Is Medicine a Profession or a Business?
A recent article in the free journal published by MedScape poses that question. My instinctive reaction was to pull back in alarm. “Profession” means an occupation which requires a certain number of years of training – generally in what is called “higher” education, distinguished from a “job” by the fact that a job pays money to feed the family, the profession is a requirement to get the job, but does not in and of itself pay the bills.
The question, however, leaves me feeling incomplete. Indeed, I did a great deal of training to become sufficiently educated to become a professional and to do what I do.
Do I have a job? That’s a little tricker. I have an office for which I pay rent and hire staff. I have a named practice, the Arizona Center for Advanced Medicine, which I advertise to the public through the Internet and largely educational but partly also promotional website, www.ArizonaAdvancedMedicine.com. I go to the office almost every day of the week, to do what I need to do in order to keep the practice functioning at top capacity.
I cannot think of any “job” in the world at which I would be willing to work 14 hours a day 6 ½ days a week for years on end, just because it paid the bills.
I went to a trusted source, the Internet, to see what Mr. Google had to say in answer to the above question.
Medicine is a profession, but Healthcare is a Businesswww.healthcaresuccess.com%20
Is medicine a profession or a businesshttps://www.ncbi.nlm.nih.gov/pubmed/24931641
“an editorial published in 1970 in Fortune, … declared: “The time has come for radical change… . The management of medical care has become too important to leave to doctors, who, after all, are not managers to begin with”. Presentation originally give in Warsaw at a conference entitled “Ethical Dilemmas in Physicians Practice”.pamw.pl/sites/default/files/inv_Sheppard_0.pdf%20
Is medicine a profession or a commodity?KevinMD, https://www.kevinmd.com/blog/2013/05/medicine-profession-commodity.html%20
Even the British Medical Journal has weighed in on the question. Medicine–A sacred profession or a kind business | The BMJ
And a similar query from the Hindu community: Medical profession: the other side of the coin – The Hindu
The closest response to what I was really feeling was the following suggestion at the bottom of the first search page in Google: “Healing Is an Art, Medicine Is a Science, and Health Care Is a Business” – and it’s only a quote from the January 2017 ASA Monitor promoting a conference dedicated to teaching doctors the business aspects of medicine. Disappointingly, no further information was available on Mr. Google, and the original article was only available to members of the organization.
Nowhere did I read anything about medicine being a vocation. Perhaps the word has fallen from favor. Once again, I turned to Mr. Google.
Wikipedia gives a fairly innocuous version of the definition:
A vocation is an occupation to which a person is specially drawn or for which they are suited, trained, or qualified. Though now often used in non-religious contexts, the meanings of the term originated in Christianity.Wikipedia
The Archdiocese of Melbourne, Australia, states much more forcefully:
If you are looking for a simple definition of a vocation, the literal meaning of the word is a “call.” But a vocation is more than an ordinary call. A vocation is a call from God, and anyone who has felt God’s call knows that the process is anything but simple. While most people think of a vocation as what they are called to do in life, it is important to understand that the first and most important call from God is a call to be – the universal call to holiness.
Whoa! Stop the music! A universal call to holiness? No wonder we don’t hear much about medicine as a vocation.
The prophet Isaiah said: “There is no hope for me! I am doomed because every word that passes my lips is sinful, and I live among a people whose every word is sinful. And yet, with my own eyes I have seen the King, the Lord Almighty.” And God’s answer was apparently to send an angel is a burning coal in a pair of tongues, to touch the prophet’s lips. Ouch!
When the prophet Job heard God’s call, his answer was: “I am unworthy – how can I reply to you? I put my hand over my mouth.”
Jonah’s first reaction was to run – he immediately took passage on a ship to foreign shores. We all know how successful that passage was.
One Episcopal Priest’s reaction was to join the army for three years before he eventually agreed to answer the call and attend seminary.
It is said that the priesthood is a great racket, if you have the guts for it. I think that the call to medicine falls under the same rubric.
The maker of our Universe, our source of Light, apparently has very little regard for what we in this world consider to be qualifications. The Buddha was born into a family of Kings – albeit the tribe of which he was King was poor. Jesus of Nazareth into a family of carpenters.
We as physicians are not called to remember everything we are taught, or to never make a mistake, or to always have the perfect outcome, or always follow the “standard of care”. Whether our licensing boards agree or not, we are called to do our best for our patients, using the raw materials we are given (ourselves, with all our imperfections), whatever the consequences to ourselves, because that is the condition of our vocation.
It’s not always an easy life. The day the baby died in my office was the hardest day I have ever lived through. The fall-out ripples in the medical world felt like tidal waves. I felt I was drowning.
Each of us, players in this field of medicine, has to decide whether we are businessmen, deliverers of a product, teachers, whipping boys, or servants called by whatever or whomever we call by the name of God to help our fellows heal from their ills.
If we are called, does that mean we are perfect? Does that mean that we better than those who do not hear a call? Does that mean there is anything special about us? Perhaps the only qualification for call is that our ears are tuned to hear it. Each of us needs to figure that out for him- or herself.
For me, following the Call means getting up every day and going in to the office to do whatever I can do to help alleviate suffering. It means going in to the office on week-ends to pay the bills, so that I can keep the office open. It means responding to patient complaints and to subpoenas and summons from the licensing boards. It means dealing daily with the fear that I might not be perfect, might forget something, might lose my license to practice medicine because of something outside my locus of control.
For me, following the call means learning everything I can, every day of my life, whether I get Continuing Medical Education credits or not.
For me, it means standing with a patient and their family, whether they get up out of their bed and walk or move to their next state of Being in the great Graduation ceremony.
Are we Called? Then let us answer the Call.
Are we not sure? Then let us do what is in front of us, and keep our ears open…