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OK, I quit!

Im tired of beating my head against the wall in a healthcare system that believes that its most valuable resource, the healthcare professional is indiscriminately disposable.

Lets face it; nurses have the hardest job in healthcare today. Hours are getting longer; job duties now include public relations, maid services, complaint resolution, cryptography and social work. Nurses are absolutely abused by the very hospitals that are in desperate need of nurses now and will soon discover the true meaning of the phrase nursing shortage.

The baby boomers are aging and the current generation of healthcare professionals is aging with them. Healthcare needs more geriatricians, those physicians who specialize in the care and treatment of patients over 55 years of age, but as our physicians age, we will need more not only to replace those retiring, but also to participate in disaster care.

Im a geriatrician as well as emergency medicine and disaster medicine and Im out!

Ive taught medical students and residents; given my specialties it will take 3 of them to fill my shoes. The problem is that most medical students are now gravitating towards the high pay, low stress, low time demand specialties. Surgical, Pediatric, Obstetrical, and Primary Care specialty residencies are closing for lack of applicants. In short, there is no one to fill my 3 sets of shoes.

Now I am not prone resigning from the field of battle. Ive earned multiple degrees and multiple certifications. Ive worked at the scene of many disasters at all levels of care. Ive served every deployment to the end regardless of personal or professional issues that may have arisen. But enough is enough.

I have recently seen healthcare take a turn that is not only unprofessional, but immoral and unethical. Money has always been a necessary evil in healthcare and I do not mind making a very comfortable living in medicine, but when outright extortion determines care, staffing and caregivers available, the stench of the system has become too great to stand.

I am not alone. I have spent the past several weeks with healthcare professionals from around the nation at a number of venues. The recurrent theme, they quit or are in the process of phasing out. Physicians are willing to spend well over $5000 per weekend for seminars on Alternatives to Clinical Practice but whine about spending less than $500 for continuing medical education. Programs in law, business and research aimed at nurses are full across the nation. None of these professionals are planning on returning to the healthcare industry after they graduate, they plan on non-healthcare careers.

Why are so many leaving? The same reasons I am, because our focus is no longer healthcare, its money. We are no longer partners with those who run the business side of healthcare; we are their opponent or their victim. Problems are no longer discussed; the business people mandate a specific solution and the healthcare professionals are expected to comply.

The latest odious trend is policies that state that an individual nurse may NOT determine that he or she is in a patient care situation that endangers their license and the life of those for whom they care. This is absolutely contrary to basic safety operations. On a railroad, on an airline, or in a mine, anyone from the baggage carrier to the captain of the jet can stop all operations for safety reasons. The Institutes of Medicine in 1999 pointed out the fact that medicine is the only safety sensitive industry in America where the ability to determine what is safe is restricted to those also charged with keeping the income flowing. This is an irreconcilable conflict of interest.

Healthcare professionals are also leaving because they are tired of being cannon fodder. With the coming pandemic those of us in healthcare know we will die in the line of duty just as our colleagues did in Toronto with SARS. We simply wont sacrifice our lives for a system that no longer values us, our positions, our education or our experience.

What impact will all this have on healthcare? If I am the only one who leaves, no one will care, but Im not alone and the pandemic is coming.

Will you let us leave?

If you do, who will fill our shoes?

Dr. Maurice A. Ramirez is co-founder of Disaster Life Support of North America, Inc., a national provider of Disaster Preparation, Planning, Response and Recovery education. Through his consulting firm High Alert, LLC., he serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple medical specialties, Dr. Ramirez is Founding Chairperson of the American Board of Disaster Medicine and a Senior Physician-Federal Medical Officer for the Department of Homeland Security. Cited in 24 textbooks with numerous published articles, he is co-creator of C5RITICAL and author of Mastery Against Adversity. Dr. Ramirez invites comments at: http://www.disaster-blog.com