Sanford J.Brown Diary——Job Security

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Affiliation:A solo practice,Fort Bragg，Mendocino,California，95437 USA

As family physicians,we have to count our blessings,the biggest of which is that we can make our living outside the politics and turmoil of hospitals.In this era of managed care,it seems hospital administrators are driving a wedge through their medical staffs,separating us into haves and have-nots - those who are on the hospital payroll and those who are not.Collegiality and fraternity,once the staples of our profession,have been replaced by rancor and adversarial relationships as physicians scramble to survive economically.We have been divided and conquered.

It wasn′t always this way.I can remember when there was solidarity among physicians,when chiefs of staff weren′t in the pockets of hospital administrators,when we could decide how to practice medicine,when taking care of hospital patients wasn′t a battle but a pleasure,and when family physicians weren′t being marginalized in the pursuit of hospital privileges but welcomed in every department.How far we all have fallen.

Where does this leave us? Actually,we′re in the enviable position of not having to be hospital-based to practice medicine.Feel sorry for pathologists,radiologists,surgeons,hospitalists and ER docs,but not for FPs.A hospitalization for us should be a treatment failure,an untoward event that needn′t happen if we ply our craft with art and skill and if our patients are compliant.In our offices,our patients are our employers.Should one of them fire us,our economic livelihood is not in jeopardy.That′s real job security.