Since graduating from medical school in 2002, I have seen a disturbing trend in the lives of doctors. For years, physicians have been squeezed from every direction. Insurance companies and hospitals are constantly fighting to remove our autonomy. The amount of paperwork we are required to produce has skyrocketed over the past 20 years, combined with the use of electronic medical records, our face time with our patients has shrunk to almost nothing. We are constantly on guard, trying to defend our decisions and our income against medico-legal threats while we try to cope with the myriad number of rules and processes created by regulatory agencies.
It is no wonder that before this crisis, around 50 percent of doctors in this country were burned out. This was due to the causes listed above and to “moral injury,” the inability to take care of our patients in a caring, compassionate way because of systems that prevented it. The suicide rate in physicians is twice the rate of the general population and the most of any profession. In addition, there was a shortage of physicians before this started. The AAMC projected that we were facing a shortage of 46,000 to 122,000 doctors by 2032. This has created a health care system in the United States that has frustrated and angered doctors and patients alike.
Now physicians will work tirelessly, for however long it takes, because this is why we became doctors: to give hope and compassion to our patients and to use our knowledge to save them. We will utilize everything we have in this crisis to advocate for our patients, to heal them, and to share as much science and information as possible to limit the death and disability that this will cause.
No one could be completely prepared for this calamity. However, you could have done a better job. Through your actions and inactions, you are going to let so many of us die. You knew that we did not resupply the strategic national stockpile to previous levels with masks and other PPE after the H1N1 flu epidemic. You have had 11 years to do so. Just restocking would not be enough for the current situation, but it would have given us more protection while companies began to increase production. The GAO issued many warnings in the last ten years that a pandemic or bioterrorism event would be realized soon and that the U.S. was severely unprepared. For the past few years, the U.S. intelligence agencies included insistent warnings about a pandemic in their worldwide threat assessment. Simulations like Crimson Contagion predicted, almost to the letter, what we are now experiencing. By ignoring these threats, you have exposed many, many doctors and other health care workers to morbidly dangerous conditions. This will also increase the deaths of the general population. As the pandemic goes on, a lack of physicians to triage and treat the ill, intubate patients and manage ventilators will become a crisis in itself.
You have also decimated the health care system and the health of this country for years to come. There was a doctor shortage before this pandemic and large rates of burnout. After this, many physicians will be ill or dead, and many more will be completely burned out by the emotional and physical toll that we are experiencing. This pandemic will pass, but the shortage of doctors and health care personnel that you have created by your inadequate response will be felt for years and years afterward. It takes a minimum of 7 years to make a doctor and 8 to 10 to make surgeons and specialized physicians. So, you may ramp up medical school admissions and residencies to deal with the doctor shortage after this, but it will take a long time to recover. You have not just failed us, you have failed many more Americans by your inactions. For the Americans who survive, you have left them with a medical system, already woefully inadequate, that will be crippled for years.
Do not mistake me. This is not only directed to the leaders in the White House; it is not partisan. It is directed to all the leaders of our nation and to all of the leaders of government agencies that had direct control over the knowledge available to protect us. Your decisions to ignore, diminish, and discount the science and data has created a misunderstanding of, and a delayed response to, the seriousness of the situation. Finally, the inability of the government, as a whole, to work together and coordinate an efficient response has only deepened the horror of this crisis.
Estee Gray is an anesthesiologist.
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