After nearly 20 years as an emergency physician, I left the profession I once loved. I’m not the only one.
According to a new report from data analytics firm Definitive Healthcare, 117,000 doctors left medicine in 2021. Each departure costs the healthcare system about $500,000 to find a replacement – $58 billion last year alone – and the ripple effect has already resulted in worsening medical care for all of us.
This mass exodus of dedicated professionals is the canary in the coal mine of a growing health care crisis and despite what hospital administrators have proposed, the solution does not involve more resilience training for the canaries. remaining.
It’s time to fix the mine.
As doctors, our indoctrination begins in medical school with an unspoken rule: the only way to be a truly good doctor is to put our patients’ needs before our own at all costs. For example, early in my career, when I was eight months pregnant, I contracted H1N1 at the hospital where I worked. Despite a fever of 102 degrees, I never called in sick. Years later, when my mammogram looked suspicious for breast cancer, I created a schedule that allowed me to work shifts in the ER after each radiation treatment. Fortunately, the biopsy was benign.
Every doctor has similar stories – from shoving their IV pole into patient rooms while working on a gastrointestinal bug to admitting themselves to hospital at the end of a shift after their appendix ruptured hours earlier. It’s normal for us. We continue because what we do matters. But increasingly, many of us are asking, do we matter?
The pandemic and its continued aftermath has accelerated a growing sense of disillusionment that the answer is actually no — at least not to leadership.
There is no doubt that our medical system’s unwavering focus on cost effectiveness places patient reimbursement and throughput above the welfare of its workforce. Before COVID, there was a tricky detente as doctors are notoriously bad at asking for help anyway. But now, as we frantically wave our white flags, we are summarily fired.
At the start of the pandemic, our administrators downplayed our physical security. As medical workers died in Wuhan, China and Italy, I was reprimanded for wearing an N95 mask and told, “You will scare the patients and the nurses will want to wear them too.” Other doctors have received the same message from above, and several professional societies have been forced to issue statements supporting the provision of adequate personal protective equipment.
As the pandemic unfolded, our emotional health was ignored. Nearly 70% of physicians reported symptoms of depression and 1 in 8 acknowledged suicidal thoughts. I lost interest in food and eventually dropped to my junior high weight. Sure, I went to therapy and got help for my symptoms, but the work — and the disdain — kept coming. The antidote we needed had to come from our leadership in health care.
This has never been the case. In fact, it got worse.
There was never any meaningful acknowledgment of the relentless trauma we had endured, and the disconnect between the support we needed and the efforts of our leaders to help us was stark. Hospital administrators ordered pizza, encouraged yoga, and told us to keep gratitude journals on our bedside tables. While well-intentioned, these efforts seemed muted in the aftermath of wave after wave of a deadly pandemic.
Physicians should not be told how to feel good by a committee of managers remote from patient care. Instead, we should be asked – asked what we need to stay healthy and what can be changed to help us do our best work.
What should our health care system do to encourage us to stay? Probably less than you think. We need to be seen and to be trusted.
Make sure we put our lives on the line and risk the health of our families every working day before vaccines become widely available. See the hurt feelings we suffer shift after shift, when, despite doing our best, perpetual understaffing and overcrowding prevent us from providing the quality of care we would want for our loved ones. See that if we ask for help, we have tried absolutely everything in our power to fix the situation ourselves, and our goal is to do good for our patients.
In July 2021, after 18 months on the front line, I asked our hospital leadership team for unpaid leave to regain my humanity. “So everyone would want one too,” I was told that my request had been categorically refused. At that moment, I knew I was done. I planned to stay in the ER for the next 13 years until I retired. Instead, I tendered my resignation.
Medicine had been my everything for decades, and I finally realized that she never loved me back.
There are over 100,000 doctors like me and many of us would have stayed – even in our appalling working conditions – if we had been treated only as respected partners instead of depersonalized commodities.
Keeping our best medics in the game is clearly in everyone’s interest. The tipping point is here, and we must immediately and radically change our hospital culture before all the canaries fly away.
Dr. Molly Phelps is a board-certified emergency physician who recently completed her first book about her time on the frontlines of the pandemic.
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