I decided not long after I started this blog – quite some time ago now – to never apologize for not writing.  I’m a doctor.  Stuff comes up.

So, I haven’t blogged in awhile.  If you’re still one of the regulars, my thanks.

This latest distraction involved graduation from my residency program.  Or rather, not graduating…the specter of it, at least.  And while the problem is resolved…the emotions on my side still simmer with grim ebullience.

Arriving in the infuriatingly innocuous manner of many catastrophic announcements, I received the news recently that I had not spent a required week with an orthopedic surgeon during this last year of residency.  Setting up that week is one of what feels like 4 bujillion stipulations that lead to graduation.  I’d missed this one, and it was too late to change my schedule to fix it.

Through some fuse-burning mental gymnastics on my part, and some heroic situation-framing on my advisor’s part, the faculty of my program have just decided that I will, in fact, graduate with my class.  In essence, we found a workaround that keeps me on-track to finish with my peers in less that 4 weeks.

This experience however, reignited an old resentment in me that essentially boils down to oft-repeated theme in the “Jason Bourne” movie series about being required to give vastly more than expected when signing up.

The frank truth is that all the permutations of mid-level medical providers – from ARNP’s to PA’s to Dr. RN’s – have one thing in common…they’ve been subjected to roughly 1/3 the amount of training as I have.  Subsequently, they have 1/3 the debt, and probably have 1/3 the family problems, health problems, and 1/3 the incidents of depression, substance abuse and suicidality.

The result of that limited training?  They do the exact same job as me…and get paid about 80-90% what I will make.

Calculate how much money I lose in training when they’re out actually working, and I probably make less than your average P.A. over the course of a career.

I was so upset over this graduation snafu, that I rammed my fist through a wall in our house, and ended up driving hopelessly around the beaches of Washington until 7am this past weekend.  Then, thankfully, I got with the program and figured out a way to address the problem a little more professionally.

No, working an extra week after graduation wouldn’t be the end of the world.  But in so many ways I feel I’ve reached the end of my rope.  And, for lots of logistical reasons, another week of “work” would have really been tough on me and my family (and probably our walls).

I should mention that what I was deficient in – observing an ortho doc – falls into my category of ‘watching doctors be doctors’.  I’m not sure where anyone came up with the idea that people learn from this particular brand of education-theory rack-stretching, but frankly at my level if I don’t have responsibility, I don’t care.  If I don’t care…I don’t learn.

Watching doctors be doctors is  easily the least valuable learning experience I’ve had in my entire medical training…and residency is rife with this vacuous requirement.  I’m quite sure that the endless hours I’ve spent delivering Oscar-level performances of intellectual interest could be completely removed from my training and I would still be the same doctor I am today…just less poor because I would have started working at least 6 months sooner.  Maybe a whole year.

Simply put, I believe that my medical training is outmoded.  It’s destructively expensive.  If people can do my job with 1/3 the training, then I’m effectively over-qualified. 

The backside to this is that M.D.’s themselves will eventually become irrelevant in the marketplace because we’re just too expensive.  We spend so much money on school and inefficient training, that nobody can afford to pay off all of our debts.  How long will it take me to pay off the $330,000 I spent on my training?  How much more do I owe on that since I’ve piddled away another 3 years on training – watching orthopedic doctors and acting interested – while a number that big generated interest on itself?

I’m deeply grateful to my advisor especially in this case, because he presented my situation to our residency faculty in a light that was very favorable to me.  He is probably the reason I’m not in a padded room at the moment. I don’t really blame my residency program, either. 

The problem is the system:  tone-deaf, needlessly arduous, inefficently stubborn.  The mid-level system was created by smart people who realized that it just doen’t take this much to make a doctor.  You shouldn’t have to sell your soul for the honor and burden of taking care of sick people.

In the end, I approach graduation almost devoid of any elation at all.  Instead, I feel like I’m sitting in a field, blood and feces spilling into my lap from the mortal shotgun wound I’ve received to the gut, looking plaintively up at the shadow hovering over me – at my colleague and killer – and wondering aloud, “Look at this mess…look at what they make you give…”