In any given year, working in the NICU brings its share of clinical challenges, heartaches, and spirit-lifting accomplishments. We’re often the doctors whose “miracles” become someone else’s “headache” once the baby moves to the PICU or the pediatric floor. Most of the general public doesn’t know a place for sick newborns even exists, until they or someone they love lands there. I always tell my friends: I hope you never need me in a professional capacity. These are among the youngest, most fragile living beings, and many of them survive against all odds to bring joy to everyone around them. To this day, I cannot predict with any certainty who will survive and who won’t, but twenty years has given me a working sense of the odds. Some babies stay a few days. Some stay months, or even years. The most complicated of them will need care for the rest of their lives.
Who pays for that? Who bears the burden?
Many children in this country are born into poverty and qualify for Medicaid at birth. A team of physicians, nurses, therapists, and other caregivers spends years trying to bring that child to parity with everyone else. Most of that work is underpaid. Most of the people doing it are women.
In medical school, no one teaches you the business of medicine. You show up for the job with your ideals intact. Then, after decades of training, you’re finally in the workforce, and the reality is harsh. No one monitors your hours anymore. You can work day and night and no one will stop you. Every month, you review your RVUs. Your administration promises transparency and shows you a graph (your “worth,” charted against a baseline, meandering up and down), and every month you wonder whether this downturn is the one that finally outpaces the up. Somewhere, in an office, someone has spent their career making sure your dollar value is assigned correctly. You work in the trenches. They decide what you’re worth. And that worth shrinks a little more every year, because inflation rises and your value stays flat.
To soften the blow, there’s a path forward: assistant professor to full professor, if you want it. Then the staffing shortages start: RNs, CRNAs, radiology techs, nurse practitioners. No one wants to work this way anymore. It’s a kind of quiet subjugation, suffocating under your own dollar value. This isn’t what you signed up for. You dreamed of helping families, making discoveries, and being respected. Instead you’re bound to your hours, your RVUs, your academic productivity, your quality metrics, your MOCs, your CMEs, on and on and on. Until one night I find myself covering seventy ICU patients with a skeleton crew, paged to the bedside every hour, wondering, after twenty years given at the cost of my own family, whether I can keep doing this.
The midlife crisis has begun.
Divya Rana is a neonatologist.
