Force Multiplier: Keeping Physicians in Healthcare through Hybrid Careers
Written by Melissa Schenkman, MPH, MSJ
If you’ve ever lived through a natural disaster like a hurricane or tornado, then you know that the uncertainty and chaos can be beyond daunting. And if you’ve just seen the photos of a storm’s aftermath on the news, the mark of humanity displayed on survivors’ faces is inescapable.
As an emergency medicine and military doctor whose bread-and-butter is uncertainty and chaos, COVID-19 still brought many unexpected challenges for Caitlin Delaney, MD.
“I think for those of us on the frontlines there has been a true mix of emotions since 2020 —from shock at this entirely new disease-causing pneumonia and oxygen saturations at 60%, to fear we would bring the disease home to loved ones, to relief upon the vaccine rollout, to heartbreak watching unvaccinated patients still die,” she recalled. “It has been a front-row seat to a lot of what most were trying to evaluate the news for.”
As the pandemic rolled on, she recalls a palpable feeling that the patient’s anxiety, stress, and frustration were increasing.
“Even as people were encouraging us with ‘healthcare heroes’ signs, there was increased violence against staff, berating of nurses and doctors, and increased demands from patients especially as it was harder to get care elsewhere in the medical system,” Delaney said. “A woman tapped me on the shoulder while I was running a code to ask when I would see her husband. She could see that CPR was in progress but said ‘that’s not my problem.’”
“It was hard to witness man’s inhumanity against man as people got more stressed and desperate,” said Delaney who served in the US Navy during the battle against ISIS.
And just like it’s impossible to not let the threat to life a natural disaster brings reshape the Earth’s landscape, so too, has the pandemic created an indelible wound on the hearts and minds of many of our healthcare workers.
“Though the pandemic seems to be transitioning to more of a steady endemic, the effect on the healthcare system continues. Patients had to delay preventative and chronic condition care and there is a backlog of appointments; they are sicker. Mental health and substance abuse have increased. Supply chain issues persist, and staffing issues are worsening,” Delaney said.
“There is loneliness in the rest of society not understanding that even as COVID fades, we are not the same people as we were a few years ago,” she said, knowing from firsthand experience. “Pre-pandemic, we also had a broken system, but it relied on the heroics of the workers to provide good care. Now the workers are suffering from moral injury or burnout, and we are losing them.”
Delaney calling home to her family early on in the pandemic, wearing her N95. Due to PPE shortages, it was not the size she had been fitted for.
A World with Fewer Doctors
This is not alarmism, Delaney tells me, it’s reality, and the data are extremely concerning.
Two-thirds of nurses are planning to leave in the next three years on top of a current nursing shortage, and 60% of physicians report experiencing burnout—something that’s not compatible with a long-term career.
Delaney called home to her family early on in the pandemic, wearing her N95. Due to PPE shortages, it was not the size she had been fitted for.
“When you order a life-saving treatment for a patient, like antibiotics for someone with sepsis (severe infection), and there are literally no available nurses to carry out that order for hours, that’s bad, life-changing bad, because we know that increases mortality,” she said. “I like to run towards the biggest problem and for me, keeping our workforce healthy feels like it right now.”
A physician shortage would be devastating for our healthcare system.
For starters, it could increase inequality. Some will be able to pay for doctors, who increasingly are turning to direct primary care to practice medicine without interference from business in a way that decreases their moral injury. Others will not, and may be cared for under a different standard by those trained via rapid-degree programs, she fears.
Challenges that already occur will be made worse, and that’s happening now, she said. Doctors stretched too thin will have difficulty communicating with their patients, shorter appointment times, a real need to adhere to only one complaint per visit, and push back other patient concerns.
The result: an increasingly challenging way to deliver care that adds insult to injury.
“I’m worried this problem will snowball. We have to figure out how to decrease moral injury for doctors, and at this transition point in my career, I’m thinking about that a lot because it can happen to anyone” Delaney said.
The Big Problem
No matter how long doctors have been practicing medicine they are susceptible to acute moral injury—something not well tolerated even once.
Delaney’s past life in the military gave her some insight into moral injury (see part 1 of Dr. Delaney’s story in our series) and also the importance of a “shipshape,” (a Navy term), medical system. She said the military is very protective of the well-being of their medical personnel, particularly in combat.
Delaney (center left) with her Navy medical and Army aviation colleagues at their forward base in Iraq.
“If they’re gone, who will take care of you? You do not want to be on a base without access to people skilled in resuscitation and damage control surgery, just in case,” Delaney said.
There is a lot of respect for medical personnel, but it isn’t necessarily special treatment, she tells me. “It’s very obvious how important we all are to each other in that environment. Some of our colleagues are shooting the bad guys before they get to us, others are feeding us or restocking us or keeping the base clean,” Delaney said.
“Society’s understanding that their survival may hinge on the wholeness of their medical personnel someday is more dilute.”
Her unique insight into moral injury and all the devastating implications a doctor shortage would bring sparked her decision to run towards these problems so she could make the most impact.
Bringing the Clinical Voice to Business
What was your last interaction with the healthcare system like? Odds are it wasn’t positive, she tells me.
“Now consider that doctors and nurses are interacting with that same system every day multiple times a day — and also sometimes as patients themselves because they are also humans,” Delaney said.
It made her start to think about how technological innovation could help improve care. So, she took a class on Leading Health Tech Innovation, studied healthcare economics and incentives, and started meeting people across the healthcare landscape.
“I was heartened by the fact that I met so many smart people trying to fix the problems, but found that if they did not have a clinical background or someone on their team with one, they inevitably had gaps and misunderstandings,” Delaney noted.
So, she signed up for multiple consulting platforms to share insight from where the rubber meets the road, patient care. One was flipMD, a start-up that took off and was acquired by GoodRx earlier this year, one of whose mottos is “doing good for those who are doing good.”
flipMD was special among the consulting platforms because it was the only platform she found specifically for physicians. It was founded by Greg Hanson, a radiology resident at the time, and his wife Lauren Hanson who is the CEO, as a way for physicians to find side gigs.
“I saw in it a way to give physicians more sustainable careers by giving them true rest from clinical medicine when they were engaging their brains in something else, encouraging them to be creative and curious, and helping them become financially free – and feeling less trapped by the average 200k in medical school loans. And very importantly, they can work on addressing the healthcare system problems that lead to their own moral injury,” said Delaney, who now is the Director of Business Development & Medical Advisor at flipMD.
She has continued to work clinically even while in a new full-time role, with 3-4 shifts per month in the emergency department.
“For me, having a hybrid career with clinical and non-clinical work was the right choice. When I’m on shift, I see problems affecting patients and feel like I can actually do something about them – talk to this person, reach out to these companies, connect these people – instead of just feeling crushed,” Delaney said. “My creative brain is engaged, and I do not feel powerless. I realized that having this balance would create a sustainable career for myself.”
Living the Millennial Way
As a member of Generation Y, Delaney believes that having a millennial way of thinking about careers helped her to not feel trapped.
Delaney and her husband, CPT Mike Delaney, who was also deployed in Iraq at the same time as her, but at a different base except for a two day period.
She has wanted to be doctor since she was 8 years old, but she feels that her real ‘job’ on this planet is to be true to her values and use her knowledge and skills to help others, and she also knows she’s capable of acquiring new knowledge and skills.
“You are your values not your titles or accomplishments. A lot of us have the same goal to be good to people and make a difference in the world, and there are many ways you can do that which are in alignment with your values. You aren’t stuck. “
Millennials can be unfairly portrayed as being too touchy-feely or too individualistic.
However, in reality, it is these very qualities that are going to help her and other millennials both inside and outside of the healthcare industry move the needle on what a fulfilling career can look like and how to stay mentally healthy after the numerous challenges our generation has faced in adulthood, the COVID-19 pandemic just being one.
“Millennials are one of the drivers of the Great Resignation and the gig work revolution, and champions of lifestyle design,” Delaney said. “To be clear, I think we have to be so thoughtful about how these effect health care. Doctors need many hours of training to develop certain skills for instance, and to maintain those skills. And we have to keep enough doctors at the bedside for the sake of patients.”
She often thinks about what would happen if every doctor switched to a hybrid career. “I do worry about the loss in clinical hours that it would create. However, with the current state of the healthcare system, amount of moral injury, and numbers we are seeing about physician plans to leave or change jobs, I think we have a shot at actually increasing clinical hours,” she said. “Also, physicians at the bedside will have better mental health and more energy for patient care.”
She shared that while a cultural phenomenon is occurring, the concept of physicians with diverse interests is actually not new; it actually marks a return to the old way of medicine, the age of the physician polymath, when physicians were not seen as interchangeable parts of a business model or merely employees.
With flipMD, so named because it aims to flip the script on physician careers, she said physicians can try out consulting even on top of their full-time careers, or as part of a hybrid career.
They are able to see a physician only job board of both clinical and nonclinical jobs across the country so they can find a good fit for them, within a trusted physician network. The platform also offers a robust referral program if you know a friend or colleague who is a good fit for a certain job, she noted.
“Our most important asset in care fields are the people that are holding it together, so we have to treat them as people. Our narrative has to change from ‘patient first’ to ‘patient AND staff first’ because the staff has to survive to care for the patient another day,” Delaney said.
“That’s entirely possible to do. A lot of great businesses operate that way. We have to let doctors be the captains of their own ships. Let them design a career and a life that works for them so that they can take the best care of you.”
This story is a part of YMyHealth’s COVID-19 Stories from the Field series. We will continue to share personal stories from millennials who are essential workers, caregivers, and those close to them, as long as the pandemic continues.
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