As a physician who has to combat the after effects of obesity day in and day out, I'm ready to beat the writer over the head with a pair of my size 11 Kayanos. We should be praising these folks that are out there battling to finish a marathon and who are physicially active. We have an epidemic of obesity mostly due to physical inactivity and their ain't no way I can criticize any of these runners. Exactly how fast do we need to run to be a "pure marathoner?" 4:00? 3:30? 3:00?

I've finished 7 marathons: My fastest was 3:15 , my slowest was 6:30 when I walked/ran with my mother-in-law. Each had their own set of challenges/rewards at the finish. I love going to races now and seeing all the 4+ hr marathoners because they are "kicking ass".

I know that my time didn't do anything to change how the gazelles at the start were doing. And I know that folks like Meb, Deena and Ryan won't run any different based on how I'm running.

By the way, if you ever do finish another marathon, maybe you'll finally understand. In the mean time, maybe you should talk to my mother-in-law about what it feels like to be a marathoner.

As a Family Practice physician in Reno, I read this article and just kept nodding my head over and over in agreement. I was then somewhat shocked to read some of the "doctor-hating" letters that followed. With some reflection, I understand where they might be coming from but I think you aren't getting the entire picture. For those folks, let me give you my perspective.

A few weeks ago I was taken aback somewhat when one of my patients asked me at the end of my visit if they could ask me one more question. I was getting ready for some serious medical problem, but instead they asked me why I had gone into Family Medicine. They had recently read an article about the shortage of primary care physicians and wanted to thank me for choosing to go into primary care. It really made me think about why I got into medicine and why I chose to be in primary care. (The running joke is that I can afford to do this since I'm married to an anesthesiologist who works about the same as I do but makes over twice as much). I'm still happy with my choice but that doesn't mean I can't have spells where I get burned out and tired. As many physicians will attest to, the patient care can be the most rewarding thing. If we could just focus on patient care, life would be much, much easier. The stuff that burns you out is fighting the fight on behalf of our patients with insurance companies, drug companies, etc. If my office didn't have to spend countless hours getting prior authorizations/approvals, we'd actually have more time to focus on why we got into the job which is taking care of people. Recently, I've had a few friends quit their private practice jobs and join the VA system for that very reason. Because I talk to so many patients every day who are going through tough times right now financially, I realize and am grateful that I have job security and an well above average income. That being said, the stress of trying to make it all work is starting to take its toll on me. (As an aside, the another thing that contributes to the burnout is fighting those insurance battles for patients who mistreat my staff and don’t appreciate the fact that there is someone there trying to help them through the complex medical system.)

For those people who have written the letters telling the docs to "just suck it up," good luck to you trying to find a primary care physician in the future, especially if you have Medicare. Despite what you may believe, the reality is that existing primary care docs are getting out and not as many medical students are going into primary care. While malpractice premiums and other costs continue to jump up dramatically every year, Medicare reimbursement continues to go up by less than 2% every year. Top that off with the stress of realizing even if your "error rate" is 0.01%, that 1 case out of 6000 you see in a year might result in a malpractice case which could destroy your career, livelihood and passion. In our community, we've already had a number of physicians close their clinical practices. Most of the others have stopped taking new Medicare patients. The shortage is getting worse and worse as evidenced by this article (http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20080827er-visits.html). So the next time you call your family physician to get in to be seen for a sinus infection only to find their office closed, you may now understand why. If you do get in to see your primary care physician, see if they'll take a few minutes out of their busy schedule to tell you about their job. It may just open your eyes to the other side of the primary care crisis.