My not so cushy cushy job

I remember a time, oh so long ago, when I was contemplating job options post residency. I remember thinking I was committed to caring for the underserved and hoped to be able to do this at a community health center (see previous posts for stories of my adventures at a CHC). Deep in my core I still do want that. I also remember thinking (never vocalizing of course) that it was a sell-out move to choose other "cushy" family medicine jobs. But fast forward a pregnancy, maternity leave, and one crazy cute child later, and the need for a more flexible schedule (and oh yeah, a better salary would be nice too) became more of a pull. So here I am, working in a larger health system, not a CHC, caring for patients with insurance. Pretty cushy, right?

Guess what? It's not that cushy. It's still really freakin' hard. Which has led me to an important discovery: Primary care (in all varieties) is really freakin' hard. Hmm, maybe that's why med students are not choosing this career path? Or is it that because we're woefully underpaid and overworked? But I digress. Where was I?

Oh, yes. Primary care is hard. I still have a jam packed schedule, 20 min appointment slots, patients with a laundry list of ailments to discuss (which would probably amount to a 2 hour visit if we could address them all). I rarely have time to breathe, eat, or pee during the day (let alone pump breast milk), and I often leave clinic with an unsettled feeling that I didn't satisfy the needs of my patients.

Which leads me to another recent epiphany: Simply having insurance does not mean you are well cared for. It does, however, mean both providers and patients do have access to things like diagnostic testing and specialists (though somehow my patients still complain about how hard it is to get in to see the specialists). This, of course, is a good thing.

Yet, it still seems like something is fundamentally wrong with the system. I'm starting to wonder if we as primary care physician can even provide adequate care within this model. Are we primary care providers all on the proverbial titanic?

Well, that certainly is just the tip of the iceberg (pun intended). I would love to get into it more here, but I have to go attend to the swarm of patients and attempt to address back pain/neck pain/depression/anxiety/lack of sleep/abdominal pain/vaginal itching/bed wetting/weakness/fatigue/abscess/rash/ear pain. Sounds like one cushy afternoon schedule, eh?