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ER Goddess

ER Goddess

Looking for the Exit

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000559975.21608.eb
    leaving medicine
    leaving medicine:
    leaving medicine

    The Bahamian seawater burned his skin when he waded in. As we watched his wide-legged waddle out of the water across the sugary sand back toward our room, my EP boyfriend joked, “I have our exit strategy.” He wasn't talking about getting out of the ocean to follow my son. “We could make a rash cream to sell at all these resorts. People would buy it, and we could retire.”

    Dreaming up exit strategies is not uncommon among doctors these days. Matt and I have a running dialogue in which we entertain each other with ideas for getting out of medicine. Last month, it was avocado farming. Before that, it had been a donut shop, an arcade-taproom, and a craft honey boutique. Or there's always the lottery.

    Doctors are dreamers by nature. No one just stumbles into a medical career the way I stumbled into writing when—poof!—one day EMN asked me to be a columnist. It doesn't happen that way for physicians. Our dream starts in high school, maybe even middle school, and then we toil for years through college, medical school, and residency to achieve it.

    Many people may have the ability and look back and say, “I could have been a doctor,” but we were the ones who actually had the drive to do it. When I look at my scribes, I remember 18-year-old me wanting nothing more than to achieve my goal of becoming a physician. Way back then I had no idea what I was getting into.

    Fiery younger versions of ourselves dreamed us into this profession. So why do thoughts of opening a brewery, being a financial advisor, or becoming a motivational speaker occupy the minds of our current middle-aged selves? Is it because we knew medicine before Obamacare, EMR, and time mandates when doctors could be doctors? Is it because the older we get, the more wisdom sets in—wisdom being a healthy dose of realism—and we know medicine will never be the same?

    Just as the chest x-ray has replaced the stethoscope, so has the EMR replaced talking to patients, nurses, and colleagues. We know we can't go back, so we dream of retiring early after making a fortune inventing smartphone apps, distilling moonshine, or whatever this month's entrepreneurial idea is. We imagine tapping into hidden talents within ourselves to become musicians, writers, and painters.

    It should be a wake-up call for everyone in health care that after working so hard to get into this career, the dream now for so many physicians is to get out. Our fantasies of being radio personalities, vineyard owners, or food critics are symptoms of the diseased health care system. When doctors deal with caregiver fatigue, PTSD, being fired, being sued, being silenced, or any of the other multiple threats to physician wellness, it changes us. When Big Pharma and Big Insurance treat us like laborers as they use their purse strings to impede our efforts to care for our patients, it demoralizes us.

    The Status Quo

    I've learned to reframe how I see what I do for my own wellness and mental health. Rather than focusing on my disdain for data entry, shift work, and oppressive metrics, I try to focus on my love of resuscitation and patient advocacy. Unfortunately, leaving it in our hands to adjust our own attitudes if we want to find any wellness is the current status quo. When the medical system breaks us and then leaves us to pull ourselves up by our bootstraps, we begin to wonder if we would be better off as professors, politicians, or even YouTube stars.

    Can we change the status quo? Instead of living with victim-blaming in a system that inspires physicians to dream up products to sell and businesses to open, can we dream up system-wide changes to facilitate our well-being? We need some of us to stay fiery, avoid being yes men, and aspire to transform medicine rather than leave. We need the dreamers among us to invent new ways that we can keep influencing people for the better, one patient at a time, while keeping our sanity.

    We can't rewind to the good ol' days, but we can at least dream up enough change in the system to release some of the seismic tension that continues to build. The same optimism that drove us to this profession should have us clamoring for change because we know deep down that it can be better than this. We believe the health care system doesn't have to be one in which physicians are committing suicide at a rate higher than any other profession and perpetually fantasizing about escape.

    Every time an EP moves out of the ED into urgent care, a skilled nursing facility, or hospice, let it be a warning. Every time a physician dreams up an exit strategy, let it be an omen. Our health care system should take better care of those who had the heart and fortitude to get through medical training in the first place. Maybe if someone took better care of the caretakers, we could keep good EPs in the EDs instead of using our talent and drive to sell rash cream. The world probably needs rash cream, but it needs capable physicians more.

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    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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