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Why do you stay?

There is a metaphor about boiling a frog which you may have heard. It says: If you throw a frog into boiling water it will jump out, but if you put it in cool water and slowly increase the temperature, it will be cooked to death. Although the metaphor is not true, it does highlight an important point. Threats or changes in the environment that grow gradually are tolerated far longer than ones that occur rapidly. Why are we talking about this? Have you ever stopped to consider your own work environment?

Here is a physician specific example:
  • In the first year of your practice, you spent time treating patients while learning how the practice worked. There were some quirks about the practice. Differences existed that seemed odd compared to your residency, but they were acceptable and you were new and excited about private practice.
  • After 5 years, medical practice was easier and patient relationships were growing. Some physicians had left and you were becoming more senior, no longer “the new one”. You became involved in some of the administrative decision-making. You recall voting on several items that increased some of the non-clinical burden on doctors.
  • After 10 years, you feel as though each time someone expands a department or goes after a new accreditation, you are asked to perform another non-clinical task. You spend more time in front of a computer than with patients and you don’t enjoy the work as you did a few years earlier.
  • After 15 years, the new physicians are joining and remarking on the burden of things they performed in residency and how similar it is to your current practice. They have no recollection of how it used to be, and they manage the multitude of tasks utilizing a scribe. Work without a personal assistant for non-clinical duties is a foreign idea to them. Expansion continues and tasks increase, but the scribes help and the younger physician don’t know any different.

So when is the water boiling? Is this really improvement or is it a gradual trend to the detriment of the field of medicine? Should you be looking for a change in your practice? Moreover, is it better at any other practice?

I don’t have the answers to these questions. But here is what I do know. About 15 years ago I moved back to my home town. Ever since, I have encountered someone I know during virtually every shift. Wether it is the patient, a family member, a new co-worker, there always seems to be a high school classmate, old family friend, or a family member somewhere in the ED. It reminds me of why I do what I do. As a physician, I am not actively seeking the next step in my career, or the next move up the ladder. I believe physicians are a different breed and meant for a long and rooted career. Sure there are locum physicians, tele-physicians, and those who will only be with you for a year. But, I don’t believe that to be the model of practice to which we aspire. Though the heat increases, we stay. We are not the frog in this scenario. We are the water; changing shape with the container, changing temperature with the amount of heat, but still present.

In 2018, take a look around at your practice. If it is not what you want it to be, make an extra effort to take part in the change. We cannot stop the change, but we can certainly effect it, and continue to keep the focus on our patients.

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