Last night, as I was getting ready for bed, the phone rang.  It was about 11:20 pm.  Anyone who is past college knows that any phone-call that late bodes ill.  Sure enough, one of my partners (who was working the 11p-7a shift) was terribly ill with vomiting.  I’ve tried, but I cannot work with GI illnesses.  He needed someone to come and cover his shift.  He had made two phone calls with no answers; we picked up.  (Note to self:  stop paying for caller-id if I’m not going to use it!)

Minion of misery...the telephone!

Minion of misery...the telephone!

Jan threw together some excellent snacks for me, we kissed good-night, and off I went into the dark.  I stopped by Jack-in-the-Box for my customary iced-tea, and strolled into the emergency department.  My partner, bless his heart, had ‘puke-measles,’ the kind of petechial rash one develops on the face from forceful vomiting.  He looked miserable, and I told him to go home post-haste, without breathing anywhere near me.  One of our nurses kindly wiped off all the phones and keyboards for me, and it was ‘down to business.’

It wasn’t a bad night.  A little chest-pain, a little flu, a little passing out, a little of this and that.  I was, unfortunately, bone-tired.  I hadn’t slept at all before coming to work, since I had no idea that duty would call at 11:30PM.  I’m home now, drifting off as I write.  I’m glad that I went to work.  It’s what you do when you have ownership in a group; when you have a stake in the prosperity of your workplace.

And it made me wonder.  If health-care reform moves forward and we engage in some great leveling, will things be the same?  If specialists and generalists are paid the same, if we end up with one payer (which amounts to one gigantic patient per year that demands to be happy no matter what), will physicians respond to their duties the same way?

I went to work because I am an owner in a small corporation.  I have employees and I have partners.  I have nurses and others who count on me, or one of the physicians in the group, to be the anchor, the voice of reason, the calm and confident influence in chaos.  Would I have felt the same way if I had no ‘dog in the fight?’  What if I didn’t make more money for extra work?  What if I didn’t reap the benefits of ownership, which allow me to profit (there’s that horrible word!) from the prosperity and quality of my group?

And what if we all worked for one entity, and that entity gave everyone sick days and fixed vacation days and paid time off?  Would we see more or less shifts missed due to the tendency to ‘call in?’  I see what happens among non-physician staff.  Sick days are sometimes ‘mental-health’ days.  Sick days are sometimes shopping days.  Sick days are an entitlement.  It doesn’t matter that the shift goes uncovered, or that someone else’s day is interrupted.  No ownership, not potential to profit, no differential for difficult shifts, all add together to ‘nobody to work.’

I’ll say it again, America.  Be careful when you constrain the health-care industry, when you seek to employ and level physicians (or executives or car dealers or anyone else).  Be careful when you take away the personal economic and professional incentive to do the right thing.  The moral ethic is powerful, but isn’t operative in everyone.  And often, in the middle of the night (short of disaster), it could prove an inadequate motivator.

I’ll probably always go in to work when called.  Most physicians probably will as well. For a while.  But if we tinker with it all too much; if we make it a compulsion not a calling, a law not a love, a threat rather than the joy of ‘doing the right thing,’ a forced volunteerism rather than the thrill and risk of success, then phones may ring and ring, unanswered, in the dark night of our future health-care system.

Nighty-night!  God bless you all today and always.

Edwin

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