Friday, June 08, 2012

Less Carrot, No Stick: Life Working for the Man

I do not miss the ER.

Not a bit.

I do feel guilty from time to time for 'wasting my skills', but that, too, is fading I find it very ironic that I have ended up (in a sense) joining the enemy, simply to preserve my sanity. What I mean is that I now work for the government in a 'lifestyle' job when my great desire, from the end of medical school through my 'payback' time in the military and through residency was to become an excellent Emergency Physician and to practice my craft until they kicked me out of the hospital on a walker mumbling about how Zithromax is not really an antibiotic and how you should NEVER order a CBC.

My, my, my. I did, at least, achieve part of the goal. I was, and still am, an excellent Emergency Physician, but I am now almost phobic of hospitals. I won't go back unless I have to for money. The joy, if there ever was any (I think there was) is gone. It may still exist in ER practice but I think that if it does it's in isolated pockets or in Academia, but, for the record, I don't know any ER docs who feel this way. Most see themselves as drones or, perhaps, as performing a 'rear guard action' on a decimated battlefield.

This learned helplessness permeates much of medicine these days. Funny how, when lives are on the line, doctors and surgeons with MD or DO behind their names are beseeched and coerced and prodded into the fray, but when they talk about work conditions and reimbursement they are derided and spat upon.

At the same time charlatans like THIS COMPLETE MORON, a chiropractor (with an 'MD' mysteriously obtained from the University of the Caribbean Breezes) dispensing platitudes and snake oil, becomes rich and people love him. They line up to pay for his crap. The supplements market is booming. It's ALL shit. Big pharma is pilloried, but the people who market 'Raspberry Ketones' and 'Acai Berry' for 'weight loss', 'pro-biotics' and such, can laugh all the way to the bank and escape all manner of liability and regulation.

It's tempting to quote from "Atlas Shrugged" at this point but it's cliche and people think that because things are 'cliche' that they are necessarily false. Not many care about the plight of doctors, but they will.... they will care when they can't find one.

I will take no pleasure in their frustration, but I also will not be running back to help, and for that I think less of myself.

It's all stick and no carrot these days out in real-medicine land. Amazingly, I have found a 'medical' job that is mostly carrot, no stick whatsoever. Guess what? I LOVE it. I feel like I'm cheating. Compared to what I used to do, this is a lark.

I marvel at the surgeons and the ER docs who still man the barricades. They would make much more money with no liability by joining an aesthetic medicine practice and shooting people up with botox or simply hawking the snake oil that everyone does on 'Dr Oz' every day... What's that? It's already happening all over the place? Oh.



  1. Jeez 9-11, I'm startin to feel like Charlton Heston in "The Omega Man"...
    I mean when's the last time Etotheipi(who I still think was you) posted?, or lofty(strange he vanishes at the same time as Bin Laden)and Old Fart gets less playing time than Barney Google...
    And I know Grumpy RN's all tied up with the Queen's affairs...
    You know how I know your gay? I mean that America's doomed?
    The top Golfer's Black, and the top Rapper's White, wait, that isn't it.
    White babies are finally a minority, hey, it's just gonna make their price go up, supply and demand...
    UGA gave Mark Richt a contract extension, hell, a BONUS, for getting blown out in the SEC championship game.
    While the 2010 BCS CHAMPION AUBURN TIGERs fans are already getting the tar and feathers ready if we don't win it this year...


  2. frank,
    I think this blog dies with the passage of obamacare. the die were cast. our passion extinguished. we will see what happens if it is overturned. maybe etotheipi will crawl back out. s-cat is out of the game like me too and being out of the game, well, it's just hard to care.

  3. The link you provided, 911, told me Dr. Ass Ann Drew "has an incredible gift of compassion and communication with people. His comprehensive use of health care in looking at the whole person; body,mind, and spirit, is a true pathway toward healing for this generation."

    Reading on, I see: "This website/URL has been blocked until further notice either pursuant to Court orders or on the Directions issued by the Department of Telecommunications"

    The Nanny State v "Holistic" Medicine?

    Obama just doesn't Care, does he now?

  4. Dear plastic Tolstoy,
    How about dialog down the Obtuse-o-meter so Frankie and I can get an IFF squawk on you?

  5. @ 9-11,
    OK, I finally read your entire screed and.......
    Whats with the slam on our Aesthetic Medicine Bretheren/Sisteren? Botox is serious stuff, lots of side effects, contraindications, drug interactions, OTOH, I like that Mrs. Drackman can't do that "Spock raising his eyebrow" thang anymore...
    So they don't have a real residency or board, neither did YOUR specialty not so long ago...
    Everyone thinks everybody elses specialty is essy/overpaid/ bla bla bla,
    Its like when I was trying to find a reason to cancel a "stand by" case in the cath lab, and the Cardiologist PA said "Just go get your little cart and keep the patient from moving" and I really would have said something sharp and biting if she didn't out weigh me by 50 lbs...
    The Cardiologist PA I mean, not the patient.
    But I stood my ground, took a good 10 minutes reviewing the echo, the stress thallium,
    OK, it was really just the "Demographic data"(I HATE EMRs...)
    and I got my little cart and kept the patient from moving...


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  7. My poor grandma actually died because she spent the little money she had, earned from cleaning houses, on herbs instead of her blood pressure medication. Stroked out and died. Those quacks kill people.

  8. Being an ER doctor in a major trauma center for 16 years, I totally get where your perspective is in writing this post. However, after suffering from some cynicism and sarcasm and being quite disgruntled with medicine in general, I have been lucky enough to have a medical scare that made me realize that the good I do far outweighs the rough parts of this job.

    Better yet, I work with residents that I hope I can instill the same perspective. Your post is very honest to the current trends of most ER doctors I work with though.


  9. thanks Jim and God bless. hopoe you are well now.

  10. what do you do? i need out too

  11. anon.
    i do primary care for the military as contract provider. it's chill.