Shani Smith, DO, knows how to treat very sick patients. The Chicago-based intensivist is licensed to practice in seven states, and has been doing locum tenens work for three years.
But trying to help patients infected with COVID-19 has been humbling for Dr. Smith and her colleagues.
“I think this is the first time—at least in my generation—where we have cared for a group of people, and had no idea what we’re doing,” she says.
Since the pandemic reached the U.S., Dr. Smith has spent countless hours in intensive care units in three states.
“A 12-hour shift may turn into 15 or 17 hours,” she says. “And then I come home from work—I eat, I relax, I take a moment. And I go to sleep and I start all over again.”
Dr. Smith does not feel burned out by all that work, and remains committed to her profession as a critical care physician. But she acknowledges that COVID-19 stress might trigger other physicians to second-guess their career path.
“Most physicians who make the choice to step away from medicine, it’s not because of what’s going on in this current environment,” she says. “It is a combination of multiple things, and this is the culminating event.”
In fact, 6% of physicians say they plan to pursue nonclinical work as a result of the pandemic, while 14% say they plan to change practice settings, according to a Merritt Hawkins survey conducted in collaboration with The Physicians Foundation.
Five percent plan to retire, while 4% plan to leave private practice and seek employment with a hospital or other entity.
Anxiety and depression rising
Monique Gary, DO, says the pandemic has increased already-existing fatigue and burnout among physicians. “I’m seeing a significant increase in anxiety and depression,” Dr. Gary says.
Many doctors are riding a rollercoaster of emotions, says the breast surgical oncologist and medical director of the Grand View Health cancer program in Sellersville, Pennsylvania.
“On a good day, it’s a great day and we can feel optimistic and hopeful, and have faith in what we do,” she says.
But the pandemic also has exposed the cracks in an overburdened and underprepared health care system.
Personal protective equipment and testing kits have been in short supply. Doctors also have been overwhelmed with comforting COVID-19 patients who often are prohibited from seeing loved ones, Dr. Gary says.
After long and grueling days, physicians return home only to end up isolated from their own families.
“A colleague of mine at the beginning of this was sleeping in his garage, because he didn’t want to infect his three kids,” she says.
At the other end of the spectrum, some physicians have seen their work suddenly disappear. The cancellation of elective procedures at hospitals and facilities across the country has been particularly tough on specialists such as plastic surgeons and dermatologists, Dr. Gary says.
“Their hours have been cut, their wages have been cut,” she says.
The result of this turmoil is a growing body of anxious physicians looking to move away from clinical work.
As many physicians consider nonclinical careers, others are examining ways to diversify their income sources and their professional activities, Dr. Gary says.
Heath Jolliff, DO, says physicians “have always put patients ahead of themselves,” particularly during emergencies and disasters.
But Dr. Jolliff—a certified executive coach with Physician Coaching Solutions—says the stay-at-home orders that have taken a financial toll on hospitals and physician practices—and led to salary cuts—have had particularly dire consequences for less-established doctors.
“This has added more stress to physicians, especially younger physicians who are still trying to pay off medical school debt,” he says.
Like Dr. Gary, he increasingly hears rumbles from doctors seeking alternatives to clinical work.
“Many physicians I know and work with are looking for something more safe, less stressful and more certain than clinical medicine right now,” he says.
Looking before leaping
Dr. Gary says that before moving away from clinical work, physicians must take stock of their situation and ask hard questions about why they want to change their career path. They should also try to understand the root of their unhappiness before making major career decisions, she says.
“We have all heard those stories from physicians who have decided to do something new and who have found themselves unhappy, because it wasn’t the job that was the ultimate source of depression or fatigue,” she says.
Leaving clinical care also has downsides, such as missing day-to-day interaction with patients, and the joy of treating them. “We go into medicine because we love access to patient care, we love that interaction,” Dr. Gary says.
Sometimes, tweaks to your current job can make a world of difference. So, before making a career change, Dr. Gary suggests looking for small, practical ways to improve your current clinical situation.
“If having a scribe can make the difference between job satisfaction or drowning, make the case for what you need,” she says. “Sometimes, that can make all the difference.”
Dr. Jolliff agrees that in some cases, getting to the root of untreated stress can help reverse symptoms of burnout. Working with a therapist, employee assistance program or hospital wellness program are all options for addressing stress.
Dr. Smith says the stress of caring for patients with COVID-19 has taught her and other doctors an important lesson: “In the midst of caring for people, you really need to care for yourself,” she says.
Taking deliberate steps to relieve stress can help prevent burnout, she says. Dr. Smith exercises—including running, weight training and yoga—and meditates. She also spends time with family whenever she can.
“Those things help me take a step away from what I do for work, and I’m able to kind of leave work at work,” she says.
Taking the plunge
However, some physicians find that no amount of tweaks will make clinical work sustainable. Such doctors may be good candidates for a change in career direction.
Dr. Gary urges such physicians to make sure their finances are in order before taking the plunge. Also, they should find a mentor, perhaps someone who has successfully made the transition to new and fulfilling work.
“You don’t have to reinvent the wheel, because there may be other people who are able to guide you, to help you do what you want to do,” Dr. Gary says.
A good career coach can also help physicians in transition find the right path by objectively assessing their current career, and identifying obstacles and potential solutions, Dr. Jolliff says. A coach who is also a physician can be especially helpful, he notes, as that person will better understand the challenges of working in medicine.