The Race to the Bottom


One of my colleagues is an internist.  He works as a solo doc, the casualty of a group liquidated under economic pressure.  He works like a donkey.  I’ve known him for years, our kids have gone to school together and I’ve watched him change.  He’s overworked, overweight, tired and his hair is falling out.  He never sees his kids.  While too proud to admit it, he’s working harder for less.  In between hurried bites at lunch recently he mumbled his mantra surrounding the changing face of medicine, “I’ve got to be lean and mean.  That’s right, lean and mean.

But where does it stop?  At first it was a matter of maintaining a salary. Now it’s survival compounded by the drive to maintain the ideal of something from another place and time.  More patients faster and faster.  It’s American medicine’s the race to the bottom.  It’s humiliating to watch, really.

Those with quiet contempt for the physician relish the dissolution of what was once a proper profession. But I have to wonder who’s really on the losing end here?