Fit the Mold or Not?

I thought once I got through all those steps, it would be straight forward to start a career caring for the population of patients to which I had devoted my training and future endeavors.


Nope. Nope. Nope. 


After fellowship, I tried academic medicine first.  The idea of being faculty at a well-known institution, with a gateway to patients with refractory medical conditions who I could serve, medical students and neurology residents in training who I could teach, and research projects that I could participate in seemed appealing.  So, what was the problem? I had to fit into a mold, which was not cut out with the headache and facial pain specialist in mind.  The mass size and bureaucracy made access to patients quite difficult, with separations in systems making it challenging to provide the quality and timely care my headache and facial pain patients deserved.  It definitely was a tough decision to leave academics behind, but with the loyalty to my patients in mind I decided to switch to private practice.


Simply put, private practice for a physician means that the organization is not tied to an academic center.  The practice can be either group or solo (individual) based.  Both academic and private physicians can participate in educating future doctors and medical research, however private practice physicians have to volunteer their time to education and typically require a high patient load to be considered for research studies. 


Given the ability for camaraderie between physicians, the wisdom of more senior neurologists, as well as the financial stability offered by a group compared to going solo, I decided to join a very well established and respected practice.  It didn’t take long to realize that the same pressures limiting quality to the headache and facial pain population in academics, were evident in group medicine.  The verbiage and systems are slightly different, but aimed at the same goals. 


Okay Cris, time to take a step back and re-evaluate.  It’s not academics and it’s not private practice groups who are the bad guys.  Why aren’t you fitting into these models? What about your practice and scope of medicine is different? Who are these stipulations really coming from?  What’s broken and how can you be part of the transformation to fix it?


Simple answer: It’s a system wide problem.  Create a clinic that fits the patient population being served while also providing affordable access, not one that is made to fit the current economic support model behind providing healthcare.  Essentially, “start from scratch, Cris.”