The Perfect Enemy | As an ER doctor, COVID taught me that I don’t matter. So I quit
December 6, 2022

As an ER doctor, COVID taught me that I don’t matter. So I quit

As an ER doctor, COVID taught me that I don’t matter. So I quit  San Francisco Chronicle

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After nearly 20 years as an emergency room doctor, I walked away from the profession I once loved. I’m not the only one.

According to a new report from the data analytics company Definitive Healthcare, 117,000 physicians left medicine in 2021. Each departure cost the health care system an estimated $500,000 to find a replacement — $58 billion last year alone — and the ripple effect has already led to worse medical care for all of us.

This mass exodus of dedicated professionals is the canary in the coal mine for a growing health care crisis and despite what hospital administrators have proposed, the solution does not involve more resiliency training for the remaining canaries.

It’s time to fix the mine.

As physicians, 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 above our own at any cost. For example, early in my career, when I was eight months pregnant, I contracted H1N1 at the hospital where I was working. Despite a 102-degree fever, I never called in sick. Years later, when my mammogram looked suspicious for breast cancer, I created a schedule allowing me to work shifts in the ER after every radiation treatment. Luckily, the biopsy was benign.

Every physician has similar stories — from pushing their intravenous-drip pole into patient rooms while working through a gastrointestinal bug to admitting oneself to the hospital at the end of a shift after their appendix ruptured hours earlier. This is normal for us. We keep going because what we do matters. But increasingly, many of us are asking, do we matter?

The pandemic and its ongoing aftermath have hastened a growing sense of disillusionment that the answer is actually no — at least not to leadership. 

There is little doubt that our medical system’s unwavering focus on profitability puts reimbursement and patient throughput above the well-being of its workforce. Before COVID, there was a delicate detente as doctors are notoriously bad at asking for help anyway. But now, as we frantically wave our white flags, we are summarily dismissed.

Early in the pandemic, our administrators minimized our physical safety. As medical workers were dying in Wuhan, China, and Italy, I was admonished for wearing an N95 mask and was told, “You’re going to scare the patients and the nurses will want to wear them, too.” Other doctors got the same message from above, and multiple professional societies were compelled to release statements in support of providing adequate personal protective equipment.

As the pandemic unfolded, our emotional health was disregarded. Nearly 70% of physicians reported symptoms of depression and 1 in 8 acknowledged suicidal thoughts. I lost all interest in food and eventually dropped to my junior high weight. Of course, I went into therapy and got help for my symptoms, but the work — and the dismissiveness — kept coming. The antidote that we needed had to come from our health care leadership. 

It never did. In fact, it got worse. 

There was never any meaningful recognition of the relentless trauma we’d endured, and the disconnect between the support we needed and our leadership’s efforts to help us was striking. Hospital administrators ordered pizzas, encouraged yoga and told us to keep gratitude journals on our bedside tables. While well-intended, these efforts felt tone-deaf in the aftermath of surge after surge of a deadly pandemic.

Doctors shouldn’t be told how to be well by a committee of managers far removed from patient care. Instead, we should be asked — asked what we need to stay healthy and what can be changed to help us to do our best possible work. 

What would our health care system need to do to get us to stay? Probably less than you might think. We need to be seen and need to be trusted. 

See that we put our lives on the line and risked the health of our families every single workday before vaccines became widely available. See the moral injury we absorb shift after shift, when, despite doing the very best we can, perpetual short-staffing and overcrowding keep us from giving the quality of care we’d want for our loved ones. See that if we’re asking for help, we have tried absolutely everything in our power to fix the situation ourselves, and our goal is to do right by our patients. 

In July 2021, after 18 months on the front line, I asked our hospital leadership team for an unpaid leave of absence to regain my humanity. “Then everyone else would want one too,” I was told as my request was flatly denied. At that moment, I knew I was done. I had planned to remain in the ER for the next 13 years until I retired. Instead, I submitted my resignation. 

Medicine had been my everything for decades, and I finally understood that it never loved me back. 

There are over 100,000 doctors like me and many of us would have stayed — even under our abysmal working conditions — if we’d only been treated as respected partners instead of a depersonalized commodity.

Keeping our best physicians in the game is clearly in everyone’s best interest. The tipping point is here, and we must immediately and radically alter our hospital culture before all of the canaries fly away.

Dr. Molly Phelps is a board-certified emergency physician who recently completed her first book about her time on the pandemic’s front line.