Posted by: notdeaddinosaur | June 8, 2016

Dropping Out is NOT the Answer

I like Dr. Pamela Wible. I think she’s doing fantastic work bringing attention to the tragedy of physician and medical student suicide. We also have similar practice styles (solo, unhurried visits, total communication) although hers is a subscription practice and I still make do with insurance. Also, she’s monetized it with the title Ideal Micropractice, an organization which costs $250 a year to join. After 26+ years, I’m pretty comfortable with my version, which is ideal for me, and can’t see paying for the privilege of sharing what I’ve learned. (I just offer it for free to anyone who asks.)

But her latest blog post, titled “Yes! You can open your dream clinic — without completing residency” crosses the line.

A video of a frustrated young resident, complaining that her residency was just training her to become a “robot doctor”, waxes rhapsodic on the joys of dropping out and opening her own practice. Complete with naturopathic medicine, acupuncture, “body work” (whatever that is; massage?) and “functional medicine” of course. All with the approval and support of her marvelous mentor, Dr. Wible.

Granted Dr. Wible lives in Oregan, where the woo flows deep and fast (ie, “alt med” is widely accepted.) But just because lots of people believe in unscientific nonsense dressed up as “medicine” doesn’t alter [see what I did there?] the inconvenient realities of science, human disease, and medical treatment.

Why stop at dropping out of residency? Medical school is dehumanizing and abusive. Why bother with it? Just take a few online courses and open up your Alternative Wellness Center right out of college. In fact, why even bother with college. Or high school. Wisdom from the mouths of babes, you know. Harness the healing power of innocence!

More from the dropout:

I started to realize that I have all of the emotional intelligence, the educational prowess, the passion and the drive to truly live my personal dream…

Sure, you can drop out of residency and open your own clinic. But no, you are not qualified to do so as an actual doctor. I’m sorry, but being a doctor takes more than emotional intelligence, educational prowess (whatever that is), passion and drive. It takes training and experience — more than you can get after only one year and a medical degree.

And by the way, those 1-year DO internships “intended to be adequate training for primary care” are a long gone thing of the past. Even DOs recognize the need for at least 3 years of postgraduate training. And some very good cases have been made that maybe even that isn’t enough.

Real medicine is hard. You’re not going to be able to cure everyone, or give everyone what they want, or make everyone happy all the time. Too often people come to us with unrealistic expectations. Alt med feeds into this by providing unrealistic solutions. Until you actually get sick with something that needs real medicine to treat. And if your alt med practitioner can’t even recognize that, you’re basically dead. When you didn’t have to be, that is. Sadly, I know lots of people who have heeded the seductive siren call of alt med — and most of them completed residency. Intellectual integrity is really really hard; maybe harder than medicine. But there is no excuse for turning away from science, AKA “reality” in our quest to help.

Humanize medical school and residency training? Absolutely! But don’t try to pretend that they’re unnecessary.




  1. I agree that while Dr. Wible is doing good and necessary work with her focus on the tragic impact of training and work on clinicians, that does not justify discarding the wheat to be rid of the chaff. Thank you for this column.

  2. My grandmother’s primary “doctor” was a chiropractor. For years he treated her recurring indigestion and diarrhea with spinal adjustments. And then one day we took her to the ER for crippling gut pain and the doctor there informed us she was in the final stages of colon cancer. Any questions?

  3. Every profession has what I’ll call a “burn in” period. You can’t avoid it and call yourself the real deal. Trades have apprenticeships – you want that second story built by a carpenter who dropped out? Educators have master teacher mentorship – necessary when you are expected to fulfill parental role/responsibilities when mom is on drugs. The dinosaur brings forward the same point for the medical profession in her response!

  4. Thank you! Thank you! I also appreciate what PW is doing to bring attention to suicide and depression for med students, residents and docs. I also will put out there that working for a large multi-speciality group for most primary care docs is much, much worse than completing a residency. I worked for one for 17 years. Once the EMR was introduced–it became a nightmare for me (and many others) because I like to spend time with patients and using the EMR took a lot of time away from patient contact time. I would like to take this opportunity to throw my 2 cents in about PW. No cruelty intended but I have always thought she was a bit of a mercenary. Why does she charge $3000 to purchase her tapes to find out how you too can be “free” and start your solo medical clinic for less than $3000? I’ve read many comments from docs asking for her advice because they live in areas where there are legal or financial issues that are keeping them from achieving their Ideal Medical Clinic and she often minimizes their very real complaints by telling them to “be creative” . She also has a tendency to be a little too self-promoting for my taste. I prefer my leaders to be humble, and to help others because they can–not because they can get rich from it. Encouraging someone that they can ditch residency on the pretense that it is “only preparing you for a robot like job” is not true and is encouraging the creation of a group of poorly trained doctors. You can open your Dream Clinic after you’ve acquired the ability to think quickly on your feet, assess whether a patient needs the ICU, read an EKG under stressful conditions, etc…. Why give up the opportunity to learn from a trained attending, your peers and lose out on the chance to teach interns and other residents–that’s where I learned to be a doctor. You won’t find that info in a book.

  5. Informative writing . I Appreciate the info ! Does someone know where my business could get access to a blank NCAA 4244 version to type on ?

  6. Great blog article. Thanks for responding to PW’s ideal clinic idea. I agree, let’s change the system, not try to skirt it and open a clinic without the training. The training is there for a reason. Until we come up with a better way to make sure that person is just as qualified as practicing allopathic or osteopathic medicine, you had better find a way to finish residency and get board certified.

    I went to a wonderful pediatric residency and never felt bullied or harassed. I worked my tail off for 3 years, 30 hour shifts and 80 hour weeks. I think the system IS changing. Maybe it’s slow, but it’s happening. None of us should stand for abuse, and if it’s the administration and the program that is the problem… transfer to a better program!

  7. Specialist training should require several years of residency. Primary care? Not so much. After a 1 year internship I could practice hospital medicine (my internship was in hospital medicine and not outpatient) at least as well as many of the attending physicians and probably better than some. Sure, you all will simply call me the cocky young resident, but the reality is that primary care is protocol and guideline-driven medicine. It’s downright child’s-play. This is exactly the robot doctoring that she was talking about. It’s the reason that NP’s and PA’s are given so much autonomy in primary care. Patient has disease: guidelines say treat with A then B then C then refer to specialist. Step outside these guidelines and you open yourself to litigation. Here’s the sad reason residencies have lengthened: cheap labor unburdened by those pesky labor laws.

    Quote: “I agree, let’s change the system, not try to skirt it and open a clinic without the training.”

    She is trained, 5 years of post-graduate training, 9 total. If board certification (which was always intended only for specialists) is the be-all end-all then tell me why does medical licensure even exist anymore? A license can be obtained in many states after 1 year of post-graduate training and successful completion of all USMLE/Board exams. A license to practice medicine is now a symbolic token usurped by the all-mighty board certification?

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