San Francisco Chronicle - (Sunday)
Doctors leaving medicine isn’t from burnout
To be a primary care doctor in America is to be breathless. A back-to-back, Lucy-in-the-chocolate-factory conveyor belt schedule packed with up to two dozen patients per day. And God forbid a patient has a late bus or needs an interpreter or has mobility issues or just got discharged from the hospital or has any number of typical, multiple medical needs that can’t be wrapped up tidily in mere minutes. Heaven help you if you do your job well and your patient cries, opens up about depression, confides in you about domestic abuse or reveals disordered eating. You run behind 15 minutes, then 30, then 45, then an hour as you sprint room to room, always running, the first words out of your mouth are an apology. You skip lunch, you skip pee breaks, and you try your best not to cut corners for your patients in a system that makes it impossible not to. Is it any wonder that our high clinician turnover rates reflect this reality? No leeway, no wiggle room, just the endless conveyor belt of unfulfilled needs — breathless.
Some of the best people I know in health care are jumping ship, and precious little is being done to stem the tide of what is a clinician exodus. Though I empathize with health care professionals safeguarding their physical and mental health by leaving, I am terrified for those who need care.
My colleagues leaving the workforce are not the clinicians who say to you, “We only have time for one concern today.” Not the doctors who cut you off when you bring up the letter you need for work or direct you to go comb through your own medical records when you need a copy of your labs. They are not the “doorknob docs,” the ones whose hands grab for the doorknob even while their patient is talking. No, those leaving medicine are the ones whose sense of mission and moral duty to their patients translate to untold hours of unpaid labor — they are the ones who do the extra, stay the extra and pay a deep personal price for it. And it has become clear that there is only so much sacrifice and only so much moral injury they are willing to endure until they flee for the exit.
“I just want out.”
That is where my friend from med school has landed, after two decades of dedication, a feeling shared by many colleagues. She is an internist who does research and publishes papers on the conditions her patients have, who takes the extra time to connect with the adult children of her patients, the doctor who makes safety plans to help prevent falls at home.
I once called her in the thick of her commute — she was stuck in traffic, breast pump wheezing, lunch in her lap, just having hung up from an in-car work Zoom, in between her morning at the clinic and afternoon at the hospital.
Unsurprisingly, she is over it. She wants out.
Another friend, a local family practice doctor with decades of working with the underserved, decided to retire early. Her clinic is chronically understaffed, with no lunch or after-hours coverage for medical assistants, no extra time given for the complexity of patients she sees, no taking into account her needs as an older, immunocompromised provider. She has grown exhausted by the constant staff turnover, the late nights and weekends spent catching up on patient charts, the unrelenting need for prior authorizations, the invisible pharmacy caps and shortages that block her patients from filling their prescriptions. Like all of us, she spends more time screen-facing than patient-facing. Her weekly countdown to retirement has officially begun — one more doctor sidelined, with a breadth of experience and depth of knowledge who still had years to give.
Specialists aren’t spared, either. A third friend in a third state, a surgeon not yet middleaged, just dropped to half-time. She has felt undervalued, unappreciated and simply got sick of pushing back against capricious administrators obsessed with productivity. She is worn down by constantly butting heads against MBAs who lack any real insight into what it means to take care of patients. She jumped off the hamster wheel halftime and is unsure how long she will last even at 50%.
It was breaking-point-badenough before COVID, but there was a fundamental breach of trust once we realized how little our health and safety mattered in our profit-driven industry. Many of us were pushed to work even if we ourselves were at high risk, vulnerable, elderly or had immunocompromised loved ones. And once your colleagues die because of inadequate personal protective equipment or take their own lives as a direct result of untenable working conditions, your devotion to your calling can take a hit.
A nurse practitioner lamented how the industry continues to push out the best of us: “They take and take and take and then order us some pizza and pretend like everything’s OK.”
There is no amount of pizza, no number of meditation apps thrown our way that will stem this bleeding.
Last week, I stood on a picket line with colleagues, pleading for conditions that allow us to care for patients without harming ourselves in the process. This isn’t burnout.
You can only destroy yourself so long fighting to provide the kind of care you can barely countenance.