“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.”

Jessica de Jarnette is a family physician.

She shares her story and discusses her KevinMD article, “COVID-19 and the Great Resignation: a catalyst, not the cause.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Jessica de Jarnette. She is a family physician, and she wrote the KevinMD article “COVID-19 and the Great Resignation: a catalyst, not the cause.” Jessica, welcome to the show.

Jessica de Jarnette: Hi, Kevin. Thank you so much for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Jessica de Jarnette: Yeah, definitely. I have a very circuitous journey, but briefly, I’m a family medicine physician with a master’s degree in global health, currently working in the public health sector. But my previous career was actually in emergency medicine, and this was actually my first experience with burnout. Also, this summer comes up on the 10-year anniversary of my first career burnout. At the time, it was the most painful and traumatic thing I had experienced in my adult life. With many years of space and time and healing, I have been able to look back at that and be so grateful that I had that experience and learned those lessons early on in my career, so I could apply them going forward.

Kevin Pho: So tell me about that experience, in terms of what you learned from it and what you are doing differently now.

Jessica de Jarnette: Yeah, that’s a great question. I would say my biggest takeaway lesson was not to let my whole identity be wrapped up in my career, in my white coat and the letters behind my name. I think most of us had spent so many years training and striving to be this perfect ER physician, and when I stepped away from that, I didn’t know who I was anymore. It’s taken, again, many years, but I think I’ve finally come to a healthier sense of self and identity that is not just rooted in my profession. So that was my biggest takeaway.

And I would say also, I think I said in the article, this is probably my third experience burning out at this point. And so it’s never easy, and it’s never fun, but every time, you get a bit better at recognizing when it’s happening and what your best interventions are to help stop it in its tracks before it does spiral into that place of depression, of dark thoughts, sometimes inside. So I think recognizing that was really important.

Kevin Pho: Tell me what you’re doing now, where you’re not solely defined by your career.

Jessica de Jarnette: Great question. I would say, first of all, my current career in public health has a very supportive environment in terms of being able to take time off work when I need to, recognizing that people have emergencies and things that happen, and if you need to step away from your desk for an hour or two to go to the dentist, that’s fully supported and fine. And so those little things are just an acceptance of your humanity, recognizing that doctors are people too, and we also have other life things going on, and sometimes we need to put those first before our career. So that’s been a big one.

And I think just my own self-reflection and exploration of what is important to me in my life. One story that I’ll share is I had a co-resident pass away in a tragic accident a few days after he graduated. And I think for many of us, graduating residency is like the pinnacle of your career, right? It’s what you’ve worked so hard for. And he was such a wonderful person, such a bright light in so many of our lives. And I truly think that any of us can go at any time, right? And so since that time, I’ve really tried to live my life like every day might be my last. How do I want to spend that day? Am I truly satisfied and fulfilled and happy in that day? And so that has really framed a lot of my decisions going forward.

Kevin Pho: All right, let’s talk more about your KevinMD article. It’s titled “COVID-19 and the Great Resignation: a catalyst, not the cause.” Now, for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Jessica de Jarnette: Yeah, definitely. So I’ll start with a quote by my muse, Brené Brown, who I think, hopefully, everyone’s heard of. If you haven’t, you must. I mean, she is excellent. And she says that there is no courage without vulnerability. And so I decided to be vulnerable. I’ve been wanting to share my story for some time, and I’ve been ignoring the call to share my story for some time, but something finally pushed me to take that step and write all this down.

Initially, I felt a lot of shame about speaking out. There’s the stigma that exists for physicians to speak out about tough working conditions and mental health issues, and there are so many barriers there. But after some time away from my standard clinical practice, and getting some perspective there, I realized that this was a story I carried, a story that’s constantly reinforced by many large primary health care employers, but it was a story that I didn’t really believe anymore. And I wanted to share that I’ve come to the conclusion that it doesn’t have to be this way, that this is not how most of the working world functions, and it’s not a healthy way for us to provide good-quality health care.

And so there are two themes that I want to share in this article that really fascinated me and saddened me in a lot of ways. The first would be the Great Resignation as a whole. I found, and still find, the whole phenomenon extremely interesting. And I realized that even though I left my job in October 2020, so I was a little on the earlier side, I was still a part of this phenomenon that I hadn’t really paid much attention to until the previous year. And I was like, “Wait a second. I was part of that.”

And I’ve been hearing about the labor shortages. Obviously, the nursing shortages have been huge in a lot of health care systems. I started looking at the data more and was just blown away by the data I was reading and seeing. I think I quoted in the article that one in five physicians plan on leaving their practice in the next few years, but I did find a more recent study that said 47 percent plan on leaving their practice in the next two to three years. That’s pretty scary. And this may be just switching roles. They did go a bit more into detail, and about 39 percent said they plan on leaving the profession altogether. So some may just plan on switching into a different situation or employer, but it’s still pretty scary to think about those numbers of people stepping down.

And then my second reason for writing the article is the belief that modern health care in America has become an increasingly toxic place of work. I know this is a bold statement, and I don’t make it lightly, though I’ve done a ton of thought and research into this. The number-one reason people are leaving their jobs across the board, in all industries including health care, is toxic corporate culture. And I found that to be very true in my experience, and very true in many other anecdotal experiences. And so I decided to write that down and make it, I think, more known and more OK for people to talk about, because we don’t talk about it. So those are the two themes of the article that I was really inspired by and wanted to just share.

Kevin Pho: So you mentioned workplace toxicity in the health care setting. What are some stories that you’ve heard, or stories that you want to share, that really illustrate that?

Jessica de Jarnette: The biggest ones that come to mind were the actions and rhetoric of many leaders in health care during the COVID-19 pandemic, especially early on. I heard a lot of really horrible stories, particularly from former ER colleagues working on the East Coast and in very busy metro areas that were really highly impacted by the pandemic. And I have a friend at a Midwestern ER where all of the nurses had left, and they had literally zero nursing support for a few months. And she told me that patients were just dying in the waiting room. And instead of being really supportive, their hospital was quite the opposite and actually cut their pay, and did some other things that were less than ideal.

And I would say, just from my experience, the place where I was working made some decisions that in a normal setting would have been stressful for all of us, and we did complain heavily, but in the middle of a pandemic, it was just not the right thing to do. And despite escalating complaints, it still happened. So without getting into too many details there, I think there’s a real disconnect in a lot of health care workplace cultures between those of us in the trenches, if you will, and those of us in the leadership suite. And I found that to be more apparent the larger the organization is. I do think there are smaller clinics and hospitals that maybe don’t have as big of an issue, but I do think it’s a huge issue in many, many settings.

Kevin Pho: Now, going forward, what are some of your remedies to this situation? I’ve talked to a lot of physicians on this podcast. One solution they suggest is to have more physicians go into those leadership roles and participate in committees, so they could rise up the ranks, so they can change the culture from within. In your view, can this problem be fixed?

Jessica de Jarnette: I do believe it can be fixed. I think it is going to be very messy and very painful, but I’m very optimistic. And the reason I’m optimistic is because this entire system was created by humans, and anything created by humans can be changed by humans. This isn’t gravity or Newton’s law. It is not written in stone somewhere that the standard of care for primary practice is seeing 20 patients a day. That is something that has happened kind of as a byproduct of a lot of other policies and, I’d say, decisions at a larger level, at a governmental level. But I do think that it starts with speaking out, with saying, “I am drowning. This is not OK. I can’t see this many patients every day. I can’t have 1,500 patients on my panel.”

And oftentimes, I do see people starting to speak out, and their complaints get ignored. That was what I was feeling at my previous employer, that we might get some lip service back. I heard this term one time, and it made me laugh: “literary leadership.” Leadership talk about, “Well, you’re doing a great job. Keep up the good work.” But I think the more people start to speak out and raise their voice, the more leadership will be forced to listen.

And also, I think in the article this was clear, but sometimes you do have to step down or step away. I do think there are certain workplaces where the culture is so entrenched that you do have to get out. And they want to say that the grass is always greener, because you do have to sort of weigh your pros and cons with leaving a role and starting a new role somewhere else. But I do think that there will always be jobs for us. Health care is always going to be a profession that is hiring. And so I think sometimes just stepping away and taking that leap of faith, that you can find something better or another workplace that will treat you with respect, is what is needed on a personal level.

Kevin Pho: One of the things that you said earlier is that there were barriers for you to be vulnerable in sharing your story. What were some of those barriers that you’re talking about?

Jessica de Jarnette: Yeah. So I think when I was working clinically, and I think for a lot of us, because I do hear this from different friends, I had so many previous colleagues and friends reach out, people I hadn’t spoken to in years, saying, “Oh my goodness, I 100 percent agree with you,” because I didn’t tell anyone that I was writing. I kind of wanted to see how people would react without cluing them in. But I did get an overwhelmingly positive response, at least from my circle.

And a lot of people said to me, “I really wish I could say something. I wish I could speak out like this.” And my first response is always, “What do you mean you can’t speak out? What’s going to happen?” And then I remembered that veiled, or not-so-veiled, threat of getting fired if you speak negatively about your employer, the fear of getting blacklisted, of not being able to get a job elsewhere because you can’t get letters of recommendation. We’re trained from the start of medical school, basically, to be quiet and to not rock the boat, and put your head down and get the job done. And once we’re in it, once we’re attending, that is so entrenched and so rooted in our own internal selves, right? And so I think there’s just a fear. There’s always that fear of, “I can’t say anything. I can’t say anything.”

And I think, too, we’re also so exhausted. I think the chronic exhaustion is a huge part of it. You just don’t have the energy to fight. I didn’t. At the end of the day, I was too tired to even cook dinner, much less try and change my organizational culture. So I think that’s a huge part, too.

Kevin Pho: Now, what was the tipping point for you? How did you overcome those barriers and share your story?

Jessica de Jarnette: Well, like I said before, the first step I took was to get out. I had to step away. I recognized that the culture of my workplace was shifting, and not for the better, and that it was not a healthy place for me to continue to work anymore. So I did step away, and I took several months off before I did go back to work.

And I think anytime you’re in a chronically stressful situation and you’re getting into that burnout zone, from my experience, it takes a minimum of several weeks, I’d say four to six, to really step away and let your nervous system calm down, so you can make aligned decisions, decisions that are the best for you. Because it’s really impossible, when you’re in that fight-or-flight mode and your sympathetic nervous system is activated, to check in with your inner voice and make the most healthy decisions, I think, for your future.

So for me, it was just getting out of a bad situation, and then giving it some time and some space, and then really deciding what I wanted my life to look like going forward. What did I want my ideal day to look like? What worked for me? What didn’t? What were my boundaries? Boundaries are huge. I mean, that’s another lesson I’ve learned, I guess, from all of these burnout experiences, is how important boundaries are, absolutely, and communicating those, right? So not just having them, but being able to speak them in a way that feels good to you.

Kevin Pho: We’re talking to Jessica de Jarnette. She is a family physician, and she wrote the KevinMD article “COVID-19 and the Great Resignation: a catalyst, not the cause.” Jessica, what are some of your take-home messages that you want to leave with the KevinMD audience?

Jessica de Jarnette: I have a few. So I’ll start with my first one, and I think the most important: It’s not you; it’s the system. No amount of resilience training or 10-minute lunchtime meditations is going to fix the effects of chronic stress from a system that is faulty. This is a foundational problem. It’s not an individual clinician problem.

I’m not sure where I heard this, but it has stuck with me and really resonated: Depression is anger turned inward. That is exactly the experience I had as an ER intern, dealing with trauma and burnout in a place that wasn’t supportive. And I’ve seen this over and over again with so many colleagues and friends that suffer with burnout and depression, but it really started as anger, anger toward a system that they felt powerless to change, and the anger has nowhere to go, so it goes inward. That would be the first lesson.

The second would be: It’s OK to take your power back, to advocate for what you need to do your job well. Like I said, I do believe the system can be changed. It’s going to be messy and painful, but I do think it’s possible, and it starts with communicating what you need to do your job effectively. For me, that was a very simple thing early on, a standing desk. It took six months, but I finally got my standing desk. The squeaky wheel gets the grease, I guess.

And then, again, I’ve touched on this, but often, if you’re in a toxic culture, you do have to step away from it. It doesn’t mean you have to quit medicine forever, but taking a sabbatical, a leave of absence, stepping down from that job and looking for another one. You have to get out of that situation to be able to make good decisions going forward and to give your nervous system a break. Those would be my top lessons.

Kevin Pho: Jessica, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Jessica de Jarnette: Thank you.