Dear Dr. Goodhook,

As a second year resident, I’m becoming more and more concerned with health care reform. Quite frankly, I’m wondering if becoming a physician was the wrong decision.

Making plans for my career after residency is difficult. I already have dozens of critical decisions to make, which are even more nerve racking considering all of the rumors going around about health care reform. More than anything, I’m worried I won’t make enough money to pay off my debts and sustain the lifestyle I want. And with increasing patient populations, I’m worried I’ll never get any time off.


Nervous in New York

Dear Nervous,

Worry is like the venomous snake. Turn rock and leaf, and you’ll find every forest filled with such dangerous creatures — including the forest of vocation. Stated plainly, you fear the path on which you stand and what lies ahead. I’m afraid, young resident, that this is the case for all. Dive into the waters of a new career and you’ll discover but one constant truth: Every man has his own “health care reform” to face, no matter his occupation.

Your query isn’t one to be answered simply, and a question of medicine it is not. Rather, it is a question of philosophy. Comforted you may be by words of the 20th century Spanish philosopher, Ortega y Gasset, from his famous Revolt of the Masses:

“The man with the clear head is the man who frees himself from those fantastic “ideas” and looks life in the face, realizes that everything in it is problematic, and feels himself lost. And this is the simple truth — that to live is to feel oneself lost — he who accepts it has already begun to find himself, to be on firm ground.”

Whether doctor, lawyer, teacher or broom pusher, you will find yourself lost and uncertain. Might I point to another influence, the existential mammoth Soren Kierkegaard, and the wisdom penned in his famous work The Concept of Dread. Essentially, Kierkegaard stated that man dreads his own freedom and possibility. He dreads that which is not, but which may be. He dreads what he may do and what he is free to do.

We are all afraid of making the wrong decision.

I am afraid the only answer, then, is blunt as rock: Listen to Ortega and look life in the face. Be warned the experience is ugly and unpleasant, but ultimately inevitable.

Having walked a physician’s path for decades, I realize what terror lies ahead. Colleagues of mine at the Association of American Medical Colleges estimate a shortage of approximately 21,000 primary care physicians by 2015. Articles such as this one from scribes at the New York Times, which detail increasing physician workloads and decreasing rates of pay are frightening.

I encourage you to look within, and to think back on those hopeful sparks of mind that stoked your initial fire to pursue medicine passionately. Keep eyes high and gait steady. Listen and respect all around you, and venture forth bravely, not with tail betwixt legs.

Finally, use not your sword to ward off imaginary beasts (the future which has not yet arrived). In doing so, you will stab yourself in the foot. In this case, only the podiatrist wins.

– Dr. Goodhook

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