When I meet new people, the same questions and comments arise once they learn I am a physician.
“What’s your specialty?”
When they hear pediatric emergency medicine, I inevitably get the “I don’t know how you can do that” and “It must be so hard” comments.
I have my canned responses to these comments, but the inevitable next question is the most jarring. “Where do you work?”
I pause and take a deep breath. Do I tell them the long story or the short one? Do I say where I used to work or what I am doing now?
I am no longer the medical director of pediatric emergency medicine, a role I successfully filled for almost ten years.
I am no longer working alongside the fantastic team that I built over that time.
I no longer work at the bedside in the emergency department I helped design. I no longer tie my job to my self-identity or self-worth.
When I agreed to return to my home state after my fellowship, I did so as a clinician and department director.
At the time of my unexpected departure, I was that department’s longest-sitting medical director.
I had no mentor, guidance, or office on my starting day.
“No problem,” I remember thinking. I’m trained to expect the worst and hope for the best.
I could do this.
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Since I had no formal training in healthcare administration, I sought out every opportunity to learn more about leadership.
I participated in leadership academies, poured over emergency department management textbooks, participated in the administrative sections of professional societies, and even completed a master’s in healthcare administration.
The hard work did pay off.
My physician and advanced practice provider staff were cohesive and had no turnover in the preceding several years.
My team knew I heard them and would always advocate for the safety of the staff, department, and patients.
Over my ten years of leadership, our volume increased by over 20,000 annual visits. By the beginning of 2023, our department saw record numbers while meeting quality metrics.
As a director, I had little administrative help, while managing a team of almost 40 providers.
My days started early and ended late, but my phone was always on.
I was always on and available.
In addition to the administrative duties, I also worked clinically, typically 8-10 shifts/ month.
Leaders cannot ask their teams to do anything they could or would not do themselves, thus the importance of being present and active in patient care.
I staffed the emergency department every Tuesday and Thursday to make things easier on myself (fewest meetings on Tuesdays) and my staff (Thursdays were education days for all residents, leaving the ED attending and midlevel to shoulder the workload). All administrative staff knew that this was my schedule. I could make myself flexible the other three days of the week, but anyone could find me in the PEDS ED doc box or running around the department during those two clinical days.
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On March 28th, 2023 (a Tuesday), I was staffing the ED and remember it being another busy day. Patient volume and acuity were up.
ED boarding hours were high during that time, often exceeding nurse staffing.
Sometime in the morning, an email came across from an administrator for a mandatory meeting at 4 p.m. that day.
I replied that I would likely not be able to attend. Although my shift ended at 4, I rarely left the ED before 5-530 p.m.
I asked if we could reschedule for the following day, but this was not an option.
I explained that I would try to make it as soon as I could that afternoon but that my priority was the department and the patients I would need to disposition.
I had written over 400 words on the facts of the meeting, but they are for my eyes alone. I can share that the required meeting, scheduled at the end of a clinical shift, was to terminate me without cause, effective immediately.
My last ten years of hard work, late nights, constant worry, early meetings, phone calls at all hours, and time with my work family and precious patients was over in minutes.
Gone in an instant.
As I sat in shock, my brain was in overdrive. I felt it touch on the five stages of grief in a matter of seconds.
I have a clean record, I thought. I have worked so hard for so long.
How can they do this to me? What can I do to change their minds?
What will I do without my job, work family, and patients? How will my family make ends meet?
It was the acceptance that surprised me the most.
My forced departure was happening, and I could do nothing about it.
My last ten years of hard work, late nights, constant worry, early meetings, phone calls at all hours, and time with my work family and precious patients was over in minutes. Click To Tweet
The details of my termination are less important than the act itself.
I know my value as a person and a provider, so I have felt comfortable sharing my story.
In doing so, countless physicians have reached out after undergoing similar events. The fact that many physicians face termination without cause and due process was shocking.
How many other physicians have experienced this?
Even for termination with reasonable cause, physicians are often not notified of their deficiencies or perceived difficulties in the system ahead of time. Human resource departments throughout healthcare have become more institution-focused, leaving physicians vulnerable to unjust surprise terminations for unknown reasons.
Physician contracts have reasonable cause termination clauses, but most contain without-cause ones.
Physicians are not taught contract law in medical school, and many do not thoroughly review and counter their contracts.
By enacting these clauses, the systematic disregard for physician due process rights threatens healthcare transparency and patient safety.
As physicians continue to face termination without cause and due process, their colleagues will feel less protected speaking up for improved operations and patient concerns for fear of retaliation. It is this cognitive dissonance that is unraveling the very nature of the fabric of healthcare.
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While I am comfortable sharing my story, many are not.
There is shame and fear associated with this life-changing experience.
An odd sense of loss for self-identity and self-worth accompanies such a traumatic change.
It takes time to remember that you are not your job. You have more than one role.
You are the medical student who had to work harder than anyone else.
You are the resident who kept their head down and did the work.
You are the attending struggling to find your place.
You are the non-traditional fellow, three years removed from residency, ready to continue learning.
You are the newly hired medical director, prepared to do whatever it takes to improve the lives of your colleagues and your patients.
After your termination, you are still that medical director, ready to share your passion with other teams and more patients.
You are still a wife, a mother, and a voice for those who cannot speak up.