The Doctor Dialogue

3.28.25

Happy Friday!

This is the second installation of a series on work/life balance in medicine.

Morphine and Memory

“I feel like I am only alive for 8 hours a day,” says Mark Scout to his sister, Devon, in the new hit series Severance when trying to explain the strange experience of being severed from his personal life. Since its first episode was released in February 2022, Severance has provided an incisive critique of identity, memory, corporate control, and a fundamental desire for human connection and meaning in the modern world.

For the corporate workhorse 8 hours is the norm; but good news, due to the 80-hour work week in medicine, you can feel like you are alive for 16 hours a day. Double the hours, double the life lived.

Jokes aside, Severance is part of a larger dialogue in modern American society surrounding the question: what is the balance between work and life, and more broadly, public and private space? Is there a clear line between the two or are there spaces of overlap? More importantly, should this remain as is or do we need to shift it one way or another?

The front lines where we see these questions played out are in disciplines where the line between work, home, and play have historically been blurred. One of the best examples is the field of medicine.

Medical School Morphine

Have you ever wondered where the term resident and intern come from? Medical education started out in the 18th century with an apprenticeship model – aspiring doctors studied under more experienced doctors. During this time, hospital-based training emerged and young physicians or "House Officers" stayed overnight to care for patients. House Officers were the precursor to modern day residents.

The establishment of formal residency programs were founded by William Osler and William Stewart Halsted at Johns Hopkins Hospital in Baltimore in the late 1880s. These programs were structured to provide in-depth training in specific medical and surgical specialties. As medical knowledge expanded and specialized fields developed, residency programs became increasingly important for doctors to gain expertise in those areas.

Notably, William Stewart Halsted is well-documented to have developed a significant addiction to cocaine and later morphine. This arose from his own experimentation with cocaine as a local anesthetic in the 1880s, a time when its addictive properties were not fully understood. If you were wondering why medical training is so hard, understand one of its founders was constantly on drugs and consistently did 3 day shifts.

Dr. Hugh Foy's 40 hours on, 8 hours off work schedule detailed a few weeks ago is starting to make a bit of sense.

In the mid 20th century, the first year of post-graduate training became distinct and was often referred to as an "internship." Initially, an internship was often considered sufficient training for doctors who planned to go into general practice. Residency was seen as more specialized and not always necessary. Additionally, interns provided valuable service to hospitals, often handling the initial patient assessments and routine care.

Residents are those who resided at the hospital; interning is when you didn't leave the hospital.

Drive for Commitment

Frank Sheffield highlights an innate hunger for purpose in our life: “I think there is something deep in all of our hearts that we want to be fully committed to something but I sit down and pray that I am able to make it through, that I am able to be myself after [medical] training.”

As I discussed last week, one of the key ways to maintain a sense of personal identity through rigorous training is to remain connected to those you love and care for. In a way, they will be the honest voices in your life reminding you of where you have been and where you are currently. If you know your past and present, you will have a strong sense of direction of how you want your future to unfold.

However, the central challenge regarding work-life balance in the medical field is a question of scale: How can you have work-life balance for all the people that are working in the system and enough care for all the patients who need it? More specifically, how do you facilitate the forming of relationships at the scale that it needs to happen?

Matchmaking

Many Americans do not receive the care they need. This is in part to structural barriers to care, but at a more foundational level, there are not enough doctors for the just over 330 million people who live in America. It is a simple supply and demand scenario with a relatively inelastic good: health care. Not enough supply and too much demand? Several things will happen: 1) Prices will increase, 2) there is increased revenue for those providing health care, and 3) there is an increased likelihood for rationing and shortages. Sound familiar?

Especially in light of the recent cuts to higher education, medical schools are going to have to start thinking outside the box for ways to educate medical students in a rapidly changing landscape. Our future depends on it.

A report in 2024 performed by the Association of American Medical Colleges (AAMC) projected that we would face a physician shortfall of around 86,000 physicians by 2036. That was before Trump took office.

Despite a massive transition starting in earnest in graduate level education, we (especially recent undergrads) must keep our heads up and start thinking creatively on how to ensure we can provide care to kids, adults, and elders down the road. Necessity is one of the greatest drivers of creativity and innovation.

A Graceful Death

The most difficult part of transition is a graceful death. The death of a system is an intensely destabilizing force. Ways of being and identity are tied up in this system. However, I am realizing I have not had enough time to anchor my identity too strongly to a system. There will be many experienced professionals that will have to go through a time of mourning, hospice, and compost to release all of the experiences and institutional knowledge built up over time.

However, us young adults have the ability to mourn, pivot quickly, use our power of observation and critical thinking skills, and come up with practical solutions. If we want to facilitate the forming of fecund, rich doctor/patient relationships at scale, an honest pragmatism will be our best worker. What is the reality? What are we trying to do? How do we build a process, iterate, and come up with robust, actionable solutions?

It all starts with listening. Go find a mentor, someone with experience, someone you admire, and listen. Listen first, then act. The Doctor Dialogue is my version of doing that process. The more we can do it, the better our solutions will be.

Cyber Free Zones

Mark Scout is severed from his personal life. At work, he can't remember anything about the outside. He feels like he is only alive 8 hours a day. I aim to be alive 24 hours of the day. I believe I can strike a rhythm where the line between public and private is more blurred than solid. However, I believe making a strong line for a cyber free zone in my life is vital. This is going to be the key to my sanity.

Friday night to Saturday night I minimize screen time and maximize face time. In this sacred, non-negotiable time I pour into those I care for. I hang out with friends and family without an agenda – maybe that is the best definition of a safe space.

Being able to run the race to its finish is important. Remember that the turtle beat the hare. But we never talk about the other competitors who never finished the race because they were too distracted. Maybe I should write my own edition of the legendary fable.

At least finish the race to completion.