I just had a very nice day. I toured applicants around the hospital this morning and that was no problem, and I was struck by 2 things. One, that one of the applicants asked about wellness and commented about how a lot of her classmates (not her, she was sure to say) were feeling burnt out even as they finished medical school and were anticipating residency. Well, okay. I guess I’m not surprised, but I’m also struck by the fact that these folks are headed for a lousy time in residency. And the 2^nd came from one of the 2^nd year residents, one who I had had a high opinion of. They had worked for an HIV clinic for years before starting down the medical route and I had heard them previously describe wanting a blend of inpatient and outpatient at a teaching hospital for a long career. Well, that seems to have changed, at least for today. Today, they were telling the applicants that they would not go back and do this route again. Not with what they know now. They’d be a barista at Caribou Coffee or whatever. Okay. These are like those cruel jokes that have so much truth that it’s just sad. Is it just complaining? I complain plenty.

But I really don’t complain all too much to my colleagues. At work, if anything I mostly buoy them up. I recognized that quite clearly this Monday morning when I was set to work with one of my favorite faculty and she came in with a “punky” mood. I apologized for her. I sympathized with her. I tried to be as easy to work with as I could. I’m not sure how much I helped, but what I took away is that even she, who has a very righteous purpose about practicing family medicine is feeling it too.

So that leads me to another story. One of being in routine clinic. And it was just a good day. I saw 6-7 patients, a very normal day, but I had such a good attitude about it. That, I’m not sure its cause (??) But the effect was tremendous. I went into each room with good intention and connected so easily with my patients. I focused in on the problem they came in with, that I either could or couldn’t solve and I communicated as best I could either with or without an interpreter as needed. I educated. I prescribed some, but other times not at all. I filled out forms. It was normal stuff, but I just had this unique feeling that “I can help a lot of people in this job.” And it feels like a commonplace thing to say, but it was an epiphany. Because I, at times, am stuck in such a negative, doubting place, that I really am not able to provide that. My patient’s show up and they expect a miracle pill for their problems and I don’t have it.

And so what’s really important about this insight is that there is a difference between doing a “good” job for my patients, and not doing it. It is not a difference that my employer can tell. It’s not a difference that the insurance payers can tell. For so many doctors, we get run down into the mode where we are just playing the game, filling out the paperwork, and it hardly matters. But it does matter to patients. And it feels good to do a good job. So if I am able to provide this kind of service, than I think this job could be sustainable. And for me, in order to feel good and feel like I can do a good job, I need to see way fewer patients.

I have determined a “dream schedule” for me. It would be: Monday afternoon, Tuesday am/pm, and Thursday afternoon. That’s it. It’s half time. 2 days a week that I do in 3. I start slow on Monday so it’s less intimidating. I have my big “full day” on Tuesday. And then I have Wednesday off to get all those charts done. And then I have another little peak of work and that’s it. The key is that I can do a good job for my patients when I am in, and I can do this for a very long time. A lot of family medicine doctors earn 180-220k. I might earn 80k. I don’t know. But that might be okay if I have such a nice lifestyle. I can work more if I someday have kids or something. But after residency, this kind of schedule makes sense to me.

A little more on “good work.” It’s about presence. It’s about waking up to what’s really going on and doing the best for our patients. Unfortunately, this is very hard to see for the majority of providers and they are stuck asleep. It is hard to wake up when your coping mechanisms, your salary depend on you being asleep. The financial drivers run the show and folks are chasing after those RVUs at the expense of quality patient care. Well, that’s the story that demonizes doctors anyways. It’s complicated.