Who Wants This Job?

     Ads for doctor positions show up in my mailbox every day.  For example: 

     Get what you want as an IPC physician.  Be collaborative.  Be well-compensated.  Be in charge.  Join a winning team dedicated to making medicine more rewarding.

Or:
     Achieve excellent work/life balance with our flexible scheduling.  Lucrative pay, full malpractice coverage and extraordinary work environments with collegial and talented peers await you here.  Find what you're looking for in your career!

Or:
     We are looking for a primary care physician for our premier urgent care facility.  We are a longstanding private group with an excellent reputation.  High hourly rate plus percentage of collections, full benefits, paid vacation, hours:  M-F 8-8, Sat/Sun 8-5.

Or:
     You can have it all in this pristine location with on-call every fifth night, fully staffed clinic with x-ray and lab, and no administrative hassles!  Leave the headaches to us, while doing what you do best--practicing high-quality medicine with patients who appreciate it.

     These recruitment firms want to read the minds of doctors.  They're no different from other marketing experts:  find out what people want--even what they want but don't know they want--and offer it to them.
     There's one problem.  Doctors in my generation went to medical school so they could be independent.  We don't want marketing agents recruiting us with glossy trifold brochures, into megalithic organizations where the focus is on profits, not compassionate care, not intellectual curiosity, not relationships with our patients--not anything else, but profits.
    In my last year at Bryn Mawr College there were corporate recruiters on campus whenever they could get past the president's office.  They petitioned soon-to-be grads with jobs at big companies like Procter and Gamble, Cooper-Hewitt, Estee Lauder, and Dow.  They promised high salaries, glamorous positions, and a chance to rise up in the corporate hierarchy.
    That was my chance to live in a scripted world, where in exchange for money and benefits I would donate my brain and prestigious-college-coddled creativity for the purpose of increasing profits for a corporation's shareholders by bamboozling its clientele into buying things they really didn't need.
     I didn't want any such position, nor the glamour, nor the CFO-type paychecks.
     What I wanted, following the peace-march idealism of the age, was a chance to make a difference in the world on a one-to-one basis, using the puissance of human interaction.  I wanted to help others (an old-fashioned ideal).  As for my personal life, I hoped to homestead five acres like other back-to-the-landers and build a Scott-and-Helen-Nearing version of life, eating organic vegetables and sunflower seeds, and raising smudge-faced children who might figure out some of the world's problems in the primordial backwoods of our property.  Like other '60's flower children, I measured the hypocrisy of my parents' post-WWII generation in terms of the numbers of dead soldiers posted in photo spreadsheets in the Bethlehem Globe Times every week.  I wanted a different world.
     Accepting one of those cushy, Armani-clad jobs would have been a form of selling out.  Being a doctor, on the other hand, might allow me to do some good in the world without relinquishing my pay--reframed as profits--over to executives.
     Doctors should be allowed to give away their services for free, like priests and shaman, when patients can't pay, and this has been the American model for hundreds of years.  We ought to be able to navigate the rules of insurance companies without needing MBA's.  But these days, even an MBA isn't adequate to figure out what codes and documentation government entities like Medicare and private insurance companies need as proof that patients got their money's worth.  Moreover, if doctors give away services for free, or reduce co-pays for sick people who don't have cash in hand, they're accused of committing fraud.
     If you're a doctor and agree to work 76 hours a week, as per one of the job listings above, why not just work for yourself?  Some of these corporate employers require doctors to sign five-year employment contracts.  After signing, doctors are pressured to make medical decisions at a dangerous pace, or have to see new patients every six minutes (the Kaiser-Permanente's model).  These businesses own doctors, and they manage money by threatening patients with debt-notices, or refusing them access to medical care if they don't pay up front.  They coerce doctors into sacrificing good judgment and the doctor-patient relationship by working faster, churning out patients as though they were assembly-line commodities.
     No thanks.   This form of indentured servitude has never appealed to me.  I doubt if there are any doctors who really want to work for corporations or hospitals.  But they continue to accept positions as employees anyway, in unprecedented numbers, out of fear, or because they believe the promises on the glossy, kaolinite-coated-cardstock recruitment materials that show up, unsolicited, in the mail every day, or maybe just because they think that if they work for themselves they'll have to work too hard.
     The landscape of medicine has changed, being run, as it is, by government mega-bureaucracies and corporate monsters.  It's being "regulated" by police-agents who must be taking orders from on high to drive solo docs out of business--and they're doing a good job.
     That's why people like me no longer fit in.