Question: What do doctors and nursing burnout, the COVID pandemic, and the Easter Bunny have in common?

Answer: Not a damn thing.

For the past few years, any article on medical labor shortages, disgruntlement, or changes in employment, such as the rise of travel nurses or locum physicians, invariably cited the same cause: COVID.

But to get to the real cause of what’s going on, you have to go further back. Much further back. Specifically, to 1906.

1906 was the year Upton Sinclair published The Jungle, an exposé on the meatpacking industry’s oligopoly and its impact on consumers, government regulation, and the labor force.

For those who may have forgotten their AP English and economics, here’s a pop quiz to refresh your memory:

Mammoth consolidated organizations tend to:

• Squeeze the consumer by raising prices charged to health insurance companies and ultimately passed on to the patient.
• Lobby the government to further tilt the competitive playing field in their favor. Does anyone else have a nagging feeling that the largest employers in your region might be manipulating reimbursement rates and regulations to their advantage?
• Manipulate employees.

The correct answer is: All of the above.

Let’s consider the perspective of an employee affected by consolidation, such as a typical doctor or nurse who has just graduated, armed with a diploma and a mountain of student debt.

The easiest, safest, and most lucrative path to paying off those debts is employment at the local chain hospital. While there is a possibility for doctors to establish their own practices, they must weigh the disadvantages, such as a slow ramp-up and lower reimbursement rates compared to larger institutions (no leverage and no facility fees that employed physicians receive).

However, once you’re in, you’re stuck. Like many others, you probably have roots in a specific region or city with only one or two possible employers. These employers are well aware of what their counterparts across the street are paying and do not intend to disrupt the status quo. Instead, they capitalize on your desire to stay rooted, using it to their advantage.

And so it continues until a line is crossed.

Perhaps it’s the feeling that colluding with the competitor across the street is resulting in money being transferred from you to corporate administration. Maybe it’s a power struggle, a transition from a thin layer of administrative support for frontline patient care to a thick corporate hierarchy of administrators. Doctors and nurses find themselves less focused on excellence in their jobs and more concerned with climbing the corporate ladder.

Or maybe it’s a midlife crisis. The first generation of doctors and nurses in the era of corporate medicine reaches a period of stability, having paid off their student loans and mortgages, and feeling confident in their clinical abilities—only to be left with a profound sense of emptiness.

They still love medicine—the patients, the colleagues—but they despise the health care system.

They have two choices: either accept the emptiness and continue trudging away, dream of a side gig, or achieve financial independence and early retirement (FIRE). Alternatively, they can join the growing minority of individuals seeking a way out of dependency on the regional oligopoly. They move every few years for a new position, join a union, or leave their local hospital to fill a gap at another hospital (created when another doctor or nurse opts for locum or travel nursing at their current hospital).

The result? Locum and travel nursing agencies siphon money from the health care system—yet another casualty of monopolies creating labor disruption and disgruntlement.

But make no mistake: this disgruntlement is most certainly not about COVID, any more than this discussion is about the Easter Bunny—unless, of course, the Easter Bunny happens to be the CEO of your local hospital chain.

The author is an anonymous physician.