I never expected to find myself in this position. Ironically, I, a family medicine physician, in a world grappling with a pandemic, became underemployed for the first time since high school. A unique set of circumstances led me to this situation, but it turned out to be far more challenging for me emotionally than I expected.
At the end of 2019, I made a decision to leave my regular job as an outpatient family medicine physician in an urban area. My last day was in January 2020. I planned to take a few months off to travel, move out of my house, and transition to doing locums work with the goal of eventual relocation. I had arranged my first locums position beginning in June. After a bit of time off, my plan was to work as a sub for my prior employer in between travel, and they were happy to put me on the schedule. I started working in clinic again in early March, just as COVID-19 was declared a pandemic, and shortly before shelter-in-place orders went into effect. I immediately offered my employer even more time than I had before, and they gleefully scheduled me back into clinic and inpatient work. I tested some of the first COVID-19 patients at the clinic and started researching how to develop a drive-in testing site. Faced with cancellations of all my travel plans, outdoor events, and family gatherings for the near future, I suddenly had all the time in the world to work. Furthermore, all I wanted to do was work. Seeing, testing, and counseling patients gave me a place in the world. Reviewing the nuances of CDC’s breastfeeding recommendations with a new mom who was a PUI helped me to feel meaning. Making sure that women got their LARCs and Depo-Proveras helped me to feel meaning. Work helped me to feel that I was contributing. Work gave me a sense of control and agency in a world of chaos.
A few weeks in, the organization started to breathe rumors of reducing the hours of all of their staff. They offered voluntary reductions in hours, use of vacation or sick time, FMLA, or furlough. My employer was one of many primary care providers who had suffered vast reductions in visit volume and thus practice revenue, even with the addition of telehealth. In addition to offering voluntary reductions, some of the organization’s main targets in staffing reduction were subs. I was told both gently and not so gently that I would be removed from the schedule. Then I was told I might be needed after all, but that it was unclear how much. After a lot of anguish-inducing back and forth, it became clear that I would no longer have outpatient work with this organization.
I volunteered for our state’s newly formed health corps, but last time I checked, so did 86,000 other health care workers. I signed up for local and hospital-specific surge planning, and was never called, because fortunately, our area did not face the surge that was anticipated. I began looking for other jobs. I had the occasional shift at the hospital, after scrambling for more hospital shifts. I had one week and two week periods with no work, leaving my house only for groceries, sitting at home doing COVID-19 CME, obsessively following the news, and the Johns Hopkins COVID-19 map. I searched for ways to help – I volunteered at a school passing out lunches, and investigated blood donation and volunteering at a food bank. Eventually, I was able to find short-term work for between now and my position that starts in June.
It was an incredibly challenging time for me. It was difficult to be unwillingly at home in the middle of a pandemic, and not even due to illness. Particularly during a time of need such as now, many of us in medicine feel a strong pull to help, to contribute, to be involved. That pull is part of the very core of our being, one of the forces behind many of us entering the medical field. Every part of me wanted to be seeing patients, supporting my colleagues, helping respond to the pandemic. I faced feelings of guilt, shame, laziness, and devaluation. This time and this situation made me recognize how much of my identity, confidence, self-worth, value, and ability to love and accept myself, is based on my identity as a physician.
The silver lining is that this period of underemployment forced me to dig more deeply into other parts of myself. It forced me to look at who I am when stripped of my identity as a physician, however briefly. It gave me the opportunity to ask who else I am: a daughter, a sister, a friend, a neighbor, a partner, or just myself: just a human being. It showed me how supportive my family and friends are.
What turned out to be a brief period was a struggle for me. I know I am not the only physician ironically stuck in this position. I wonder who else is out there grappling with the same feelings and in need of support, but feeling embarrassed and reluctant to reach out to their physician friends. What other physicians are out there in limbo, struggling with shame while their colleagues post on social media about being on the frontlines? It is hard to ask a friend for support when they are testing or caring for patients with COVID-19, and all I have to do is stay home. While there is an outpouring of mental health support for health care workers (EAPs, peer counseling, free access to Headspace), it somehow feels wrong or fraudulent for me to use those resources that are earmarked for those on the frontlines.
Many of the conversations I’ve seen online have focused on financial relief for struggling practices and physicians. The conversation I found missing, however, was one about the toll taken on our mental health by un/underemployment during a pandemic. I would like to suggest that it likely impacts our mental health much more than our financial health. I want to share my story, add to that conversation, and remind other physicians and health care workers that it is not your fault, it does not make you any less, and that you are not alone.
The author is an anonymous physician.
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