According to a recent publication by the Robert Graham Center, the number of family physicians practicing high-volume obstetrics (more than 50 deliveries per year) dropped by over one-half from 2.3 percent of practicing family physicians in 2003 to 1.1 percent in 2016.1 In small corners of the country, though, innovative training programs continue to foster these skills among learners and build supportive communities for family ...

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I have been working with psychiatric patients for the better part of 30 years. During this time, I have worked in psychiatric emergency rooms, prison wards, substance abuse treatment centers and inpatient psychiatric units. I have been proud of the fact that, despite working in some dangerous areas, I have never been harmed by a patient. I have been threatened, swung at — but never injured. Once a patient decided ...

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Many years ago, on a busy day in my obstetrics and gynecology office, one of my partner's patients came in for "bleeding, early pregnancy." Since my partner wasn't in that day, I saw the woman, whose name was Sarah. After we'd talked a bit, I examined her and did an ultrasound. As I'd expected, she was having a miscarriage. Feeling sorry that Sarah had to hear it from me, rather ...

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Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the "working population" from inequality, gaps in wages and a political system failing to represent specific industry groups. Historically, unions organize skilled workers in a specific corporation, such as a railroad or production plant. However, unions can organize numerous workers within a particular industry. Known ...

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Five years ago today I was at a memorial. Another suicide. Our third doctor in 18 months. Everyone kept whispering, “Why?” I was determined to find out. So I started counting dead doctors. I left the service with a list of 10. Now I have 547. Immediately, I began writing and speaking about suicide. So many distressed doctors (and med students) wrote and phoned ...

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It’s every emergency resident’s dream to be part of a big procedure: The rush of a heart-pounding, adrenaline-filled moment of slamming in a chest tube, "criching" someone or being part of the big show — a thoracotomy. The holy grail. Cracking a chest, performing intracardiac massage, cross-clamping the aorta. A last-ditch effort to pull a patient away from the clutches of the grim reaper. A typical level-one center hums to ...

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There are a couple of times a year when there are no house staff to be found anywhere in the hospital or the outpatient practices. These include the holiday and end-of-year parties, resident retreats, and the annual house staff picnic. The house staff picnic is a particular favorite among the interns and residents, a full day away from the hospital, dressed like civilians, fun in the sun, barbecue, softball with their ...

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They come in all shapes and sizes. They are health care customers. The conveyor belt works relentlessly, and takes them to caring providers eagerly waiting for them. What is on the menu? Healing, understanding, human touch, reassurance, medical advice. All of that in a time efficient manner, in accordance with the sacred laws of productivity. It’s a miracle how top-notch care and productivity are ...

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The prevalence of burnout among physicians is estimated to be more than 50 percent and has grown in recent years. This alarming trend is largely due to changing patient demographics, increasing cost constraints, new federal and state regulations, and other external factors that have reshaped the daily work experience of physicians. Too often today, physicians spend more time on data entry than in direct patient care. Professional burnout, ...

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I was a chubby kid, but my parents still introduced me to lots of sports. Soccer, swimming, tennis, basketball; so many sports, when all I wanted to do was read and eat Doritos.  I wasn’t particularly good at any of them, but some of my teams were better than good. We were champs. My swim team won the Cape Cod Summer League, my soccer team won its division one year, ...

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