To My Friends in the Medical Profession

My dear medical friends,

Your industry is a nightmare administratively. I’m reading piece after piece about administrators and managers scheduling nurses sometimes up to six 12-hour shifts a week, understaffing the floors, and then telling them that even though there aren’t enough staff to take breaks and still manage the safety of the patients, they still have to clock out for their law-mandated 30-minute break. They are required to clock out before they’ve finished their tasks because they are allowed only so many hours of work, so they clock out and then finish their tasks because the tasks still have to be done. Doctors find themselves micromanaged in even the minutiae of their schedules, as if people who spent a decade learning their profession cannot be trusted to get their jobs done.  Not only are they micromanaged, but they are also overtasked, just like their RNs and other medical staff. I’m reading about people taking this kind of thing for decades. And they take it—they take it until they crack—because the well being of their patients is Priority One.

If I don’t stay, the patients won’t get the quality of care they deserve.

I wanted to make sure my patients were safe, and that was my number one concern.

I didn’t want safety to be a concern. I care about the patients.

So let me be blunt.

The altruistic aspect of your profession is being used both as cover and as a bludgeon against you. All of the political/administrative skullduggery that happens in every field gets the halo of “but we’re doing it for OTHERS.” And the workers get used and abused and overworked, but if you complain, you can be guilted precisely because you tend toward the altruistic in the first place.

Not all medical administrators are that way, of course, but even they fall into the altruism trap. And the ones who are that way appear to be a special sort of nasty.

The medical profession: where they weaponize your own virtue against you.

And seriously, my medical profession friends, you are so incredibly vulnerable to this that it hurts. It’s nature and nurture and training combining into a torturous combination.

I’m gonna ask you to do the one thing you’ve been trained against. The one thing that goes against your very nature. stand up for yourselves.

This is not another reason to feel guilty, another addition to your monumentally long to-do list. This is a reminder of how important you are.

You are the mother on the airplane who must put her own oxygen mask on before she puts one on her child. You are valuable. You are just as important as your patients.  We need you functional and whole.

We do not show that enough, especially in our insanely complex healthcare system that values process over people. We don’t have enough of you—of all things, we limit the number of residencies even as our population grows—and we ignore that this is the crux of our problem. So you work back-to-back twelves and do your paperwork at home.

Incentivize us to stop now, before you wear out, before you are irrevocably broken.

Again, this isn’t a guilt trip. It’s a plea. Tell your friends and family about your working conditions so that they can support you in improving them. Encourage your coworkers. Heck, go to HR when admin does the whole wink-wink, nudge-nudge on hours and clocking out. Don’t suffer in silence. Say no when you can.

I’ll get off my soapbox now and let you get back to your patients.


Update: Welcome, Instapundit readers.

I appreciate all the comments, folks. They add depth to my post.

For a great book on how we got to this point in health care, I highly recommend The High Price of Socialized Medicine by Dr. James Brook.


  1. Nitay Arbel

    Management that has never actually worked on the shop floor (or was “percussively sublimated” upward into management because they were doing damage on the shop floor) is the bane of so many industries, my own (academia) included.

  2. Jim

    Blame the AMA. It is a cartel that restricts supply to increase demand/prices. It makes no secret of this goal. And the AMA controls the working conditions of all the other medical workers. Hence shortages of doctors, nurses, etc.

    Lower the unnecessary barriers to entry and you will fix a very large part of the problem.

  3. Hal

    Correct in every respect. The best advice that I have been given by a more senior doctor is that I MUST understand that no one cares about me or my career except me. Years of experience bear this out. Trust no one. Pay off all debt. Save for retirement. Get out and move on with your life. There is almost certainly an army of consultants that specializes in manipulating doctors. Many people have all sorts of great ideas about how we should do our work and could care less about us or patients. We are no longer a profession. Previous generations of doctors sold us out and/or use and abuse new young doctors just like everyone else. Retiring from this disgrace asap. Might become a cpa. Mine sleeps at night and enjoys her work and has no emr, icd10, racs, auditors, etc etc. If you are thinking about med school do not unless you can get into derm or rad onc where you are still paid enough to get out of debt. A 4th year from my med school told me that three of his classmates killed themselves during the third year. There are not enough residency spots for all med school grads so if you are a weak applicant but still good enough to get in realize that you are there to pay tuition to enrich med school admin but you will not get the 250,000-400,000 dollars back if you do not match. Good luck paying it off without some training after med school. I was lucky when I went. Ten years later med school costs twice as much, approaching 70 grand yearly just for tuition, and you might not get a residency afterward! Awesome! Go to welding school or become a plumber. I could go on and on….

  4. Alec Rawls

    All medical care should be fee for service. Would bring price competition back and would end the exploitation that comes from channeling all medical services through insurance bureaucracies and government requirements.

  5. nwwrftgv2uo35

    Why not report abuses to government regulatory agencies? The bureaucrats like to wield power and justify their existence by persecuting for profit corporations. On rare occasions it is even in the public interest. Why not take advantage of it? (You can find out if the protect the identity of complainants before you make a report.)

  6. Micha Elyi

    I’m still wondering why there are more Catholic colleges and universities in the USA with law schools than ones with medical schools, nursing schools, dental schools, and even chiropractic schools combined.

    Says a lot about priorities, doesn’t it?

  7. Michael Smith

    You are damn right medical professionals should stand up for themselves! All human beings have the absolute right to exist for their own sake, neither sacrificing themselves to others or sacrificing others to self.

    Thomas Jefferson:

    “. . .that all men are created equal, (and) they are endowed with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” That’s right, the pursuit of ones own happiness!

    More Jefferson: ” . . the light of science has already laid open to every view the palpable truth that the mass of mankind has not been born, with saddles on their backs, nor a favored few booted and spurred, ready to ride them legitimately, by the grace of god. ”

    Man is not a slave to the needs of others! Stand up for your right to exist freely and by the direction of your own, best rational judgement!

  8. Nate Whilk

    Ayn Rand wrote about the extreme end point of all this in “Atlas Shrugged”. Dr. Hendricks is speaking:

    “I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce.”

  9. Anon for this

    Excellent post, but I do not agree that going to HR is good advice in these situations.

    HR works for management, not you. Their sole function is to enable management to do whatever it wants to do without QUITE stepping over any line that will get them in legal trouble. To them, you are just a “resource”, like a piece of equipment, or a dairy cow, or a mountain full of coal waiting to be strip-mined and abandoned. Heck, it’s right there in the name!

    Many have learned this lesson the hard way.

    If it comes down to it, go to your own lawyer — one that you are paying, and who works for you.

    1. Dawn Smit

      That may explain why, in what I’ve been reading, every single time a person has been asked, “Did you go to HR,” the answer has been, “No.”

      One person even mentioned coworkers who did go to HR having a target on their backs.

  10. Dawn Smit

    The whole situation makes me hope that more medical professionals will find their way into the Direct Primary Care/cash-pay side of the medical industry. It’s still small, but it’s our last, best hope for saving health care.  The perceived risk is high; new doctors fear they won’t make enough to cover their debts, and established doctors fear losing the lion’s share of their patients. Nurses and other medical professionals must enter the field under a doctor, which limits their options. But on the other side of that door is freedom. And freedom lets you control your own hours and requires a lot less paperwork.

  11. Dawn Smit

    I saw a lot of great comments on Instapundit and had to share one from Man in the Middle: “It’s important to know what you are willing to walk away from your job for. And interestingly, once I decided that, and my boss knew it, I was never again pushed anywhere near that limit.”

    This is key.

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