I am not an employee. Maybe I should have said this four years ago when I was an employee. When I opened my private practice in 2014, I was running away from something as much as I was running to something new. I’ve been out of training for over a decade. Early in my career, I envisioned myself as an employee of either a non-profit organization working with underserved communities or with an academic institution serving a similar population. I appreciated the consistency of an employed position at an established organization and valued the collaboration and support of my colleagues and other staff.
Six or seven years out of training, the term “employee” took on a negative and punitive tone in my workplace. While employees are an integral part of any organization, our health system made us feel undervalued and dispensable. I know this is the case in many industries. However, I think that this is uniquely dangerous for physicians.
Physicians should feel empowered to work autonomously and to make clinical decisions that are evidence based. We are trained to be team leaders who add valuable insight and perspective to medical institutions. However, my friends and colleagues continue to echo the same complaints that I once had, “I feel like a cog in the wheel.”
What happens when physicians are left feeling undervalued and expendable? Or even worse, how do doctors thrive when threatened with termination if they can’t adhere to non-clinically focused expectations in a toxic work environment? If fortunate, they can choose a healthier and more fulfilling practice environment. While I miss discussing cases with my team, I don’t miss the frustration of caring for patients within a system of ever-changing demands and expectations.
However, when a physician is not able to leave for a different setting, both physicians and patients suffer. My experience left me feeling like a faceless employee. I felt a lack of institutional trust that I would make decisions in the best interest of my patients. I felt judged not to be competent enough to understand the challenge of offering high-quality clinical care in a setting where finances mattered. I felt that my perspective and well-being — as an employed individual — did not matter. When an individual feels like she does not matter, helplessness and hopelessness can set in. At their worst, those feelings can lead to burn-out and other manifestations of stress. While I got out without experiencing any lasting adverse effects on my well-being, I appreciate that others are not quite so fortunate. The fact that many physicians are suffering can be seen from the high rates of burnout and all too frequent reports of physician suicides.
When physicians suffer, their patients often suffer too. Let’s be honest — as a patient, I would much rather have a physician who felt energized and motivated in her practice than weary and dejected. People are most inspired at work when their well-being is considered relevant, and they feel valued. My physician working at her best can mean the difference between my new unexplained numbness dismissed as stress rather than the subtle onset of a potentially serious medical condition.
I am not naive. I know that physician well-being is not considered a top priority by health system administrators. However, the spirit and well-being of the medical professionals who are charged with treating our communities should be a focus. An impending physician shortage looms due to demographic trends, and the risk of burnout may only exacerbate this issue. I know that some health systems are aware of these issues and are actively engaging with their employees to improve their workplace environment. Hopefully, others will follow this trend. Caring for the doctors who are in the business of caring for people is just the right thing to do.
Tracy Asamoah is a child and adolescent psychiatrist.
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