We deeply appreciate the conundrum these authors1 identify in response to our article2—when a desired scope of practice is affected by health system inefficiencies and priorities, especially those that erode physicians’ joy in practice and their commitment to providing high-quality care to their patients and their communities. A fourth year of training could provide young family physicians with additional skills that may not be supported in the current health care system. It is disheartening to hear that feeling unheard is a common experience and that precious time is wasted when it can be put to much better use. The most worrisome concern is the thought of physicians leaving medicine at a time when physician shortages are becoming ever more desperate.
Physicians have always been advocates for their patients. We wonder if we are reaching a point where physicians’ role as advocates for changes in health policies at many levels, including those at the national and system levels, is now needed in even greater quantity. It seems that quality improvement initiatives may not be enough to generate real change. This would require more efforts on top of a work-life balance that is already difficult. We are hoping that emerging physician leaders will have the fire in the belly, political will, and the patience needed to leverage actual change during a time when many American citizens are feeling concerned about the future of our country. The time for pulling ourselves up by our bootstraps has passed; we need much more than this for a sustainable joyful future.
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