Tap, Tap

Is this thing on?

::crickets::

It's been so long since I've written a blog post that it feels beyond bizarre to be sitting here typing. Truly, I'm not even sure what compelled me to open up this page, but as we're all here (all two of you), I shall get on with the actual blogging.

When I last wrote in August, I was in the throes of studying for the last of my Boards which is now, very thankfully, behind me. At the moment I am playing the waiting game which I feel like I spend half my natural life doing. So yeah. That's that. Vague city.

Work has been steady, full of its own tragedies and comedies. Apparently the new, cool thing to do now is for teenagers to snort crushed cold meds. Yeah. I don't know either. Personally the notion of snorting anything skeeves me out. I can't even handle Afrin! On the other hand, there are some patients whose cases sit with me for days and weeks after we've parted ways. The one thing I hate about the ER is lack of follow-up. Once a patient is admitted or transferred, we typically have no idea how they do or what happens. Every patient in the ER leaves us as an incomplete story whose ending we'll never know.

We do deal with A LOT of inanity on a daily basis (there is no good reason a 25 year old needs to go to the ED at 2 am with a chief complaint of runny nose), but aside from the fact that it's boring as hell to send yet another person home with a diagnosis of URI, it's more frustrating to know there's not much I can do about it to prevent people from coming back for the same reason. Under EMTALA laws, an ER is obligated to take care of anyone shows up requesting medical care regardless of demographics, insurance status, or the ability to pay your bill. It makes us an incredibly enticing venue for people who don't have the means to seek medical care elsewhere. And I don't begrudge them their decision to do so. You SHOULD take care of your health after all. But it sucks because while an ER can take care of your acute problems, it is completely useless with regards to preventative medicine or long-term care. Sure, we can give you a pill to lower your off the charts blood pressure or inject some insulin to take care of your critically high glucose levels. But when it comes to managing the uncontrolled diabetes that's causing those high sugars or putting you on a proper diet and weight loss regimen to get your blood pressure down, ER docs are largely powerless. We refer so many patients to our hospital continuity medical clinic every day- but whether they actually get there and choose to follow-up is a complete crap shoot. And when patients don't follow-up, we seem them in the ER again and again for the same reasons- frequent acute exacerbations of a chronic problem that is not being properly managed. No matter how much we explain that they need follow-up, some people just dont care.

Effective healthcare is a combination of both preventative medicine and acute care. But when it's seemingly easier to just get things taken care of as they pop up versus maintaining a steady quality of life and health, it's no surprise what people go for. I don't know what the solution is necessarily. I would argue that we need more Primary Care physicians in this world because the ones that are already out there are spread way too thin, but it seems like our current government is more concerned with making sure that people enroll in their Healthcare programs without first ensuring that there are enough Physicians to deliver said healthcare.

It's ironic because there have been a handful of new medical schools that have opened their doors in the U.S. in the past 6 years, which occurred in an effort to increase the numbers of American physicians. So great! More med schools = lots more little doctors in training. However, the number of residency spots available after graduation has NOT increased accordingly, which creates a really uncomfortably bottle-necking event that leaves loads of massively qualified doctors without the opportunity to practice medicine after they've busted their butt and broken their bank during 4 years of med school. So there's all this talent sitting around, which is very much needed to take care of the droves of patients that need primary care doctors, and yet the lack of training opportunities prevents them from being utilized. Water, water, everywhere and not a drop to drink. This is the part that kills me and continues to kill me every day. Because Residency programs are funded by the government and Medicare/Medicaid subsidies there's no way to create more spots unless the government agrees to. Hands tied. 

What it comes down to is this: with the exception of the obvious things (my family, friends, limbs, unpaired organs, principles), I would do just about anything to have the opportunity to take that next step to becoming a Physician. If I could pay a program to train me, I'd do it in a heart beat. If a program told me that they could train me but could only pay me half the average expected salary I'd still do it. Hell, I'd work for free if it meant I could be a full-fledged Physician. In spite of knowing how utterly messed up American healthcare is and experiencing those frustrations on a daily basis at work, I'm still that girl, who at the age of 3 decided she wanted to be a doctor because she wanted to help people.

I still want this in so many ways, but at some point, I feel like I need to start being practical. Let go of the romanticized notions and childhood dreams and look towards a different future, instead of the one you've always planned for. It's terrifying not knowing what your next step will be, but you can only remain stagnant for so long. Even if the path isn't visible, it's a matter of putting one foot in front of the other, and slowly making your way to something new, whatever that may be. It feels like I'm on the precipice of that right now. 

I will very plainly state that I'm envious of my peers who are slowly starting to settle down. Engagements, marriages, house buying, babies, world travel...it's all unfolding in front of my eyes. And in fact, in a few months, most of the classmates that I graduated with will be third-year senior residents and then go on to become Attendings. I am happy for them and I in no way begrudge them their successes, but I'm also tired of waiting for my turn. I know that their timeline bears no relation to my own, but that goal of achieving things and being settled? I don't think you can blame me for wanting that. I'm 28 now (where are my dentures?) and my desire to be personally, professionally, and financially independent is slowly starting to encroach on that part of my stubborn heart that refuses to settle for anything less than what I set out to do. I don't want it to seem like I'm giving up on my dreams, just that I've decided on a different one maybe? 

Letting go is hard. But sometimes it needs to be done.

PS- If anyone has any thoughts as to what my next step should be, I am seriously ALL ears.