Hi everyone,

This is a difficult topic. There are so many levels, and so many aspects to it.

Bert, I think we are of roughly the same generation, I am 63 years old. I suspect that many of the posters on this board are of about the same generation.

Professionally, medically, we are the "awkward in between generation".

I remember, probably about 5 years into practice, one of the order drug reps came in on a busy Monday morning. He saw me rushing around, when I stopped to talk to him, he said "Doctor, I think I know what your problem is." This clearly took me aback. My mouthwash? My deodorant? My personality?

He said "You were born about 10 or 15 years too late. I have been in this business for a while, and I have seen what you guys go through, and it has gotten so much worse for you over the last 10 years." And this was probably about 25 years ago.

I think the generations before us had it worse in terms of time and professional demands. But, financially and in terms of professional and societal respect, they had at all over us.

On the other hand, the newer generations are much better at balance in their lives. There were no restricted residency hours when I trained, and basically the expectation is you would put the entire rest of your life on hold, as long as necessary, for your career, both day today and long-term. This becomes internalized.

So, at least for myself, we have this awkward situation where we still have the internal expectation to be everything for everybody, always available and always perfect, but having largely lost the financial benefit. Certainly I make a decent living, but if you figured it out hourly, a lot of nurses make more.



Which leads to current practice. I am in a solo practice, so I am my own boss and answer to no one right?

From day 1 of practice, there was always the specter of medical malpractice. Which, of course, still exists. There is OSHA. And HIPPA. And narcotics over prescribing. And clinical practice guidelines. (By the way, anyone else who listens to Audio Digest Family Practice, over the last few years there have been a few excellent speakers on the lunacy of the tyranny of clinical practice guidelines. A few speakers have actually brought up the heresy of questioning tight control of diabetes, especially in the elderly.) Charting. Addressing labs. Forms. And prior auths. And prior auths. And prior auths.......

And the patients are not getting any easier. I have been practicing in the same area for just short of 33 years, and still have many of the original patients. Those who were young are now middle-aged, those I recall as being middle-aged are now old with multiple medical problems. The average age of the practice has definitely gone up, as have the complexity of the medical situations.



Finally, if you really look in the philosophical, I am probably around three quarters of the way through my life.


So do I understand you talking about burnout? Absolutely. Do I understand being busy enough to put such thoughts out of your mind? Absolutely.

How to handle it? Poorly. That will be another post.

Gene

Gene Nallin MD solo family practice with one PA Cumberland, Md