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Disappointment is not unique to medicine, but there is arguably at greater tragedy occurring therein because of the idealistic nature of the participants. Without expectations, however, there can be no disappointment. Even the most humble and mature physician-in-training would expect his or her colleagues to behave with integrity, but this is too frequently not the case. Hostility, unethical conduct, and poor role modeling are more commonplace than ever reported outside incestuous hospital cultures. Once the student realizes these realities, yet another proverbial gauntlet has been laid down. “Am I to continue working in this environment?” may be part of the internal dialogue, but speaking out in the workplace has been all but abandoned, especially if the individual has less than a perfect academic record.

The let-down extends outside the walls of one’s institution, to the global health care system. In light of the poor overall medical care provided to citizens of the United States, corporate marketplace pressures become the bane of daily existence. Physician shortages, medically underserved populations, looming health care reform and pay-for-performance changes have made the practice of medicine very different from when most physicians began their careers.

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