Tuesday, March 24, 2009

R-E-S-P-E-C-T..(Part Two)

A commenter on this post exposes what could be the dark underbelly of the whole issue of inter-specialist respect:
This leads to a another point. Could it be this very sense of superiority, that drives the attitudes of some of our surgical colleagues, and is influencing our medical students as they make their way through their training?
Could that be behind their reluctance to accept that primary care be paid at parity with them?
Do surgeons have a sense of superiority? For the most part, yes. Why? It probably goes back to training. Now my residency may have been unique in the quality of categorical IM residents it hired, but I don't think so. As surgery residents we did all the lines in the hospital. Many times I and other surgery residents beat on the call room door of an IM resident to get their lazy ass out of bed to do their own damn line. We ran our own ventilators, wrote our own TPN, managed our own antibiotics. Sepsis was not something we consulted Infectious diseases for. Renal failure not requiring dialysis was not something we consulted nephrology for.

IM had a night float, we did not.

The IM/FP residents did all sorts of stupid, silly and dangerous things in the middle of the night, without staff supervision, and had no requirement to defend their decisions. Surgery residents did all sorts of stupid, silly and dangerous things in the middle of the night, sometimes with staff, sometimes not. And every week we had to defend our decisions and actions in front of everybody.

My program was very benign, yet some residents were let go. A FP resident at the same time was paying his colleagues to take his out-of-house call, so he could moonlight. This only came to light when he gave his "employees" 1099 forms so he could avoid taxes. He was not fired, and only suspended from moonlighting for awhile.

We were the cavalry called when all else had failed. Sometimes we got the bear, sometimes the bear got us. But we tried, cared, fought, bled, and sweat. We sacrificed family, social skills, and good hygiene. We complained, but we loved it because as Hyman Roth says the The Godfather: Part II
...this is the business we've chosen..
With all the things described above, how can your average surgical Chief Resident not feel like he/she is like Jules in Pulp Fiction?

In the not too distant past, the shoe was on the other foot. The really smart medical students went into internal medicine, not surgery or orthopedics. The old joke of you take the bottom 25 percent of a medical school class and those that can bench press their body weight go into orthopedics, those that can't go into OB/GYN. LOL!!! And there are those out there who view me and my ilk as mere technicians.

But when I finished, the economic and political realities of private practice revealed that the local cadre of FP and IM folks were pretty good and they would be oh so happy to assist in the medical management of patients. No problem. But the realities remain.

An admission for pneumonia can be handled over the phone, acute appendicitis cannot.
An admission for COPD exacerbation can be handled over the phone, a severely injured patient cannot.
An admission for DKA can be handled over the phone, acute extremity ischemia cannot.
An admission for abdominal pain can be handled over the phone, the surgical evaluation of same cannot.

The hospitalists take care of the admissions at night, no such thing for me.

And unlike some of my neurosurgical and orthopedic brethren, I have no midlevel to separate the sheep from the goats.

Yes I piss and moan and am reminded (by Mrs. Parker, no less) that that is what surgeons do, and I went into it with my eyes open.
...this is the business we've chosen..

So you have chose to go into a field, and/or modeled your practice where you are over-regulated, underpaid, overworked, under-appreciated and disrespected. You specialize in a field where others of your specialty state that individuals with about half your training can do "90 percent" of what you do you complain and wring your hands, remember:
...this is the business we've chosen..


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