I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass. I know this because I can see right through the water in the Bahamas. There is clarity here. When I started this journey thirteen months ago, I was burning with anger. I was angry at insurance companies for developing complex, mutable formularies, coverage policies, and appeal procedures, maximizing my burden to minimize their cost. I was angry at pharmaceutical companies and the many layers of profit-seeking middlemen between them and my patients, their unregulated maneuvering resulting in arbitrary swings in drug pricing so that I was unable to tell my patients if they could afford even their generic seizure meds that month. I was angry at the government, which shortsightedly addressed the morass of medical economics with more bureaucracy, and, with ICD-10, even defined more diseases. I was angry at my physician leaders, who awkwardly wielded their newly-acquired economic jargon like a weapon, distancing themselves from the fellow doctors they supervised. And finally, I was angry at multiple EMRs, which clearly placed the doctor’s time and effort last on the priority list. After all, medicine is complex these days. The doctors must pay for this. These concerns of mine could be extracted from any online physician forum, conference dinner conversation, or burnout retreat. But most of those doctors are still practicing. So why did I quit? Consider how I was trained. In my medical school, I was acknowledged as an intellectual with a higher calling, and the humanity of medicine was emphasized. I will not just maximize patient outcomes, I will heal; I will not just fill my 3 p.m. slot with a well-reimbursed EMG, I will bear witness to suffering; I will not just maintain my certification, I will embrace the fascinating science of medicine. When I finished medical school and residency, I didn’t just feel qualified to do a complex job, I felt ennobled, as if my life had a higher purpose. When I started my outpatient neurology job for a multispecialty practice, I had a lot of fun. It wasn’t so hard to make a difference. But over time, my practice started taking on water. It is a story familiar to many by now. The administrative duties escalated in spite of a competent but dwindling support staff, and the time allotted for paperwork disappeared out of the workday. It became all uncompensated time, which was humiliating, as that fact suggested that if I was just more efficient, I should be able to get it all done before dinnertime. My frustration built as my employers seemed unable to address my difficulties in a manner that respected my time and autonomy. I needed something more than a “support group,” with the implication that the problem lay within myself, not the system. And so my dream of becoming a great doctor dissolved. The message received from multiple institutions was loud and clear: You are no longer special. You are just an employee. So I quit. I live on a sailboat now. I jumped into my lifestyle change with the old enthusiasm I had for neurology. I spent several months lying on deck watching sunsets, relishing the fact that it was 6 p.m. and I was home with my family. These days, my husband and I have control over what we will do each day, where we will go next, and when we will leave. If a mistake occurs, we change our system rapidly to minimize future errors, and we document only what is necessary. Finally free to think, I have gazed at the sea on night watch, Southern Cross in my headphones, searching for answers. What is the fix for uncontrollable health care costs? What is the fix for Parkinson disease? What is the fix for burdensome documentation requirements? What is the fix for me? I am calling this a self-funded sabbatical rather than a career change. It is hard for a person to give up a profession that requires such a large initial investment. Slowly, the neurologist in me has resurfaced from its burial ground in the deep sea of disillusionment, and the tsunami of anger is starting to subside. It is not a panacea, but taking a break from the degrading surge of checkboxes and lethargic dropdown lists has rejuvenated my soul. While sabbaticals have been traditionally reserved for academics, I propose that more practices consider offering them. Many benefits are obvious, from improving recruitment, encouraging loyalty, promoting education, and addressing burnout. Of course, there will be resistance to this expensive idea. Offering sabbaticals acknowledges the physician as an intellectual with unique motivations, a person worthy of respect. It may be perceived as elitist, this idea to give physicians special treatment. But there is a deeper consequence. On sabbaticals, one can regain control over one’s day and recover a lost sense of agency, an underappreciated but important cause of physician discontent. This is dangerously empowering. In fact, my sabbatical has given me new strength to take the helm of my career and do more to be heard, as Iam ennobled and willing to fight for my patients and fellow physicians. Physicians cannot continue to work as uncompensated paper-pushers for a multitude of silent overlords seeking profit above patient care. The establishment may reject this call to mutiny, but nothing will change until physicians start requesting sabbaticals if they are not offered. We have given so much already to this system. It’s time to start taking something back. We have to restore our status as captains of the ship. Fortunately for me, those problems seem far away at the moment. In this light breeze, I search through the clear water below me for the hope that someday this respect I seek will spread like a wave through the health care industry, and physicians will regain their voice before they drown. Source
