Anecdotally Speaking

Throughout twenty-one years of private medical practice, my mailbox has been cluttered with an uninterrupted stream of unsolicited enticements to consider opportunities and offers to quit my job, move my practice and relocate to greener pastures.

When I was younger and less experienced, the arrival of such offers occasionally triggered an involuntary interlude of fantasizing on my part. Especially if the advertisement guaranteed salary numbers in a range higher than I currently was making, promised less work, more time off, less stress, better everything and if I had just had a particularly bad week, in my mind, I was packing the bags already.

Oh, and if I offered any encouragement to the places where these things originate from, such as sending for more information, checking a box, returning a reply card, calling a toll-free number, just the slightest hint of interest whatsoever, then the volume of these things in the mailbox triples for about three years before finally dying back down to what seems the background rate of ten or so per week.

I do not even glance at them anymore. They go straight to the trashcan. It has been many years since I had to indulge in one of those greener pasture fantasies, thank goodness. There must be an enormous amount of money spent sending these things out. However, they must work or they would not do it I suppose. They must find doctors for these jobs somewhere by this method.

This one caught my eye because it was on a postcard. I thought it would be fun to go through it and read between the lines and translate the hidden meanings and the secret code that I see there as an experienced practitioner. Things may not be apparent to the untrained eye.

"Don't miss an outstanding "lifestyle" opportunity."
This is a good lead off using the lifestyle word. It is a hot-button word in recruiting; it gets people's attention. The docs that are looking for lifestyle practices are interested in the non-monetary rewards; they usually do not want to work that hard. They are docs that are willing to make less money to have more time-off. So, by putting the word lifestyle in quotation marks, what they are really saying is, that this is a nice place to live kind of lifestyle, but you can expect to work your butt off here.

"Practice in this progressive and cohesive medical community..."
Saying this is a "progressive" medical community is a nice way of saying that the docs in this town do not get along. Saying it is "cohesive" means that there is a truce and a pecking order has been established. Guess where the new guy will fit in?

"...where your neighbors are your patients."
This means you are on your own. This place is rural rural remote remote. The nearest consultants and specialists are probably a long way away. Some docs like that kind of excitement, being the Lone Ranger. As long as they know what they are getting into. This also means you are going to work your butt off here.

"Hospital employee"
Most docs take this to mean "we take care of that nasty old business crap you doctors don't like to deal with so you can do what you are really good at which is save lives and take care of sick people" and the docs are happy if they can just practice medicine and collect the paycheck they were promised. However, what it really means is the only ultimate control the docs actually possess is just the ability to leave. That is a position of weakness that many docs do not realize they are in until they find themselves unable to influence matters of significant concern to them.

"Obstetrics, including c-sections"
This means you do not have to compete with specialists to do the things as a family doctor you were trained to do. This would be attractive to many family doctors that are being shut out of medical staffs in urban hospitals because of so called "turf" battles. This also means you are going to work your butt off here.

"1:4 call; and every fourth weekend"
This is "code language"; it represents the most ideal call arrangement for the average family practice. It is an ideal. It never happens in real life. Here is what this is saying, that there are at least three family docs there now. That is all it is saying. Here is a likely scenario. One of the three docs is holding on by his fingernails waiting for you to sign-on so he can finally retire. So, when you get there you end up being on call 1:3 and every third weekend. Except the other two guys get twelve weeks off each year as part of their contract, so half the time you are on call every other night and every other weekend. Until the guy you are sharing call with gets sick while the other guy is on vacation and you are now the only one on call without any breaks and a hundred miles away from any backup and how about that for "lifestyle"?

"Cutting edge technology; state-of-the-art equipment"
What this really means is that they just bought a new heart monitor for the CCU and a new fetal monitor for OB. Never mind that they had to because they could not get parts anymore for the old models. They are very proud of their shiny new expensive machines. They are the first things they show you when they give you a tour of the hospital.

"Significantly above average salary plus bonus"
Ha! I should hope so! Whoever ends up here is going to work their buns off! (I think I have made that point?) The thing is, if the salary was actually significantly above average they would put the actual numbers in the flyer. Not only that, they would set the numbers in the largest type on the page to catch your attention and make sure everybody would notice them. It would be their biggest selling point. No actual numbers means the salary is just average.

"Generous sign-on bonus and relocation allowance"
Ho hum, everyone says that.

"This community fits neatly into the landscape... agricultural countryside."
Again, read rural rural remote remote.

"Denver 145 miles, Cheyenne 200 miles."
What this means, besides rural rural remote remote, is that when you get your chance to leave the other poor bastard to be on call alone by himself, to get away for a medical conference or a vacation, you will have to endure passage on an infamous knee-to-chin, 100 decibel, teeth rattling, vibrating, turboprop, turbulence chasing, regional airline connecting flight, to get to any major airline terminal hub in order to escape to the real world. Moreover, when you get there, sometimes you will wonder if it was worth the trouble. Or, you will give serious thoughts to ever going back. In some places, I bet they never do go back. Which may be why this card came in the mail?

"Enjoy, camping, hiking, swimming, horseback riding, and many other outdoor activities"
What this means is that you will spend many long hours of your life in the hospital ER taking care of people who have injured themselves enjoying camping, hiking, swimming, horseback riding, and many other outdoor activities.

Do I sound jaded and cynical? Maybe. Nevertheless, a word to the wise. Buyers beware.

As for me, I am happy right where I am.
(Want to know what that really means?)