Is There A Third Pathway Of Resilience?


By Gitanjli Arora, MD

My social media feed has increasingly included stories of friends “quiet quitting.” A term popularized through TikTok, quiet quitting is a reaction to the exploitation of employee labor without providing additional compensation. Simultaneously, my IRL conversations have been filled with stories of the Great Resignation, in which employees have voluntarily resigned, often without other employment secured. A recent report by the U.S. Surgeon General recognized the problem of workplace stress and cited the toll of endless hours, unpaid leave, and chronic stress as harmful to our mental and physical health.

I work in health care. I don’t want to Quiet Quit. I also don’t want to Loud Quit. Since I was three years old, I have dreamed of being a pediatrician. Other than a small detour to study marine biology – just for one summer when daydreaming about a very handsome Australian scuba diver – being a pediatrician has been my lifelong dream. Like many of my colleagues, I spent much of my twenties in a library, then gross anatomy lab, and then in long shifts in the hospital. I missed birthday celebrations, weddings, and holidays with family and friends. I delayed having children. When I did have a child, I took four weeks of maternity leave. I wore my sacrifices as a badge of honor. As aptly described in the book Joan Is Okay by Weike Wang, the main character, a female physician, describes, “while I was angry at myself … I was also slightly proud. Because how else could you be providing great service to strangers if you didn’t take that time away from people who were not?”

In our own hospital, I have heard many administrators thank us for our service, selfless care, and dedication to patients and families. As the months of the pandemic have rolled on, the thank yous have felt increasingly hollow. At the gratitude breakfasts, the free blueberry muffins are now moldy, and the coffee is cold. The hospital continues to be full of patients but is now empty of staff. Nationally nearly 1 in five health care workers have quit their jobs since the start of the pandemic. And for those who remain nearly 20 percent of HCWs are considering leaving their profession, and nearly 60 percent reported mental health impacts from the pandemic. As we greet each other in the hallways, you commonly hear the exchange, “How are you?” “Tired.” “Yeah, me too.”

In addition to the occasional free breakfasts, gratitude journals, wellness seminars, and listening sessions offered by institutions, national organizations have provided essential resources such as the Emotional PPE toolkit. These supports are important and needed, but they continue to place the responsibility for resilience at the individual level. These resources subtly and not so subtly tell me that with a pat on the back and if I just took better care of myself, then I should be able to continue. To borrow from a common analogy – it may not be that the canary needs more yoga, but rather the coal mine is the problem.

A recent study found that to provide the guideline-recommended preventive, chronic disease, and acute care for a standard panel of patients, a primary care provider would need to work 26.7 hours a day. As explained by Ed Yong in the Atlantic, “Health care workers aren’t quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs. Even before COVID-19, many of them struggled to bridge the gap between the noble ideals of their profession and the realities of its business. The pandemic simply pushed them past the limits of that compromise.” 8 It’s true, this isn’t a new problem, and it is true that it is worse now. Physicians have reported increased levels of depression, anxiety, and burnout. In 2021 an estimated 333,942 health care workers dropped out of the workforce, and as a profession, physicians lost the most members, with 117,000 individuals leaving their roles. After all the hard work and sacrifice throughout our careers, it seems unlikely that quitting was an easy choice, yet for some, it was perhaps the only choice.

But what if there is a third pathway of resilience? Maybe it is a pathway of resistance. As so many of us wrote long ago in our applications to medical school, it is a privilege to care for another being and to provide medical treatment, support, and guidance through some of the most challenging times. The time spent in partnership with patients, in healing, and in listening is the reward for all those missed events in our personal lives. But the health system, as it is structured now, does not allow us time to be in partnership with patients. We now answer to administrative leadership, align our practice to maximizing RVUs, engage in endless struggles with insurance companies, and spend more time entering data into a computer than acquiring data from hearing the stories and lived experiences of our patients.

Health care workers know that this isn’t what healing looks like. More importantly, patients know this is not what healing looks like. Curricula and trainings that aim to improve patient care and increase humanism in medicine all emphasize the importance of valuing the patient through respectful listening. In the evolving conversations of health inequities, we have begun to understand the importance of cultural humility in health care decision-making as the practice of creating space for the individual expression of a patient’s beliefs and values in guiding their own health. However, perspective-taking, centering the patient’s voice and experience, valuing the person who has the most knowledge about their own body and their own experience all takes time.

In palliative care practice, we are given time. Our value will never be in revenue-generating procedures or the volume of patient encounters. Instead, we structure our practice based on the needs of patients and spend as much or as little time as is required to elicit goals of care, navigate difficult decisions, and advocate for the use of medicine to provide the best life possible as defined by the patient and their family. Residents who rotate with us regularly say, “I wish I had the time to sit with patients like you do and hear what they want and what they need.” This last time a resident shared this sentiment, I paused and offered a deliberately provocative consideration: “If we are doing something to someone’s body without hearing them first, is that care or is it more akin to assault?” We entered this field to provide care, but we find ourselves not encouraged, enabled, or empowered to provide person-centered care. Instead, we may find ourselves doing things to people’s bodies that they would not want or choose for themselves.

But what if we could collectively reimagine leadership in health care as not coming from what is now the top of the hierarchy but instead from patients and from those who work most closely with patients? Instead of allowing ourselves to be tools of malpractice, perhaps there is a way we could stand in solidarity with our patients and reject the allotment of 15 minutes for a physician visit, the need to push patients through to an expeditious discharge, or the non-methodical excessive testing practices of CYA health care. Perhaps there is an opportunity for us to turn health care back to the ideals we saw when we chose this profession. The health care industry cannot function without health care workers, and as our numbers continue to fall, our voices have even more power. As we lament the burnout among health care workers, let us shift away from blaming the individual for quiet quitting or resigning and instead turn to ask the system we work within to stop harming patients and to stop making us complicit in that harm.

We chose this profession knowing there would be a sacrifice but believing that it would be worth it if we could help people. The distress we feel at this time may be in being asked to continue to sacrifice while worrying that we are harming those we had intended to care for by not listening, rushing, and being understaffed and overworked. If there is a way forward to better health care for patients and better satisfaction for health care workers, perhaps it comes from amplifying the voices of our patients, joining with them to advocate for the care they need and deserve, and rejecting the economic model of health care that has proven time and time again to be inefficient and ineffective. Perhaps by taking the time to hear patients, to listen to their hopes and worries, and to have them share their expertise about their own bodies, we can truly partner in healing them and, through that, also begin to heal ourselves.

Gitanjli Arora is a pediatrician.


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