I’m a physician working part-time in Richmond, Virginia. I graduated from Stanford University in 1997 and earned my medical degree from Ponce School of Medicine in Puerto Rico in 2008. I completed the dual residency program in Internal Medicine and Pediatrics at Virginia Commonwealth University in Richmond in 2013. I passed both initial board certification exams and I maintain my Internal Medicine certification with the American Board of Internal Medicine (ABIM) and the National Board of Physicians and Surgeons (NBPAS).
I quickly realized that the traditional path wasn’t for me. I found my niche in urgent care as an alternative to the grind of primary care and the hierarchy of hospital medicine. During the first year of the pandemic, I did telemedicine as well.
During my training, 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. The American medical system is broken and is hazardous to patients, staff, and physicians.
What's wrong with medicine?
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. The exact numbers vary, but even before the pandemic half of physicians identified themselves as having at least one symptom of burnout. Burnout has three manifestations:
- Women tend to feel the “emotional exhaustion” that crowds out every aspect of life.
- Men tend to “detach emotionally” from the human beings in front of them.
- Many feel a “sense of hopelessness” – feeling that all the 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 modern medicine. Patients rightly feel rushed in their few minutes with us. They have no idea that we might spend twice as much time documenting the visit, justifying our reimbursement, and haggling with insurers. Also, in no other industry is the most highly trained individual responsible for the majority of the data entry. The fact is, precious little has been done to address the system-level changes needed to improve physicians’ 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. The well-being of physicians does not seem to be a priority.
Problems intensified by pandemic
A decade ago, the swine flu epidemic revealed how unprepared health systems were to protect their staff. Unsurprisingly, when the COVID-19 pandemic began, hospitals could muster only “adequate” PPE for their physicians and staff.
The pandemic magnified the dilemma faced by physicians and medical staff. We are torn between our commitment to our patients and our own well-being. Before vaccines became available, we risked our own lives and put our families and friends at risk.
In the first months of the pandemic, physicians and staff encountered unprecedented trauma. Many doctors spent weeks away from their own families to stay on the front lines. Some physicians were required to work in areas outside of their training. Others were furloughed and forced to abandon their patients. Many physicians quit. Too many physicians died.
Burnout vs moral injury
Wisely, Canada has quantified the cost of physician attrition. Unlike the US, the Canadian government funds medical education, so they expect a certain number of decades of work from the investment. Millions of Canadian dollars are lost when physicians reduce their hours and retire early. And retire early we will. Studies confirm that physicians who intend to reduce their hours or quit will do so within two years.
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 hospital systems that monopolize communities. Physician autonomy is at an all-time low as we are squeezed by our employers’ attention to the bottom line and by patient ratings/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 diabetic patients could get the insulin pump for which their insurance refuses to pay. We know some patients must choose between paying their bills and paying for the new medication we prescribe.
The term “moral injury” is more accurate than “burnout” in describing the heartache that physicians and medical staff suffer. This chasm between what is and what should be is wider than ever. We physicians straddle this gap every single day.
Physician seekers and influencers
In my view, there are two groups of physicians. The first is questioning their current careers while the second has discovered answers for themselves.
“Physician seekers” might want to learn how to add a side-gig to their existing medical career, how to open a med spa, or how to negotiate their hospital contract. In my experience, neither search engines nor social media groups offer sufficient depth, variety, and/or anonymity to these physicians with questions.
“Physician influencers” are trained doctors as well as entrepreneurs, coaches, and podcasters (to name a few). Each has a unique point of view that represents a subset of physicians. We have all been trained to “see one, do one, and teach one” and this is precisely how we are supporting each other. Each year, I’ve watched physician influencers proliferate, thanks to the work of pioneering physician coaches and conferences.
Physician seekers have more options than ever but are divided by specialty, by generation, and by preference for social media platforms. The Physician Project is designed to bridge the gap between physician seekers and physician influencers, for their mutual benefit.
Why did I create The Physician Project?
I am neither coach nor consultant, neither programmer nor social media maven. But I have certain qualities that make me suited to tackling this challenge.
I’m both a seeker and an 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 inside medicine and one foot outside. While I treasure the teachable moments with my patients, I dislike the fee-for-service American medical system that is unable to prioritize holistic wellness and longevity.
This dual motive is at the heart of my business model: I genuinely want physicians to find support as much as I want physician coaches to reach more clients. I intend for both physician seekers and physician influencers to have free access to The Physician Project. No commission will be levied on influencers and no “premium features” will coerce money from seekers. Who pays, then? I plan for advertising to sustain the site.
I’m ridiculously thorough. I prefer to work behind the scenes, get to the bottom of something, then share it with others. In med school, I loved microbiology despite its being taught at warp-speed in Spanish (I am not a native Spanish speaker.) After each lecture, it took me hours to type and organize my notes, but it helped me learn and I was happy to share with my classmates.
Likewise, I have been exploring physician-oriented resources since 2011. Since my residency, I have been trying to find alternate career paths for myself. My initial collection of physician-oriented resources was personal, but it became communal when I discovered that friends and colleagues had similar concerns. This collection became the foundation for The Physician Project.
I crave meaning. I feel most fulfilled when I am able to translate my experiences into something useful to others. Many of my experiences during my training were harsh and disappointing. I struggled, feeling like a cog in the system.
I now have opportunities to mentor trainees. Although it’s upsetting to learn how little has changed in a decade, I can truly empathize with students and residents. If I could be a sounding board as they process their thoughts and navigate the system, then my ordeal would be worthwhile.
I’ve got time. I work part-time and I have no dependents. This allows me to focus on things that others cannot. I feel privileged to be free to invest my energy as I wish.
I 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 that they make. What suits me is to be a virtual guide. I want to point curious physicians toward these fantastic coaches in an organized and interactive way.
Website under construction
This entire website is completely DIY! I discovered that it was within my power to build an online database where physicians could browse topics of particular interest to them. I’m still astonished by how much I have been able to do on my own, without a programmer or a web designer, thanks to the modern marvels of WordPress, Elementor, Dynamic Content for Elementor, and YouTube.
In March 2020, I bought the domain and made my first attempts at designing the site. In 2021, I added the LEARN page which allows physician seekers to search by category and topic. In 2022, I developed the SHARE page which will allow influencers to add themselves to The Physician Project. In 2023, I’m adding the ability for influencers to update their own content. Official launch is a moving target but is projected to be Winter 2023.
We physicians are in this together
We physicians have a powerful shared experience, yet historically we haven’t been very good at supporting each other. But this is changing. I’m heartened by the recent increase in physician solidarity 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. Stay tuned as I develop a platform where physicians inspire each other.