Carmen J. Holmes, MD

FOUNDER

About me

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

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 pandemic, I have done some telemedicine as well.

During my training, I became disillusioned when my expectations collided with reality. I found the practice of medicine to be fragmented and disappointing, filled with well-meaning physicians and staff who can’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 medical system is broken and is hazardous to patients, staff, 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 experiencing burnout which has three manifestations:

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

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

(3) Many 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 as well as the trust our patients place in us, but we resent the administrative aspects of medicine today. Patients rightly feel rushed in their few minutes with us. They have no idea that we spend twice as much time 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. 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. It feels that our health and well-being matter to no one.

Some effects of the 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 the majority could muster only “adequate” PPE for their physicians and staff.

The pandemic has 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 family and friends at risk.

In the first months of the pandemic, physicians and staff encountered unprecedented trauma. Many spent weeks away from their own families to stay on the front lines. Some physicians were forced to work in areas outside of their training. Others were furloughed and forced to abandon their patients. Many physicians quit. Too many physicians died.

As we enter the third year of the pandemic, we are exhausted and heartbroken. We mourn with patients whose treatment for cancers and non-COVID illness are delayed or denied due to the strain of the pandemic. We lament those who die of COVID and its complications.

The pandemic has been dreadful for all of us.

Who cares?

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 a physician who intends 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 mergers 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 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 diabetic patients could get the insulin pump for which their insurance refuses to pay. We know our patients are choosing between paying their monthly bills and paying for the new medication we’d like to 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 continues to grow. We physicians straddle this gap every single day, and 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, 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 learn how to add a side-gig to their existing medical career or how to negotiate their hospital contract. I don’t think search engines or social media groups offer sufficient depth, variety, and/or anonymity to these physicians searching for answers.

The other are “physician influencers.” Physician influencers include career coaches and entrepreneurs, as well as physician authors of articles, books, and podcasts. Each has a unique point of view that appeals to a subset of physicians. I strongly believe that the existing physician-oriented resources are able to meet the needs of physician seekers.

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 inside medicine and one foot outside. While I treasure the teachable moments with my patients, I loathe the fee-for-service American medical system that is unable to prioritize long-term outcomes.

This dual motive is at the heart of my business model: I genuinely want to help physicians find support as much as I want coaches (for example) 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 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-oriented resources since 2011. I have a plan for sharing this information with physicians and trainees in the US.

I crave meaning. I’m 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, 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 no dependents. This allows me to focus on things that others cannot. It’s 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 physicians 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. I am astonished by how much I can 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 time developing my own website.

In March 2020, I bought the domain and made my first attempts at designing the site. In mid 2021, I added the LEARN page which allows physician seekers to search by category and topic. I am now developing the SHARE page which will allow influencers to add themselves to The Physician Project. I’m aiming for the official launch of The Physician Project in Spring 2023.

Let’s do this!

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 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. Stay tuned as I develop a platform where physicians inspire each other.

Carmen J. Holmes, MD

Revised September 2022

where physicians inspire each other