Technically, I have four more days before I strap on the pager again and get an insane amount of calls as I return back to work. But, the holidays may as well be over for me. My next break won’t be until the end of June, well maybe mid-April if you count the research weeks where I will be taking call but will not be on service.
I’m beginning to wonder what it means to be an Infectious Diseases consultant in the real world. Afterall, come summer next year, that would be me. You may think I should already know what lies in store for me, but the training in medicine is such that you never know until you are there. That’s one thing I dislike immensely as I’m a planner. I don’t like surprises.
Anyway. I had previously seen myself remaining in academic medicine, affiliated with a major teaching hospital, bestowing my knowledge on medical students, residents, and fellows, being a mentor to them, and being involved in clinical research. Research. We all like to think that we have the next breakthrough miracle up our sleeves or that we are each future Nobel Prize winners.
I learnt a long time ago, when I was a research assistant in college, that benchwork and basic science research was not for me. Back then it was fun to apply my recently learned molecular biology skills in the lab, but my goodness, the wait in between runs, the constant failure of tests, and the reworking of protocols got old fast. You can’t go into research, especially basic science, expecting a [publishable] result in a matter of days. No, research is a career that eats up your whole life!
My idea of research had always been clinical or behavioural analysis. You know, the translational variety. Not so much developing the next anti-HIV medicine, or vaccine, or cure but rather studying the attitudes and perceptions of various populations to an illness. Why, in 2007 is the rate of HIV increasing in young gay men, in Latino and African-American young people, and in women especially? How can we address the needs of HIV infected immigrants and refugees who come from societies with unspeakable levels of stigma without worsening their burden when it’s so hard to even help them disclose their status to family?
Eh, but even then, the world of academic medicine has its own aches and worries. As my entry date into the “real world” is fast approaching, I see myself going into private practice though not entirely by choice. Private practice infectious diseases. Almost sounds like an oxymoron to me. I’m probably disillusioned. I would like a break from the hierarchy of academic medicine. I would like to just be….at least for a few years, you know? I can always return to academia right? RIGHT?!!! Hmmm!
But what is private practice like? I don’t know. My attendings have never been in private practice. I can’t see myself staying ahead of new HIV guidelines years down the line if I’m not actively involved in the academics and research side of it. That worries me.
Who would fund my behavioural and clinical research if I’m not associated with an academic centre? And worse, what if, just like fellowship, I get called consult after consult just because someone has a fever or an elevated white count with no prior workup being done. I mean, as doctors, one should be able to start to work up a fever, or get cultures and track them for results, or treat a simple cystitis or community acquired pneumonia without the help of an infectious disease specialist, right?
On the other hand though, if I’m being paid directly for my services, would I mind yet another Foley-associated urinary tract infection or MRSA furunculosis consult if what to do is so routine for me even now 6 months into ID fellowship? Wouldn’t that be my life-line?
The likelihood of encountering dengue fever, or malaria, or another “exotic” illness at a community hospital in a non-major city is slim to none so I won’t be able to get my kicks from them. What would keep me going then? Would I be challenged enough? Would I see XDR-TB (extensive drug resistant tuberculosis), or MDR GNO (multi-drug resistant gram negative organisms) like Acinetobacter and Pseudomonas?
Or would I end up the antibiotic policewoman, infuriating other doctors, especially surgeons, when I prevent them from using an “inappropriate antibiotic”. Or gulp, would I be forced to practice primary care to boost my revenue (hey, that’s not funny!), and would I want to be a primary care physician at all, in this economy, in this crisis of a health-care system?
Oh boy! Questions! Questions!
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