Jayma Anne Montgomery
HONEST REFLECTIONS ON DOCTOR’S DAY
In the spirit of this underrated holiday and wanting to shift the tone of the blog to begin to talk about the things I truly love and have actual expertise in (because politics, yuck!) I wanted to reflect on Doctor’s Day. This was established in the United States in 1842 in honor of the first use of general anesthesia which was a huge win for modern medicine. It is apparently celebrated in many other countries on many other dates. I didn’t really know it was a thing until about five years ago when my office staff made a huge deal about it. It was honestly adorable and I still have all of the cheesy memorabilia. Here is the problem with a day like this for a person like me: I would much rather be treated with integrity and respect on a daily basis than be treated with over-the-top gestures on a single day of the year that in no way makes up for bad policies and practices that routinely make my job harder. I simultaneously appreciate the gestures and understand that most of the people extending them aren’t individually responsible for making my role as a physician darn near impossible to do at times but I still legitimately have work to do and taking time to enjoy the office party means staying later or taking work home with me so…this smile is super forced and I’m ducking out early and I don’t really care if you talk about me behind my back for not being appreciative.
2022 has been somewhat of a crossroads in my professional life and I’m almost certain that I will never be a full-time physician again. I still love medicine, the real stuff not the political and administrative crap they don’t warn you about in medical school. I enjoy a good diagnostic challenge or even just helping a patient understand their disease process better. I graduated medical school in 2011, a little over ten years ago. That’s still considered a fairly young career. As I look back over that time, I can honestly say that it doesn’t feel worth it and that I would not choose to become a physician again knowing what I know now. Almost every physician I know feels the same way. I think that’s a poor reflection on the profession and probably means it needs to reform itself in some very deep ways. Here is a brief overview of my journey.
Medical school is essentially an endless obstacle course of lectures, labs, rapid fire memorization, study sessions, written exams, practical exams, and clinical rotations at a pace designed to stress you out for four straight years. Then you go through internship and residency to train in your chosen field for three to seven years in most cases depending on if you choose to become a surgeon or non-surgeon. Think of the most exhausting job you have ever had where you are expected to do all of the work for the world’s most demanding bosses and give on the spot lectures to attendings who will chew you out in front of your peers for not knowing the answer to some random question. Your expected to be the first to get to work and the last to leave. You are constantly sleep deprived and your schedule changes every few weeks to monthly. You run codes and get paged so much that even when you get a stretch of quiet you find yourself constantly waking up and checking your pager or your phone. I trained in the military which added an extra layer of stress since you were expected to follow military customs and practices, maintain weight standards, and put the needs of the military ahead of your medical career. My residency program was academically excellent but extremely toxic. The egos were so big that even the staff attending physicians tried to outperform each other at noon report. The minorities in our program were particularly targeted and held to standards that our non-minority counterparts were not. We huddled together like antelope in the wild, hoping it would somehow shield us, but inevitably we could only watch helplessly as another one of us would get picked off for a minor infraction. Graduating from that program felt like surviving a deployment in some ways if I’m honest.
The theme of my career has been to always be overwhelmed without adequate support and to face shocking circumstances of structural corruption and fallacy. From residency I was thrown into a clinic chief directorship job just months after graduation. I found myself bogged down with an understaffed clinic, disgruntled employees, union complaints, and an aging physician under my supervision whose liberal opioid prescribing practices ultimately lead to the fatal overdose of a forty-two year old patient on his panel. This ultimately resulted in me getting appointed to lead an investigation committee to call for his forced retirement which then turned into heading a chronic pain multi-disciplinary committee for nearly two years. Now if that’s not a stellar recipe for first job burnout I don’t know what is.
After that, my time in the military thankfully came to an end in December of 2018. Since then, I have managed to cycle through a whopping four full-time jobs not to mention a number of per diem side jobs. I have relocated twice between two states. None of this was planned or expected. I’m only going to discuss the highlights of the last two jobs because I think they lend the most perspective. I was offered a generous contract to relocate to the Charlotte metro area and work in a clinic focusing on ER and hospital reduction. This job would be a nightmare for most physicians because you are essentially signing up to work with the sickest, most medically complex, and non-compliant patients in the clinic. However, I saw it as an opportunity to essentially run an observation unit with a group of extremely talented paramedics providing vital services at a lower cost to patients than the ER or the hospital. It was hard work but tremendous fun. They seemed to be willing to give me the time and liberty I needed in order to make the schedule work for the patients. The low hanging fruit was cellulitis, AKI, hyperemesis gravidarum, and pneumonia. But I’m proud to say that I successfully treated several cases of early diabetic ketoacidosis, pyelonephritis, and hyponatremia with close daily follow-up. I even got into changing wound vacs and some ostomy care. Things were rosy until I spoke up about blatant bullying and mistreatment of some of the Physician Assistants that I worked closely with. My Medical Director, who came across as a perfectly normal and nice human being at first, verbally agreed with me when I spoke with him. But then when I addressed it in a follow-up email to the office manager and copied him on it, he literally gave me the silent treatment. Then, a week later, he ambushed me with a phone call including the assistant medical director and informed me that my contract would not be getting renewed due to underperformance despite having given me rave reviews on my performance review. When I went to his boss for clarity, she informed me that he essentially made the whole thing up. What I learned from this experience was that he was actually a closet narcissist who was threatened by outspoken women and only wanted to be surrounded by people who blindly did whatever he wanted and fed his ego. Even though I was bringing valid criticism with helpful ideas on how to improve the workplace environment, it wasn’t welcome because it didn’t fit his vision of self-aggrandization.
Then I landed a job as a Medical Director with a small company that specializes in grooming medical directors in the long-term care setting. This was something I was dying to get back to because I had loved the scheduling flexibility when I had done it previously as well as the medical complexity of the patient population. Everyone knows that things were pretty rough in nursing homes pre-COVID but the situation after two years post-COVID is just downright immoral. I found myself at war with a cruel administrator who wanted to make an example out of me simply for doing my job and trying to protect these vulnerable patients from neglect and untenable living conditions. Rather than stand behind me, my company gave me the choice to resign or be terminated. I sent my rather lengthy list of concerns that I tried to address with the leadership at the facility straight to the state Department of Health and Human Health Services. They called me back after completing their investigation was complete three weeks later and let me know it was one of the longest list of deficiencies they had ever done off of a single complaint with over 30 citations found.
Now I work per diem as a hospitalist and I love it. It's by no means easy but I make my own schedule and at the end of it, I completely turn over my patient’s care to the oncoming hospitalist. When I am off from work, I am really off from work and that has become so precious. The reality is that I am mentally and emotionally fatigued in ways that I can’t even fully express. Years upon years of ignoring symptoms have resulted in my body now being fragile, broken, and weary. I now have an endless schedule of doctor’s appointments to keep up with and am ironically now a chronic pain patient. I really just need to start taking care of myself in basic ways that full-time employment as a physician is not conducive to. My young children need me to be more present than I have been in the past. My husband needs a wife who is more alive, fun, and companionable. This career is great in many ways and pays so well but it doesn’t satisfy nearly as much as I thought it would. Writing makes me come alive inside. Even thinking about writing makes me buzz with excitement. Medicine is more than a job. It is definitely a calling. But writing is my sixth sense. I would be a lesser physician and human being without my writing abilities.
And so…Doctor’s Day is a complicated day for me. I don’t love it because sometimes I don’t love that I’m a doctor. I’m thankful for it. It provides for my family and I know that I have helped many patients back to health. But it has come at great cost…and not just to me. My family has lost many hours of my time that I will never be able to give them back. For me, medicine now needs to become smaller. Still very important and meaningful but no longer in control. I can no longer serve it but it must serve me. This is the only way I can continue to love it and not harbor resentment. To my colleagues that continue to work full-time, I thank you from the bottom of my heart. We need you more than we can say. I need you because I am now the most reluctant of patients. Happy, happy Doctor’s Day.