Many physicians have surely had it rough lately.
Between getting the squeeze from insurance companies, private equity buyouts of practices, and (oh yeah) a raging global pandemic, there has been a lot of pressure placed on physicians and medical staff across the world.
Do you feel a little on the “fried” side? Has some of the joy, the raison d’être you had for practicing medicine diminished somewhat?
As The Darwinian Doctor points out in this guest post, you are surely not alone.
Today, I explore why it seems like all doctors are quitting medicine. Is it just perception, or is our nation’s healthcare on the brink?
You may have noticed something strange if you’re friends with any doctors on social media these days. It seems like a startling number of doctors are quitting medicine to pursue other career paths or retire early. Some might be leaving to become life coaches, while others might be leaving to become investors or business owners.
Has the Great Resignation finally come for health care providers, or is this just a continuation of historical trends pushing medical professionals towards non-clinical careers? As a practicing surgeon who straddles the worlds of clinical practice, education, and investing, I’d like to add my perspective.
A couple of questions seem pertinent: What the heck is going on? Is our healthcare system in trouble?
What the heck is going on?
If you’re nodding your head in agreement, perhaps you’ve noticed firsthand that some of your colleagues at work are making changes to their medical careers. Some might simply be switching health care organizations.
Job hopping is fairly common, especially in the first couple of years of practice, so this isn’t revolutionary. What’s more interesting are those that are leaving to start their own practice or doctors who are quitting medicine altogether for nonclinical careers.
It’s not just your imagination. Over the past year, I’ve personally noted dozens of physicians choosing early retirement or a new career entirely. These are high-functioning doctors in the prime of their careers, giving up literally decades of education, hard work, and well-established medical careers.
There is clearly something larger going on, both acutely over the last couple of years, and chronically for the past decade or two.
To begin this discussion, let’s address the elephant in the room.
The Covid-19 Pandemic
The Covid pandemic has clearly caused unprecedented challenges for the medical community. The sheer crush of morbidity and mortality over the past two years is like nothing the medical community has ever seen.
The number of deaths from Covid is now more than the deaths we saw from World War II, Korea, and Vietnam combined.
Depending on your specialty, you’ve had varying levels of exposure to the “front line.” If you’re an emergency physician, you’ve seen the triage areas full of gasping Covid patients. You’ve likely experienced the fear of treating a Covid patient with minimal protective equipment. If you’re a pulmonologist, you’ve likely had to make unbearable decisions about withdrawing ventilator support for the unrecoverable patients in the intensive care unit.
This level of death and emotional trauma takes a toll. It heightens feelings of depersonalization and moral injury, AKA burnout. There’s only so much emotional reserve you can have when so many of your patients lose the ability to breathe and die under your care.
For the rest of us further from the front line, the impact of the pandemic has come in many forms. At the beginning of the pandemic, many of us experienced:
- Anxiety about job stability
- Clinic and OR shutdown
- Redeployment to Covid patient care
- Redeployment to vaccination drives
Then as the surges ebbed and medical care opened up again, the pendulum swung back to:
- Staffing shortages
- Unhappy and frustrated patients
- Long surgical backlogs and operative days
- High patient volume and overbooked clinics
When you overlay all of this onto the background of vaccine controversy, it’s been an incredibly tough couple of years to have a medical degree. It’s safe to say that this applies in general to healthcare workers in both private practice and employed medicine.
More doctors are retiring
Data from late 2021 shows that it is in fact true that more doctors are retiring from medicine. In fact, 25% of physicians are thinking about early retirement. This shows that it’s not just a feeling. More doctors are in fact quitting medicine, and many more are considering it.
Dissatisfaction with the status quo
Another factor in this overall trend towards career upheaval has been the recognition that the traditional work paradigm perhaps isn’t so great. And it’s not just physicians that are unhappy.
Working a 9-5 job with a commute has never seemed so unsatisfactory for our nation at large. In 2021, somewhere between 25% to 40% of workers planned to leave their jobs. Most are planning to move to a better job, but many people (especially women), may have left the workforce for good.
Even well into our economic recovery in early 2022, job openings are high and workers continue to quit their jobs.
The experience of healthcare workers
Another driving force in career unrest for healthcare workers is the increased corporatization of medicine over the last few decades. Medical practices are increasingly being bought by private equity groups and hospital systems. In fact, 2020 marked the first year more physicians were employed, rather than in private practice (according to the AMA).
While this trend brings advantages such as standardization of care and electronic health records (EHRs), experience has shown that these swords are double-edged. Physicians now spend more time with electronic medical records systems than with actual patients. As health professionals know, EHRs are great for storing past medical data, but they’re incredibly time-consuming to satisfy in regards to visit complexity levels and billing codes.
Most physicians would agree that they spent four years of medical school and 3-7 years of residency so that they could care for patients, not to satisfy finicky EHR systems riddled with hard stops and requirements.
Don’t even get me started on the frustrating world of prior authorization, insurance companies, and pharmaceutical medication coverage. For a purportedly modern society, it still takes so much paperwork to navigate our nation’s healthcare system.
These dual trends of corporatization and increased documentation requirements have warped the practice of medicine. They lead to a decreased sense of autonomy, which is a potent predictor of burnout/moral injury.
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Many physicians are also bad with money
Adding fuel to the fire is the fact that physicians are not great with money. A recent report showed that about 25% of physicians are worth under $1 million by the time they hit their 60s. For one of the highest-paid job categories out there, I find this pretty startling. I’ve written before about the phenomenon of golden handcuffs amongst high-income professionals, and it’s another big problem.
Physicians who are trapped in their jobs by financial pressures can’t make unbiased decisions about their careers or the medical care they provide. This is why I focus so much on personal finance literacy in my writing.
Is our healthcare system in trouble?
I do believe our health care system is in trouble. We can’t take the loss of more unhappy and burnt-out physicians and healthcare workers.
The field of medicine is facing a severe doctor shortage within the decade. We’ve had an epidemic of physician burnout for quite some time, and it’s only gotten worse since the pandemic began. Therefore, it’s high time for us to reverse these troubling trends.
As a physician leader within my own organization, I know that rallying physicians behind a common cause is like herding cats. But the general population in our country deserves our attention to this matter.
Administrators take note: Helping healthcare workers prioritize mental health and reasonable work hours takes more than just resilience training and appreciation lunches. It will take a fundamental revamp of our nation’s approach to public health. Physician leadership will be essential in this process.
I additionally believe that physicians who are financially free will have the best shot at influencing our system for the better. It’s difficult to enact change from a position of financial instability. Therefore, I also support inserting personal finance and business education into the curricula of our medical students and residents to better prepare them for the realities of practice on the other side of their training.
The good news is that recent months have given the United States a glimmer of a post-pandemic future. Mask mandates are dropping, as are Covid infections and deaths. While a new variant can upend our worlds once again, there’s reason for optimism now.
In regards to our healthcare system, I’m worried that we’re at a tipping point. More doctors are quitting medicine early, with many more considering it. Perhaps some are quitting the workforce for good, or perhaps they’re exploring other career opportunities. Regardless, they’re facing a difficult decision about life balance and professional satisfaction.
As for me, I’m hedging my bets. I continue to operate, serve my patients and my hospital, and work on financial freedom via real estate investing and business. This is my own insurance policy in case our nation’s healthcare continues this troublesome descent into corporate moral injury. Prove me wrong, please, I beg you.
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Do you know of doctors who’ve quit medicine?