July 2003
Un-Presidented
By Michael J. Katin, MD
Change is inevitable, sometimes unplanned and sometimes foreseen and gradual. Some people may have the courage to change and others may be swept through of necessity. The Greatest Generation needs to be respected for living through the Depression, World War II, and the Cold War, although given a choice most of them probably would have preferred to have been born in the 1980's and to have survived Vanilla Ice, Newt Gringrich, and Enron. Regardless of the era, however, some people have the fortitude to branch out in different directions rather than settle for security. It wouldn't take much deliberation to get out of the financial field in 2001, but to have done it in 1999 certainly deserves recognition.
Some people try to stay flexible. Nearly all of us have relatives (usually in-laws) who hoped to be successful as professional musicians and are now working in convenience stores but are still willing to stay up late two weeknights a month to play bass in the lounge of a Holiday Inn 75 miles away rather than give up completely.
Up until recently, it was rare to find anyone leaving the medical profession, with the exceptions usually being those who had achieved success in their new field before making the final transition (Michael Crichton, Robin Cook, Ayman al-Zawahiri). Unfortunately, recent events have made these individuals seem prescient and it may be that the stampede out of the medical profession will be taking on the appearance of the evacuation of Saigon in 1976. We may try to protect ourselves against the threats of increasing liability and stagnant or decreasing reimbursement, but ultimately other venues will seem much more attactive, including the ultimate fallback option--the government job. I'm not referring to working for the VA system. I'm talking about actually running the government.
Three of the pioneers in this movement need to be recognized. Dr. William Frist was first elected to the U. S. Senate in 1994 and is currently Senate Majority Leader. He is a Harvard and Stanford-trained cardiac transplant surgeon and obviously had a change of heart about his profession. Dr. Basahar al-Assad gave up a promising career in ophthalmology to become President of Syria in 2000, setting an enviable standard by winning 97.29% of the popular vote for a seven-year term. Finally, there is the first physician to seriously make a run for the Presidency of the United State: six-term Governor Dr. Howard Dean.
I'm sure most radiation oncologists would still not take the opportunity to switch to the government sector, but it may help to tabulate thedifference in characteristics between a high-ranking government office and a typical clinical practice:
President of the United States Radiation Oncologist 1. Eligibility requrements
yes
no
yes
no
no
yes
no
yes
no
yes
2. Continuing education mandatory no
yes
3. Salary $200,000 per year plus perks, unquestionably to be increased in the future not fixed, minus expenses, unquestionably to be decreased in the future 4. Retirement plan takes effect after one day on the job; guaranteed by the government usually takes effect after at least 25 years; heavily invested in i2, WorldCom, and Martha Stewart 5. Typical job-related trip G-8 Summit in Paris 7:30 am Tumor Board at County General Hospital 6. Ethical requirements can lose license with traffic conviction 7. Recertification 8. Technical
- B-2 Stealth Bomber
- BGM-109 Tomahawk Missile
- GBU-24 Advanced Unitary Penetrator
- Machidascope
- IMRT
- BAT
9. On call schedule all the time, but when you get called it really is an emergency usually every 3rd night and weekend; frequent calls for prescription renewals from bogus patients 10. Ultimate recourse if threatened unleash nuclear holocaust write nasty letter to ASTRO board The decision to switch careers may still be difficult and maybe the ultimate strategy is to continue what one is doing and still achieve secuirity by another method. In recognition of the uiltimate achievement in this category, I will plan to nominate Dr. Neil Murray for this year's Nobel Prize in Economics.
email: mkatin@radiotherapy.com
