patient had canceled, so it was easy to fit them in to his schedule. He noted his 4 hour session that day was quite pleasant, as he had only 9 patients to see, and felt like he was able to attend to all the issues presented, without feeling harried, or in need of cutting a patient short.

I felt such a statement was pathetic. Why couldn't most days be like that? Why did that have to be the exception and not the rule? I often told patients, "You don't like the way my schedule is set up, as it's hard to get in to see me, and I'm always running late. I surely don't like it as I feel incredible pressure to stay on time, so who benefits from it?". I have explored some of the factors and entities which have contributed to the current practice of health care, and what we might be able to do to fix it. We need to permit health care to devolve back into a system where patients, and their issues are the primary consideration, and not a secondary issue, addressed only in slick marketing material.

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