“Now that I have my own clinic, many of the frustrating aspects of practicing medicine are gone,” Jodi Ritsch, MD, a family medicine physician in solo practice in Menomonie, Wis., told MedPage Today in response to the question “What frustrates you?”
“In Wisconsin, family physicians still deliver babies. I practiced for 15.5 years at a large multi-specialty clinic. For 11 years, I was on-call 24-hours a day for my pregnant patients. I really loved it, but I completely burned out. I have a husband and four kids, and I was missing more than just sleep. So for my 40th birthday, I gave myself the gift of giving that up but then I missed having real relationships with patients,” Ritsch said in a phone interview with MedPage Today.
Here’s what else she said:
My daughter said she wanted to go into medicine. And, I had worked with students and a life-coaching client who was thinking about applying to medical school. But, I couldn’t endorse medicine as a career path.
I had a hard time telling people that they should pursue their dream and go into medicine. I realized what a big problem that was. And, at that point, I knew I had to make a change. If I’m living something that I’m not willing to endorse for anyone else, I have to make a change.
I kept trying to make things better where I was working; trying to make a difference. I became the medical director of employee wellness. I thought if I felt like I was making changes in a big system, then maybe that’s where I was supposed to stay.
But I felt like that role was just a figurehead position. I realized that I wasn’t going to be able to move the ship, and that I was going to have to go out on my own little inner tube in the ocean.
So I jumped ship.
After a little less than a year at my own small clinic, I recently went with my daughter to an orientation for a summer doc-shadow program, and I realized that I do like medicine again, and I could get behind her desire to pursue it as a career. That felt like real progress in a short period of time.
I can only speak from my personal experience. But, it starts with all of the debt you take on. Then you begin to feel like you’re the only one who can take care of your patients’ needs.
I used to feel that way with my pregnant patients. When I finally let go of that idea, I saw that people did just fine. The world continues to spin.
I realized that it’s better if I’m in a good place and only taking care of my patients half the time versus being there all the time in a sort of martyr situation.
Stress comes when demands outweigh resources, and when you have lack of meaning, or lack of control. You have that trifecta in health care right now.
There have been times in my career where I felt that I was doing everything that I thought I had to do and should do, but none of that seemed to coincide with things I wanted to do.
There’s a twisted badge of honor in being super-busy. It’s not exclusive to doctors, but it is amped up in medicine. For some reason as a culture, we think it’s really important to be spread thin. As though, if you’re totally stressed out, you’re doing a good job.
It’s all perception though. If people feel like they’re in control and heard by others, then they’re less stressed.
Most of us go into healthcare because we really want to help people. If we feel like we’re not helping people because we’re tied to the computer or we’re tied to the paperwork sitting on our desk, it loses the meaning. We begin to ask, ‘where is the purpose in this?’
This can be especially tough in primary care, because it’s rare to have a definitive outcome. There aren’t really endpoints with diabetes and hypertension.
I really believe in a lot of the quality measures in medicine. But in certain areas, it’s gone so far, there’s no room for the human factor. Diabetes doesn’t walk into my office. A person walks into my office.
New Practice Model
Direct pay clinics provide a method for removing a lot of the loops of complexity that cause many of the issues in the bigger organizations. Right now is good timing for this model, too.
There are a lot of people that are in a crunch now with no insurance or new high deductible insurance plans. Patients are more in-tune with the costs rather than just paying their co-pay and being kind of oblivious to it. Not many people have “good insurance” where they don’t have to worry about the cost of visits.
Patients pay me $100/visit and we decide together what needs to be done, if they want to spend money on lab tests, and we get to spend much more time together. They leave happy and feel empowered.
Technology in Medicine
Unfortunately, when you’re in a big system, a lot of the times technology is working against you, because they’re tying to make the technology work for everyone, and then consequently it works well for no one.
When you’re in a small or solo practice, you can pick the technology that is the best fit. That way it can be used to the fullest, and make the encounter better rather than having the provider spending all of their time on the computer.
You can mess things up more by not knowing the energy you bring into the room. If the doctor is stressed out because he or she has 800 tasks to do, that are not necessarily enhancing the encounter in any way, and then that stress infringes into the patient encounter, all of a sudden the patient will become more stressed.
I like to reverse that spiral by being a joyful doc, staying balanced and bringing more peace into the visits to promote healing.