Physician Autonomy 101: Time, Energy and Resources
Disabled from clinical anesthesiology in 2010, I found out my group disability carrier and policy did not come close to meeting expectations. I struggled, I fought, I sued, my case was dismissed. My pain and suffering was irrelevant to the Courts and the Group Insurance Carrier under ERISA Law. I never felt more alone and more out of control of my life. Luckily, I also had and have a great private disability insurance policy. I'd saved and planned properly.
On October 15, 2019, it will have been exactly 10 years since I practiced anesthesiology in an operating room. I still miss it. I miss the challenge, the people, the patients and the... well, being a doctor. My brother, wife and many friends still practice anesthesia today. However, in my many interactions and conversations today, there seems to be less joy in practicing medicine today; less justice in the equation between training and practicing, more costs to bare for much longer in life, a reduced sense of 'doing good' or beneficence and as one client put bluntly, 'performing the job as dictated' outweighs any sense, feeling or thought of the 'Do No Harm' learned in school.
I speak and write about stress, burnout and physician suicide because that is something that has changed in the last 10 years. The research, the articles and the discussion has been building for years. It's discussed on most of the medical blogs. While there are many things said and being studied, in my opinion one of the core issues at hand is Autonomy. Specifically, Physician Autonomy. You've traded your Time, Energy and Resources to achieve Mastery in the Art of Medicine. Twenty-five years ago, that Mastery meant the Responsibility to Direct & Choose your patient's care and treatment with near full Autonomy over your own career and job life.
Take one minute and consider the trade you made in your own life.
Medical Ethics 101: Bioethicists tout four basic principles of "Health Care Ethics" when evaluating the merits and difficulties of medical treatments or procedures for patients. Ideally, for a medical practice to be considered "ethical", it must respect all four principles: Autonomy, Justice, Beneficence, and Non-Maleficence
We all learned this in medical school for our patients. We strive to deliver this to our patients. Many of us even sacrifice our own health and personal well being to be the best we can be for our patients. You can feel it in yourself... you've done this in your career thousands of times. Sometimes in big ways and often in small ways daily, to make a difference. To be a difference in this world. To heal.
At the same time... 'ethically' how have You been treated? How has your hospital or healthcare system treated You? How does the administration choose to treat You? Lastly, and often most painfully, how have You chosen to treat Yourself, the career Doctor?
Technology and Business moved so far so fast into medical healthcare since the turn of the century. Demanded and recorded inhuman-efficiencies exist everywhere now to purge every free profitable dollar from each level of the massive American Healthcare Conveyor System... even feel like a stop on the assembly plant? Processing widgets, I mean, patients. Is that what you thought you traded your 20's away for?
Expectations of all sorts left the breathable human healthcare atmosphere years ago. I see and hear the human-results because I actively seek those physicians in need. The broken bodies or minds of those in their 50's asking how do I get disability insurance now? Tough conversations. Many "I wish I would have..." or "I should have done it Intern Year."
While I am not sure what the entire solution is or what shape it will take over the next 25 years, I have a part of it, definitely. One powerful antidote to stress. burnout, depression and, I believe, even the rate of physician suicide may be something very human - safety and security. Its time and I teach others; re-focusing on the ethics of the practice of medicine itself, can be accomplished, one individual practitioner at a time.
If you are struggling: Look to increase your work autonomy - start by asking for it. Consider if what you give is in balance with what is taken at work - is there justice in this balance in your career? Are you performing repetitive tasks that may or may not be doing good for your patients or are you doing good each day at work? Lastly, we all know, "Do No Harm." Only in hindsight do I understand that was meant for BOTH the patients and the doctors.
If you are a fellow, resident or medical student. Your practice years from 2020-2060 will be different than the past 40 years! Technology will continue to outpace human adaptation year after year. Some things will get better. Other new things will get worse. What should you do? It is not rocket science or even brain surgery. Make yourself safer and more secure, personally. Then, help others and do good in the world.
Choose to do things that INCREASE Your Personal Autonomy:
Protect Yourself, Safely and Securely: Acquire great disability insurance as Young and as Healthy as possible. This is one of the most critical steps in protecting your physician income, your greatest asset, your greatest material resource for you and your family. Add proper life insurance(s) as needed for those you love beyond life itself.
Save for Yourself: You and Your Life and Your Happiness depend on it. Literally, your older self(s) depend on having some choice. Financial independence is great! Financial autonomy is to be able to say 'no' to those aspects of your future career that become unjust or no longer do good for others or cause harm to yourself. Strategically pay off educational debts quickly and aggressively. Your young physician generation will have to save at a higher rate than your predecessors. Your educational costs are higher and it is taking more time to complete them. The trade is not as 'Just' as it used to be.
You went to all this time and effort and expended all the energy to become a doctor. The balance of the trade you made with society has shifted for the worse, for You, the doctor. You must heal Your Life first, then others.... that is how control is regained, that is how Autonomy comes back to You.
~Chris
Dr. Christopher Yerington
Columbus, Ohio
Link: https://www.doximity.com/pub/christopher-yerington-md
Link: https://physiciansincomeprotection.com/
Link: https://www.quora.com/profile/Christopher-Yerington
Bio: Retired from clinical anesthesiology by a disability in 2010, Dr. Yerington has turned his love of teaching and service to others to his family, medical colleagues and community. He speaks, writes and educates medical groups and residency programs about the importance of great disability and life insurance, basic physician-financial literacy and work-life balance. Chris also consoles and counsels young doctors on stress, burnout and physician-suicide. Having attended law and business schools, Chris is a perpetual student of human life, a scientist and an optimistic futurist in his heart.