All debts are paid. God owns me but I hold temporal title. Society has no share. Like any other human being on the face of the earth, anyone who wants my labor must make it worth my while. When he as done so, I will give it my best. The only exception is when I make a fully free decision to extend charity. My reasons for doing so, or not, and when to do so, or not, are a matter between me and my maker/owner which is no other person’s affair.

What does enslave doctors is the depth of the identification with the values and identity that one has acquired by the end of training. Walking off from that leads to grieving and requires a lot of flexibility and usually a lot of pain to motivate one to do so. People often choose death rather than surrender the core of their identity and some physicians do so, working themselves to death.

No one goes to medical school planning to not practice medicine. By graduation, maybe 1% are looking for an out. By completion of residency, probably about 15% are wishing, but hiding the thought, ashamed of it. The percentage grows over time as a result of abuse and lack of the expected rewards. What is frightening for the future of the profession is that we have turned the corner. We have alway had “desertions” by those who were mismatched in the first place and those who got burned out, and evictions due to disability, impairment, or malfeasance.

Of late however, I have noticed that it is the best and brightest, the leaders and the top med school graduates who are exiting clinical practice. It doesn’t bode well for the future quality and professionalism of medicine, and consequently, being ill.

Every day, some doc somewhere, sees another Norman, someone who sees him as not a human with a calling but just a public utility, and realizes that all of his self-sacrifice for others has done is morally corrupted them making them entitled ingrates and spiritually emptied himself.

I feel for your situation. My father is a General Surgeon with the same heart as your husband. I saw him lied about and slandered by an HMO because he stood against their unethical (and almost illegal) business practices in our little community. Because of his stand, he lost significant income, was forced out of private practice, and was almost ruined financially. He did the right thing and he paid a heavy price for it. He has no regrets and his patients still revere him, but it left a very bitter taste in my mouth.

This group that is anti-doctor seems to resent the fact that doctors are paid above average salaries. They seem to think that if doctor salaries were brought down, their health expenses would also go donw. What they don’t realize ist that in medicine, someone makes money. To me, it is much more ethical for a physician who has sacrificed a decade of his life in training and is legally and ethically responsible for people’s lives to be paid, rather than a kid just out of a Master’s program somewhere who works for an HMO.

I am so sorry about what has happened to your husband. I have no doubt that you are telling the truth since I have seen it as well. At the end of the day, however, he can put his head on his pillow knowing he did the right thing. I’m not sure how some of these others sleep at night.

I believe we are going through a transition period in medicine. Up until the past ten years or so, physicians were trained in medicine and believed that as long as they were good doctors, the money would take care of itself. They did not need to be entrepreneurs or good business people. They just served the community with their medical skills and everything else fell into place.

Today, if a physician practices medicine according to this old paradigm he/she will end up broke. I personally know many physicians who are barely able to make ends meet due to their heavy student loans and the grueling hours of their practice. Many are at their wits end and they are very frustrated.

Medical students are told by everyone around them– older physicians, loan officers, administrators— that if they can just stick it out through med school and residency that things get better. Their finances will be solid and their jobs will be satisfying. I was told many times by independent financial officers, administrators, and older docs not to worry about my student loans since I could pay them off quickly once I got out of training.

Many young physicians are seeing early in their careers that things do not get better. I now work as much as I did as a resident and many of my peers work more (especially since federal law has limited the hours residents can work). Physicians are now entering their careers with loan payments that can be as much as their mortgages and work hours that are worse than their residencies.

With the work environment getting worse, the stigma of leaving medicine is lessening. Those who can leave are leaving and are breathing a sigh of relief that that chapter of their life is over.

It is sad, really. Society might not want to hear this, but the typical medical student is way more talented than the average person on the street (and way more talented than the typical paper-pusher setting policy these days). Many of these medical students were at the top of their classes is every subject and could have done anything. They chose medicine from a variety of opportunities offered to them because it was interesting and seemed fulfilling. These talented individuals are now realizing their talents are not compensated or appreciated in medicine, and since they have many other opportunities they are opting to exercise their options once again and are leaving.

The only thing holding back a massive exodus from clinical medicine is that many physicians do not have the broad exposure to other fields that those in law and business have and they are too overwhelmed with their practices to learn much about the possibilities. However, this is changing. Once physicians begin to bridge this gap in knowledge and learn how to make the jump, I expect the floodgates to open and young docs to begin leaving clinical medicine in droves. I don’t blame them, but it makes me very concerned about the future of medicine in this country.

Medicine in this country is suffering from a classic case of death by bureaucracy. The jealous and small-minded– obsessed with the process more than the outcome– have regulated a group of talented leaders into nothing more than drones running faster and faster in a hamster wheel trying to survive. However, these drones are beginning to realize that the box that they are in has no lid, and they are talented enough to leave if they want. Once they learn this– to the dismay of bureaucrats everywhere– they will be gone in a flash and the regulators will have only themselves to boss around. The process will be perfect but the outcomes will be dismal.

Those who are anti-doctor might win every argument out there then come to realize they lost the war. You do not have physicians under you thumb. These are people who have the ability to do almost anything and once they realize they can, they will leave this circus for more calm waters and let you guys bicker and lecture others. These former docs will use their medical knowledge to take care of their families and friends and shake their heads in wonder while you wait for months to see the handful of docs still practicing.