Dear Obama

For those of you that may not know this, I'm a quasi exercise addict. I regularly wake up (ok maybe daily) and swim from 6 am to 7 am. Every morning the alarm goes off at 5:33 am and I mutter to myself, "I'm not doing this again tomorrow." But then the evening comes and I set my alarm once again, and the cycle repeats. Here's the thing, though - that hour of swimming is complete calm meditation time. Unfortunately it involves prematurely wrenching myself from my warm bed and forging into the (still - hey, Seattle, isn't it JUNE?) chilly early morning air. But at least it's light out these days. And let's be honest, quality sleep at this point in my gestation is a thing of the past. Oh, second trimester, you were such an unappreciated moment in time.

But I digress. The purpose of me confessing my exercise fanaticism is to explain that often during my early morning swims I have epiphanies. Frequently, later in the day these ideas seem less brilliant, though are intriguing to recall later in the day. It is sort of like piecing together dreams from the night before.

Recently I constructed a letter to President Obama in my head while lap swimming. The letter was prompted by my feeling, after 9 months of my job, completely and utterly beaten down by primary care and the health care system in general. Granted, this feeling comes in waves, and it is not all gloom and doom in my day to day. But, after seeing 25 patients per day with 23/25 of those interpreted visits, I'm starting to question the sustainability of the job. A lot of the providers in my clinic have worked there for decades. Is it just me? Am I not cut out for it?

In my letter to Obama, I explained that the real tragedy of the health care crisis and lack of primary care providers is what the system is doing to smart, passionate providers who want to make a difference and care for the underserved. It seems like a lot of the talk is focused on how few medical students are choosing primary care, which is a valid discussion. But perhaps we should focus on those of us who have chosen this field and want to make a difference, but find in the actual doing of the job, that it is really stinkin' hard. And doing that job day in and day out kind of makes you wonder if anyone actually values what you do. Yes, I'm partially talking about salary compensation. But it is so much more than that. How about good ol' job satisfaction? How about quality of life measures? Why can't a primary care job at community health center be compatible with descent work-life balance?

Over half of my graduating residency class chose jobs in the community health center realm. Yet, one year into the trenches, nearly all of us are either changing jobs completely, working at those jobs part time, reducing from full to part time, or reducing from part time to even more part time.

Is it just me who is seeing this problem clearly? If we can't get today's most energetic, optimistic, and idealistic primary care providers to stay in these jobs, do any of the finer details of health care reform make a difference? Doesn't anyone else think that if we can make these jobs sustainable for the primary care providers who truly want to do them today, this may solve a lot of the problems of our broken health care system? Yes, we need to ensure bright and motivated medical students continue to choose primary care. But what about the ones that already did? I'm starting to feel that I, along with my fellow recent graduates, am a part of a nebulous generation of primary care doctors. We're the 'tweeners. In between the old schoolers (Residency work hour restrictions? That's for softies!) who started up family practices in towns and thrived, and are retiring after 40 years in the same practice, and the newbies (48 hour call shifts? That's inhuman!) training now with the promise that once they arrive at their future jobs, the health care crisis will be all but solved in the name of Obamacare.

So you see how an hour of lap swimming can really fly by. Maybe the answer to the health care crisis is an hour of forced lap swimming for everyone daily. We would have calmer, healthier people in this country, without a doubt.

I know this is a doozy of an entry, but I think I needed a release. I knew it when yesterday, in the middle of seeing my 25 patients, a fire alarm went off in the building. I continued to go about my business, examining and questioning my patient through the din, until an employee interrupted our visit to tell me I was the last person in the exam rooms, and we all needed to vacate. I reluctantly trudged outside and thought to myself, "Is it a poor reflection on my job that I'd much rather continue to see patients in a potentially burning building than evacuate and get more behind in my daily schedule?"