Demoralization

I have been a physician for 24 years. I have been a fierce patient advocate throughout my entire career. It never occurred to me that physicians do not have the same rights of citizenship that the very patients I fight for do. I always thought I lived in a democracy. Medicine is not what it used to be. Articles relentlessly speak of physician burnout as though we are responsible for what is happening but that could not be further from the truth. Other articles look for causes like the EHR (electronic health record). The problems are not the hours we put in – that we signed up for – starting with third year of medical school every physician got used to sleepless nights. Every physician has been through call and what post call days feel like. Regardless of specialty, somewhere in training there was sleep deprivation. That is not the source of burnout.

It is the progressive demoralization of our hard work to attain our degrees and position. We worked 80-100 hour weeks in training absorbing as much knowledge as we could, because we knew we were responsible for someone’s life, and after training we would be the final person in charge. That responsibility weighed heavily on us. We wanted to make sure we were optimally prepared.

Meanwhile, businessmen and women invaded medicine. People with no training came along and decided to tell us what we could and could not do. Though we had years of training, these people, essentially practicing medicine without a license, following some arbitrary protocol on a screen in front of them, would deny the medications and procedures and referrals to colleagues, we, with our training, felt necessary. 

To add insult to injury, legislators have jumped in, also practicing medicine without a license, and codified recommendations into law. Thus creating an atmosphere of fear on top of the demoralization that has already occurred. Boards of Licensure in Medicine (BOLIM), feeling a need to “protect the public”, yield a heavy hand against any such infraction they can find. Mind you no due process exists with licensing boards and no one oversees them. What used to be a process of correction has become so punitive and arbitrary that entire careers of good, caring physicians have been ruined.

This is not burnout. This is moral injury. This is the denigration of an entire profession. No other higher level degree profession is put through this kind of scrutiny and questioned at every turn. Demoralization compounds when those who have been through BOLIM processes get dragged through the press – and when BOLIMs continue their onslaught and family ask what you did to deserve this – as though you had to do anything.   Even physicians whose complaints are later dismissed find themselves branded when they apply for positions as this information is readily available.

When a BOLIM receives a complaint, they ‘investigate’ it. They act as investigative and adjudicatory arm. They are the investigator, jury, judge and executioner. There is a huge amount of subjectivity to the process and personal animus is clear. Watching careers ruined has given me a new purpose. This is happening all through the country and needs to stop. Physicians are a balance of empathy and scientific inquiry  – the persistent attacks are designed to kill – to demoralize, punish and drive physicians to harm. That makes these licensing boards not only operating outside the law but actually culpable. Driving physicians to suicide is murder.  Misusing psychiatry, the press to achieve these ends, violating right to privacy that everyone else in society has, violating right to due process, all of these together make them arms of destruction, bodies of harm – not bodies of protection and they should be held accountable for this harm.

To fix this will take a multi pronged approach.  We need to scrap the current State Boards of Licensure in Medicine and start over. Physicians deserve an open, fair process. We deserve to be innocent until proven guilty. Not every complaint deserves an answer. There needs to be screening. Lay people have no business being on these Boards as there often needs to be careful consideration of complex medical issues.  Physicians, like every citizen, deserve due process.  Too many physicians have been harmed. 

-Cathleen London, MD