Sad Like Leaving Kansas

This morning I'm drinking coffee, enjoying a beautiful Spring morning in the desert with the breeze blowing in through the window.  In a few minutes I'll start packing up the car and I'll be moving out of my cozy little Navajo Best Western.

I'm really quite sad to be leaving Chinle.  Sad like I was when I left Kansas.  

This was my first Indian Health Services(IHS) assignment.  When you hear people discuss working for IHS they talk about how depressing the experience can be.  I don't know where those people worked, but I have no idea what they were talking about.  Working at the Navajo hospital here has been one of the most joyful experiences of my career. Chinle Hospital has attracted physicians of incredible quality and talent from around the country.  The hospital and clinic staff are approximately 99% Navajo and there is incredible investment into the community as a whole, and the patients are some of the most delightful people I've ever worked for.  

Chinle is what you would expect for a rural high-desert community.  It's a one-horse town (it's actually a seven horse town- those jerk horses run the place wandering through the streets wherever they want) but it lacks nothing in charm or sophistication.  There are only three restaurants, but there is always something to do, from potlucks to  yoga, trail running to ultimate frisbee.  There's even the random dance party in IHS housing from time to time.  And if you look in any single direction you'll see some of the most beautiful and sacred scenery you've ever seen in your life.  

So I'm heading out to Albuquerque for the night to visit with a friend, get the desert sand vacuumed out of the car, eat at the Frontier, and use some normal-speed internet. After those simple luxuries, it's up to another Navajo hospital in Shiprock, New Mexico for a few weeks and then off to China.

If you're a physician or nurse who has considered IHS but has been scared off by people's perceptions or comments, I highly recommend you rotate through some facilities as a contractor and get a feel for the system.  I think you'll be pleasantly surprised at the opportunity to work with great colleagues and a wonderful patient population. 

As for me, I'll be back for sure.  I just have the curse of wanderlust to deal with first. 

Debt & Reward

Becoming a physician in the United States is an expensive proposition.  Nearly everyone has to take out massive student loans.  Some people get around this by making commitments to service agencies, the military or small towns for an equal number of years of service for years of medical school paid.

I like the former, borrowed.  Extensively.  

If you look up average medical school loan debt you'll get an eyebrow-raising figure.  Well take that, and at least double it.  At least.

This surprising amount of debt is one of the major things that keeps medical students from selecting Family Medicine as a specialty and pushes them towards more financially rewarding specialties like Dermatology or Radiology.

But students should consider the  other aspects of Family Medicine that make it amazing. 

Being trained as a Family Doctor in 2013 means that if you graduate from a high-quality program you can take care of adults and children in the clinic or in the hospital.  You can deliver babies.  You can work in the emergency room.  You can work in the ICU. You can inject a knee, ultrasound an abdomen, or console a family as their loved one declines in their health and passes on.  And a wide range of skills means you can work in multiple settings, around the world, from a hospital in Boston, the Navajo reservation, or the ruins of a church in Haiti.

And the intimate relationship of seeing patients over weeks or months or years is a reward in itself.

I think the flexibility to do so many things as a newly-minted or seasoned Family Doctor, combined with a short or long-term career as a locum tenens is the ultimate experience in reward and opportunity.  While anybody graduating from an orthopedics residency or a cardiology fellowship would also have the chance to avoid being locked down to a contract allowing 2 to 4 weeks of vacation a year from their 6am to 8pm days (not counting call), only a full-scope Family Doctor has the chance to work in so many settings.  A Family Doctor can do so many things, never be bored and still earn a living.  And they have the chance to set their own schedule when life and the world present the opportunity to do something amazing.

Last night while during call I managed a complex sepsis patient in the ICU, provided conscious sedation for another Family Doctor in the emergency room as they performed a procedure, counseled a recently intubated young man on alcohol abuse, and took care of a teenager with pneumonia.  

Today I finally paid off the credit card debt that I've carried since shortly after I started college.  Something I was never able to consider before.  And now I will focus on aggressively paying off the massive amount of student debt that hounds me, and keeps other physicians from being able to manage their own fates.  

What a change from only 9 short months ago.

A year ago I was miserable.  Now I work 60% less, make 100% more, have been around the world once already, and am nearly completely free of consumer debt.  I've even funded an emergency account for myself.  And I'm still doing critical care and obstetrics unlike many Family Physicians who feel they need to back off of these things to make their lives manageable.  

Life balance is too important, but it doesn't have to mean sacrificing challenge or financial reward.

I think any student considering a medical specialty should consider this.

And I think any person who is in a personal rut should consider the things that are important to them and ask if they are moving forward towards those goals.  If you are not, consider what the next step is- from planning to quitting- and take it.

Being a Family Doctor is the greatest reward in the world.  And tonight I have this small but significant joy of paying off of 16 years of credit card debt to enjoy as well.  That right now is as much as I could ask for over 24 hours.

That and some nice scotch with a piece of good dark chocolate.