The last post painted a somewhat depressing picture, indicating that while physicians certainly provide some benefit to their patients, the average physician's direct impact on their patients is not all that high, or at least not as high as we'd sometimes like to think.
But it's not all bad news - as mentioned, there are plenty of ways physicians can beat the average, either by improving their direct impact on their patients or by having an impact outside the clinical setting. Here's some approaches I'm trying to keep in mind as I move through my training.
1) Do a Good Job
I'm in Medical School because, presumably, I was a better candidate than the person who would have gotten in if I had never applied. However, since medical school admissions is an imperfect process, there's no guarantee I'll be a better physician than the person who would have replaced me. If nothing else, my job is to do my absolute best to be an improvement over my hypothetical replacement.
That means reading as much as possible in a way that it'll stick in my head long enough to be of value. That means developing physical skills I'll use in my career in a way that leads to mastery. It means keeping on top of new developments, new studies, new innovations that have the potential to improve care meaningfully. It means understanding some of the wider contributions of society on health and incorporating that knowledge into practice.
It's pretty cliché, but being good at what you do for a living can make a considerable difference.
2) Pick a Meaningful Career Path
As mentioned multiple times on this blog, I'm a bit obsessive over what my specialty choice will be. Every physician (hopefully) does some good for their patients, but exactly what kind of effect they have on the patients they serve can vary wildly. The previous post talked about the average effect on QALYs physicians have, but not every physician has the same effect on their patients' QALYs. Some physicians improve or prevent disability, working more on the "QA" side of QALYs. Some spend more time on extending life, improving the "LY" side of QALYs.
There's undoubtedly some variation in the overall impact on QALYs each physician has as well; some physicians' daily work probably saves or improves more lives than others, though I can only guess which specialties and practice types have more or less of an impact. Given trends in global health, I'd argue physicians who care for pregnant women, young children, or those who focus on infectious disease are probably contributing more than their fair share to overall QALY improvements. Likewise those who work in specialties that need more physicians, such as geriatrics, or in underserved areas, are providing a high marginal value of care since their work is often in place of nothing (rather than in place of another physician).
Ultimately, a physician should enjoy the work they do - it certainly helps with point #1 - but it's worth considering the net effect on patients when choosing a path. All physicians feel like they're doing good, but the point of the 80000 hours site is that feeling good isn't enough. It's something I'm keeping in mind when choosing a specialty.
3) Donate Some Money
Doctors as a whole suck at money management. The typical physician goes from being a student with no money (and potentially a lot of debt) to being a resident with some money (but a lot of debt to pay off) to a practicing physician with lots of money. There's not much time for proper budgeting to be learned - either there's not enough income to budget with anyway, or there's so much income that budgeting feels unnecessary.
This leads to a concerning number of physicians with money problems, because their high incomes get cancelled out by equally high (and often unnecessary) expenses. That can lead to some bad consequences for the physicians themselves, but it also cuts off a major way in which physicians can help others - donating to charity.
The impact of charitable donations depends heavily on the organization or cause being donated to. Evidence-based charities can be very effective, especially in lower-GDP countries where there are a lot of identifiable problems to address. A physician living conservatively with strong money management can easily donate 10%, 15%, or even 20+% of their income to worthy charities while still enjoying life and saving for retirement. Over a career, that's hundreds of thousands of dollars going to improve others' lives. That can make a much greater difference than even the most dedicated clinician can contribute directly.
4) Work Outside the Clinic
Physicians have surprisingly good career flexibility. They can do research and/or development. They can be advocates for better health. They can teach the next generation of physicians (and sometimes non-physicians). They can transition from being a physician to other careers in business or politics. This can provide a lot of indirect benefit to people both through healthcare and outside of it.
There's lots of options, so it's worth figuring out which ones are best for each individual physician or physician-to-be. I'm focusing pretty heavily on the research side of things right now, though it's mostly just career development at this stage. My advocacy is largely limited to my online postings, which are probably of minimal value given that my audience is fairly small (but highly valued!) and I'm probably preaching to the choir more than anything else. I am putting in a fair effort on the education front, through organizing teaching sessions, some educational research, and even direct teaching myself.
How these evolve as I move forward in my education and then in my career as a physician is pretty uncertain at the moment, but I want to push ahead in at least some of these areas, if not all of them. Not only do they provide some variety in my day-to-day activities, but they could be as meaningful as my direct patient contact, if I pursue them with some wider goals in mind.
Anyway, I wanted to present this as a counter-point to the previous post. Being a physician isn't automatically as beneficial to the world as we sometimes like to believe - but the potential to do a lot of good is still there, even if it takes some work, some discipline, and some thinking outside the box to make it happen.
No comments:
Post a Comment