I recently read Dr. Toledo-Pereyra's editorial “You Do Not Have to Work Hard to Be Successful and Entirely Happy” in the journal (18(1):1–3, 2005), and I shared it with my colleagues in our Surgery Department. Although I would agree with the ultimate principles espoused in that editorial, it would seem that we practice medicine in a different reality. We have watched as reimbursements for our services have radically decreased over the past several years. In addition, our overhead expenses have continued to skyrocket, as we have had to add personnel to our billing departments to assist in collecting from recalcitrant insurance companies and patients. We have assumed more administrative functions to deal with increasing regulations (HIPAA). Need I mention the malpractice crises with soaring insurance premiums (mine went up $17,000 this year). Many of our colleagues have stopped delivering babies and staffing emergency rooms because of the latter. The salaries of our employees and rent have also increased. In order to stay afloat, most of us have had to markedly increase our patient loads and operating schedules just to maintain the same level of income.
In addition to the above, while our residents now have an 80-hour workweek, we the faculty, still are responsible for our patients' welfare and therefore have to spend more time in clinical endeavors. Alternatively, we can hire physician extenders and further raise our overhead expenses.
With regard to academic faculty, state support to university faculty and medical schools is uniformly drying up around the country, forcing deans to increase their tax on faculty-generated revenue and reduce faculty positions. Furthermore, academic surgeons still have teaching responsibilities to both students and residents, not to mention our desire to do research and continue to be productive in the laboratory, publishing our results in this journal. By the way, many of us have children in college, and these days, tuition and expenses are through the roof. Our editor suggests we just have to “work smart” to accomplish our goals. Although I try to “think outside of the box,” I am quickly running out of ideas to further increase my efficiency. Perhaps the smartest thing I do is to support organized medicine in the hope that our climate will improve.
If being “entirely happy” as suggested by Dr. Toledo-Pereyra means you do not have to “work that hard,” then I would argue that you will not be very productive either, nor will you “be Successful,” at least not in today's medical environment, unless you radically alter your definition of success.