A Difficult Time
My Journey in Medicine	by Jerry Sobieraj, MD © 2001
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Introduction

A difficult time, indeed! Changing my career wasnât a decision I took lightly. In fact, it wasnât a decision I made quickly either. My initial attempt to modify my career wasn't focused on any particular change, and turned out to be quite unfruitful. However, the continued perils of practicing Medicine prevented me from ignoring a change altogether. Finally after additional deliberate consideration, early in the year 2000, I was able to formulate and begin to execute a detailed plan as to how I would leave Medicine.

To me, a career implied durability with the potential to accumulate experience. The career I had chosen, Medicine, required extensive training. This led to a significant time lag before I could actually practice my trade. Yet, if I did not change careers, I felt as if I would have been held hostage to the folly of my youth. A decision I made when I was young (i.e. mid-20s), no longer seemed relevant to me. There was a confluence of societal factors which had made mid-life career changes less unusual, so it did not feel inappropriate to make this change. In fact, for many, industry no longer seemed interested in providing long term security, and with this change, employees had made a commensurate change in their expectation of longevity in the workplace. As a result, we the employed, had developed a greater willingness to change jobs, both within our fields, and outside of them.

Yet another important factor in my wanting a career change seemed more internal. There was disquiet in my soul. I had been asked by friends and family if it was a depressed mood which was the source of my disquietude. I am not religious, so I am not referring to a soul in this context, but of my spiritual being. That part of us which seems to be coming from our brain, but as we contemplate its existence, the less certain we are of our spirits origin. Those of us who came of age in the 1960s and early 1970s developed an expectation that we would be true to ourselves (unlike Vietnam and Nixon). Rather than live the forced life-style we inherited from the post-war 1950s, we decided to try and be honest with ourselves. To me, this implied a pervasive honesty, not a selective one. When I looked at my soul, I realized my time in Medicine had led to a conflict at my core being.

Thus, an evolution of external and internal factors had come into conflict by the time I reached my mid-career. Many of the difficulties I experienced in my practice every day made me feel uncomfortable with the many practical decisions I was making on behalf of my patients. As a result, I needed to resolve this conflict, and resolve it definitively if I were to remain true to my soul. Most days, the career I had chosen no longer seemed appropriate for me. The factors that attracted me to Medicine were no longer discernible in my daily life. Instead I was confronted with a routine, unchanging process. I longed to be rid of these doldrums, returning to the environs of my loved ones. My home came to take precedence. What was the point of this continued procession to the office when it was so meaningless, and filled with little, if any, excitement and anticipation?

These were the seeds of my career change. Yet, just as the Southern States did not attempt to secede from the Union without due consideration, I also required a reflective process to be certain that a career change would solve the problem. Before considering a career change, I had made attempts over several years to restructure my interests within Medicine. I worked as the Director of Health Services in a local public school system, and became quite interested in School Health. Yet school systems in Massachusetts werenât ready to make the investment recommended by the Centers for Disease Control and Prevention (CDC). I also worked on curriculum development, and saw a couple of promising areas of clinical research that could be quite useful in caring for patients. Yet, ultimately, I had the problem of insufficient time to make the investment necessary to attain the requisite skills to make a lateral move. This lack of time could also have been enough of a barrier to prevent a career change from ever happening (as it often does). Over time, I came to the realization that a significant and professionally satisfactory change would require a substantial effort on my part (not to mention the impact on my family). So, if the investment was going to be so great in the first place, why limit myself to Medicine? I began to consider the prospect of learning a new skill set. If I was going to invest the time to garner new skills, I wouldnât limit myself to my current field. I finally took a look at the big picture, and assessed other skills I had. How could these skills be utilized, and how could I develop them further?

The changes in the practice of Medicine had outpaced me. It occurred to me that I was called to a new profession, one included under the rubric of high tech, specifically, Information Technology (IT). This field barely existed in the late 1970s when I became hooked on cellular and molecular biology. What had kept me in the clinical (as opposed to research) realm of Medicine was my ability to effectively communicate with people. Ultimately, the time demands of this realm, and my inability to control these demands, stifled me. When I was asked by friends and acquaintances about work, I would mention my intentions to seek a new career in IT. Generally, they would raise the onus thrust upon doctors by HMOs and managed care. Yet, the reality was, HMOs and managed care had created order in some ways, but hindered health care delivery in other ways. Despite their flaws, HMOs alone were not the sole culprits. In this book, I have detailed many of the factors which have contributed to my dismay with Medicine. Some of them were likely longstanding, and only became known to me due to my submersion in primary care medicine. Others had been part of the evolution of the health care system. The health care system had changed in front of me, and what I saw, I couldn't continue to support, tacitly, nor explicitly.

This is the prelude to the story of my journey in Medicine, from my initial spark of curiosity, to my final undoing in primary care medicine. A journey that began with promise, but ended in dismay. Since I worked in an academic medical center, I had the opportunity to discuss many of the issues affecting primary care with people who were still in the midst of their training as physicians (i.e. residents). Most of them were hard working, and dedicated to the task at hand. I've always found this laudable. Yet, as a society, to transform Medicine once again into a career with longevity, we would need to act on the issues I have discussed in this book. At times I have told trainees, with all sincerity, that "Medicine is a good 20 year career". I said this not with anger or malice (but maybe with some disappointment). I said it from the perspective that I had learned a lot during my 20 years in the field. It did not feel wasted. I sensed that the knowledge and experience I had gained during this time would remain useful to me, yet in what way, I did not know. And now, to begin the journey through that difficult time!

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