Working at the faculty practice of a large academic medical center -- the primary outpatient teaching site for 140 internal medicine residents -- can be a tough place to inspire. They spend one quarter of their residency learning how to take care of non-hospitalized patients, addressing the acute and chronic health needs of people living their daily lives and coming in to see their doctors. Given the current state of healthcare, it's no surprise that the newly minted physicians who rotate through this practice are just not choosing careers in outpatient primary care internal medicine.
During the rest of their training, primarily on the inpatient wards and sometimes on subspecialty electives, they're exposed to a lot of the "gee-whiz" really cool technology-based stuff; doing procedures; taking care of critically ill patients in the intensive care units; meeting mentors who are doing sexy stuff, like electrophysiology studies and endoscopies; or they are getting involved with research around cutting-edge tertiary and quaternary care health science.
Unsurprisingly, spending time seeing outpatients, trying to juggle incredibly challenging sick patients facing the myriad social problems we are often powerless to address, in a chaotic and desperately under-resourced system, is often not an inspiring environment. This makes it tough to encourage them to choose this as a life.
