New Attending

Well into my first month as an attending in general medicine at an academic medical center, I admit I am completely overwhelmed. I thought I could handle this whole outpatient clinic gig. Preventative care of outpatients was what I was trained to do in residency. Calcium with vitamin D, breast exams, colonoscopy referrals, vaccines. But now that I've gone and started the practice of medicine in the form of crazy full-time outpatient clinic immersion, I feel like I'm digging out of a freshly-dug grave every day and my fingernails can't quite get clean or get a good grip.

It's only that bad sometimes. Other times, I think I know what I'm doing, but there's no one else above me anymore to check that. We have an electronic medical record, which is great for legibility and communication, though challenging for my carpal tunnels.

Last week, I had a new patient visit, 79 yr old monk with multiple medical issues, transfer of care from his long-time physician for reasons unclear to me. He arrived with his monsignor and 300 pages worth of medical records for me to read, know, and act upon. His new patient visit. was somehow scheduled, likely by accident, for a 10-MINUTE VISIT. He will make another appointment to complete the new patient visit, which was no problem, the monastery is flexible. But my god. I read through the patient chart after hours and typed in his history into the EMR and actually REACHED MY CHARACTER LIMIT. The computer would not allow me to type in any more characters. It was possible. I'd hit some alternative dimension.

I had to open a new chart for him in the end.

Having that large stack of medical records in front of me, newly charged with responsibility for this patient as his new primary care physician, I felt like I was back in medical school and perhaps even organic chemistry class again. All that memorization, pages and pages of text. The fact that I could read that much information and try to remember some of it in my 20's helped me forge ahead with the textbook of a real person in my 30's.

I'm still overwhelmed. It doesn't help to know that hardly any U.S. medical student dreams of doing what I'm doing-- primary care medicine-- when they finish residency. I don't blame them. My medical school loans are heavy, but not even half as heavy as average med school loan debt today, mostly because I attended a public university for medical school and paid in-state tuition. I was lucky to have that option.

I shouldn't really complain. But that's what this blog is for! Constructive complaining, at least. I'm still optimistic the road to primary care private practice gets easier. It has to.

Hunter-Gatherer

I have been looking for a primary care physician job since December 2007.

How can that be? Some may ask. I guess my only response to that is that 1) No, I'm not an ex-con and I don't have any dings on my permanent record... that I know of... 2) I'm picky, have been, ever since I was 5 and didn't drink all my milk, and 3) Job hunting is still job hunting. No one's knocking down my door to hire me, except the hospitalist recruiters from Texas, Wisconsin, and Alaska. Not that I would not consider living in those beautiful places, and they are truly beautiful, but hospitalist? Not for me.

I have been job hunting for a while now. I've had 5 deeply inquisitive interviews, some of them lasting days at a time, and even with that particular interview parade, I did not get an offer. This particular job was for an academic clinician educator position at an impressive university medical center, so perhaps I was not what they were looking for. Or they sensed vice versa. Two physician recruiters later-- one mysteriously resigned 2 weeks ago without telling me-- leaving me to think I was a lost cause? -- I have gathered the fruits of a couple of job offers. Yay! Not a lost cause after all. And now I am faced with the awful truth...

Money matters.

Some may say, that's impossible. You're going into primary care. Why would you go into primary care if you care about money?

I realize that money is not the first best thing to matter. It should be family, love, friends, God, self, core values. But once they FedEx that job contract and you're looking at a number, and then you're looking at your educational loans and debt number, and then you're looking at the offer number again, then you start to realize you feel sort of unsettled.

And then you scold yourself and say, We didn't go into this for the money. We never did. We love our job. We love the fact that practicing medicine isn't a job for us. I like giving myself that pep talk. Sometimes, it works.