This month, U.S. News and World Report weighed in with some sobering news (as opposed to the side-splitting, laugh riot pieces they normally run): that only two percent of almost 1,200 surveyed graduating medical students said they want to work in primary care or internal medicine. Why? Because they did not relish the paperwork, having to tend to the needs of the chronically ill, or the quantity of work they would have to bring home. Not to mention the thirty-five times a week some hypochondriac at a cocktail party with a drink in each hand and the flaky remnants of a cheese puff dangling from his upper lip recounts his entire medical history while pointing to the Tic-Tac sized bump on his neck and asking whether it is simply a cyst or the incipient emergence of a second head.
Like many of us, I was raised with the image of the gentle family doctor whose passion allowed their professions to choose them, sometimes from a very early age. As opposed to someone like me, who played doctor from the age of five, but could never get an insurance company to endorse my unique health plan: a pee-pee O. Nonetheless, in those days, the homespun dedication of TV physicians like Dr. Kildare, Ben Casey and Marcus Welby set the tone. Now, we have the self-involved Vicodin addict on House. But even in his case, it seems that being a doctor is the life he was meant to lead. Just like my own great uncle Irving Sobol. Here was a pediatrician who showed up at people’s homes with his little black bag. He listened to even the smallest family concern. He cared. He had a calling. And callings can seem tough to come by in an increasingly market driven society. Why do I feel like if "miracle worker" Anne Sullivan were alive today, healing Helen Keller would not be enough? She would also demand a large retainer and a percentage of her client’s lucrative public speaking tour. Interestingly, another main reason the above-mentioned graduates said they did not want to pursue primary care was that it has the lowest average salary, of only $186,000 per year. (Orthopedic surgeons, apparently, make three times that, and all without having to take a urine sample from anyone.)
I’m not saying internal medicine or family practice is not without its challenges, and I am definitely not saying I haven’t been on the receiving end of the lack of bedside manner that can result from such a demanding job. Once, when diagnosed with Chronic Fatigue Syndrome, my GP’s recommendation was that I try pretending, to the best of my ability, that I didn’t have the condition. I told him that would be fine, as long as he didn’t mind if I pretended to pay him. At the risk of giving you more personal detail than you may want or require, I can tell you that the paperwork involved in my colonoscopy last year was almost as brutal as the procedure. When I was done with all the forms I asked to have them back so I could check ‘yes’ for carpal tunnel syndrome. The doctor very bluntly told me that having a colonoscopy would mean that I would soon have a camera inside me. I said that would be fine, as long as I could direct. But he drew the line at my demanding final cut, and told me I wasn’t even entitled to a small percentage of the back end.
Now we live in the world of the HMO. In fact, I’m a card-carrying member of the Society for Choosing an HMO. Which makes me a SCHMO). And, experts are predicting a shortage of general practitioners in the near future. And goodness knows these med school graduates who aren’t interested in being my personal Marcus Welby can easily justify it by pointing to all the money they dropped on medical school. And here again, the potential true calling is replaced by economic desire. Still, let’s take their objections one by one.
Having grown up with my uncle Irving, I was given a model for success and happiness that is rapidly declining in a bottom-line world. Here was a man who came through the depression and endured intense economic strain, yet somewhere along the line he answered his call and decided to make life a non-economically-driven thing. There are very few models for this kind of behavior left. If there were, the CEO of Lehman Brothers would trade his platinum parachute for an Orange Julius franchise in the slums of Calcutta so that the impoverished and indigent could not only get a full day’s supply of Vitamin C in a refreshing, frothy elixir, but also free advice on how to invest their life savings of eight cents in a highly leveraged derivatives package. Indeed, my uncle represents a bygone era.
First, the fear of too much paperwork. Come on, what profession doesn’t have too much paperwork? If you don’t want paperwork, join the Mafia. Because you’ll never hear a hit man say, "Listen, Don Vito, I don’t mind shooting and burying my own mother, but do I have to fill out all those forms?"
Second, the medical students expressed worry over having to deal with the constant needs of the chronically ill. ("So, I’m on the seventh hole at Pebble Beach and I get a phone call from the wife of one of my patients. Turns out the jerk had an aneurism! These people think they know pain? They should try practicing their swing six hours a day and still hitting a slice!")
And finally, there was the concern of having to bring so much work home. These med school grads should count themselves lucky. In a few years, with more and more demand on the hospitals, they may well have to start taking their patients home. ("Honey, get dinner ready. And don’t forget we have to leave some room on top of the table for Steve. I think it’s his appendix.")
I guess it’s just a case of what one is willing to put up with for the sake of the profession they have chosen. And, increasingly, the concept of a "calling" seems to only exist in sports or the arts. Nike says "just do it," the implication being that you have to, you’re driven to. That’s why people in these fields follow their dreams. How else does a New York Shakespearean actor survive, knowing that the closest he will come to having an audience for a soliloquy is when he dramatically interprets the list of daily specials? (Whether ‘tis nobler in the mind to choose the lo-fat Italian dressing, or order the chili fries and by consuming, belch them.")
Money drives us, seemingly more than ever. Twenty-four hour financial channels on TV spit out the implied make-it-or-break-it message. Yet within the maelstrom, between Smart Money and The Bloomberg Channel, are a few encouraging signs. For example, it often happens that people who find a way to treat their job as an art end up happier, and some of them even rise to the top. Richard Branson, for example, is always smiling. But then again, wouldn’t you be if you were surrounded by a fleet of giant virgins, each with an airborne thrust of 7,500 pounds?
So maybe we all have the answer right in our own greedy little heads. If you cannot find a calling, make what you are doing your calling. When I began in the recruiting field, management consulting was exploding, and I pretty quickly succumbed to the allure of a well-paying profession. But it got old. And gradually, I began to see that what I loved about my job was the ability to get people to open up to me, tell me whom they really were. I share something vital with my clients, and it is rewarding and energizing. It’s like being a therapist for careers. So, in my own way, I have, on the rare occasions when I get it absolutely right, continued my uncle Irwin’s legacy, by becoming the caring country doctor who listens and is there for the needs of their community. Just don’t call me in the middle of the night with your worries. I’m not getting paid enough for that.