By Steven Reames, Executive Director, Ada County Medical Society
Last month, US gymnast Simone Biles turned in comparatively sloppy performances during her qualifications at the Tokyo Olympics. After not sticking her planned vault, she suddenly withdrew herself from the team all-around competition. The world was stunned and some were outraged. She had experienced a case of the “twisties” or “yips,” a sudden and inexplicable loss of air balance awareness. It was downright dangerous for her to continue in the team competition, but her departure enabled the Russian Olympic Committee athletes to win the gold in the event.
For an elite athlete who shares the title of Most Decorated Gymnast of All-Time, it was a shocking move. She was called courageous by many and criticized as a quitter by others. Stating she “felt the weight of the world on her shoulders” and the pressure of the Olympics, she wrote:
"I say put mental health first. Because if you don't, then you're not going to enjoy your sport and you're not going to succeed as much as you want to. So, it's OK sometimes to even sit out the big competitions to focus on yourself, because it shows how strong of a competitor and person that you really are — rather than just battle through it."
Biles is not the first high profile athlete to have begun championing her own mental health rather than bowing to the world’s expectations laid on her. She cited tennis star Naomi Osaka who had withdrawn from the French Open and Wimbledon earlier this year for similar reasons as an inspiration. Even Michael Phelps, who holds the most Olympic medals in history, has been forthright about his challenges around perfectionism, depression, and suicidality.
While not all fans and commentators are indignant, some are uncomfortable seeing the veneer come of the mythology of the perfect performance of a human being. We have elevated these superhuman titans of natural grace wedded with focused discipline to pedestals where they are not allowed to step down from without our consent. When they do, or when they fall, suddenly we do not know how to cope with their limitations.
Does any of this sound familiar?
It should not be news to any here that the unrealistic demands on physicians is also not sustainable. We have been watching the medical workforce begin to collapse over the past 10-15 years under the weight of administrative burdens, employer productivity requirements, consumer and market demands, and no time to really be present with patients or colleagues. Add to that the wave of Baby Boomers retiring, and then, of course, COVID.
Last week, I spoke with a local physician leader, who is very concerned about the number of timebombs set to go off in the near future in his medical group. Unfortunately, he does not even know who they are. “What are we doing proactively to reach out to these physicians and get them the support they need so they don’t crack?” he implored, pounding on the table.
I inquired about employee retention, and he said, “We’re bleeding out medical assistants, LPNs, and RNs.” The influx of newcomers to Boise is heavy on retired professionals, who aren't necessarily coming here to extend their career and low wage workers can hardly afford to live here anymore. With less support in the clinics and hospitals, it is not difficult to predict the train wreck coming as physicians and APPs take on even more burdens.
While some older physicians scoff at the generations of doctors that follow them and say they show "a lack of productivity, commitment, and fortitude,” younger physicians simply aren’t having it anymore. GenXer doctors watched their parents sacrifice to advance their careers (some as physicians), only to be chewed up in favor of corporate profits. While they share a strong work ethic that mimics their parents’, they also form an understanding bridge to the Millennial workforce which has vastly different expectations of work-life. But with staggering medical school debt loads and feeling no room to negotiate, the dissonance between their career hopes and aspirations and reality is likely to become a cacophony.
GenXers who are now moving into C-suite leadership and middle management may play a huge role in starting to address these issues. For one, they are trying to embrace a real acceptance of and commitment to supporting the mental and emotional health of their lead stallions. But they are also going to have to focus on giving back the autonomy to doctors that their training affords. They must relieve them of ridiculous paperwork and red tape in the provision of excellent patient care. And while not digital natives, they recognize the need to reshape EHRs that would actually make meaningful use of a doctor’s workday without intruding on family time.
These types of changes could provide a pathway to a healthy and optimized workforce, under which circumstances, I have no doubt they will continue to lay down their lives for their patients. But given the current environment where physicians are treated as any other production employee, why should they?
