Why I Gave Up Practicing Medicine by Christine Tsien Silvers, M.D., Ph.D.; June 2011

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Every year in February we travel from Massachusetts to California so that my three young kids, Daniel, Steven, and Katherine, might someday remember their 94- and 96-year-old great-grandparents. "So, are you still a doctor?" my Uncle James cheerily asked in Mandarin.

"Well... yes," I stammered, somewhat dumbfounded. Had Harvard revoked my diploma during the thirteen months since my maternity leave for Katherine had ended? "Well, I mean, I'm not currently seeing patients, but I now serve as the Chief Medical Officer of a small company, which I could not have become without being an M.D.," I tried to explain, intermixing English with Mandarin.

Uncle James seemed bemused. "Na, bu shi zheng de yi sheng le." ("Then, no, you're not a real doctor anymore.")

For the record, when Katherine was born, I had fully intended to return to the Emergency Department (ED) as I had after my first two maternity leaves. Admittedly, the thought of taking 15 minutes to breastpump, in the midst of the organized confusion that working in the ED seemed to have become, evoked both anxiety and sadness. I didn't want to wean Katherine at three months, yet also didn't think my "average number of patients seen per hour" could take the hit.

Let's be honest: leaving clinical medicine had crossed my mind before — for example, at Hour 24 of pained wakefulness during Emergency Medicine (EM) Residency at Massachusetts General Hospital and Brigham and Women's Hospital. Later, while working in the community, I would sometimes sigh, proud and privileged to be able to help patients, yet nostalgic for less harried work. Those belligerent types yelling profanities, or the guy tired of waiting five hours and promising to sue everyone, those towering chart piles of could-be-critical yet still waiting-to-be-seen patients, the hallways littered with ticking-time-bomb, semi-stable admitted patients awaiting inpatient rooms... such moments, unfortunately not infrequent, definitely gave me pause. Five-digit medical malpractice insurance premiums also meant that for my first twentysome per diem shifts each year, I was paying to treat patients. My independent consultant work in my MIT dissertation area of "multivariate trend analysis," such as used in developing improved patient monitors, in stark contrast was not only rewarding but also accommodating—teleconferences could be scheduled between school drop-off and pickup, for example. Moreover, nobody was pressuring me to sacrifice my desire to be thorough in order to be faster.

One month into my maternity leave, I confided in a mentor. Here was his emailed response:

"Well Chris, it is very interesting to read your thoughts...YOU ARE NOT ALONE!!! A lot of people in EM feel this way... Actually, a lot of people in medicine overall feel this way. I work with a lot of physicians who have moved away from the bedside. They have done their stint in clinical practice, they have made their difference (and, trust me, in EM you've made a difference already...), but then moved on. No one can expect a sane person to still work in the craziness and irresponsible chaos (which we promote for profit motives) when one is older. I expect to eventually walk away from clinical work. Right now I have to keep working to make ends meet. But someday..."

Yow.

As my maternity leave too rapidly drew to a close, I felt increasingly convinced that perhaps I should hang up my stethoscope.

Then, as if the awaited sign, three days short of Katherine's turning three months, both our au pairs gave their two-week notices. (We had had one au pair per year for the two previous years, each of whom had worked out beautifully with our family, so having two au pairs simultaneously had been my brilliant solution for being able to more safely leave three young children for 12+ hours to work each ED shift.) Minutes after our childcare plans had imploded, while I was still flabbergasted, Daniel whispered, "Mom, I'm so sad you never have time to spend with us anymore."

The kids are now 7 years, 4 years, and 20 months. I have no regrets — not with the decision to become a doctor, the once daunting medical school loans, the arduous process of training itself, the stressful yet rewarding years caring for patients, nor the decision to leave the ED. I do wonder, however, how many other health care professionals find themselves with similar concerns. And if too many of us stop practicing medicine, who will take care of us when we are injured or ill?

About the Author

Christine Tsien Silvers, M.D., Ph.D., is a Board-certified Emergency Medicine physician residing in the Greater Boston area and is Chief Medical Officer of AFrame Digital.

Editor's Note

The United States has fewer doctors per capita than most other wealthy nations. The United States has a growing population, but growth in the number of medical schools has been very slow. Meanwhile a lot of new non-clinical jobs have opened up for medical doctors while simultaneously attitudes toward work while rearing children have changed for many MDs. It may be that we have dramatically underestimated the need for medical training in the U.S.

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