After I published my ‘confession’ to having left clinical medicine there was, understandably, a lot of interest in what I had done.
I had succeeded in generating “buzz”.
You can read my original statement here. Don’t expect anything fancy or Pulitzer-worthy. It’s simply a blog post in which I say goodbye, but also brace myself for my ‘more’.
“How had I channeled the necessary ‘courage’ to leave such a coveted position – a medical doctor! – and what, in heavens name, did I plan to do?”
People have inquisitive minds, and inquisitive minds wanted to know.
While I do have answers in place for such queries, I think the bigger question I have, and one which I’m – rather surprisingly – NOT finding myself fielding, is WHY I left in the first place.
It’s amazing that none of my physician audience asked.
It’s this very fact that serves as a testament to the state of healthcare.
No one asks because they ALREADY KNOW!
But does EVERYONE ELSE know? And I mean the rest of the world, who aren’t doctors themselves?
The very fact that physicians didn't ask (why a colleague left medicine) serves as a testament to the state of healthcare. No one asks because they ALREADY KNOW! Click To Tweet
Barriers
(Is it just me or does the title of this section sound like the name of a Top Ten Adam Levine song?)
Below are just a few of the barriers that stand in the way of optimal patient care. I was prompted to write them down by Medscape, who kindly reached out to get my take, as I left. They chose, instead, to focus on a different angle: how my family reacted to my leaving. So I re-wrote the script.
But not before holding on to my original writeup, listing out some of the ‘why’,
Know that I got a lot of criticism for leaving. Surprisingly enough, the majority of that criticism came from colleagues from my field.
I have a lot to say to those who criticized, and do intend to respectfully respond when the time is right. I hope that this interests you to stay tuned. I truly believe the content of this type of banter is exactly what we need today – more doctors not afraid to speak up.
Please note that this is simply MY take; one of a single physician, who once channeled her passion to serving patients, and to heal.
Here are just 7 answers to “Why are doctors leaving medicine?”:
1. Legalities
I don’t think I need to expand here (though I could!), but this is one’s a biggie.
Many of us are paralyzed with fear, and this has to, at some point, be properly addressed.
It’s a looming cloud that hangs above us, following us wherever we go as we practice.
2. EHR burdens
The electronic health record is a double edged sword, for many reasons: no eye contact, set of questions that are often unnecessary, difficult to use, doesn’t work, needs internet connection.
The list goes on.
3. Insurance companies
Quite plainly, they’re making ALL the rules. I mean all of ‘em.
I prescribe a medication, the insurance says no.
I order an MRI, insurance says no.
Even when it’s blatantly warranted, they’ll make you go through hoops.
My wild imagination pictures them as the bully, standing in front of us, arms crossed in front of their chest, arrogantly barking, “Make me!”.
4. Pharma
Patients can’t afford medication because of prices these days.
So you get instances where a medication isn’t covered, and then the physician has to put in extra time figuring out why, which alternative exists, and revisiting the patient’s case, even when the patient’s visit time ended long before.
I ask candidly here – what lawyer on this earth would put in extra time to help out their client, on a regular basis, and pro-bono?
You and I both know the answer to that question.
5. Big systems
What can I say? It’s become one big fraternity.
Healthcare is splitting into factions, with each hospital system flexing their muscle in a bid to win the biggest prize – patient adoration and love.
It’s really become a tasteless popularity contest, worsened by the fact that real decision-makers sit nowhere near the playing field, but at their c-suites on top.
It feels like it’s become a factory, with the physicians mere cogs in the wheel. What’s worse is that patients think we’re in charge (as we’re the face of the ‘transaction’) when, in fact, we aren’t.
It’s perfect for the factory itself, from a public-relations perspective, but not for the workers within. It contributes, in fact, to the dissatisfaction, and has been at the root of the burnout of today. While I laud valiant efforts to develop ‘wellness programs’ to heal the reality many physicians face, I sadly view them as mere ‘band-aids’ covering up the boo-boos that our healthcare system has created.
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6. Patient reviews
What, are we pieces of steak?
That’s literally how it feels when a healthcare interaction is ‘rated’, esp when it focuses on unimportant things.
You simply can’t accurately put a review on health! Don’t get me wrong, I appreciate the need to enforce kindness and compassion, from the caretaker side. But with patient empowerment on the rise, given the growth of online use and other factors at hand in which our abilities are limited, this has become a weapon. What we’re starting to see is medical strong-arming, where patients use reviews as a weapon against the other side.
“Oh yeah? Don’t want to give me an antibiotic? I’m going to write you a scathingly bad review!” The problem we face today is that we’re handing one side the knife, and not arming the other. And when you give one side the power to control another’s fate, it’s empowering.
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Eventually, it will head to the other extreme. We may already be there in many instances.
To be clear, this is where the doctor basically does everything the patient asks for. And while this may seem like the right thing to do when you’re a patient, and when you’ve properly educated yourself on treatments, it doesn’t always work. Antibiotics, for example, don’t work on viruses (and have their own side effects). Should we give a patient an antibiotic if they’re demanding it but we truly believe they have a virus? The negative review we’ll get won’t mention our side.
Opioids are another example. They are a highly addictive pain medication and have led many to die due to overdose. Should we give a patient opioids if they insist on having them, but we suspect that they may be getting addicted? These are real life issues that we regularly face. The review we’ll get here, once again, won’t mention our concern.
It is especially important to address this issue now, as we head into a future in which physician salaries will be based on what people say.
Let me make one more thing clear here, and it’s an important thing to note: it’s not so much the reviews I have an issue with, as that’s how we so things today. It’s more the fact that we cannot properly respond to them. Like, ever. Because of HIPAA (the laws that protect patient privacy).
7. Codes
(aka language we cannot keep up with)
As if learning medicine wasn’t hard enough, someone decided to throw a new language in there, in order for the physician to bill.
So instead of simply saying that you saw someone for a cough, you need to expand by giving it a number. If this were straightforward and clear, I’d still find this cumbersome, because we already have to learn so much.
But the fact is, there are over 70,000 existent codes these days (I know, I looked it up!)! Try fumbling around in that lingo! Plus, they change every year!
To make matters worse, we often struggle to find the right one, because the process isn’t exactly ‘straight-forward’.
Some of the most commonplace ailments take a while to find, or worse, don’t exist. And yet, ones like ‘sucked into jet engine, subsequent encounter’, will pop up, every single time.
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These are just 7 of the reasons that come to mind, when I start to think about the ‘why’ of leaving.
They are, in my opinion, issues that don’t work optimally in the healthcare ‘playing board’ of today.
Some of them need simple tweaks, to make better, others a complete overhaul. Or maybe we need to restructure it all.
In the meantime, I’ll continue to run SoMeDocs, as a healthcare innovation hub that gives doctors the structure for building up their personal brands. I’d hate to see our commitment and dedication go to waste, with the exodus from medicine that’s on the horizon, and yet to come.
