The cure for the jaded physician

Medical Economics Journal, Medical Economics February 2022, Volume 99, Issue 1

At our first in-person county medical society meeting in nearly two years, I found a balm for my jaded thinking.

“So, you want to be a doctor?” my pre-med preceptor asked, cocking an eyebrow. “My advice, kid? Don’t do it. Go to business school instead — anything else.” But I was 18, and like most teenagers, I knew better. “He’s just jaded,” I thought. “It won’t be like that for me.”

Thirty years and a global pandemic later, I find myself reflecting more than ever on that conversation. I feel privileged to be a physician, and I love my relationships with my patients (most of the time), but the daily aggravations often feel like death by a thousand paper cuts. And even though I’ve escaped much of the reimbursement rat race by converting to direct primary care, I still find myself frustrated daily by nonsensical demands, such as prior authorizations for generic medications and prolonged peer-to-peer phone calls to get necessary tests approved.

And, of course, add COVID-19 into the equation. Even before the pandemic, doctors were reporting high rates of burnout, with almost half making active plans to leave the profession. Tack on more than a year of full hospitals, social isolation and emotional angst, and some doctors have simply had enough.

But at our first in-person county medical society meeting in nearly two years, I found a balm for my jaded thinking, and it came straight from the Collier County Medical Society’s Physician of the Year, nephrologist, Mark Russo, M.D. His words of wisdom were just what I needed to hear.

Remember where you started

Before he became a physician, Russo started working at the bottom rung of the hospital system. “I was a patient transporter, nurses’ aide and psychiatric attendant, and one of my jobs was to walk around and light the patients’ cigarettes,” he said.

This made me think about my own days of volunteering in hospitals and clinics to boost my medical school application. I remember how excited I was when a nurse let me check a patient’s blood sugar—I even wrote about it my diary. That pre-med student would be thrilled to know she would one day not only routinely check blood sugars but help patients manage their diabetes.

Take a moment to consider who you were before you started medical school. What motivated you to want to become a physician? What did you write on your medical school application personal statement? Most likely, you talked about wanting to help, to heal and to make a difference in someone’s life. I bet you’re doing exactly that.

Take stock in how far we’ve come

Russo obtained a doctorate in molecular biology but found himself urged to attend medical school by his research mentor and discoverer of the Philadelphia chromosome, Peter C. Nowell, M.D.. Recollecting the early days of his medical career, he pointed out how much medicine has improved in the past 20 to 30 years. “Isn’t it great to be practicing medicine now?” he asked. “We have been blessed with improved treatments for cancers, hepatitis C, immunosuppressants [and] mRNA vaccines. We have better diagnostic tools.”

As a nephrologist, he is ecstatic about research on xenograft transplants. “We may even put dialysis out of business in our lifetime,” Russo said. This outlook resonated with me. Although we’ve struggled with COVID-19, the mRNA technology perfected to prevent the disease may change the trajectory of vaccines for many diseases and even cancer. Although it’s often automatic to think about the negatives when we are dealing with disease, practicing cognitive reframing to focus on how far we’ve come can change your outlook.

It’s not all about doctoring

As physicians, we truly do make a difference in the lives of our patients, but we make an impact in other ways, too. Russo talked about the three years he spent working as a wrestling coach before medical school, and he recalls this as one of his favorite jobs. “I was able to help kids become outstanding citizens in their respective communities by instilling the discipline they needed, and they still call or write me, thanking me for teaching them,” he said.

It’s easy to focus on our shortcomings. Instead, take a moment to think about all the people you have helped and inspired over the years. Maybe it was through your work as a doctor, but maybe it was just through a kind word or deed. Know that you make a positive impact on the lives of others every single day.

Oftentimes, just being there for someone is enough. “Sometimes we cannot cure or treat. All we may have is our human touch.” Russo said, noting that medicine has been moving away from touch over time. “It’s OK to hug. It’s OK to just hold their hand and comfort them.”

Focus on your friends and family

An entourage of family members accompanied Russo to celebrate his award, and his family’s pride truly touched me. “Mark is the smartest person I know,” his older brother said. “The kid always had his head in a book. I remember the rest of us had to be quiet because he was always studying for some kind of test.”

Rather than focusing on people who don’t matter, such as social media trolls or anonymous reviewers, let’s give our attention to the people who really matter. Remember that we all have our own cheering section of friends and family who want to see us succeed and will be proud of us no matter what.

Own yourself

“My entrepreneurial spirit began when I was around 13 years old,” Russo said. “Everyone in the neighborhood was getting an allowance of $2 to $3 per week, so I asked my dad if I could have an allowance, too. My dad thought about it for a while and finally answered, ‘Yes. I’ve decided I’m going to allow you to continue to live here.’”

So Russo started his own business with his friends, mowing lawns and making $20 to $30 per week. He continued his entrepreneurship as a physician, opening a solo practice, Naples Nephrology, in 2002. In 2007, he added a partner “who is like a sister to me.”

Russo encourages physicians to take a chance on self-ownership, and I couldn’t agree more. After 15 years of employment, opening my own practice was the best thing I ever did. I never thought I could run a business but having physician mentors like Russo helped me realize I could—and you can, too. Talk to colleagues who have opened practices or check your state medical society for resources. As Russo says, “Follow your dreams!”

Don’t be afraid to speak out

“During the pandemic, I was saddened to see mostly politicians speaking about the illness. I yearned to see more physicians,” Russo said. “Many of us answered the call and educated our citizens, leading us to have a strong response to [COVID-19], but when we tried to stand up and guide our leaders, we were pushed aside.” In addition, doctors who tried to speak up were harassed, heckled, and even threatened and abused, which I experienced firsthand when I attended county commissioner and school board meetings on behalf of our medical society.

“What I learned is that we need more voices. We need to be louder. We need to be tougher and stronger,” Russo said, offering to get out his wrestling whistle to motivate physicians. “We need to take back control. This is our lane. This is our automobile. We know how to drive it, not the politicians.”

Give back to your community

Russo reminds us that as physicians, we all trained at top-notch, highly competitive universities. “We bring special skills and experience from these tertiary centers into our own communities. We must continue to recruit new physicians to meet the needs of the community,” he said. Consider precepting medical students or residents and taking newer doctors under your wing to show them the ropes and provide support. Russo also challenges physicians to serve the community outside of medicine. Volunteer work has been shown to lead to improved physical and mental health, and also allows us to be a part of molding the community we want to live in. “If we don’t do it, someone less qualified will,” Russo said.

Rebekah Bernard, M.D., is a family physician practicing in Fort Myers, Florida, and is the author of “How to Be a Rock Star Doctor.”