Why physicians are staying in medicine

As physicians are leaving the field of medicine — some via retirement, some due to dissatisfaction and burnout and depression — what is motivating the ones who are staying to continue to practice?

Becker's connected with 11 physicians to learn what keeps them in their careers — despite any concerns they may have.

Note: These responses have been edited lightly for length and clarity.

Question: Physicians are leaving the field for a number of reasons. Why are you staying?

Alex Barkan, MD. Chair of Surgery at Richmond University Medical Center (New York City). I am staying because I enjoy my work. I enjoy working with my colleagues in the clinical and administrative fields. I have an opportunity to run my practice the way I see fit despite being employed. I am OK with my salary. I don't know what I would do if I was not a surgeon. It allows for constant growth, excitement and surprise. It is a stressful field, but every win, despite the stress, makes you stronger mentally. It allows you to assess risk in a new way and that can be used for any aspect of life. I have a meaningful and fulfilled life because of the profession of surgery. 

Frederick Dennis, MD. Medical Director at Torrance (Calif.) Memorial IPA. I was burning out in the '90s when I was working in the emergency room at Cedars-Sinai in Los Angeles. I had been successful at insulating myself from sustained empathy from the patients as a defense mechanism to avoid feeling the daily pain of personal tragedies (i.e., why do bad things happen to good people?).

Then patient satisfaction became an item in the ER. I spent a while analyzing how to get good scores and I discovered for me, the solution was to ask the patient, "Why are you here?" This was asked on two levels. One: What symptoms were you having that brought you in today (chest pain, weakness, shortness of breath, etc.)?

And two: What were you worried about was going on? I would work them up to address the first one to figure out if there was something serious. Then I would explore further with them what the symptom meant to them (Dad had similar pain before his heart attack, Grandmother had those complaints before her stroke). The workup for the first assured me I knew what was going on. The workup for the second was often easier and assured them I knew what was going on. And when I told them, "Good news, you’re not having a stroke or MI," etc., they breathed a sigh of relief and often smiled.

Once in a while they even said, "I'm so glad I came to the ER today because you were here."

Whoever says "I'm glad I came to the ER"?

I let down my guard and was rewarded with the affirmation that I was truly making a difference in their lives. Which was why I went into medicine in the first place. Compassion cured my burnout.

That sustained me clinically for another 15 years — recharged my batteries, so to speak.

The last 15 years, I have enjoyed making a difference at another level, helping patients and physicians and advanced practice providers navigate the system to get as good of care as possible with all the complexities while enjoying the positive feedback when they tell me I'm helping them make a difference with their patients.

James Fortenberry, MD. Chief Medical Officer at Children's Healthcare of Atlanta. For me, I am continuing to work because I believe in Children's mission and the impact I get to make in the lives of many kids, often one child at a time, each day. At 66, each day I can find joy in the kids, the physicians and the staff with whom I interact. Also, we are closing in on the biggest step in Children's history to date: opening a new 446-bed hospital as a key part of our system of care in September.

Anthony Frank, MD. Senior Vice President of Medical Affairs and Chief Medical Officer at UNC Health Blue Ridge (Morganton, N.C.). I stay because there is much left to be done. As a clinician and administrator in healthcare now in my third decade, I worry about the access I will have to care as an aging individual and physician. Access to care is terrible. Coordination of care is impossible, and payment from insurers is a nonstop dance of denials.

I really believe that physicians want to care for patients and would continue to do that for a reasonable wage for much longer than they are planning for all of the right reasons. The system as it is currently is crumbling; the solution is to remove the non-value-added tasks of physician’s work so that we can care for our patients.

Joseph Giangola, MD. Endocrinologist at Hackensack (N.J.) University Medical Center. Simple. My patients need a doctor. I feel like I would be abandoning them while I can still work. 

Michael Gomez, MD. NICU Medical Director at Pediatrix Medical Group-Orlando (Fla.) Health Winnie Palmer Hospital for Women & Babies. The organizations I work with are intentional about mitigating physician burnout through their words and actions, and they allow me to focus on leadership, professional and team development activities through mentorship. My clinical team knows what to do but struggles with the complexities of being their best. It is both an obligation and an honor to teach them what I believe matters when in a high-stress intensive care environment. If they are satisfied with what they do and feel supported as they learn to navigate those complexities, the risk of burnout is significantly decreased. Over time, my role has transitioned from providing bedside clinical care to leadership and mentorship, which is both exciting and fulfilling. It keeps me engaged as I am guiding the next generation of clinicians who will practice in a very different future.

Michael Havig, MD. Orthopedic surgeon at OrthoCollier (Naples, Fla.) and Founder and CEO of HealthMe Technology. I've been in practice for 25 years. I'm staying to try to fix the things that are making doctors leave: burnout, lower reimbursement in the face of increased administrative headaches, less control of your practice and a disconnect from the doctor-patient relationship. As an orthopedic surgeon, I take great satisfaction in getting my patients back to the activities they love, but in exchange for that I'd like to be paid a reasonable fee, in a timely manner, without a lot of expensive, time-consuming hurdles to get paid. To that end, I've been a pricing transparency advocate, helping my physician colleagues bundle, price and retail their services to direct-pay patients and employers through HealthMe — a marketplace for transparently priced bundled healthcare I founded. Physicians name their price, give patients improved access to care through our consumer-friendly marketplace and are paid their fee the same day they treat the patient. In doing so, doctors can focus on caring for their patients, and patients can focus on getting better without concern about cost for their care. 

I feel that this endeavor has brought on a new and bigger challenge and helped me power through some of the hurdles we face practicing medicine in today's healthcare environment. 

Jason Ko, MD. Vice Chair of Clinical Operations for the Department of Surgery at Northwestern University Feinberg School of Medicine/Northwestern Medicine (Chicago). First off, I love what I do. I am the son of a surgeon, and I always knew that becoming a surgeon was my calling. At Northwestern Medicine and Northwestern University Feinberg School of Medicine, I am in an ideal environment to stay committed to the tripartite mission of clinical excellence, research and education. As a plastic and reconstructive surgeon that does 100% reconstructive surgery, I come to work every day energized and excited for the impact my team and I can make in people's lives, and I feel well-supported by my colleagues, bosses and executive leadership. I have also been fortunate to play a leading role in groundbreaking clinical research focusing on advanced amputee care, bioprosthetics, and the reduction of nerve pain/phantom limb pain, which has been adopted all over the world and has been immensely satisfying for me professionally. From an education standpoint, I am also the program director for the plastic surgery residency, and it has been fun and invigorating to teach residents and medical students throughout my career — ​the two-way exchange of ideas that I engage in on a daily basis is important for someone like me who is always trying to learn and improve.

With that said, the U.S. healthcare landscape is ever-changing — and surgery is a physically demanding career — so I am mindful of my own career path and longevity. This is why I chose to get my MBA from Northwestern University Kellogg School of Management in 2019 so that I could gain more real-world knowledge and learn new skills that will help me as a leader as my career continues to grow and evolve. Over the past few years, I have been fortunate to take on more administrative and leadership roles within our health system, which have added new dimensions to my career beyond just being a surgeon. Northwestern Medicine is great at supporting physician leaders within the health system — our current CEO is a great example — and it has been exciting for me to step outside of my "silo" as a surgeon and learn more about the complexities of delivering high-quality healthcare while focusing on improving efficiency and the optimizing the clinical experience for our patients. All of these factors contribute to why I'm excited to come to work every day and don't foresee that changing anytime soon.

Brent Powers, MD. Senior Vice President and Chief Medical Officer at Lexington Medical Center (West Columbia, S.C.). I still really enjoy the satisfaction of helping a patient through a health issue by determining the correct diagnosis and/or course of clinical treatment. Whether it's in the hospital or the clinic, my patients' improvement brings joy to my daily work. I recognize that the delivery model of that care continues to evolve, sometimes making it more difficult (but also less difficult) to deliver that care, but the core function of my desire to help patients remains.

I have also matured in my ability to set appropriate boundaries in my interactions with patients, staff and payers. I have empowered my patients to be stronger advocates for their healthcare by deferring to them to advocate for the prior authorizations of their studies and/or medications. Patients now have immediate access to their medical record; why should they not be handling the coverage of their care with their payers? Even if the insurer declines coverage, the patient can then make an informed decision on whether they want to proceed with the plan of care (or not).

If they want to adjust the plan of care based upon their benefits, then we meet again to discuss the options and then support their informed decision. As the provider, I remain in dialogue throughout the clinical engagement, supportive of my patients and their health.

Carmelita Teeter, MD. Orthopedic Surgeon at Texas Bone and Joint (Fort Worth). I think the reason that I continue to practice medicine despite some dissatisfaction and burnout has a lot to do with how I identify my place in the world. I dedicated so much time and then energy into training as an orthopedic surgeon that despite other really important roles in my life — I am a wife, mother and a daughter — at my very core I often define myself as an orthopedic surgeon.  The ability to care for vulnerable people brings value to me and is fueled by those people who are appreciative and genuinely grateful for the care that I provide. When I think about doing something different or I think about no longer being able to perform surgery from a technical perspective or interact with patients and offer them care, I just cannot picture what that life would look like.

Gian Varbaro, MD. Chief Medical Officer and Vice President of Ambulatory Services at Bergen New Bridge Medical Center (Paramus, N.J.). I am staying because I still love what I do. There is a real opportunity to impact people's lives, which for me still outweighs any dissatisfaction or burnout. Probably more importantly, I also feel that this is a really exciting time to be working in healthcare. Even though things are difficult now, that means there is a true opportunity to change the system for the better that we can seize upon.

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