Musings

Hierarchy is a funny thing, and it exists everywhere. I am in Long Island, finishing up a 2 week vacation (which has recharged my batteries for more doctoring), and have had the fortunate opportunity to do some fun things this vacation, including going down to Atlanta to see some old classmates, having my parents come to North Carolina to visit Nicole and I, and heading out to the Eastern point of Long Island, where it is calm and quiet, surrounded by vineyards and farm stands.

Anyways, we visited Hobie, Nicole's mom's uncle. He is an avid flyer - he flies airplanes and gliders, and has been flying since the 1930's. He is one of the long-standing members of the Long Island Soaring Association, a group that flies mainly gliders. A "tow plane" pulls the glider a long, taking it up to around 3000 feet or more, and then releases it and the glider is free to fly and maneuver until it lands, usually in about 15 minutes at 3000 feet.

Hobie is very well respected, and you can see it in the way people greet him, ask him how his family is, how they say good morning. And Hobie doesn't ask for this, it just is. He's a sweet man, humble, assuming. But he has been around and seen it all.

Almost anyone can join the club. They pay a initiation fee, and they pay a small amount ($30 or so) for each flight, and the lessons are free. That's it!

But there is this unspoken hierarchy that everyone silently follows. I met some of the new members, younger guys. They seem to "know their place" - they do more of the labor of picking things up, they drive the older guys out to the airfield where the gliders are, they speak and act with reverance when around the senior guys. They step aside when the older guys walk by. Its a silent ritual of respect that they pay, and they do it in exchange for their tutelage, their education as new pilots.

We do a very similar ritual in medicine, and have a very similar hierarchy. The experienced, senior, wise physicians (chairmen, department chiefs, professors) are highly respected. Then beneath them are junior faculty and attendings, who have finished their training and we all respect, but they then step aside and defer to these elder, wiser attendings. And then there are fellows, who have finished residency but are training to specialize. Then their are residents, and then interns, then medical students.

As an intern, my job is to get things done. In exchange, I actively observe my residents' and attendings' decision-making process, and get to see the outcomes of these decisions. And the idea is that I learn enough that I will be making these decisions within a year. Just like a new pilot getting ready to fly on his own.