We sat down at a sun-drenched table in an outdoor restaurant enjoying the fresh breeze while sipping on our favorite drinks. He is a man with immense talent, a slight frame, and the art of the skill in dissecting the arborized vessels away from his main focus during surgery. He is also one with a keen perception of absolute relations between right and wrong. He has the finely formed hands with strong fingers adept at handling tiny tasks within the human body with great respect. His patients love him for his expertise and decision-making skills. When to go into the surgical operating room and when to stay away. He sits quietly in front of me with his right forefinger toying with the ice cube, swirling it around the edges of the clear glass. The careful thermodynamics of cooling the clear liquid and the endless thoughts are at play, it seems. “Hey!” he says, with a sudden jolt of thought, “What do you think about this virus?” And off we go into the wild frontiers of the unknowns, expectations, and potentials. After the many “it mights” and “it coulds” with nothing resolved but a whole host of questions pondered, we settle down to our lunch laid out meticulously on bright white china. A jet breaks the quiet as it knifes across the bluish sky with its entrails exposing the whitish interior of the sky. The sound recedes, and he muses, “You know this medicine stuff is getting very difficult to keep pace with.” “How so?” I ask, knowing full well what he is going to say yet wanting to know his perspective, whether it aligns with mine. “I spend 40 percent of my time during and after actual patient care feeding the computer information and codes of my daily activity. Most of the time, I access the computer from home before going to bed. The more you provide the beast, the more it demands.” “I know.” I empathize with his sentiments. But he is caught up swirling the entropically dissolving ice cube. He looks up, the furrows on his forehead deepened in thought. “I’m not sure I can take this anymore.” After a brief moment, “You need a vacation.” I suggest, “Perhaps a quiet one with your family out of the area might do you a world of good.” “I can’t! I have bills to pay. I hired a billing person and another person for ‘pre-auths and denials’ that the insurers force us into ever-faster circles of chasing our tails. My office started with a nurse who doubled as a biller and me, and now I have six workers, and I am constantly trying to catch up to the bills I owe. It is a never-ending battle.” He sinks back into the chair with his drink, exhausted from the thought. The ice cube is barely visible as he stares at it. His finger continues poking the sliver of ice into motion. As reality cusps into the overhang of his thought, another window of distress opens wide and lays bare the tightening gyre of his constant-constricting fears. “If it wasn’t for the debt that I have for this office and my home mortgage, I’d quit today. I know if and when I did, I would miss it, because medicine is my calling, but the trauma of bearing the daily burden that only seems to increase exponentially is going to bury me, if I don’t. Besides, the windshield of my life has less in front than the rearview mirror, and time is fast receding.” He looks up and raises his eyebrows in a questioning gaze. The waiter comes by and offers more, both of us in unison politely decline. The waiter smiles and refreshes our glasses with water and walks away, a decorum of efficiency and politeness. “So, what do you plan to do?” I ask, concerned about his dilemma. “Nothing for now. Just keep plodding along until my debts are paid.” His eyes narrow, and he slaps the edge of the chair’s wooden armrest. “You know those two cases I told you about, both died. Both were physicians and working until their illnesses got them. I have wondered what they might have been thinking about their futures. What were their plans? Were they thinking about retiring and having some fun?” He looks straight into my eyes, and there for a moment, I can see the eternal silence of his infinite fears. He straightens his back and says, “I have desires of retirement, but this chokehold of bureaucracy has me stifled. It is almost as if the powers that be, do not want us, doctors to think for ourselves. Just push us from one corner of the maze into another, while we are forever seeking sunlight.” He picks up the glass, which is empty except for the last few drops, and empties it into his mouth. Puts the glass down gently on the table and moves to stand up. Lunch is over. As we walk to our vehicles, he says, “You know, my practice has dwindled to 20 percent of what it was.” “I didn’t know that,” I reply, alarmed at this statistic. “Yes, the hospital has hired three vascular surgeons, and any patient that is admitted other than mine with a vascular problem is automatically referred to them. Outpatient referrals are all I exist on at present.” His eyes seem fixated on the crack in the sidewalk as we are both brought to a standstill. I look at him in silence, knowing not what to say. “What is interesting is that when the hospital hired these surgeons fresh out of residencies, they gave them a big signing bonus and salaries on the lower end of the current pay spectrum. The second-year salaries were based on RVUs. So, if they don’t produce, they get an automatic pay-cut. The incentive to recklessly produce is written in their contract. Is that good care for the patient?” The thought recoils within me. Silence beckons as we look at each other and then walk to our respective vehicles. The world has changed. Hospital corporatism is in charge, and the private physician is being squeezed out into a forced exile. Parvez Dara is a hematology-oncology physician. Source
