Carmen J. Holmes, MD

FOUNDING MEMBER

About me

I am a physician in Richmond, Virginia. I graduated from Stanford University and earned my medical degree from Ponce School of Medicine in Puerto Rico. I completed my residency at the dual residency program in Internal Medicine and Pediatrics at VCU Health System in Richmond, VA.

 

I realized very quickly that a traditional path was not for me. I was glad to find urgent care as a flexible alternative to the daily grind of primary care and the hierarchy of hospital medicine. During the pandemic, I’m doing more telemedicine than urgent care.

 

During my training, I became disillusioned when my expectations of medicine collided with reality. I found the practice of medicine to be fragmented and disappointing, filled with well-meaning physicians and staff who couldn’t fully advocate for their patients. My mentor reassured me that I was “ahead of the curve” in my understanding of the deficiencies of healthcare in this country. I concluded that the system is broken and harms both patients and physicians.

Why do physicians need help?

Burnout is a part of modern life. All working adults experience job-related stress, but the intensity and the consequences of physician burnout are alarming. Pre-pandemic, half of physicians identified themselves as having burnout with at least one of three manifestations:

(1) Women tend to feel the “emotional exhaustion” that crowds out every aspect of normal life.

(2) Men tend to “detach emotionally” from the human beings in front of them.

(3) Others feel a “sense of hopelessness” – the feeling that all our training, sacrifices, and sincere best efforts aren’t enough.

 

We physicians are trained to project confidence and to reassure patients. But what our patients don’t realize is that burnout is eroding physicians from the inside out.

 

Inside many of us is a war. We cherish the craft of medicine and the trust our patients place in us, but we resent the administrative aspects of medicine today. Patients rightly feel rushed in their 10-minute visit with us. They have no idea that we spend an additional 20 minutes documenting the visit, justifying our reimbursement, and haggling with insurers. In no other industry is the most highly trained individual responsible for the majority of the data entry.

 

But this is old news. The fact is, precious little has been done to address the system-level changes needed to improve the physician experience.

 

How are physicians responding? We grin and bear it, we change locations, we reduce our hours, and/or we quit. In the piecemeal, profit-driven American medical ecosystem, every physician is replaceable. Our physical security (not to mention our emotional well-being) is simply not a priority to the powers that be.

 

A decade ago, the swine flu revealed how unprepared health systems were to protect their staff. Unsurprisingly, in 2020 the majority could muster only “adequate” PPE for their physicians and staff. (“Adequate” is not a part of my vocabulary as a physician.)

Who cares?

Wisely, Canada has begun to quantify the cost of physician attrition. Unlike the US, the Canadian government funds medical education, so they expect a certain number of years of work from their physicians. Millions of Canadian dollars are lost when physicians reduce their hours and retire early. And retire early we will. Studies confirm that a physician who intends to reduce their hours or quit will do so within two years. We won’t always wait until our loans are paid off.

 

But the administrative burden of medicine is just the tip of the iceberg of what ails physicians. Physicians nationwide are fed up with the increasing burden of maintaining board certification, the lack of transparency in state medical board decision-making, and the anti-competitive mergers that monopolize communities. Physician autonomy is at an all-time low as we are squeezed by our employer’s attention to the bottom line and by our patients’ online reviews. But it is NOT just about us.

 

Daily, we physicians witness the disparity between what is and what should be. We know how many amputations could be avoided if patients could get their hands on the insulin pump for which their insurance refuses to pay. (And if their insurance didn’t change every year!) We know our patients are choosing between paying their utility bills and paying for the new medication we’d like to prescribe. We know that phone visits could prevent hospitalizations, if only our health system would prioritize that.

 

The term “moral injury” is more accurate than “burnout” in portraying the heartache that physicians and medical staff suffer. This chasm between what is and what should be is huge. We physicians straddle that gap every single day, but it takes a toll.

Where to begin?

In my view, there are three types of physicians: those who are asking themselves questions about their career and lifegoals, those who don’t know what to ask, and those who have discovered some answers for themselves.

 

The first two types I call “physician seekers.” Physician seekers want to see how to add a side-gig to their existing medical career or how to negotiate their hospital contract. I don’t think internet searches or social media groups offer sufficient depth, variety, or anonymity to these physicians who desperately need answers.

 

The third type are the “physician influencers.” Physician influencers include career coaches and entrepreneurs, as well as physician authors of articles, books, and blogs. Each has a unique point of view that appeals to a subset of physicians. I believe that this diversity of resources is the best way to meet the multiplicity of physician needs and interests online.

 

In my assessment, physician seekers are difficult to reach. Physicians are divided by specialty, by generation, and by preference for social media platform. The Physician Project is designed to bridge the gap between physician seekers and physician influencers, for their mutual benefit.

Why me?

I am neither coach nor consultant, neither programmer nor social media maven. But I have certain qualities and quirks that make me suited to tackle this problem.

 

I’m both seeker and influencer. I can relate to different perspectives. Being multiracial, I have never fit neatly into any category. In college I took all sorts of classes, enjoying environmental justice as much as human virology. Even now, I have one foot in medicine and one foot outside. While I treasure the teachable moments that I have with my patients, I loathe the fee-for-service medical system that is unable to prioritize long-term outcomes and quality of life.

 

This dual motive is at the heart of my business model: I deeply want to help physicians find advice as much as I want coaches to reach more clients. I intend for both physician seekers and physician influencers to have open access to the service. No commission will be levied on influencers and no “premium features” will coerce money from seekers. Who pays, then? I expect sponsors to fund the site.

 

I’m (ridiculously) thorough. I prefer to work behind the scenes, to get to the bottom of something, then share it with others. I’m the one who likes the meaty 45-minute YouTube instructional video, not that 3-minute recap.

 

What I have to offer is the breadth and depth of someone who has been a student of physician well-being and physician-oriented resources since 2011. I have a plan for how to share this information with my fellow physicians and with physicians-in-training.

 

I search for meaning. I’m most fulfilled when I am able to translate my experiences into something useful to others. My experience during residency training was shocking and disappointing. In retrospect, I had an unrealistic view of health care and of my (then) intended specialty of infectious diseases. I struggled, feeling like a cog in the system.

 

I now have opportunities to mentor trainees who are having difficulty. Although it’s upsetting to learn that not much has changed in a decade, I can truly empathize with students and residents. If I can help them process their thoughts and navigate the system, then my ordeal was worthwhile.

 

I’ve got time. I work part-time, and I have chosen not to have children. This simpler life allows me to focus on things that busier people cannot. I consider it a privilege to be free to invest my energy as I wish.

 

I’m available but strategic. I initially looked into coaching certification, but realized that I wanted a more macro approach. I admire the additional training that physician coaches have undertaken and the incredible impact they make. What suits me is to be a virtual guide. I want to point others toward these fantastic coaches in an organized and interactive way.

What’s next?

I discovered that it was within my power to build an online database where physicians could browse and search for topics of particular interest to them. To my astonishment, I learned how much I could do on my own, without a programmer or a web designer, thanks to the modern marvel of WordPress. Unlike the majority of physicians, I have more time than money, so I can afford to spend some time fiddling with a website.

 

In March 2020, I bought the domain and made my first attempts at designing the site. In 2021, I will add the database and integrate the site with social media. My goal is to establish myself as a resource for my fellow physicians as well as for medical students, residents, and fellows.

Let’s do this!

We physicians have a powerful shared experience, yet historically we are not very good at supporting each other. But things are changing. I’m heartened by the recent movement toward physician unity and empowerment, and I look forward to contributing to it. My role is to promote existing resources that might make the journey less onerous for trainees and less isolating for physicians. Please stay tuned as I develop a platform where physicians inspire each other.

 

Carmen J. Holmes, MD

February 2021