We’ve been experiencing a lot of volatility this last year. The stock market has shown us wild gyrations this last month – one day your 401k was beckoning you toward retirement, the next to hunker down and earn some more money! The temperature, after stubbornly sitting in the teens, suddenly began to swing wildly, with twenty degree shifts in the course of a morning or an afternoon. Up was good – down not so much! In Washington the revolving door admitting and disgorging White House personnel seems to be spinning faster. And the politics of the budget – well – one needs to know not only the date but the time to know what to expect. One moment your heart sings with the longer term renewal of the CHIP program, and then you see the President’s budget cutting the NIH, and then Congress assures us that those proposals will be roundly ignored.

Some of us are used to volatility in our lives. Those of us with children in our lives experience it, minute to minute. Those of us in the Emergency Department or the ICUs also feel it – in a heartbeat, calm and organization is superseded by danger and (at least superficial) chaos. As hard as we try to keep the lab on an even keel, we despair when an experiment has not produced the result we desired (or any result at all!) and we exult when the experiment gives great insight and proves the point. Our students wring their hands until suddenly, the whole concept becomes clear and falls into place.

We as humans are built to be flexible. We must be flexible. But we do need stability in some areas. I am delighted at the apparent support of Congress for the NIH budget, with planned modest increases year over year. It is important to have some stability so that the best and brightest students are encouraged to conduct discovery research, even knowing that while it is possible the experiments will fail, the research enterprise will not.

It is important for clinicians to have some security in what will be valued. Will it be volume, as it is in many areas right now, or value, as is increasingly being touted as the wave of the future? What is best for our patients? It is important that patients feel that, no matter what swirls around them, they will receive first-rate compassionate care from their health care team.

Educators are now being pressed to consider competency based rather than time based education – could we discharge students after 3 years, or 3.5 years, if they have mastered what they need from medical school – or residency? How can we take advantage of this to allow physician scientists to emerge into independence before they are 40? How can we be sure the surgeons we graduate have the requisite skills and experience? Yet we must be secure in our commitment to turn out first rate practitioners and scientists.

In the 20th and 21st centuries, medicine has not been a sleepy profession. Acceleration of knowledge acquisition and new information changes, sometimes with startling rapidity, the way we think about research, or the way we practice medicine.

Welcome to the new world of volatility.