This article’s been making the rounds the past week or so, so it’s already been discussed to death. Here are my two cents anyway. I generally agree with the idea that medicine is a career of service, one which requires more dedication and sacrifice than your run-of-the-mill job. But I also took great offense at some of the things that Dr. Sibert wrote, and her take on the workforce shortage issue really missed the mark. Maybe one reason why we have a shortage of certain kinds of physicians is the result of unrealistic expectations on the part of colleagues and even patients of what a budding physician can and should take on. 

First of all, I really can’t agree with her assertion that physicians owe something to society beyond what they are already required to give in training and throughout their whole careers… because their medical training is subsidized by taxpayers. I do feel that I’m incredibly privileged to be entrusted with people’s lives and we do owe our patients dedication, diligence, and humility, not because they helped pay for us to go to school but because that is what the job requires. And while I’m happy to have access to some federal loans that are subsidized and perhaps carry lower interest rates than they otherwise would, I actually see the financial investment in my medical education as a huge burden and a personal sacrifice, and not particularly as a gift from the American public. Frankly, because I chose to go to medical school, I can’t contribute to my family income for at least a decade, and even after I am fully trained, my ability to contribute will still be limited by the fact that I will be in SO MUCH DEBT. In fact, part-time practice probably won’t even be an option for me in the first decade of my career just because of that debt. (Note: I might be extra sensitive to this issue at the moment, having just signed my loan papers for this upcoming school year. And I’m admittedly kind of unusual, since my family is poorer than that of the average American medical student, and my school is pretty much the most expensive one in the country.) While my situation doesn’t represent the majority of my colleagues in medicine, let me assure you that those of us who really actually absolutely need financial assistance to attend medical school don’t ever feel like it’s a free ride. Besides, the government subsidizes medical training at multiple levels because it’s in society’s interest to do so: we would have very few doctors if everyone had to pay for medical school upfront. My annual tuition alone is about 15K more than the median household income in the US. The government also subsidizes higher education in lots of other fields, but we don’t see engineers and teachers giving each other gruff about not being maximally productive for the sake of the taxpayers. Weird. 

Second, there was a paragraph where Dr. Sibert seemed to imply that women, particularly those working part-time, were largely responsible for the primary care shortage. Yikes.

“This gap is especially problematic because women are more likely to go into primary care fields — where the doctor shortage is most pronounced — than men are. Today 53 percent of family practice residents, 63 percent of pediatric residents and nearly 80 percent of obstetrics and gynecology residents are female. In the low-income areas that lack primary and prenatal care, there are more emergency room visits, more preventable hospitalizations and more patients who die of treatable conditions. Foreign doctors emigrate to the United States to help fill these positions, but this drains their native countries of desperately needed medical care.” 

So okay, if you do the math, women being more likely to work part-time than men, and more women than men in primary care fields equal fewer hours of care provided than the maximum possible if, say, there were more men in primary care or if everyone worked full time. But this fails to acknowledge that the proportion of physicians going into primary care fields has been declining for a long time and ignores the important question of why men aren’t more interested in general practice. Yes, the prevalence of part-time practice contributes to the workforce shortage, but even if every PCP were working full-time, we would still have an overall shortage, and the urban and rural underserved would still be underserved. 

Finally, the whole thing just felt… unfair. And self-righteous. I’m sure Dr. Siber didn’t mean to come across that way, but she did. It’s unfair to say that because you chose to be a physician, the demands of your career have to supersede your identity and needs as a human being. Because we are human beings. We need sleep, and food, and affection, just like everyone else. One of my mentors at school is an MD/MPH who used to practice at a community health center in the Bronx, which is more or less what I want to do clinically, except hopefully in San Francisco or Oakland. One of the reasons why he turned to administration and teaching is that he burned out after ten years. I don’t ever want to get to that point. It would break my heart. I would feel like I had failed my patients. 

I am not a saint, and I shouldn’t have to be just because I want to become a doctor. Again, we would have very few doctors if that were a requirement for entering medical school. I always want to do the best I can for my patients, but that means being able to step back sometimes to take care of my own needs. Believe me, for most of us, most of the time, medicine is absolutely the highest priority. 

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