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The lost dream of a small-town doctor

As a child, I was a daydreamer, especially in algebra class. Picture this: my teacher, reminiscent of Droopy Dog but on a heavy dose of barbiturates, droned on from the textbook. And just like that, my mind would escape – soaring out of the window of my quaint Midwestern high school, wandering around the courtyard square.

Back then, several businesses on the square were small physician offices. You could spot white-coated doctors darting from their practices to the tiny country hospital atop a nearby hill, even from a distance.

Perhaps that sight seeded my dream of becoming a physician. I associated the profession with freedom – hard work paired with the autonomy to follow my own judgment.

Or maybe, I just knew I needed a career that steered clear of algebra.

Regardless, the dream was clear: a small-town practice. I envisioned a simple life where I’d tackle interesting cases, collaborate with colleagues I respected, and return home after a fulfilling day. A profession offering quirky joy and autonomy, where my presence was a choice, not a schedule slot crammed between mid-morning and lunch.

This dream of professional autonomy and freedom rendered the monotonous years of institutional education – from algebra to organic chemistry, and then to medical school – bearable.

Graduation day from my fellowship (which my wife jokingly called the “22nd grade”) felt like emerging into a brilliant June day, school doors slamming shut behind me, with an endless summer ahead. Had it rained, I might have resembled Andy Dufresne escaping Shawshank.

But times have changed.

Those quaint offices have either been swallowed by hospitals or shuttered.

Instead of my dream, I face a future of institutionalization until retirement. When that day comes, I won’t be leaving a legacy, but merely punching out for the last time.

Now, my days lack autonomy, flexibility.

I’ve sacrificed countless lunch hours without compensation, only to be denied a request to leave 30 minutes early to avoid temporary traffic. Despite my productivity and patient satisfaction scores soaring above practice averages, I’m asked to use vacation days to address our backlog – compensated with “donuts and lots of appreciation”.

My story isn’t unique. The world has evolved – perhaps for the better. If sacrificing professional autonomy means enhanced patient care and access, then maybe it’s a worthwhile trade.

Yet, I find myself questioning.

Has the shift towards regulation and consolidation truly enhanced patient care or reduced costs? Are we better off than when independent doctors were commonplace?

Is this the hallmark of a victorious health care system?

Or is there a path where the benefits of coordinated care coexist with the advantages of market competition fostered by small, independent practices?

Do higher premiums for care by employed practitioners versus independent ones reflect improved service, or are they products of flawed regulation and monopolistic pricing?

These are the questions that occupy my thoughts during mandatory employee meetings, where my department’s administrator, bearing an uncanny resemblance to Droopy Dog, tediously drones on.

The author is an anonymous physician.

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