Tuesday, February 12, 2013
The End of Medical Freedom in America - A Doctor's Lament
I wanted to write to convey some aspects of the influence of the government control of the medical field here in the U.S., from the perspective of a practicing Emergency Medicine specialist, and its impact upon my life. First, let me confirm what you have stated on many occasions about the shackles of professional licensure requirements. My training required a 4 year college degree, 4 years of medical school, and 4 years of residency for my specialty. In addition to the massive financial cost of the didactic requirements, my residency training basically was indentured servitude, involving 40 hour long spans of continuous work, 120 hour work weeks, extreme sleep deprivation, being absent from my wife and children, not to mention the critical nature of the work itself involving life and death decisions under the conditions of extreme exhaustion. As compensation, I received a salary equivalent to the hourly wage of a fast food worker. I do have massive regret, for having not been more physically present when my two sons were young children. Fortunately, my wife of now 27 years (a nurse), and I made the conscious decision back then, to not put our children in daycare, and she was present for my kid's upbringing in the home. I can't tell you how grateful I am for that decision. However, I do have guilt for my short temper when I was at home. Although I very rarely spanked my children, (which I now realize was morally reprehensible) ,I did, at times snap and yell, and occasionally would clearly frighten them with my emotional volatility. For this, I am now ashamed. My sons are grown now (21, and 22 years respectively). I currently have a wonderful relationship with my sons, and we are very close. I have actually apologized to them for laying hands on them at all and we have actually listened to your podcasts together. In summary, my training and certification had a massive impact on the quality of my life and that of my family. And that impact was not merely a financial impact.
Once out of training, I joined a private group involving the provision of emergency services to a group of hospitals. One would think that after having gone through all these years of training, that this was the "brass ring" you were about to grab. Not the case. There was a two year track to partnership, during which, once again, I was working 14 hour days, taking care of extremely critically ill patients in the setting of an understaffed, and surreal environment with a heady mix of screaming, vomit, feces, blood, disease, fear, death, and extreme medico-legal risk. Certainly, I felt like a passenger on an out of control roller coaster, careening out of control. You have even the risk of death yourself. I cut my hand with a scalpel while doing a tracheotomy during a critical life-saving attempt during resuscitation. I've had countless body fluid exposures, disease exposures over the years. Not to mention the risk of physical assault by intoxicated or otherwise psychotic patients. The absolute worst worry was that of making a mistake that might endanger the life of another human being. I can't tell you how many of my colleagues identify their entire humanity with their professional reputation. Many physicians in my field have committed suicide when accused of malpractice. We are, as a group held to a "no mistakes under any circumstances" standard, and it is ingrained deep in the identities of my fellow physicians. Unfortunately, there is no black and white as to evolving situations, given the time sensitive, and critical nature of this job. So, you are basically living with your testicles on a chopping block every day, and people are taking swings.
So, you can expect a few close calls.
Getting back to my story, I was a founding member of what eventually became the largest private Emergency Medicine group in my city, with 35 physicians, and 4 hospital contracts...
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