Of there’s one thing all ER docs have learned is that there is one thing you can be certain of. Eventually all the chronically ill, drug abusing, frequent fliers die. Sooner or later you’ll walk into work and everyone will be like, “Did you hear?! So and so finally died!!!”.

For a second you are dumbfounded. Years of drug abuse, neglect of chronic illness never managed to kill them before. How could this be?! There must be some mistake. There’s no way she could die.

Then you feel relief. It’s a selfish relief because you realize that she’ll no longer be plaguing your department, absorbing resources, making demands, driving everyone that works there to the brink of suicide.

Then you feel sorry that you felt that way. Then you just feel sad. Sad about how they’re life spiraled down the crapper years ago. Sad they’re dead. And sad that they’ll be replaced by another seeker/abuser/frequent flyer.

The circle of life continues.

So lately it seems like many doctors I know are hanging up their white coats (or at least their stethoscopes) and leaving clinical medicine. A cardiologist is going to work for Pharma. An internist is going to work in finance. A surgeon got his JD and is going to work for a law firm. A colleague is going back to school to get an MPH. An ID doc is going to work for a health plan.

Why? It seems the reasons are varied. In some cases it’s the crappy call schedule and the way it dictates your social life. In others, it’s dropping reimbursement rates for what used to be their bread and butter. Others are just sick and tired of dealing with whiney, needy patients. Others are just bored intellectually. Some complain that MD’s have lost the respect they used to have.

I wonder if this phenomenon is more common in the last decade or two than before. In any case, you can’t just peg it to one reason. I also think there are more opportunities than ever before for doctors who don’t want to be in clinical medicine any more. I also think people are less tolerant of unpleasant aspects that impact their lifestyle. In the 60′s and 70′s I think most docs just stuck it out even if they were unhappy.

It was with a sense of dread combined with admiration that I read THIS article about how the ER staff at a hospital in Aurora, CO handled over 20 gunshot victims in the middle of the night.
I love the bit where some of the morning shift staff come in and, not realizing what it happened, say “how was the night?”