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Wednesday, September 21, 2011

Who wants me?

Today was filled with the usual stuff, which is actually never the same from day to day. My first patient of the day dropped in because she was having a stroke. She was actually my partner's patient, but I knew her pretty well from a previous visit and was happy to be able to help her out. I was also wickedly late for my first scheduled patient who just needed a preventive physical exam. Both were good interactions, understanding people with commendable patience (especially the one who waited an hour) and despite being clearly way behind for the rest of the day, it was what I love to do.

I have been more late, of late, because all of my routine appointments involve an explanation of what I'm doing when I quit my job next month, a recommendation for what to do for any health care needs, including a pretty exhaustive review of all of the doctors in the community who might be appropriate matches and some kind of heartfelt recognition of the length and depth of our doctor-patient relationship. This takes awhile, but is necessary and valuable. I have taken care of some of my patients for 17 years, and that means lots of stories told and heard, trust won and compromises hammered out. These are mini-divorces. They are not acrimonious, but they are intense. And then, of course, there is also the problem that the patient is having at the moment to be heard and maybe solved. My agenda at these appointments also involves looking at the whole set of problems and trying to make sure that we both have a clear view of the best strategies for getting them solved and that any loose ends are tied up.

The number of patient for whom a physician is responsible is difficult to glean from our medical records, due to the fact that many patients see a doctor only rarely, or see different doctors based on availability. But based on my official patient panel size when I worked for Group Health, and based on information from an internal medicine preceptor of mine many years ago, a full time physician might have 1800-3000 patients who regard them as "my doctor." The doctor patient relationship is important to most of these patients, even if they are seen infrequently, I am finding out.  Some of the people who are most unhappy to see me go are people I see at most once a year. They don't come in with every ailment, but the fact that I exist and know them is really important to their feeling safe. At least that's what it sounds like.

But I'm not just doing this important doctor patient stuff, I'm also trying to find a job.

A primary care internist who is well educated, board certified, speaks English and hasn't done anything reprehensible is in demand in the US. I will find a job. The easiest of jobs to find will be in places that are very hard to get to, in rural areas where there are desperate doctor shortages.

When I first decided to contact a locum tenens recruiter, I went to the organization which had an excellent reputation with a locum tenens surgeon who I respected. I called them and was immediately put in contact with a man who told me a little bit about the whole process. He told me which states really needed physicians, what different jobs paid, that sort of thing, and tactfully tried to ascertain what awful skeleton in my closet was leading me to look for work. I told him my story of planned adventure, and he told me that anything was possible. He failed to outright relieve me of my misapprehensions about how I could get a really short term job anywhere I wanted whenever I wanted and be home with my family lots. He did that acquiescent groveling thing that representatives of drug companies do when they try to get me to use medications of dubious utility and ridiculously high cost. I tried to be reassuring so he would treat me like a regular person and give me straight advice, but it took over a month for me to realize that unless I wanted to go somewhere and work really hard for 3 or more months straight and then consider moving there, I was going to be looking at 12 hour hospital shifts or really remote locations with really not enough doctors to handle the patient volumes.

Just two days ago I finally decided I needed to contact a larger company with more job opportunities. I was immediately put in contact with two people who seemed more than capable of making me understand how the process works. There were several jobs that sounded possible, if not perfect. And today, through the first guy, I got a call from a very jolly, clearly English as a second language family practitioner from a microscopic town in Wisconsin not far from the Canadian border, and frankly it sounds pretty sweet. We shall see what comes of all of this.

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