The Great Resignation. I doubt there is a medical practice out there that has not been affected by it. And experts predict we are just at the beginning. The U.S. Bureau of Labor Statistics’ early data from 2022 shows that health care is among the top three industries increasing in monthly “quit rate,” second only to accommodation and food services. 2.6 million health care workers quit their jobs from May to September 2021, and 1 in 5 physicians plan to leave their current practice in the next two years, according to a survey funded by the American Medical Association. So this is likely the tip of the iceberg.
Yet I think many of us recognize that the COVID-19 pandemic, while a major contributing factor, is not the main reason behind the Great Resignation in health care. The U.S. health care system was already akin to a leaking and cracked dam; the pandemic had just broken the flood gates wide open. I say this because between 35 to 54 percent of American nurses and physicians were already feeling burned out before the pandemic. The number of physician suicides — 28 to 40 per 100,000 — is more than twice that of the general population at 12.3 per 100,000. It is the highest rate of any profession, including the military. While we encourage our patients to get treatment for mental health, there is still so much stigma around treating ourselves. We suffer in silence because we were trained to.
So are doctors just a more depressed group of people, in general? While difficult to study, In the U.S., there is some evidence that the prevalence of depression in doctors is similar to the general population. A cohort of male medical graduates from Johns Hopkins self-reported a lifetime prevalence of 12.8 percent, similar to the 12 percent lifetime prevalence of major depression in American men. Self-identified lifetime prevalence of depression in American women doctors has been estimated at 19.5 percent, comparable with women in the general population and women professionals. But I don’t think the one million-plus of us (1,018,776 to be exact, as of a 2020 census) are more prone to mental health issues than the general population. We are a diverse group practicing in a diverse range of settings, and the only commonality we all share is our profession. So burnout and mental health issues are old news. But this quit rate is most definitely a plot twist.
I am well acquainted with health care burnout. I have been burned out in my career at least twice before the pandemic. As painful and life-altering as each one was, I am grateful I had been through it before because I knew the signs, and more importantly– I knew what my boundaries for overwork and underappreciation were. I also knew I needed to respond before I got to the “danger zone” of depression and very dark thoughts, because I had been there previously. Burnout #3 was very predictable and likely similar to many other stories out there. My very corporate and for-profit primary-care practice of two years which I had started in the fall of 2018, became less tolerable as the pandemic wore on, not because of COVID-19, but because of our leadership’s oblivious behavior and decision to choose profit margins over patients and providers. It was the final straw from two years of unsupportive leadership and lip service, so I left in October of 2020 and never regretted my decision. Many other providers followed suit. Has this company changed its ways? From what I hear through the grapevine, that is a resounding “nope.”
While I did not feel regret, I did have pangs of guilt. Guilt over leaving my patients, of the extra workload my panel disbursement would create for my colleagues, many of whom were my good friends. And just the larger existential guilt of tapping out in the middle of what I knew was going to be a very long road to the end of the pandemic. So this was not a decision I took lightly, but one I had to make for self-preservation. So many of us in the practice had tried to bring our concerns and frustrations to our leadership, many times before the pandemic. And our complaints were brushed aside and glossed over, always. So ultimately, I knew it was time to call it because I couldn’t be of help to anyone if I was a frazzled, exhausted, angry mess.
I took four months off work, sailed down the California coast to Baja and the Sea of Cortez, and found contentment at a time when I knew so many of my colleagues were miserable. I took a remote job in public health. Although it was a sizeable pay cut, my work culture is supportive and flexible, and my work stress is basically non-existent compared to what I have previously experienced. It took a few months, but my burnout gradually faded away sans any therapeutic intervention except regaining my sovereignty.
This is my experience, and I am only one person. But anecdotally, I know I am not alone. We aren’t quitting because we aren’t “resilient” enough, or got a better offer elsewhere, or had that lightbulb moment that now is the time to pursue a career as an artist. We are quitting because we are done with martyrdom. We are done with the infantilizing speeches and practices of our leadership, with not having control over our schedules, our panel sizes, our visit times. We are done being cogs in the great American medical machine. We are finally standing up for our mental health, our freedom, and our work conditions. Most of us don’t have union access, and organized strikes by physicians in the U.S. are essentially illegal. But if we individually quit, give our honest reasons why in our exit interview (I sure did!), and uphold our own personal boundaries of what we will and won’t tolerate at work? A strike, by proxy.
Jessica de Jarnette is a family physician.
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