“There are too many doctors,” they told us as we gathered for an all-class meeting in the auditorium of Memorial University of Newfoundland Medical School. It was the fall of 1992, a few short months after starting my first year of medical school. I had entered medical school filled with excitement and enthusiasm, taking my first steps in realizing my dream of becoming a doctor.
As I sat there, hearing the details of the recently released Braer-Stoddart report, my heart sank. They told us the report had said there were too many doctors and nurses in Canada, and that a large number of measures were being set into motion by policy makers across the country to systematically reduce the number of nurses and doctors in Canada to help deal with this “problem”.
After this heartbreaking meeting, I called my mom in tears, “Mom, I’ve already worked really hard to get this far and now I’m going to do all this work to get through my training … and when I finish I won’t be able to find a job!?!?”. After listening to me sobbing about how I would never find work as a physician in Canada, my wise mother reassured me, “Sweetie, you’re going to be just fine. This is extremely short sighted and they are digging their own grave with these measures they’re putting in place. You’re in your first year. You still have at least 5 1/2 years to go before you’ll be practicing, and the need for doctors is going to keep growing as they put these short sighted policies in place. The baby boomers are aging. There are more women in medicine, and younger doctors are not willing to work 100+ hours a week like your dad’s generation did”.
I found some solace in my mother’s wise words and continued on with my medical training. I graduated from medical school in 1996 then did a 2 year family medicine residency which I completed in June 1998. That summer I moved out to British Columbia “for the summer” and decided to stay. When I first moved to BC, I was told my billing number was temporary and that if the BC government won their lawsuit against the Doctors of BC (which was contesting the restriction of billing numbers), my license would be taken away and I would no longer be allowed to practice in BC.
My billing number was never taken away and I’ve spent most of the past 26 years practicing medicine in BC. I have, however, seen the slow erosion of our medical system over the past 26 years. I did my best to make it work as patient care became increasingly complex, administrative demands became increasingly challenging and overhead costs skyrocketed while our antiquated billing codes demanded we do more and more with less and less. Finally, in August 2020, after sacrificing myself at the altar of medicine for over 2 decades, I hit the wall. I couldn’t do it anymore. I’d spent far too long neglecting my own health, time with my family and my sanity, and I had nothing left. I was burned out. I was a shell of my former self. I no longer wanted to spend time with friends or family because I was too tired. Too exhausted from giving, giving, giving in a system that kept taking, taking, taking. I was ready to walk away from medicine forever. I was done with being a doctor. I was too battered and bruised from trying to make it work for far too long, and I couldn’t do it anymore. That enthusiastic young woman who started medical school in 1992 had been replaced with a stressed out, frazzled, cynical, burnt out shell of a woman barely getting through the day, exhausted from way too much time on the hamster wheel of “modern medicine”.
I was lucky. I was one of the first to “burnout” and was able to find two lovely young doctors to take over my practice. One of them joined me about a month later, so I was able to drop down to half time. The other began helping me a few months after that and by April 2021, I was able to walk away completely and leave my practice in their capable hands.
From there I embarked on a healing journey that continues to this day. I am happy to say, I am doing much better and starting to enjoy being a doctor again. I do part time clinic work and am involved in projects where I feel like I’m helping to design a health CARE system, rather than our current disease management system. I am also leaning into my creativity and am building a business “helping women come home to themselves”. I am making myself a priority and learning to put clear boundaries in place around my clinical work. New payment models have also made a huge difference. We still have a long way to go as we move away from our former model that was based primarily on volume to beginning a migration towards models that recognize the TIME it takes to provide quality care in an increasingly complex healthcare system.
I’ve learned a lot over the past 26 years about the cost of sacrificing myself to a system that’s felt almost hostile towards us as a profession. I am heartened by a lot of the recent changes in billing models and the increased focus on collaborative team based care. There’s still a lot of work to be done, but I am hopeful that better times are coming. In the same way my wise mother predicted the downfall of the past 2 ½ decades, I am optimistic we are now heading in a better direction and that the upcoming decades will be a rebuilding phase. I am optimistic that the next 2 ½ decades will see us working together to build a health CARE system. One that treats everyone involved as human beings, not commodities. One that focuses on care and compassion, caring for the person as a whole rather than a volume based system that tries to break things down into a series of 10 min individual issues.
Things are changing, I can feel it. I am optimistic that together we can build a much better system, one where we get to be of service in a way that’s in alignment with our values. One that treats everyone involved as a human being. One where we are excited to go to work. To sit with our patients, hear their stories, share their lives, shed a tear with them over something profound or difficult. To journey together towards healing, not just for our patients but also for ourselves.
Shana Johnston, MD, CCFP, FCFP