Want to Know Why Professionals are Leaving Healthcare?
Allow me to give some examples...
This was inspired by a LinkedIn post I wrote a few days ago that has so far had 111,000 impressions, 84 comments. I have borrowed from those who commented but have tried to protect anonymity. Anyone is welcome to comment and explain their own sources of frustration…or hope.
Every day I get calls, texts and emails from recruiters looking for locums, part-time or full-time docs.
“Dr. Leap, I have a great opportunity for you!” (Which, by the way, usually means at best an average opportunity.)
“I’m not interested thanks.”
“Well if you aren’t interested, do you know anyone who is?”
“No, not really. Sorry.” And I’m being honest. Physicians are exiting the system as fast as they can.
Every day a hospital, or hospital system, finds that it’s having a harder time staffing.
Week by week patients wait longer because there are fewer of us available.
Year after year, men and women who fell in love with the idea of caring for the sick and injured, who spent decades getting into the profession, find themselves falling out of love with it and looking frantically for new opportunities in or out of healthcare. There are entire websites and online groups devoted to non-clinical opportunities.
It’s not a mystery. It’s a calamity. It’s the growing dissolution of medical care thanks to the unbridled mismanagement of systems, fueled by greed. It’s the epidemic exhaustion, dissatisfaction, even disgust of those who thought it was reasonable to dedicate their lives to the job.
Physicians are weary of being little more than white-coat wearing Jenga pieces, moved around randomly and waiting for the tower to collapse any second.
If you wonder why people are leaving medicine, here's a little example of what we face from those in charge. The things we hear from those in offices, on boards; the financial geniuses who purchase and sell systems, monetize them, get bonuses from them, wreck community health, ravage the finances of their patients. The people who then have the unmitigated audacity to feature themselves in photo-ops about how they care about the wellness of the community and how proud they are of their doctors.
Mind you, I’m focusing on physicians because that’s what I am. But it goes far beyond.
Here are some things we’ve all heard in the last few years. Some are mine, some are drawn from the comments in the LinkedIn post or from conversations I have had with people I meet. Often they are afraid to speak openly.
But these barely scratch the surface of the things making physicians, nurses, PAs, NPs, medics, techs and everyone else exit whenever they can. They are in no particular order. Bear in mind that I work in several hospitals, in different states. I interact with so many people in healthcare. I also write columns about medicine at least monthly. I hear from my readers and have for 24 years.
This isn’t me being a whiner. This is me reporting what’s happening.
Here goes:
"Don't use too many blood culture bottles, but be sure to get blood cultures."
"Don't use too much IV fluid due to the shortage, but be sure to give those sepsis boluses and give fluid when you need to do it."
"Make sure and get the patients moved as fast as possible despite having no open beds to put them into for care. They’ll just have to hold in the ER."
“Put your drinks and food away because the surveyors are here. Just eat or drink on your scheduled break.” (Almost nobody has time for a scheduled break.)
“It doesn’t matter if there aren’t any beds, the patients can’t wait in the ambulance so put them in a bed.” (“But there aren’t any…”) “Well find one.” (A little gem from the COVID days.)
"You have a full EMR inbox. You also have online educational modules to do. Clear those out or you're suspended, can't get bonuses and can't have access to the schedule. Do it from home if you have to...and no, you can’t be paid for working on it from home. Just do it between patients."
“If our staff quits because they’re unhappy, we’ll just hire more.”
“I know it’s been rough lately, and you’ve all been working really hard. So here’s a pizza party and a Snickers Bar. Well done.”
“Keep the patients moving quickly, but sit down and speak slowly when you talk to them.”
“Don’t ever tell patients we are understaffed or that something isn’t your job.”
“Don’t touch the agitated, dangerous psychiatric patient. It’s assault. But don’t let them leave.”
“Can the police be in the hospital but without their weapons? We’re not comfortable with weapons.” (After a nurse I knew was nearly choked to death and we had meetings about hiring police for security.)
“Please provide dignity and respect to all those you interact with or you will be written up.” (???)
“Do more with less and make sure you document it all real time!” (A nursing frustration.)
“Do nothing to keep local talent, just use travel nurses.”
“Oh, and if the patient is a no show, that comes from your paycheck.”
“And the peds version. And yes this is what I spend my time on instead of patient care.
…make sure your adolescent patient is compliant with their ADHD medication…sorry there’s a drug shortage and alternatives are not on formulary. Make sure your asthmatic 4-year-old doesn’t end up in the ER or hospitalized…sorry we don’t cover that inhaler that can be used with spacer, they have to use this breath actuated inhaler that will deposit all the medicine in their mouth.”
Other frustrations:
“The entire pathway into medicine is fundamentally broken, which strangles the supply of physicians.”
“The idea is that everybody (except, of course, for the executives) must do more with less.”
“The forces of greed have overrun our healthcare system and it’s time for us to fight back as hard as we can.”
“Declining reimbursement and outrageous government theft in the form of taxation. Years of training. Large litigation risk despite sicker patients.”
“Administrators bend over backwards to implement some protocols for CMS (the Centers for Medicare and Medicaid Services) and monetary gain- not about patient care. Before no time these protocols are rescinded and forgotten because they were never evidence based. Happens all the time.”
Of note, comments suggest that the same things are happening in other countries as well. It’s not a uniquely American problem. There are even frustrations with this sort of thing in highly government controlled medical systems, like the UK and Canada. Even India isn’t spared, according to one physician comment.
What a mystery, this physician shortage! How unexpected, this nursing shortage!
I know that there are good, caring administrators. But the level of dissatisfaction among the highly educated, dedicated professionals, among the people who do the patient care and actually make the money, is incredible and rapidly growing.
Those at the top need to figure this out, listen to the folks on the ground and learn to show them that they’re valued.
Otherwise things are going to get very bad, much faster than anyone realizes.
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Just a few of my (additional) frustrations - my last ED employer installed Epic at Midnight on a Saturday night. I started my shift on Sunday morning at 8 am, with the ED backed up for 5 hours (it had never been backed up that much, before, in my experience). It took me 45 minutes to order meds and treatments for my first patient, an unstable CHFer. A colleague had to use Brutacaine to intubate someone as she couldn’t get meds from the Pyxis until the patient information was entered. I handed in my notice that day.
I was fired from my longest ED job (15 years) because I told an attending that I couldn’t move his patient to a bed, because every bed was filled, and patients were on stretchers in the halls, and ambulances were bringing more patients, despite our being on divert. He complained to the CEO of the hospital and I was given notice that day.
I handed in my notice in my last ED job when I was chewed out for transferring a patient who was as stable as I could make her in a hospital without any capacity to manage her problems, and nurses too new to have any idea of what to do. The week before, I had to put a chest in a attention, and no one, besides me, knew how to set things up.
I decided to retire from an ED residency I had helped to establish when the then current program chair threatened to punch me out in full sight (and sound) of the patients and staff. He had been at another program, and left there due to anger management issues.
I was thrown under the bus by the owner of an ED practice who didn’t have corporate malpractice coverage, because “it would cost me money to have a lawyer review the changes you wanted to make in your contract.”
So, yeah, I guess it’s all my fault that I decided I was a dinosaur, and concluded it’s better to retire 2 years too early than 15 minutes too late.
In a nutshell: Hire moronic, non-clinical middlemen, ie "administrators", in large numbers, to make decisions based primarily on financial/ industrial "quality" parameters - divorced from any actual bedside patient care experience - and then tie their compensation directly to such cost-cutting and efficiency metrics... What could possibly go wrong...? SMH in surprise! Sincerely, a dual borded ED doc/ director of 30 + years, forced to resign for refusing the jab, after having Covid twice as a front-line "hero". You can all burn in heck, good riddance...