It was the year 2020 — the month of March. The world shifted on its axis in ways we could not imagine. The job of a physician-mother is one of never-ending tightrope walking while juggling batons on fire and crystal figurines, all while herding cats.

You see, the physician and mother are so intertwined in our being, one cannot leave either role for the other at their respective doorway. There is always a need for more time, space, resources, availability, creativity, patience, and capacity. The constant delicate equilibrium of ensuring we are at the top of our game for all our responsibilities is hard to explain outside of our circles.

Before the pandemic, I was already dancing this delicate dance – maintaining full-time clinical work, single parenting two children who were very young, paying off student loans, mortgage, and car payments, and living in a newish city to us. When COVID hit, I came to find myself needing to reconfigure everything.

If you ever wondered whether your employer truly is invested in your personal well-being, rest assured, they generally are not. Granted, these were unprecedented times, but this was not a manifestation of the stresses of COVID. We are both necessary and expendable. That sentiment was and continues to be reflected in the overall devaluing of our importance as leaders and designers of our professional roles.

One role we are not expendable in is that of being mothers. During COVID, this became abundantly clear.

In my city, schools were shuttered, childcare possibilities for health care workers were scarce, and as you can imagine being a frontline emergency medicine physician — providing childcare in my house was not a job most people wanted. My employer wanted to switch my position to a different location rather than keep me in the existing one that was familiar and worked with my cobbled childcare. So, I went out on FMLA, OFLA, and, ultimately, LOA. For those unfamiliar with these programs — they were federal, state, and company leave of absence that ensured my position wouldn’t be gone when I came back, but they also were unpaid. Did I mention they also cut our pay such that at one point, I was making $103 per hour (minus $25 per hour for childcare = $78 per hour pre-tax for a physician at the onset of COVID)? Hospitals got bailed out; industry got bailed out. Clinicians? Not so much.

I was thankfully able to secure a COVID relief contract that allowed me to work 7-10 shifts in a row out of state and then come home to parent my kids for the rest of the month. Working these shifts during COVID was exhausting but at least allowed me to cover the mortgage, the school tuition (which was not reduced or discounted), and childcare (barely). My favorite (insert sarcastic smirk) misadventure was when there was a communication mishap between two childcare providers. While donning full PPE in another state, I had to scramble to find childcare when one did not show up, with two days still on my contract, to pick up my kids. Miraculously, thanks to the village of other doc moms, they were retrieved and had a few unanticipated sleepovers until I could get back.

Now let’s shift to homeschooling. I think all parents following this pandemic agree that teachers are not paid enough. Period.

I would rather handle a mass casualty incident in full PPE than homeschool my kindergartner on Zoom. There is no universe in which a 5-year-old can be expected to gain the social skills that are meant to be learned that year by staring at a screen. Even under the best of circumstances, they can barely sit still for 20 minutes. My second grader was only minimally more capable of Zooming all day. We had a unicorn of a kindergarten teacher, and even with that as our ace-in-the-hole, I can say this is an experience I never want to repeat.

All in all, 2020-2021 were years of education mostly lost. On the plus side, my kids learned that even as much as they annoy each other (as all siblings are known to do) — they at least had each other. Adaptability and resilience are skills they gained, and that’s a win of sorts.

So, what does an otherwise super-motivated mom who has to change everything to make the universe right again do? Of course, start a company to address the resounding gaps in health care as she has experienced them. That makes total sense to a crazy person, probably.

The chaos 2020 elicited made me pivot and step away from the “health care industrial complex.” Physicians are no longer valued for their expertise, unique training, and role. I had to carve out my own path to reset my schedule so that my physician’s and mommy’s lives could co-exist in the best way possible. While maintaining our own health care was a concern throughout (thank you, ARPA), this change was the best decision I ever made. We can design our careers and not be tethered to a system that sees our personhood and contributions as expendable. By creating a series of clinical roles that fulfilled my intellectual curiosity with people I enjoyed working alongside and aligned with my values, I was able to bring the universe’s axis back to alignment.

Creating that mental space allowed me to take my expertise to become the CEO and founder of a company that intimately understood the health care silos. I created a company that addressed these gaps and their impact on care delivery for patients, families, communities, and physicians. Let’s be clear. The pandemic exacerbated what we already knew — the world runs on women’s labor.

I continue to hear of the exodus of physicians and clinicians across the board. There is a feeling of “mostly miserables” in the industry. It is representative of the moral injury and lack of agency that has come with the health care industrial complex taking over decision-making. Jurists, legislators, politicians, insurance companies, and administrators have bastardized health care and are practicing medicine without a license, which is illegal.

Medicine is a calling; it is an art. It cannot be relegated to AI and code books. We must demand that it is practiced only by those with a medical license and refuse to stay subservient to this beast. The more we speak up for patient-centered care in the hands of physician expertise, we can iterate a health care system we are proud to be a part of and lead. We owe it to ourselves, our families, and our communities.

Arian Nachat is a palliative medicine physician.