Doctors did not sign up for this

Health care workers face significant rates of burnout if our system is not fixed soon

Without meaningful systemic change that focuses on primary and preventative care and stops using the emergency room as a safety net, we will have generations of doctors that will burnout at an irreplaceable rate

“You signed up for this.”

When we took that oath and committed to a life as physicians, we knew that it would change us. We knew that we would carry these patients with us for the rest of our lives; that this sacrifice would be balanced by witnessing the best and most rewarding outcomes of our efforts. So much has changed.

I first decided that I wanted to be a doctor because it combined my love of human science with the ability to make a positive impact on people’s lives. In medical school, I enjoyed every rotation I was assigned, but it wasn’t until my emergency medicine rotation that I felt at home. The mix of acute medicine, varied patient presentations and thinking on my feet drew me to this specialty. Naively, I thought I understood what it took to be a doctor and what it would take from me.

In my first year of residency, I witnessed my first true trauma. Not the physical injury kind, but the kind of devastating patient death that sticks with you for life. I was rotating through as an internal medicine resident, doing a consult in the ER, when one of the attendings pulled me into a resuscitation room. The patient was in their 20s and had suffered a cardiac arrest from severe asthma. I stood there, did what I was told, and witnessed an entire team do everything they could to try to save this patient.

The agonizing sobs of the patient’s mother still echo in my brain today.

Through my career, there have been dozens more cases like this; ones that leave us feeling helpless and hollow. Patients where using every life-saving treatment medicine has to offer still isn’t enough. The young pregnant patient with a cardiac arrest from severe COVID pneumonia, where the obstetrician had to come down to the ER and perform a 30-second C-section to give both patients the best chance of survival. The law enforcement officer shot and killed by a civilian. The six-year-old with a blood infection so severe that putting them on a machine to pump blood and oxygen for them wasn’t enough. The mother of three with an unexpected heart complication that left her family without a mother.

After each of these cases, we take a couple of breaths, and get back to work. There is never enough time to truly process the trauma.

We compartmentalize and push things down to the depths of our souls, chipping away at ourselves, each time emerging as a different human than we were hours before.

Between the moral distress of the COVID-19 pandemic and new heights of overcrowding in the ER, that delicate balance has crumbled.

Now we see even more devastating patient circumstances, have to further compartmentalize trauma and endure endless moral injury. There is no more joy in the work that we do. This work — it breaks us. It makes us numb to everything around us, at work and outside of it. Slowly, we become shells of who we were when we started this journey. The last few years have changed us in ways we could have neither anticipated nor been taught about. This is what we have been forced to become in order to survive.

This is not what any of us signed up for.

Most of all, this is unsustainable. Without meaningful systemic change that focuses on primary and preventative care and stops using the emergency room as a safety net, we will have generations of doctors that will burnout at an irreplaceable rate.

Every Canadian needs access to a family doctor. Governments need to step up and commit to doing what’s right for the system, instead of focusing on Band-Aid solutions. We need a true understanding that the best patient care is care in the community, and that in part, hospitalization for preventable illness is a failure.

We must stop failing our patients and our doctors. Our system needs governments at all levels to sign up for real change.