When you envision the classic American TV doctor from yesteryear, what do you see?  An older man, with silver gray hair, dark suit, white coat and doctor’s bag right? He was a solo practitioner who worked long hours, made house calls, neglected his home life and garnered respect by the entire community.  Popular culture today depicts a younger, more diverse workforce of doctors, with complicated personalities, drama-filled personal lives, who save the day at the end of every episode, and continue to imply that their individual struggles must take the back seat.  

The constants across the decades remain; doctors feel called to do work that requires self-sacrifice.  Most physicians I know, will always put a patient’s needs before their own (most, not all). We stay late, come in early, miss lunch, skip bathroom breaks in order to take care of our patients.  We take charts home, read medical literature in bed and neglect our own physical health.

Having autonomy is at the core of being a physician.  We want to make the final call, have the difficult conversations and shoulder the responsibility when things go awry.  We want to be the captain of the ship. Please don’t confuse this statement with not being a team player. Every captain requires a good team.  And, we all know team work makes the dream work.

The changing landscape of medicine is altering the hierarchy of the team.  I’m not the biggest fan of the word hierarchy, however we cannot ignore that it exists.  This changing landscape is far removed from the solo practitioner who only answered to his/her patients to top down decision making from large health systems and accountable care organizations.  

I hear more and more physicians describe increasing requirements of outpatient office visits and surgical cases, quicker reads of radiology studies, etc… while maintaining quality and accuracy. I hear complaints of complicated coding systems and long nights charting after hours in the EHR (electronic medical record). Meetings discuss decreasing overhead and maximizing reimbursement.  Don’t get me wrong. These things are important. Our national healthcare expenditures have to be reeled back. However, in this transition, it seems our title as captain has been stripped away. Many feel more like factory worker #226, as there are days when we resemble cogs in a wheel churning out patients like widgets. These are the days when we returned home feeling defeated, feeling burned.

I feel incredibly concerned/disheartened about our profession as younger and younger physicians describe the symptoms of burnout and contemplate leaving medicine.  As I travel around the country, the shortage of physicians is palpable, what happens if we cannot retain or recruit future physicians? The system needs to change. Change is not bad.  Change is necessary. This change requires us to redefine ourselves in this new system. We have to reclaim our title as captains. We need to harness our innate abilities as teachers and leaders.  We need to use our voice to advocate for our patients and ourselves.

Mary E Fleming, MD, MPH is a traveling OB/Gyn. Locums gives her the flexibility to create her own practice model and the opportunity to work in multiple clinical settings across the country. Her website is nomadobgyn.com