by Hujefa Vora, MD
Chair, Publications Committee
This article was originally published in the March/April 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
We all had a choice. We graduated from medical school and then picked a residency along the way. We knew that this choice had to be lasting. That was a lot of pressure for those of us who think too deeply or gaze off too far toward the horizon. And yet, the decision was made, none of us grasping the fact that an even bigger decision lay ahead of us just around the bend, past the undergrowth.
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,
What did we do next? Some chose academics, though that was a minority. An even smaller minority chose private practice. And many chose to join the world of corporate medicine, working for hospitals or insurance conglomerates or large multispecialty groups. That may be three roads, not two, but you get the gist.
And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
At the time, all of these choices looked to be equal. It felt right, though, that I would start my own business, put out my shingle, a welcome mat of sorts, try my luck, and let the cards fall as they may. And fall they did. For 20 years, I have run a business, something I was never trained to do. I have built a successful practice (knock on wood), successful not because I’ve made a lot of money, something solo primary care physicians rarely do anymore, but because my staff and I have helped a lot of people live better, fuller lives. Above all else do no harm, but that really means do the best for your patients, their families, our friends, and all of us.
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.
But now, it is so much easier to look back and ponder a new choice. With the advent of quality measures, ever-changing metrics where the finish line is constantly moving, with the dissolution of the fee-for-service system, it has become infinitely harder to run a small practice. To oversimplify, we don’t always know where or when revenue will come in, and the variability increases with the fact that we never know how much we will be paid for the work we do. And when my patients remind me that I’m not doing it for the money, I also remember that without the incoming stream of revenue, I would not have a practice that does so much good for my people, my friends, my patients. Perhaps as I continue to walk this chosen path, I will cross a stream or two, get tangled in the brush, maybe even trip, fall, and get back up again. No matter what, as all of us who are in small practices are apt to do, I continue forward, not knowing what lies ahead. Perhaps I will come to another place where two roads diverge in the woods, and I will have to choose again. For now, I bow to one of the Greats, and let Robert Frost have The Last Word.