Saturday Morning Rounds August 3, 2019 - Why physicians are leaving medicine and what you can do about it

Posted by BossB, MD on August 3, 2019
BossB, MD

Saturday Morning Rounds
A weekly round-up of everything that captured our attention over the last 7 days

What we're reading

The doctor is out? Why physicians are leaving their practices to pursue other careers by Nicole Spector

General interest in becoming a physician is decreasing throughout the population, and our already large shortage of physicians is increasing as a result. This article highlights a few different reasons for these related trends. The author starts by discussing the fact that with more STEM jobs available than ever before, undertaking the long, difficult path of becoming a physician has become less appealing. She goes on to quickly address residency, pointing out that (a) there are often not enough positions for all med school graduates to be guaranteed a spot, especially in some of the more widely appealing specialties, and (b) that the "desire among millennials to be in hip, urban locations" is "a luxury you likely won’t get when you’re fresh out of medical school and in need of a residency."

But the most compelling section of the article focuses on the stories of three practicing physicians who left the field because "the cons started to outweigh the pros." In their own words:
“I began to feel like an easily replaceable cog in the health care machine. With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.”
“Some parts were incredible, but the moments when I felt I was making a true difference were too few and far between. And then there was the issue of work-life balance. I had my first child and was barely seeing him. The schedule was relentless.”
“We are burdened more by nonmedical business or insurance professionals without any medical training. It's disheartening. ​I have transitioned to more part-time clinical work [so as to focus more on] speaking, writing and consulting."

The article finishes with an admonishment from one of the above physicians to "Become a full-time consultant, author, speaker, entrepreneur, baker, cheerleader — whatever. Just be happy. Life's too short.”

While the whole life is too short to be miserable argument is certainly true, this pithy closing line does a disservice to all who read it in that it (a) egregiously oversimplifies the problem and all the factors at play in most physicians' lives, and (b) assumes that there's no way to have your cake and eat it too in the world of medicine. That last assumption is patently false - as a matter of fact, the idea that one can actually both have and eat one's "cake" (ie live your best life while practicing medicine) is among the most important perspective shifts that we try to achieve early on in our work with clients. More importantly, staying connected with one's sense of purpose - when done correctly - protects against burnout, increases engagement at work, increases physical and mental health, and even leads to a longer life. In today's "tip of the week" section, we will highlight a simple intervention that can help you do just that.

Who we're following
Dr. Kimberly Manning, MD (@gradydoctor) published a twitter thread yesterday that exemplifies what it looks like to have purpose and meaning at work. Your version of that might look different from hers, but it will likely share a focus on other people and the positive impact your efforts can make for them. Her Twitter feed in general is one of the best in all of #medtwitter - so give her a follow to stay on top of what she's up to!

BBMD tip of the week
One of the best ways to stay connected with one's sense of purpose at work is to create and regularly review a "positive portfolio," or "wins folder." What do we mean by those terms? Essentially, it's a collection, preferably physical, of moments when you were at your best. A thank you note from a patient, a compliment from a mentor, a picture with someone you've trained and made a special impact on, an email from your administrator about a process you improved, an award you won, etc.

The key here, though, is to actually use it, and not just when you start to feel disenchanted! Set a calendar invite for yourself that recurs maybe monthly or quarterly, and sit down to remind yourself why you love your job and are good at it, as well as to add anything new that should be included since the last review.

This also serves a second, more tactical purpose. It can be really easy to forget all of the achievements that we rack up over the course of time, and it can be equally as difficult to paint a compelling, concise picture of one's positive attributes when it's time for performance assessments, promotions, and the like. This collection of wins will serve as a great way to (a) avoid the common mistake of letting your positive contributions slip through the cracks of memory and (b) highlight your achievements in a way that won't seem like bragging.

Quote we're contemplating
"He who has a why to live for can bear almost any how” - Friedrich Nietzsche


As always, please let us know your requests and suggestions on Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, all!