How physician burnout varies by specialty, gender and sexual orientation

[@letoquarles6399]

Let's get honest. I'm grateful that Drs Peccoralo and Faggen (and so many more behind the scenes) are doing what they can, where they can, as best they can, and none of what I am saying below is meant to diminish or disregard their efforts. But SO much more is needed. Something *different* is needed. Not all of us work for well-resourced institutions or large practices which have taken up genuine concern for the well-being of staff (physicians or otherwise). Even if one works in such an institution (as I have in the past, yet still left to preserve my own well-being), we have to fit into the existing organizational culture, and overcome a lot of internalized barriers & anxieties, to reach out for more support when we need it - even when that support is just mechanistic or procedural, without touching on deeper emotions or our private lives. Over the course of my career, I have seen my scope of practice simultaneously whittled away (Family & Community Medicine physician who started off with full hospital, OB, ICU & some OR privileges, and now finds herself limited to clinic and post-acute care), and expanded inappropriately (data entry clerk, phone-holder and rage-checker for endless PARs, IT trainer for staff & patients alike, social worker, public benefits navigator, ersatz therapist and addiction counselor, translator, liaison for public schools and law enforcement, and now tactical security consultant/instructor for my staff). As a solo doc in private practice, more than 60% of my actual time is spent on non-reimbursable and generally meaningless bureaucratic tasks. In the past three-and-a-half years of the pandemic and its collateral damages, I have personally attended 207 deaths which I classify as "preventable" and yet which I was helpless to prevent. I have lost three of my own best friends to such preventable deaths, and seen my life partner severely disabled by complications of both the virus itself, and the near-fatal failings of our shattered healthcare system (medication error which put them in the ICU for nearly 5 months). I am working two additional side jobs to try to keep up with the bills, and am still teetering on the brink of bankruptcy. I buck up each day and do my best against an increasingly frayed and hostile social backdrop: as a Jew, I choke back my revulsion and resentment to treat the patient in front of me covered in swastika tattoos and messages of hate; as the mother of a Black son, I keep a cool exterior (and strategic wardrobe) to hide the cold sweats and nausea every time he gets in a car or picks up his cellphone while sitting on his own porch, and I have come to view the nightly news with trepidation and bile. I am not fragile, nor lacking in confidence, skills, or the determination to continue learning & growing. I have spent decades caring for seriously ill and wounded human beings under all sorts of adverse circumstances. I know a thing or two about overcoming adversity, and have learned at least as much in the School of Hard Knocks as I ever did in my medical training. The problem is not me. I will persevere and find new ways to thrive. I am pivoting my career away from primary care, and pivoting my life away from the centrality of my career. The idealism and dedication to service that fueled my determination and got me through medical training have been utterly shattered, and the shards incinerated to a powdery ash. But carbon, compressed over time, builds diamonds. The person I am today emerges from this crucible, forged into something stronger, harder, and far more pointed. Primum non nocere - first, do no harm. At some point, we each come to the understanding that we, too, are not to be harmed, and that we must allow no further harm to ourselves, nor to be carried out under the banner of "healthcare." Physicians, above all, are teachers. It is time we teach what we are learning. What I want my colleagues and the broader public to know is this: "Burnout" quite literally implies a burning. Not all who enter the flames are consumed. The forge is also where alloys are transformed, and where tools and weapons are hardened. As individuals, we do not have control over the flames that are the larger healthcare-industrial complex. But we do have a choice in our response: to be consumed, or to be transformed. Choose the transformation that forges you into your own best self, and leave what no longer serves you behind to be reduced to cinders.