Learning to love medicine again

There has been a lot of discussion about the state of medicine. Physicians face many challenges in our current healthcare system.  Long hours, liability concerns, electronic record documentation, ever increasing regulations, corporate interference, the need to make patients happy customers despite doing what is in their best interest and the list goes on and on.

Statistics show that almost 50% of the physician workforce is burning out or already burned out; others such as myself prefer the term moral injury.  Physicians are taking their own lives at record numbers. Everyone knows there is a problem, but no one seems to actually be doing anything about it. I’m inundated with emails, snail mail and articles about how to lessen burnout and improve physician wellness with little tangible measures to actually make a difference.  Many say take a yoga class or meditate; well when the heck am I going to do that when I don’t even have time to eat a real lunch? Develop a better work flow, use a scribe or get your staff to do more of the administrative tasks they say; sounds good, but as employed physicians we are rather powerless, and in reality have no staff, the people we work with are also employees and any change must come from the powers above.

What most physicians don’t realize is they have a choice.  It’s not always an easy choice, but nevertheless the choice is still ours.  As physicians we need to stop allowing ourselves to be managed by those will lesser training or conflicting values.  We need to regain our independence. Physicians by our training and professional nature were never meant to be employees.  Most of us would agree the work we do daily is a true calling, not a mere occupation. We own our profession, not the insurance companies, big hospital organizations or the government.  These entities unfortunately have over time infiltrated our profession unknowingly to many of us and now physicians are in a terrible predicament.

I recently left a large hospital employed position.  Just for the reasons above. I started my day at 6am reviewing labs that came into the computer overnight and completing paperwork I was too tired to complete at the end of my previous day.  First patient in at 8am, continued until 12:30p, no time for breaks and hard to even keep up with charting. Lunch hour was drinking a protein shake, so I could continue to type or dictate my morning notes, refill prescription requests, review correspondence, call specialists if needed and answer nursing questions.  Most times I didn’t even get all that done before the afternoon patients rolled in. Finished seeing responsibilities. With the advent of the EMR/EHR it is so easy for all that patient information to be readily available on our phones and computers. Many if not most physicians spend some work time on vacation. I know in my prior practice it was impossible to get another physician to see a patient in your absence, they were generally referred to urgent care.  Messages/tasks continued to flow into my inbox daily with expectations for me to answer these promptly, there were no other docs to manage these minor questions. Physicians don’t necessarily cover another’s inbox when lab and imaging results are coming in. In some cases, you may have an excellent nurse or medical assistant to review and prioritize the abnormals, but I always feared I’d overlook a critical lab sitting in my inbox for days if I didn’t check it regularly while I was away.  Now some may say I was just being overly cautious, or not trusting the system in place, but in reality there was no acceptable system in place. We as physicians bear the brunt of responsibility and I can count numerous times where things were overlooked and if I hadn’t continued to check my inboxes daily a patient’s health may suffer or care be delayed. I can also bet, the administrators count on us to do this with no additional compensation.

Now to the part of loving medicine again.  Because of the long hours, no real time off, the push to see more and more patients in less and less time, while maintaining an excellent level of care and high patient satisfaction rate with no improvements in sight I became more and more disillusioned with being a doctor. I longed to have work-life balance, be able to exercise and take care of my own needs, as well as those of my family.  But even more I craved the ability to provide care on my terms, the way of was trained, not the way a corporate entity wanted me to. I longed for the relationships with my patients, to know more about them as individuals so I could provide personalized care and not just treat only specific concerns or refer them out because I didn’t have the time to properly manage more complex health issues.  I not only needed more time in my life to recharge and enjoy my non-work time, but I needed more time with my individual patients to develop this relationship and gain their trust and confidence.

For many physicians this means taking a big step out of a false sense of security as an employed doctor.  For most, to truly be happy and love medicine again we need to find ways to become independent again; we need to remember what initially ignited that fire in us to become doctors in the first place and focus on incorporating it back into our practice and our lives.  We as physicians need time to recharge our batteries, eat healthy and exercise regularly, this not only improves our own health, but makes us good role models for our patients and family members. Sometimes we have to make difficult decisions like cutting back on material goods, driving less expensive cars, maintaining a mortgage within our reach, or having our children attend community college or instate universities with better tuition rates.

My way out was starting a Direct Primary Care (DPC) practice, I had the support of my husband, former patients many of whom followed me to my new practice and an amazing community of DPC docs who have mentored me along the way.  Only 5 months into my new independent practice I now finally feel free. I practice medicine on my own terms, I have time to learn new things, I see about 1/5 of the patients I was seeing prior and enjoy the time I have with them to manage their health needs in a unrushed setting.  I have more time to counsel on diet and nutrition. I’ve regained an extra 4-5 hours per day to exercise, take a walk on the beach or just read a book for pleasure. My pay is not what it was prior, but I suspect will get there soon. Even with that, I am truly more happy and satisfied with my personal and professional life.  Most importantly, I am a better doctor for it. Oh, and by the way I get lunch every day away from my desk and make a point to enjoy lunch with my husband out every Wednesday afternoon because I can.

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Jaclyn Nadler MD

Jaclyn S. Nadler, MD, MBA, FACP is a practicing internal medicine physician in Southwest FL. She received her medical degree from the University of Miami and undergraduate (BSN) and graduate (MSN/ARNP) training from the University of Florida in Gainesville. She attended residency at Wake Forest Baptist Medical Center in Winston-Salem, NC and completed her MBA degree with a concentration in medical management from UMass, Amherst. Dr. Nadler recently joined the Direct Primary Care/DPC movement when she became disillusioned with the current state of healthcare including physician abuse, corporate medicine’s focus on quantity of care over quality and the loss of physician autonomy. She started her own DPC clinic, CoastalMED DPC in January 2019 where she can practice medicine on her own terms and provide her patients with the time and superior care they have grown the expect. She is passionate about physicians regaining their rightful place at the helm of healthcare and physicians reverting back to independent practice and regaining autonomy. She is a member of the Florida Medical Association and Direct Primary Care Alliance, she is a Fellow in the American College of Physicians and received her certification as a physician executive (CPE) through the American Association of Physician Leaders. You can learn more about Dr. Nadler and view her blog at www.JaclynNadlerMD.com 

  2 comments for “Learning to love medicine again

  1. Rick
    May 11, 2019 at 3:40 pm

    What an inspiring message! Thank you Jaclyn, and good luck as your DPC practice grows and thrives.

  2. Pat
    May 11, 2019 at 12:50 pm

    Bravo Dr. Nadler. You did the right thing for your patients, family, and self.

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