“When you start seeing your worth, you will find it harder to stay around people who don’t.”
After graduating from my residency a few years ago, I accepted a job within my organization as a staff psychiatrist and a medical director.
The idea of familiarity was a big driver in my ambivalence towards pursuing alternate opportunities, even when they came knocking on my door. As the job started and progressed through it’s ebbs and flows, the challenges started to become painfully obvious.
In a poorly run state system plagued with budget cuts and endless bureaucratic red tape, the struggle to keep my autonomy as a physician became increasingly difficult. To the casual observer, including myself, I was doing what I was supposed to.
I was providing psychiatric care to the most underserved and sick patients in the community and was making strides in improving teaching experience for the trainee doctors. But in reality, I was taking on more and more work as physician recruitment took back seat, with no end in sight and no leadership plans to help me alleviate the burden.
I am a strong believer in physician autonomy and the belief that physicians managed by clinically active and practicing physicians are more engaged and more tolerant of many other shortcomings, their jobs may have.
One of the problems with physician burnout today lies in the way physicians are managed. Most of the administrators who manage us are not clinically oriented, let alone medically trained. Many state agencies hire non-physicians to manage their physicians, whose job is to cut costs and keep the status quo. To make matters worse, physicians are constantly portrayed as not being empathic, being arrogant, and “not good enough.” National trends in health care are marching to the tune of promoting a whole new workforce of physician replacements in the form of mid-levels. Pick any publication, any job listing from any hospital or academic center and you will see promotion of non-physicians as someone who can provide “comprehensive, compassionate and complete care” — as if physicians with 20,000-plus hours of training and over a decade or more of education are already not doing so.
This hostile attitude towards physicians is becoming part of a culture that devalues our education and training and continues to put us in little boxes. Boxes on an EMR, boxes on a superbill, boxes of patient reviews and boxes on quality initiatives. Numbers on financial sheets.
That is where I found myself after three years of trying to change the culture.
Five months ago, I walked out of a clinic that I poured my heart and soul into for the last three years as evident by increased revenues for physician services and revamped resident supervision, along with streamlining hundreds of day to day processes. I decided to value myself as a woman, as a leader, and as a compassionate physician.
I had to be compassionate to myself before I lost my joy of practicing medicine to the state bureaucracy.
I decided to set up my own private practice, rather than working in a system that didn’t value me. I quickly learned to unload the myth of “private practice is like taking care of worried well.” This process has made me aware of how ambivalent I had been to the burden I was carrying, as a state psychiatrist, who was unappreciated and overworked.
I had forgotten that patients go to the doctor, appreciate the time doctors spend with them, and are used to paying a share of their health care costs. Managing my own practice has slowly but surely made me realize my value as a physician, not only by virtue of my patients actually paying for my services but also by being able to work the way I want to. I have learned that I deserve to enjoy my work, in order to continue to be a compassionate physician.
My value doesn’t lie in boxes on annual reports. I found my value as a physician when I decided to take a risk and refuse to be continuously pushed and used by a system that only cares about cost-cutting rather than quality. Because when I took the oath to “Do no harm.” I had taken that oath not just for my patients but for myself as well. I reclaimed my value as a physician by facing the devaluation the system had normalized for me and got rid of the guilt that working for myself and on my terms means I am selfish. Because as I had read somewhere, “If you find yourself constantly to prove your worth to someone, you have already forgotten your value,” and I had for a long time.
Najma Hamdani is a psychiatrist.
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