Idealism inspired post-pandemic health care careers: caveat emptor - STAT

Health care workers facing notoriously difficult work lives and high levels of burnout were some of the brightest stars in the U.S. over the past year.

Stories about how they went above and beyond to deliver care to their patients during the Covid-19 pandemic — providing drive-thru and virtual primary care; triaging patients in parking lots and tents; reusing personal protective equipment while working to save lives in emergency rooms and intensive care units — made lasting impressions on Americans of all ages.

Are such stories nudging more young people to choose careers as health care professionals? Maybe.

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Applications for 2021 admissions to U.S. medical schools increased 17% over last year, a larger increase than in previous years. Applications to nursing programs also increased. Many individuals who want to become doctors or nurses are idealistic. Post-pandemic careers as health professionals may blunt that idealism, or even extinguish it.

Although much of what I describe here affects nurses and other health care professionals, I’ll focus on physicians. That’s because I study doctors. I have also worked alongside them, written books and research articles about them, know a lot of them as colleagues, and understand them well. Medicine as a profession continues to suffer from high rates of burnout, career regret, suicide, and substance use disorder. As might be expected, physician burnout only got worse during the pandemic year of 2020, and increases in many of these other negative outcomes will likely follow suit. While acts of physician heroism are real, the fact remains that high numbers of doctors find themselves never having enough support, resources, or control to do their jobs in ways that leave them satisfied, energized, or happy.

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All too often, physicians’ heroism comes from being left by their employers to fend for themselves, or from trying to be the kinds of caregivers patients want in health systems that won’t let them do it.

Many health care organizations and the government continued their poor treatment of doctors over the past year, when in fact they should have been doing the opposite. Too many health care workers were put at unnecessary risk in their jobs with insufficient protection against Covid-19. Many doctors had their concerns about safety ignored, were given crushing workloads, had their support staff cut, and were victims of short-term financial decisions that affected their ability to effectively do their jobs.

These realities existed before the pandemic. But the pandemic made them worse. That so many doctors performed at a high level anyway is noble and uplifting. But we should view this past year, outside of the heroism appeal, as further evidence for why becoming a doctor is a higher-risk career decision, at least right now, in the health care system we have.

As long as the health care system does not care enough about putting physicians in positions to succeed, doctoring remains a decision most young people should think very carefully about before pursuing. Idealism by itself is not a sustainable motivator these days for choosing this career. It is too demanding a job and has too many opportunity costs, including significant personal investments of time and money, on average several hundreds of thousands of dollars and up to a decade of a young person’s life.

Many begin to understand the disconnect between the fantasy and reality of a career in medicine during medical school and residency, and may quickly begin to lose whatever idealism they have. For the near future, some will bring to their training even greater pandemic-inspired idealism, which could generate higher expectations for what a medical career can bring in the way of personal reward and contributing to society.

These expectations will not be met easily in dysfunctional health care work settings where doctors face great disruption to their work over the next decade, disruption facilitated mainly by large corporate health systems and retail-oriented companies bent on transforming care in less physician-centric and more technological ways. These stakeholders have been empowered by the pandemic’s forced emphasis on getting care to people in whatever ways possible, even if it means bypassing physicians or making their workdays more hectic. Telemedicine is but one recent and growing example of a positively pitched disruption that has numerous negative implications for physician autonomy, satisfaction, workload, and job discretion.

Personal traits like resilience, flexibility, and pragmatism can help some individuals navigate the significant downsides of a career as a physician and deal with changing job descriptions over time. Those qualities are the ones that need to be nourished in medical students and residents to make their choices ones they will embrace and not regret.

Medical schools and the medical profession should not congratulate themselves for seeing a dramatic one-year rise in applications and what seems like a renewed interest among young people for becoming doctors. Instead, they should move quickly to better prepare recruits for the types of challenging circumstances they will face once they are practicing medicine in the real world. Time is of the essence.

The pandemic should offer all sorts of opportunities to improve the way health care is delivered and to make the lives of physicians, nurses, and other health care worker better. But if it’s business as usual moving forward, and health care professionals are still asked to do too much with too little in return, the soundest advice to those thinking about becoming a doctor, nurse, or other health care worker may be caveat emptor.

Timothy Hoff is a professor of management and health care systems at Northeastern University in Boston, a visiting associate fellow at Green-Templeton College, University of Oxford, and author of “Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health” (Oxford University Press, 2017).

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