There’s little question that the workplace environment for doctors is deteriorating.

Especially in primary care, where physicians are arguably needed the most.

That’s why is so disheartening to read this Newsweek essay from pediatrician Karen Li, explaining why she left the field.

Much of her piece can be attributed to the bad old days of managed care, where doctors were frustrated by the bureaucratic impediments placed before them:

Why would a businessman or, worse yet, the HMO secretary with a treatment algorithm on her desk have any right to tell us what was best for our patients? After all, who had the medical training? Increasingly, more time and effort was devoted to fighting back for our patients, writing rebuttal letters to HMOs, calling secretaries and working up through the system to finally presenting our arguments to the medical directors of each HMO. Trying to justify basic treatment for our patients became a regular and distasteful part of life.

All while physician salaries have not kept up with inflation, which Dr. Li starkly takes: “Hospital nurses questioned why we took on so much responsibility and worked such long hours for paychecks significantly smaller than theirs.”

The reason why Dr. Li stayed on for as long as she did was for the sake of her patients, and the gratitude they expressed when their health issue was addressed. Indeed, that’s a feeling that makes it worth the hassle doctors have to fight through and the burnout most physicians face.

But in the end, it became too much, and the field is now down one less pediatrician.

A similar situation is facing primary care throughout, and it’s becoming sadly inevitable that more passionate doctors will be forced to leave the profession.