Why I left my job as an Orthopedic Trauma Surgeon

Medicine is a complex system, which can consume you faster than you know. It doesn't matter on which side the consumer or provider it swallows you, if you're lucky you save yourself before it's too late. It's a system with no regard for the individual, despite many articles, academic aristocrats saying otherwise. The patient is the goal. But it also the means, the sacrifice, the currency, the collateral...

I am lucky, I saw through the veil, through the hidden handshakes. And for the sake of my health, my family and my future clients, I made a choice to follow my own path. That is my philosophy: adapt, improve, create.

But let's dissect some of the reasons that ultimately contributed to my choice to leave a secure job in a public hospital.

Unsatisfied personnel

In the last few months, I rarely had the privilege to talk to someone, who was satisfied with the job or was happy to have a job in the hospital. The paycheck was low. Patients and relatives were frustrated and angry on a daily basis. Every week the workflow was dialed to the max. The nerves were tense like string on a guitar, but the melody was not pleasant. But the leadership was blind to the fact that this was the new „normal“. They were also pressed to fulfill the year's quota and to juggle with the personnel that they have. Which lead to...

Many nurses and support personnel quitting their job

Those who had enough found a job either in a less burdened environment or in a completely different field. Those who could not leave their job, because of their financial situation took more sick days than usual, which left more work hours to the others. Entering a vicious cycle, which will continue to the collapse of the system.

A system of quotas and numbers

In our country it was determined by the only state insurance company, how many doctors visit and how many procedures can be done within a year. So the hospital stopped some procedures or ambulatory visits at the end of the year, because if they did more than they were allowed to do, the surplus of procedures would not get paid by the state insurance. This resulted in more relaxed work space at the end of the year in some areas, but ultimately it all came back, right after new years eve.

Most surgeries are unnecessary

After doing, assisting, watching thousands of operations you get a sense of what is difficult, who can operate well, which surgeries are urgent and which are ego boosting surgeries.

Yes for some fractures you need surgery otherwise your limb will not function properly, yes if your vessels are ruptured and you are bleeding uncontrollably you need immediate surgery, yes also various acute abdomens need immediate surgery.

But bariatric surgery, joint replacements, diagnostic arthroscopies, any kind of elective surgery which can be replaced by lifestyle changes are unnecessary.

Also doing elective surgery in patients with multiple diseases increases the risk of complications. It seemed to be the rise of complications that I only noticed by myself.

I was not in control of patient care

I admit as a doctor you don't see your patient as much as other personnel. Most of the time surgery is the easiest part of the whole treatment. Patients with fractures need pain management, they need physical therapy, they need the support from relatives, they need good instructions and information about their condition. If you have personnel who are always in a hurry, who have no time for instructions, who need to prepare for the next patient, because they're pressed for time. Also follow-up outpatient visits are only a few minutes again, always in a hurry, because the next patient waits for his turn and the next one and the next one...

Without commitment from the whole team, without taking the time to engage in a conversation, noticing subtle changes to prevent complications it is only a matter of time that is coming back as a tsunami.

Ego battles

Doctors have huge egos. They sacrifice their 20's and 30's, building, establishing themselves in a workplaces were hierarchy is sacred. They endure insults, abusive behavior, sometimes backstabbing, sleep deprivation, little family time for their goal to be a great expert, to be respected by peers. Seniors shall be respected, junior are the workhorses. Sadly, that's the deal. First of all, not all are the same, but one or two bad apples and the whole basket goes bad. If your emotional intelligence is not zero you quickly recognise who to follow and who to ignore. But the problem is that the bad apples are most of the time very loud. They don't like innovators, they don't like out of the box thinking, because they established their career on brittle foundations and are blind to research that proves them wrong. Also there are no sanctions for those kind of people, we were all paid the same, little to no extra pay for the diligent. At one point you ask yourself is it all worth it.

My philosophy changed

Many doctors have the messiah complex, they want to save everybody. That results in prolonging someone's life for weeks despite him being in pain, living 90+ years, and has no outlook for a full life. But our watch nobody should die. Yes, that is one extreme. But you see it everywhere. Patients coming for a sprained ankle, just to be sure it's not broken. Heroically jumping out of ER, when the sprain is confirmed. You can only help people who want to be helped. Most people don't want a doctor's opinion, they want a doctor's confirmation of their opinion. They already know which treatment will satisfy them, despite giving good reasons against. Most of the time you just give in, because it is not worth the effort to move mountains. Also my reading material made me think that there are all kinds of different options if someone is willing to put in the work.

So here I am finding a place on the interweb. Doing my own research, setting my own work day. Away from a hostile environment for the body, soul and spirit. Do we need hospitals? Yes. Is the current system functioning efficiently? Absolutely not. Is there a lot of money involved in healthcare and it will take a lot of effort to change the system? Yes, but the more people do it, the easier it will be.We need a paradigm shift. Chronic matters should be managed outside the hospital. Elective procedures should not be the norm. People should be health conscious.

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