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I want to respond to writeups on January 26, 2011.

First, re unity. I think any community has to go back and forth between individual voices and unity. The community has to have an agreement in order to be a community. Yet people need to have freedom as well. Both are important and there will always be arguments about that boundary between individual rights and the needs and agreement of the community as a whole. The discussion is important and the meeting of minds comes when each side can see the other side's position and understand their argument.

Then cassparadox's writeup. I had a job in Colorado where I was 5th senior doctor out of 15 in two years. A doctor resigned after one year, giving up 50K in loan repayment, and stayed in the Valley to work in the emergency room. I said to the administrator that I was really upset, because she was an excellent doctor. The administrator said, "She just doesn't fit in." I felt grief and despair, because I knew that I would not fit in either and that the current regime was not open to change. I resigned nine months later.

While I was struggling with my grief and anger at the administration, I had a dream. I dreamed that I was at an airport. We were all ready to board and suddenly I thought, "No." I said, "I am not going to get on this plane." I asked other people not to board, but they all avoided my eyes and boarded. I stood on the ground and watched the plane take off. I woke up knowing the plane would crash.

I thought that the job was like the plane. I stopped feeling guilty about leaving. I had talked to the administration for three years about the problems. They were ignoring me and I'd seen multiple other doctors get frustrated and leave. I'd asked a partner how she'd managed to stay for fifteen years. Her reply was, "Pick your territory and guard it." I did not want to do that. So I left. I was very sad to leave other people on the plane, but I'd done all I could to change the system.

Sometimes it's almost as if the job has to hit bottom. Enough employees leave and everything gets more and more chaotic. Either the business will fold or it will eventually reorganize to keep good people.

And once you leave, the other people who have left sometimes welcome you. "About time you got out of there. Don't stay in a mess you can't fix." I was welcomed by the community doctors last year when I no longer worked for the hospital clinics. Welcomed with warmth. That was a surprise. I had watched the docs who stayed in the system stop talking to the ones who left, so I expected that. But I didn't know about the welcome.

Yesterday the head of a big department at UW Hospital in Seattle happened to be the person to call back rural docs with questions. I quickly ran three patients past him. He answered and one of them will be fast tracked to that clinic. He said, "You know, our department considers you rather a hero right now for the way you've stepped up." "Thank you very much," I said. That was really nice, to hear that, especially since my local hospital ex-employer still won't communicate with me very well.

And! It looks like January, the ninth month we've been open, might break even for the first time! Surprise!

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