Kim Downey:

Pulling into my driveway, I grabbed a handful of envelopes from the mailbox, one of which was from my doctor’s office. I could tell it wasn’t a bill, and I became anxious. Upon opening it, I was relieved to find that it wasn’t about my doctor leaving his practice or that anything had happened to him. Rather, it was a notification that another doctor I’d seen once was leaving. My relief was tempered with concern; how would this affect my doctor and his already packed schedule?

Months later, another envelope arrived. I tore it open, more anxious than before. This time, it was to inform me that a physician assistant I’d seen briefly was also leaving. Again, relief gave way to worry. How would this impact my doctor, and how would he manage with even less support?

Not long ago, mail arrived from another health care system where I am also a patient. Knowing it wasn’t a bill, I experienced a moment of panic before ripping it open to find out it was a donation request following a recent medical procedure. Though it wasn’t about my doctor, my reaction was the same: trepidation followed by intense relief.

Each time I receive medical envelopes, a familiar wave of anxiety hits. It’s not the bills that make my heart race; it’s the fear that one of my doctors may be leaving or that something has happened to them.

A couple of years ago, there was no relief at all.

I went to see one of my trusted doctors for what I thought would be a routine visit. Upon arriving for my appointment, I was hit with an unbearable shock. My doctor had died a month earlier. I came to know he had taken his own life.

The loss was devastating.

The trauma of the unexpected news left a lasting scar on my heart.

My doctor’s death changed me. It sparked a deep sense of responsibility to advocate for those who care for us—our doctors. The trauma of losing my doctor drives my work every day to support physicians and raise awareness of the challenges they face.

As a physical therapist, I always worried about my patients. Now I worry about the well-being of my doctors.

I’m determined to make a difference.

To amplify the voices of physicians, I created the Stand Up (for) Doctors! YouTube channel and Substack newsletter. These platforms, along with LinkedIn, are more than just spaces for information; they’re a community where doctors can share their struggles and triumphs, and where I can help foster the support they need to keep going.

The tragedy of losing my doctor will always be a part of me. It fuels my mission every day. My loss has ignited a drive to support doctors and advocate for a health care system that not only cares for patients but for those who care for them.

I’ll continue to stand alongside doctors, sharing their stories, amplifying their voices, and fighting for their well-being.

Todd Otten, MD:

Medicine is a world of gray …

As I reflect on over 20 years of practicing medicine,
I wonder, how did we get here?
How did the profession I love become so black and white?

I am despondent with the clerical burdens.
I am saddened by the box clicking.
I am disheartened when it’s just one more form.
I am discouraged when I hear prior auth.
I feel desolate.

Black or white?

I feel happy seeing patients.
I feel fulfilled teaching students and APPs.
I feel content making a difference.

Black or white?

Lest we forget the patient…
Access, insurance, polypharmacy, mental health…
Providers staring at a screen.
Does data make the dying feel better?

Is this the balance we want?

I question if I am truly making a difference.
How many burned-out providers does it take?
Will this crisis in medicine end?
Perhaps when health care leaders actually hear the voices of
physicians and patients, and listen.

Too often, issues in health care are assumed to be black and white…
medicine is a world of gray.

—Todd R. Otten, M.D., 2021

I wrote this poem approximately two years after surviving burnout. You read correctly: surviving. Clearly, my tone indicates sadness and frustration as seen by the eyes of a seasoned family physician. During those 20 years, I have known four physician colleagues who died by suicide. A classmate. A fellow. An ED physician. An office partner. What was their story? What pain and desperation existed to see suicide as the final answer?

Unpacking those traumatic events has been difficult. Stuffing your emotions into a box and never addressing them is a fool’s errand. Eventually, processing is required. There is no shame in asking for help. If you are struggling, I implore you to reach out. Coaching, therapy, and counseling are all incredible resources.

This epidemic of physician suicide must change. The current cohort of bright young minds in medical school and residency are desperately needed: to lead the collective out of the despair that is so pervasive in health care. We need courageous leaders to assist in unlearning “learned helplessness.”

But how? I often challenge others to share their time, talent, or treasure in service to others. However, self-care is paramount. Look in the mirror first. Learn to set boundaries. If you are saying yes to something, you are saying no to something else. The negative ripple effects of a burned-out physician can be disastrous. Just being more resilient is not necessarily the answer. Balance is essential.

Fortunately, there is hope. Organizations like the Dr. Lorna Breen Heroes’ Foundation, the Medical Society of Virginia, the Kern National Network, the Health Care Reinvention Collaborative, and Medicine Forward (to name a few) are working towards positive systemic change. What positive ripple of change are you working on?

Todd Otten is a family physician. Kim Downey is a physical therapist.