Analysis & Comment

Opinion | Why Doctors Are Calling It Quits

To the Editor:

Re “Doctors Aren’t Burned Out. We’re Demoralized,” by Eric Reinhart (Opinion guest essay, Feb. 8):

Dr. Reinhart’s essay on the need for universal health care as a moral obligation is important and well founded. But I question his assertion that its absence is the cause of physician retirement.

The obvious causes include aging baby boomer doctors, pandemic concerns, excessive bureaucracy, reduced time to spend with patients and reduced insurance reimbursement from managed care companies.

Personal decisions are rarely made based on concerns for public welfare.

Alan J. Kluger
Great Neck, N.Y.
The writer is an endocrinologist.

To the Editor:

I have been a practicing physician for 45 years, and I have never once considered it appropriate for physicians to unionize. Until now.

Listing medical care on the stock exchange totally changed my profession from its focus on the patient to a focus on profit, without improving people’s health or their access to what they need for their health.

The recent nurses’ strike in New York City to get safe staffing ratios in hospitals illustrates the ability of unions to help ensure patient safety and care. Dr. Eric Reinhart has presented a call to arms for physicians to band together to take a major role in redesigning our outdated and broken health care system to truly meet the needs of our patients, society and practitioners. I applaud him.

Rosanne M. Leipzig
New York
The writer is a professor at the Icahn School of Medicine at Mount Sinai.

To the Editor:

I can well imagine that health care workers generally are demoralized. But their physical and emotional exhaustion is not from the U.S. health care system. We do not have a health care system.

There is no National Health Service or anything organized and centralized such as in Denmark, Austria, Singapore, France, etc. Instead, we have thousands of profit centers with highly variable qualities of medical practice. These profit centers represent an expensive unsystem. And our medical delivery is the most expensive in the world.

Patient care cost, however, is not related to the quality of medical care. The United States ranks 30th in quality just behind Mexico on the CEOWORLD Health Care Index.

If I were a highly trained employee of a corporation (three-quarters of doctors are not in private practice) in a field that gave so-so service in a critical area — but at considerable cost — I, too, would be demoralized.

William Wentworth
Belton, S.C.
The writer is a retired professor of sociology at Clemson University.

To the Editor:

Thanks for this revelatory, hard-hitting essay on the crisis in medical care. For routine appointments, my family members are often told these are three or four months out — and we are privileged people with excellent medical insurance!

Eric Reinhart reminds us that many are not so fortunate, and tens of thousands of lives have been lost because of our broken system, long on greed and short on compassion.

I hope doctors do unionize, as Dr. Reinhart suggests, but I’m guessing most of them are too busy serving their patients and struggling with the administrative load required by insurance companies.

We citizens need to act politically, demanding medical care for all and supporting the beleaguered doctors who serve us as best they can in a patently unethical system.

Marilyn Sewell
Portland, Ore.

To the Editor:

Dr. Eric Reinhart wrote an excellent essay. Unfortunately, this essay has been written many times before by others.

The reality is as follows: Our public health system has suffered from underfunding for many years, and the pandemic just made it worse. After all, when the cry for independence and personal choice overwhelm the public good and saving lives, there is little or no hope.

So, just as in other areas of our culture, money talks, racism flourishes and the disregard for those in need is again exposed. And the result is that Dr. Reinhart’s legitimate arguments will fall on deaf ears. Sad but true.

James J. Cullen
Yarmouth Port, Mass.
The writer spent 40 years as a C.F.O. and C.E.O. for not-for-profit hospitals.

To the Editor:

While Eric Reinhart’s essay is a thoughtful assessment of the pitfalls of our free-market-based health system, he misses the mark on burnout. Doctors are burned out from overwork, period.

In my role as a primary care physician leader in a large academic health system, I am a daily witness to the emotional toll of electronic inbox task overload, and I coach clinicians who are struggling.

Never have I heard a clinician say they are on the verge of leaving medicine because of “dwindling faith” in the U.S. health care system. They leave because they are finishing chart documentation, reviewing data and responding to patient portal messages late into the evenings at home when they should be spending time with their families.

Our health care system is ailing, yet any fix — including universal health care — is not going to suddenly simplify the grueling work conditions of primary care clinicians. Ideological relief will not fix burnout. Managing patient expectations, more efficient work flows, robust care teams and better work-life balance will.

Jeffrey H. Millstein
Woodbury Heights, N.J.
The writer is regional medical director at Penn Primary Care.

To the Editor:

I appreciated and can relate to Eric Reinhart’s essay on demoralized physicians. His concerns have wider application beyond physicians. Nurses have been working under increasingly dire circumstances of staff shortages, mandatory overtime, and large and sometimes unsafe patient assignments, to name but a few of the challenges my nursing colleagues face.

Meanwhile, C.E.O. bonuses in some health care organizations are tied to how well the organization investment portfolio does with little accountability for quality outcomes and staff satisfaction.

If physicians and nurses, and their professional organizations, would band together and rise up to demand a reorganization of the entire health care system, we would serve our patients better, decrease costs and find increased job satisfaction.

Jane Barnsteiner
Miramar Beach, Fla.
The writer, a registered nurse, is professor emerita at the University of Pennsylvania School of Nursing and an editor for the American Journal of Nursing.

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