Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The beautiful exhaustion of primary care

Ryan McCarthy, MD
Physician
January 8, 2024
Share
Tweet
Share

I’ve been reflecting lately because, honestly, I feel like I am—finally—good at primary care. With experience, patience, and, dare I say, wisdom, I experience satisfaction, knowing I can do this job. I’m the real McCoy. Or, in my case, the real McCarthy. And despite this, maybe because of this, the effort required often leaves me incapable of doing much else.

At 47 years old, having survived a pandemic, having found my North Star, I can’t think of another job I would rather do. Each morning, assuming I am rested and caffeinated, I bring enthusiasm to the day’s work. But I cannot say that I endorse my job, which is not to say that I don’t love my job, because I, in fact, do.

As a medical student, a siren song called me ashore, and despite myriad obstacles, I traveled the long road and became a trusted primary care doctor. During my journey, unbeknownst to me, American medicine changed, a fact that made me arrive at a much different destination than the one I glimpsed from the water’s edge.

Between my medical school graduation in 2002 and now, West Virginia’s citizens aged ungracefully while American culture devolved in negative ways. Today, we have fewer primary care doctors; more expensive medications; a more difficult “system” of health care, one which is increasingly electronic, impersonal, and nonsensical. These are but a few of the fracture points which sinkholed the foundation of primary care, the supposed terra firma where I planned to build my career.

And this is before social ills like divorce, loss of pensions, substance abuse, and the haunting specter of America’s silent epidemic, loneliness, are considered. I expected the medical problems, and they are, in fact, what I am better at managing. What I did not expect was that, because of society’s dramatic changes, my patients today need a level of attention not described in any textbook. So, they turn to me.

My job, it turns out, drains all of my “social battery.” Today, at the end of a primary care workday, I have nothing left, not a care to give and no desire to speak to anyone. I’m ambivalent about my job’s impact on my life. I thought that, by middle age, I would belong to a clique of doctors, a running group, a band, or something like that. This informal fraternity never materialized and, even if it had, I wouldn’t have anything to give these folks. Social organizations, church, and fraternal groups, I have nothing constructive to contribute.

Seeing people at the gym, spending time in a coffee shop, going out for the evening, I used to be a person who enjoyed social events. I had a reputation as someone who was fun and outgoing. That man, whoever he was, has been erased. I still have enthusiasm to pet my dog, Trixie, and hang out with my beloved wife, Erica, more so than ever as they bring me true joy, the kind that recharges me. They are the keys to me continuing the work to which I am devoted. I am authentically myself with them—Thank God— and there is no need to be “on.” I can just be me, a man who is increasingly seen after dinner in a bathrobe with his feet propped up.

A punchline from a tired joke, “I gave at the office,” unfunny as it is, it applies to me. I will repeat the same routine tomorrow, pouring my heart into my patients, leaving me with little to spare at day’s end. My fatigue will, I know, mostly be erased come the following sunrise, assuring me that I am not, in fact, burned out. I have faith that, in the clouds of my morning coffee, I will see a new horizon, one which calls me to serve my flock.

Today, I’m grateful for my youthful ignorance, having no clue this is where I would arrive. Had I known, I may have been scared away and never committed to primary care, a job which leaves me mentally drained. As long as there are fractured and broken people in front of me, doing their best in a disjointed society, I will freely and lovingly drain my battery to care for them. I did not know this would be my service in health care, and yet here I am. Had I chosen another path, I would never have known a beautiful form of exhaustion, the kind that comes when your brain can no longer concentrate, but deep down in your bones, you know that you gave, as much as anyone can, at the office.

Ryan McCarthy is an internal medicine physician.

Prev

Addressing physician burnout differently [PODCAST]

January 7, 2024 Kevin 1
…
Next

I discovered the Holy Grail for doctors

January 8, 2024 Kevin 1
…

Tagged as: Primary Care

Post navigation

< Previous Post
Addressing physician burnout differently [PODCAST]
Next Post >
I discovered the Holy Grail for doctors

ADVERTISEMENT

More by Ryan McCarthy, MD

  • When a doctor becomes the narrator of a patient’s final chapter

    Ryan McCarthy, MD
  • What my first Match Day as a program director taught me about hope

    Ryan McCarthy, MD
  • What The Far Side taught me about belonging in science

    Ryan McCarthy, MD

Related Posts

  • The solution to a crumbling primary care foundation is direct primary care

    Sara Pastoor, MD
  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD
  • Health care’s hidden problem: hospital primary care losses

    Christopher Habig, MBA
  • The rise of direct primary care in America

    Andy Bonner
  • Primary care colonialism: the impact of profit-driven health care on communities

    Michael Fine, MD
  • The demise of primary care in America

    Gregg Coodley, MD

More in Physician

  • The physician who turned burnout into a mission for change

    Jessie Mahoney, MD
  • Time theft: the unseen harm of abusive oversight

    Kayvan Haddadan, MD
  • Why more doctors are leaving clinical practice and how it helps health care

    Arlen Meyers, MD, MBA
  • Harassment and overreach are driving physicians to quit

    Olumuyiwa Bamgbade, MD
  • Why starting with why can transform your medical practice

    Neil Baum, MD
  • Life’s detours may be blessings in disguise

    Osmund Agbo, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician
    • Time theft: the unseen harm of abusive oversight

      Kayvan Haddadan, MD | Physician
    • How one unforgettable ER patient taught a nurse about resilience

      Kristen Cline, BSN, RN | Conditions
    • The future of clinical care: AI’s role in easing physician workload

      Michael Wakeman | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician
    • Time theft: the unseen harm of abusive oversight

      Kayvan Haddadan, MD | Physician
    • How one unforgettable ER patient taught a nurse about resilience

      Kristen Cline, BSN, RN | Conditions
    • The future of clinical care: AI’s role in easing physician workload

      Michael Wakeman | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The beautiful exhaustion of primary care
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...