America Is Failing Primary Care Doctors


By Jen Baker-Porazinski, MD 

While the pandemic sparked a renewed (if only temporary) appreciation of the medical profession, this alone wasn’t enough to induce change in the system overwhelming them – a fact blatantly revealed to me this year at the annual conference of Family Physicians.

I admit I was a little disappointed when the pandemic forced the location to be changed from sunny California to virtual. But, since I’d recently signed a contract to work at a wellness center, I took consolation in the fact that at least my lecture choices would be more fun. Instead of studying diabetic drugs, heart failure, or chronic kidney disease, I signed up for lectures on gratitude, nutrition, and stress reduction for busy people.

As I listened to the speakers, though, my feelings fluctuated between enormous relief at my impending escape from 21 years of primary care and a deep sadness in the dispirited voices of my struggling colleagues.

Over the past few years, a growing number of Family Physician conference hours have rightfully been devoted to addressing physician burnout. This topic took even greater precedence this year, likely spurred by the pandemic. Because my lecture choices didn’t require as much mental focus as previous conferences, this was the first year I paid any attention to the chat column scrolling alongside every virtual lecture. I was shocked by what I read.

Even though I’ve written extensively on the problems facing primary care, my colleagues’ comments were eye-opening. My virtual colleagues wrote of exhaustion, frustration, and depression – their desperation evident by the very fact that they were seeking advice from doctors they’d never met. Perhaps emboldened by the anonymity of the virtual platform, they didn’t hold back their despair. In turn, other concerned (and unknown) doctors validated these grievances and offered advice and assistance. I readily admit I’m biased, but the family doctors I’ve worked with over the years are the most dedicated and sacrificing people I know, rendering their plight even more heartbreaking.

As I (literally) count down the number of days until I’m freed from a system that I believe is squeezing the life out of good people, I can’t help but wonder if my own increasingly negative outlook is more than just eager anticipation of my new job. Maybe it signals something graver? Maybe what I’m feeling is not just a need for change, but actually the beginning of burnout – a thought that scares me. The very idea that I may have been teetering so close to the edge challenges longstanding beliefs about my endurance, my toleration, my superpowers. Doctors are a resilient bunch, accustomed to toughing out difficult circumstances and pushing their limits. My strength as a mother, wife, and doctor form the core of my identity, my understanding of who I am. So, if even I am fallible.

Whatever the truth, my planned escape instantly granted me a different, more carefree, perspective on the remaining days of my current position. Suddenly, the frustrations of a new electronic medical system are insignificant. I no longer feel compelled to master yet another EMR (that doesn’t communicate with any other EMR), secure in the knowledge that I’ll only need to use it for a few more months. I’m relieved that the absurd information overload of my inbox and the inefficiencies plaguing my workday are waning. I will not miss the hours I donate to my computer screen every day or the fragmented nights of sleep on-call. I’m relieved (though I’m ashamed to admit it) to turn over the care of some of my more challenging patients to my colleagues. As a person who has spent much of my life trying to help others, it doesn’t feel good to be taking comfort in leaving behind those who probably need me the most. I understand that difficult patients are likely suffering ones. I understand that their doctors are suffering, too.

I don’t like to think about what might have happened if I wasn’t given an opportunity to escape. What if I simply endured, ignoring the toll of the daily stress on my health? Would my exhaustion lead to mistakes, as reported in the medical literature? Would I have become bitter toward the very people I want to help – patients who can’t be blamed for the lack of “care” in our health care system? Would I have eventually burned out entirely and left medicine? I’m grateful (at least for now) I won’t be forced to learn the harsh answers to these questions.

Beyond the anguish captured in the margins of my last conference, though, I see daily reminders of struggle. I see it in the eyes of my colleagues when I sheepishly tell them about my future job in holistic medicine, where I’ll be working with a team of providers with a common goal of promoting wellness. What I see, when I describe my new role as a physician consultant, is longing – even envy. The other day, when I told my patient that I was leaving primary care, she put her head into her hands and folded over on the exam table. After a moment of stillness, she bolted upright, threw her arms up into the air, and demanded, “Why do all my doctors leave?” I nodded, in full agreement, at the stark truth of her statement. Yes, doctors are leaving. They are being pushed out in droves by a health care system that seems indifferent to their suffering and, therefore, incompatible with healing. I tell her the painful truth: It’s only going to get worse.

It is well past time that America’s health care system supported primary care doctors in their faithful commitment to their calling. As a nation, we can’t afford to fail in this. If doctors continue to leave medicine, retire early, or choose to specialize for better pay and less bureaucracy, then who will be left to care for the health of Americans?


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