C1 My Turn: And who will heal the healer?

By ERIKA BECK

A tribute in recognizing and honoring Physician Family Day on August 29th.

Years ago we were on the road to Las Vegas for my husband to take the MCAT. I remember it perfectly. Countless hours had been invested in volunteer service, research, classwork, applications and personal essays; much work, dedication, and money goes into even applying for medical school. Many who spend years preparing and sacrificing come to the defeated conclusion, after a year or more of denied applications, that the goal of becoming a doctor is not going to happen and pursue another course. But maybe they were the lucky ones.

I sat in the large auditorium at the university, watching my husband along with many others proudly walk down the aisle with their white coats. The room was filled with hopes and high aspirations. I thought the hard part was over. I laugh now at that naive perspective. Neither my husband nor I came from families of origins with physicians; we did not know the road ahead.

On the other end of my husband spending years in schooling, between undergraduate, medical school, and residency training, and my personal training as a clinical social worker, I see a need. I raise concern for the wellness of physicians in a system that seems set up for failure rather than success. I offer insight into a complex system that people often don’t see or understand. I didn’t, until I lived it. The physician doesn’t just live “the cushy” life. The physician is the epitome of grit.

The U.S. is currently facing a physician shortage, which is expected to increase in the next decade (AMA Alliance, Physician Family, “Dissatisfied and Burnout," Goeders and Tutty). Have you ever found it difficult to get in to see a doctor? There are many factors at play.

First, it is difficult to even get into medical school. The costs of tuition have greatly increased compared to the older physician population. The Association of American Medical Colleges (AAMC) estimates that for the year 2019-2020, the average medical student could expect to pay for their four years of training between $150,444 - $247,664 plus. This does not take into account additional fees, added loans for cost of living or personal health insurance.

Increasingly high interest fees post graduation leave the process of even beginning the medical journey a bit daunting. Not to mention the lost opportunity of accumulation of savings. Being accepted and even completing medical school does not guarantee one will become a physician. I recall learning in our second year of medical school that not every medical student will match for residency.

Say what? I was shocked. How could one sacrifice so much time, effort, and money only to not match? This is the reality. There are not enough spots for every medical or DO (Doctor of Osteopathy) student around the country to enter residency or in the specialty that they desire.

Post medical school training, including residency and fellowship programs, may vary among specialty between 3-7 plus years. Clearly this journey takes a physical, mental, emotional and spiritual toll. An average of 60-80 hour work weeks for the resident leaves little time for personal or family care outside of work. And that is the hours clocked at work, not to mention the personal hours of study behind the scenes.

It’s a sad dichotomy that these physicians are getting trained to heal others yet have very little time to heal themselves. It is noted in the AMA Alliance, “Guide to Physician Burnout and How to Effect Change,” that physician stress, burnout, and suicide are at crisis levels in the medical community. Studies have shown that 46-50% of physicians would classify themselves as having at least one symptom of burnout fatigue. What happens if new graduating physicians are already burned out before they even begin? We need them. What about the physicians who are run down and are more likely to leave practice or retire early, and / or decreasing patient caseloads? We need them.

Many factors contribute to an atmosphere of stress for the physician, including long hours, increased regulations, administrative burdens, prior approval process, decreased direct patient care, and the threat of medical liability litigation. It seems as if the physician is being asked much more than to honor the Hippocratic oath.

More than one in three physicians have a medical lawsuit filed against them at some point throughout their careers. “Information in this new research paints a bleak picture of physicians’ experiences with medical liability claims and the associated cost burdens on the health system,” said AMA President David O. Barbe, MD, MHA. “The reports validate the fact that preserving quality and access in medicine, while reducing cost, requires fairness in the civil justice system. Every dollar spent on the broken medical liability system is a dollar that cannot be used to improve patient care.” (https://www.ama-assn.org/practice-management/sustainability/1-3-physicians-has-been-sued-age-55-1-2-hit-suit)

It is sad that we live in such a litigious climate with the risk of suit hovering over physicians. Is it fair that physicians need to view every patient as a potential threat?

Who is there for the physician? If the goal is to protect patients, the doctors also need to be protected, for the physicians are also becoming the patients. When my daughter tells me she wants to be a doctor when she grows up, I smile and in my heart I hope she is not. That is sad. It is difficult to make such great sacrifices and dedicate years to training when the system is failing.

It is not only the physician who takes the physical, mental and emotional toll. The physician’s family throughout training and beyond is impacted as well. The family unit makes sacrifices together. The physician often works nights, weekends, and holidays. Soccer games, dance recitals, school performances, Christmas mornings, vacations are often missed as the physician in training and beyond has a heavy load.

The physician often leaves for work in the dark and returns home in the dark. There are family opportunities and moments missed that cannot be replaced. Strong family bonds and relationships help increase resiliency, something both the physician and family need throughout medical training and their career. It is difficult to create strong bonds when time is limited and stress is high.

These concerns are just the tip of the iceberg — as the first step with any change is awareness. Solutions need to be implemented on a national, organizational, and individual level.

We can begin in small ways. Individuals can take the time to complete patient satisfaction surveys. Often physicians have many more positive responses than negative; however, it’s the negative feedback that is voiced. Helping boost personal morale may contribute to a reduction in burnout. Recognizing that for every patient visit, the physician and the team does much more work “behind the scenes,” with charting, follow-up, prescriptions, billing, etc. Much more time and energy goes into a patient visit than what the patient actually sees.

We need great physicians, physicians who are not burned out over the complexities and injustices of the system. At some point each of us, or someone we love, will be greatly blessed by a physician’s care, time and sacrifice. I hope we can be there for them, so they will be there for us.

“It is a joint, collaborative effort. Physicians, their families, their patients, and future of our healthcare system depend on it.” (AMA Alliance, Physician Family, “Dissatisfied and Burnout," Goeders and Tutty).

So to all the physicians and their families who have sacrificed and continue to sacrifice, thank you. I hope physicians and their families can have more opportunities to recall why they chose medicine in the first place.

I hope for younger generations to aspire to be healers without fear of the system, or once they have completed training, physicians and their families can voice, “Yes, this was worth it.” And I hope one day I can look at my daughter and whole-heartedly say, “Yes, become a physician!”

Thank you to the medical families in our beautiful community.

Erika Beck is a Coeur d'Alene resident.