After nearly a year of planning my exit strategy, my final day as a hospital-employed physician was June 30th, 2023. How surreal to finally be independent! In a recent phone call, a dear friend and fellow physician asked what drove me to my decision.
“Because I felt like a failure every day,” I disclosed to my normally sympathetic colleague. To my dismay, he responded with a chuckle. I asked why he was laughing at me. “It’s just that I recognize that sentiment,” he replied. “I am exactly the same way, beating myself up and catastrophizing when I’m not perfect. You know it’s not true, right?”
I protested, “But I wasn’t expecting perfection. Just … improvement. No matter what I did, I was always behind.” He reminded me that what matters most is the actual work of caring for patients, not the billing, coding, and sundry box-checking, dictating, and typing that in any other field would largely be relegated to a trained paraprofessional. I retorted that for better or worse, American medicine is a business, and the business of mainstream primary care depends on physicians spending the bulk of their day chained to a screen. In fact, unless we are performing a billable procedure, we are punished for taking the time to have a meaningful (but wholly non-billable) conversation with a patient. A day full of such conversations means a lunch hour, dinner time, and late night of catching up on administrative tasks. Heaven forbid that we actually eat and sleep—that means double work for the next day. Only the most efficient physicians with well-trained, experienced staff; generally straightforward patients; and intuitive electronic medical record systems consistently stay afloat.
Such was not the case for me. So I suffered from this repeated ethical conundrum: Do I choose to actually listen to my patients and work collaboratively to help them feel their best, knowing I would not have sufficient time for my family or myself? Or do I fly through the day, doing the bare minimum for my patients, but actually complete all my documentation at a reasonable hour? I almost always opted for the former. Eventually, I got so busy that all my obligations piled up to an unsustainable level. My efforts to catch up were too little, too late, with any progress inevitably followed by an onslaught of even more tasks that threatened to drown me.
No more. I have taken a hiatus from outpatient family medicine, with the intention to jump back in as soon as I am able. Next time I won’t have insurance companies or administrators to answer to because I will be practicing direct primary care (DPC). DPC keeps medical decisions where they belong: between the doctor and the patient.
My friend was right; I am not a failure. The traditional American health care system sets up multiple players to lose. Often it’s the patients themselves. Sometimes it’s the office or hospital. At my former practice, it was me. Now that I am an independent entity, I am excited about the prospect of a future in which my patients and I can win together.
Jacqui O’Kane is a family physician.
