“Wrong! The most important part of your job is to make money.” I will never forget those words from an attending in residency – though I did not know it at the time, it was a pivotal moment in my decision to pursue a nontraditional route in medicine. I loved my patients; I loved the critical thinking required for taking care of them, I loved the scientific knowledge underlying the care we provide as physicians. However, making money would never be the most important part of any job for me. The most important parts of my job would always be caring for my patients and providing for my family (the answer that my attending found so offensive).
It was not until complications following our first baby’s birth that I allowed myself to look for a way out of this system that was so at odds with my own values as a physician. I still vividly remember rushing back to our OB’s office at 4:45 p.m. actively hemorrhaging for the second time just days after our baby was born. My hemoglobin came back under 6 in the office where they also saw possible retained placenta on ultrasound. My heart rate was somewhere in the 140s and my blood pressures were in the 70s/40s when I got to the pre-op area a few minutes later. The anesthesiologist asked for two large-bore IVs and quickly started talking about other options to give fluids and blood because they were having trouble finding veins. Somewhere in there I began to panic because I knew what the vital signs meant, I knew what trying (and repeatedly failing) to place IVs meant – it meant I was in hemorrhagic shock and may not make it back to my baby and family. My dad called our family from the pre-op area. I tried to calm down and told my husband not to worry – I told him our parents would help him take care of the baby. It was the single most terrifying moment of my life, but it also taught me that there is no point wasting your time doing something you are miserable doing.
It took time to process the trauma of what happened. It took time to figure out what I wanted to do. However, I quickly realized going back to traditional patient care was never going to be an option. I started working locums 1 day a week at a private practice, began doing chart review work for Medicaid part-time, and still had plenty of time for our family. After our second baby was born, I decided to drop the locums work and focus on my nonclinical work – adding utilization review to the functional capacity assessments I was already doing. I enjoyed the work and it paid adequately for our needs, but it still felt like something was missing.
I missed caring for patients, but knew that I could not go back to an insurance-based, high volume practice. After having our children and a difficult time with breastfeeding with our first due to our delivery complications, I found a love of learning about breastfeeding, infant nutrition, and how to help other new parents. After helping friends and family who were having difficulty feeding their new babies over a few years, I spent the first 6 months of the pandemic completing the certified lactation counselor (CLC) course and continuing medical education (CME) on breastfeeding medicine. During that time, I also worked on the logistics of setting up a cash-based breastfeeding telemedicine practice which launched at the end of 2020. The plan is to eventually expand this to a more comprehensive direct primary care (DPC) practice with a brick-and-mortar location once our children are older. The Female Physician Entrepreneur group and resources about how to set up a DPC were both extremely helpful in figuring out the logistics of how to bring my vision to life.
Burn out, moral injury, whatever you want to call it – what the system is doing to compassionate, thoughtful individuals who followed a path in the hopes of caring for others is absolutely wrong. For me, the problem was never about caring for patients – I enjoyed helping them figure out what was going on, managing their medical problems, and helping them make difficult decisions. The system was the problem – endless charting, spending hours learning how to follow rules that had nothing to do with patient care, taking additional time to fill out stacks of unnecessary paperwork, the list goes on. By refocusing on the doctor-patient relationship with a direct care model, it finally feels like I can get back to practicing medicine and taking care of patients in a meaningful way.
If you are happy with where you are in the current system – that is wonderful, continue what you are doing. However, if you are feeling trapped, frustrated, or like the work you are doing is no longer meaningful, then there are plenty of opportunities for you to get out of the system. Start looking at your options – start learning about them and looking for opportunities now. Whether you end up deciding on an alternative clinical career, a nonclinical career within medicine, or a career outside of medicine altogether – you have the skills you need to succeed as long as you are persistent. There are options if you want to stay employed and opportunities to start your own business. The critical thinking skills, listening skills, and drive to succeed that you need to survive training to become a physician can help you create a career that will support you and your family and allow you to live a fulfilling life. The first step is to start.
Nithya Natrajan is a family physician and can be reached at Blossoming Mamas.
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