As a first-generation college graduate with the honor of earning my MD and PhD at a federally funded medical scientist training program (MSTP) and nearly no debt upon embarking on the journey of residency, I have a lot to live for and am grateful for all that life has offered me with regard to both mental health and capacity. I am a product of the Baltimore City Public School System. My road to success was no small feat but has been immensely satisfying in regard to how far resilience can take an individual with a dream in mind. My dream: Cure leukemia. Naturally, I am currently a fellow in hematology and oncology at one of the largest hospital systems in the world.
To most, it would seem that my tenacity and work ethic would carry me to great success in my career. Having been told by superiors that my mind would no doubt benefit the field of medicine by enriching the thought process behind treating cancer, no one would guess that my body had other plans. A young physician bound for greatness falls ill with a rogue autoimmune disorder, left crippled and heartbreakingly unsupported by the same supervisors that sang praises prior to the news. Simple to say but I believe if I had cancer, things would be a lot different. A name for my illness and an algorithm for the cure would clearly delineate my future functionality within my program. I found that physicians don’t like the unknown and their attraction to rigidity has left one of their own confused, disappointed and angry. I write this not as vindication but as introspection into why there is a lack of empathy in physician-to-physician interactions when one physician becomes the patient. It can certainly be said that physicians do not treat their own as they treat the unknown patient who walks through their clinic door asking for help.
For over a year after suffering from a case of consolidative pneumonia, I had noticed that my already present Raynaud’s was worsening, I was developing livedo reticularis on both my arms and legs along with prominent acrocyanosis. I felt enlarged lymph nodes in my neck. It was time to ask for help. Some tests came back abnormal. I know what they mean and will have to deal. I am denied any leniency with regard to schedules despite having finished the hardest part of fellowship — first year. I am asked to take medical leave. I aim to start treatment and go back to work when I am at a place where I confidently feel I can complete my required duties and then some to make up for my lost time.
After one month of leave, the tension is palpable even over the phone when my supervisor tells me that my “mystery illness” will prohibit me from succeeding in my chosen field. I stop her to clarify that my illness is not a mystery, has a name — systemic lupus erythematosus with lupus anticoagulant, mixed connective tissue disease with scleroderma features, B12 deficiency, and Sicca syndrome — and a treatment that works. These clarifications fall on deaf ears, and I am reprimanded for interrupting. I am asked to exit the program. I say no. I have worked too hard to get here and will do everything in my power to make sure I finish even if it extends my already prolonged training. There was a lot of discussion about my perturbation to the fellowship due to my illness and how the fellows are overburdened. To the contrary, I have received nothing but support from my colleagues and have lamented that I will repay them upon my return. They know this promise to be true because I would never leave a co-fellow feeling unappreciated even at the cost of my illness. It made me wonder at which point in one’s medical career does the mindset change from altruism to numbers on paper. My guess is when the training ends, patients turn into RVUs, and your salary depends on everyone graduating on time if you run a program.
As we approach a time when multi-level management structures in the name of efficiency are created to help non-profit organizations stay afloat in a setting deemed “Affordable Care Act gone wrong,” we need more physicians to just say no or at least put their foot down in defense of fellow colleagues. I hear so many respond: “Because that’s what management wants” to the question, “Why are we implementing another new policy?” As physicians, we all have voices. The art of saying no is no less awkward than saying yes and explaining to your coworkers that you don’t understand the reasoning behind the rules. Our ability to stand up for what we believe is right and beneficial to our workers and learners is lost to those who, in climbing the ladder of success, have no interest in anything other than their personal success. Fair enough, but I perceive a career in medicine to be one that is pursued in the name of sacrifice and altruism, not in pursuit of riches. An MBA and job at a consulting firm with far less debt and schooling would suffice if a name on a plaque with a bonus was what someone was looking for in a job.
My situation has left me not in depths of hopelessness or fear of being terminated but instead asking myself, when did physicians become such pushovers? When did we start sacrificing our own at the expense of losing more future physicians in order to meet the hospital or program’s bottom line? I thought a program’s number-one priority would be the success of its trainees particularly if they are paid with benefits. It seems so wrong that my story is not one of a kind but one of many. We need to forge our own path and know our rights as physicians so we can fortify our specialties with beliefs that will benefit both our patients and ourselves. Otherwise, I fear burnout and lack of ingenuity will transform physicians into pariahs ripe for the firing only to be undermined by clumsy attempts at artificial intelligence learning. Remember: Robots need no salary, no sleep and don’t have a conscience.
The author is an anonymous hematology-oncology fellow.
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