By Shannon Winakur, M.D.
Kate Gace Walton, editor of Work Stew, just posted a link on Facebook to an article about the high rate of physician dissatisfaction. It is disheartening to read this article, as well as the results of a 2012 survey conducted by a large malpractice insurance company that claimed that 9 out of 10 doctors surveyed would not recommend the profession.
Is it really THAT bad? In some ways, yes, it is that bad. There are more and more demands on doctors these days, especially the least well paid of my colleagues, those in primary care. See more patients, fill out more paperwork, answer more phone calls, learn a cumbersome computer system…all for the same or less income. Many physicians feel that the public looks down on them these days, that they have been vilified in the whole Obamacare debate. We certainly don’t command the respect that we once did. Reimbursements from Medicare used to be the “floor” in comparison to what other insurers paid for physician visits and procedures, and are now the “ceiling.” Every year, these reimbursements are cut, or there is a threat to cut them by Congress. And many physicians face a higher income tax bill due to changes made to pay for the Affordable Care Act.
Now, don’t get me wrong. Doctors still make a good living, for the most part. But we sacrifice a lot to get where we are now. The years of training are long, arduous, and essentially are rewarded with pay that is less than minimum wage if you factor in the number of hours worked. And now we are being at least partially blamed for driving up the cost of medical care. What doesn’t get discussed as much is the fact that we have to practice defensive medicine, in the face of a significant threat of being sued for malpractice. Because most lawmakers are lawyers, the tort reform needed to do away with defensive medicine will likely never happen…but no one sees the lawyers as the ones causing the high cost of health care.
In spite of all of this, I still like what I do, and I would still recommend medicine to my daughters as a profession. I am a cardiologist, and I am fortunate enough to be able to work part time: three days a week, with one weekend of call a month. I feel privileged to be of service to my patients, and I am honored that they share so much with me. I have been inspired by the work of Rachel Naomi Remen, author of Kitchen Table Wisdom, and My Grandfather’s Blessings. Rachel is also a physician, and talks about how each patient has a story. In reading her work, I have come to appreciate how lucky I am to hear these stories each day. I am fortunate in that I still have enough time to listen.
I find the workings of the physical heart fascinating – the muscle, the valves, the blood vessels, the electrical system. I am energized by educating patients and the public, especially women, about their cardiac risk factors and how they can prevent heart disease from developing. But even more compelling to me is the emotional heart, and how much emotions and stressors can affect the physical heart. To help with this aspect of heart health, I need to listen to each patient’s story. It is so gratifying to help a patient make the connection between the mind and the body, between the emotions that she carries and the physical symptoms that she experiences. In my view, the symptoms are “real,” even when patients don’t have anything wrong with their hearts. I do my best to go the extra step not to dismiss patients’ symptoms and fears when their testing turns out to be normal. Something made them come to the doctor, and that something still needs to be validated and addressed. I feel that that is my role as a “healer,” and I am grateful for this aspect of my job.
I am fortunate that my hospital has taken the issue of heart disease in women very seriously, and has developed a Women’s Heart Center. The program now consists of screening appointments with a cardiovascular nurse who educates each woman about heart disease risk factors. A profile is generated to help each woman know her own risk factors and what she can do to decrease the chance of having a heart attack. It is gratifying to know that we are giving women the tools they need to prevent heart disease – the number one killer of women.
While I thoroughly enjoy my job as medical director of our women’s heart center, my ultimate dream is to include the emotional heart in the process, and to give women the tools they need to take care of their whole heart – physical, emotional, and spiritual. I dream of having a more integrative center, providing women with ways to care for themselves through yoga, meditation, spiritual practices, and other methods to ease the stressors that affect their hearts and their psyches. This will likely take years to develop…so until then, I will continue to find the blessings in my job, in spite of all the “negatives” that exist. I will continue to find the rewards, one heart and one story at a time.