By Elham Raker, MD

Suppose you have watched the news, been on social media, or have had any conversations with others. In that case, it should not be a surprise that health care workers are physically, mentally, and emotionally exhausted and extremely burned out.

We are currently entering our third year of a global pandemic. So, burnout physicians are not a big surprise, especially when doctors’ opinions are marginalized over political beliefs about a virus. I’m still not sure how a viral pandemic becomes a political issue, but I digress.

The unfortunate truth is that doctors and nurses have been burned out for years before the pandemic. The pandemic has just become the straw (a massive straw) that broke the camel’s back.

When health care workers are already at their breaking point, adding a global pandemic with very little regard to science just becomes unbearable.

Doctors have been leaving medicine for non-clinical jobs for many years. Many have started side gigs in order to help supplement their income and build a “way out” for their future. This is after years of studying, sacrificing, taking out massive debt to find a “way into” medicine and the highly coveted spots at medical school. Currently, there are multiple Facebook groups for physicians looking for non-clinical jobs. Just one of them, Physician Side Gigs, has over 85K members. In a recent article women had a burnout rate of 56 percent and men at 41 percent, which was increased for both genders from 2020. 54 percent reported that burnout had a high impact on their life. And 64 percent report colloquial depression, while 24 percent report clinical depression.

I want to highlight three areas of particular difficulty in medicine, especially at larger organizations.

There is a huge lack of appreciation in medicine.

Doctors are often berated for making mistakes and never told they are doing anything right. A call from a superior causes a pavlovian response of “What did I do wrong?” with paralyzing anxiety before you even get on the phone. We have been conditioned to believe there will be no good outcome from this phone call.

As is common in any industry, patients will often only speak up to complain, rarely to leave a good review or go out of their way to let administrators know how great their doctor was. And I am in no way referring to mistakes that lead to injury or loss of life (although I will address that). I am referring to being human and making human mistakes. Forgetting to sign a chart, leaving a chart note undone, a patient that waited too long because of a scheduling error that the doctor had no control over. Over time, these continued criticisms without any praise can really take a toll.

Second, the culture of medicine lacks psychological safety — being able to show and employ one’s self without fear of negative consequences of self-image, status, or career.

Adverse events in medicine can have life or death consequences. The stakes are much higher than most professional jobs. This is a responsibility that physicians and other health care workers take very seriously. But again, we are human. Mistakes happen. And hopefully, we can learn from them and put systems in place to minimize them. But that can only happen if the environment in which these mistakes are made are safe to discuss.

Only if we can foster a psychologically safe environment of learning and camaraderie. In my experience and in talking to other physicians, this is lacking at many organizations.

Lastly, I have to bring up the thing that doctors are never meant to talk about; money. In the real world, people use money to get things and pay for things. But somehow, doctors should not be concerned about how much they get paid because they have a higher calling.

Unfortunately, our higher calling does not pay the mortgage. In every other profession, you are meant to advance and get raises. Doctors are getting fired or pay cuts during one of the most stressful, exhausting periods of their life. And this is only partially related to the pandemic.

When I share with people my hourly rate as a pediatrician after multiple years of training, in debt, with many nights and weekends of call, they are usually in complete disbelief and start to understand my need for a side gig better!

Did we go into medicine for the money? I promise you the answer to that question is a resounding no from anyone you ask.

There are far easier ways to make money without first going into debt. But the harsh reality is we still need to make money. Physician salaries have not increased significantly for years despite inflation. And as I said, they are at risk of being cut in the current state of medicine.

These are just a few of the reasons we are slowly but surely losing our most valuable non-renewable resource. Physicians need a safe environment to work and learn, they need to get appropriate feedback in the hopes of improvement, they need to feel appreciated, and they need to get paid adequately. This is not a lot to ask, but I think it would make a world of difference in the desire for doctors to stay in medicine. To fulfill their original calling for going into medicine, to help people.

Elham Raker is a pediatrician.