In the rural area where I practice, two general surgeons recently retired, a medical oncologist moved out of the community and two urologists left over a year ago. Patients with cancer are left wondering who will care for them. And this small community is not alone. An aging physician population, burnout, and understaffing of other healthcare workers all contribute to rising rates of physicians moving and leaving communities.
It's so nice to hear your perspective as an oncologist. I currently have leptomeningeal disease, a metastasis to my brain and spine and I'm outliving my prognosis. I've learned a lot about doctors personalities over the last 20 years since I was first diagnosed with bladder cancer. From a community clinic to a large cancer center, from neurosurgeons to small town urologists, from multiple surgeries, treatments, a clinical trial, remissions and progressions, I've learned to adapt to the doctor treating me. I found in the beginning a good bedside manner was paramount. Now, it's all about the science, experience and success rate of the doctor. I was reminded of this yesterday when a met a nephrologist to treat my solo kidney. He was all brain, no heart, but I trust him. I've had 2 oncologists in the last year leave clinical practice for research. I was sad to see them go but maybe they'll be like Dr. Li and find a cure for my type of cancer!
Thanks so much for your insight on this problem. Currently a chemo patient at a local, world respected clinic, I cannot seem to put together any coordinated at this clinic. Diferrent departments do not collaborate, forcing me to go outside my oncology "team" to alternative medical facilities to save my immune system from destruction. Chemo is reducing my tumors, but it is killing all the healthy cells that used to work so well keeping me safe and healthy. There is no interest in this aspect of care. Frankly I do not think my excellent oncologist is allowed to offer me anything but more chemicals with side effects to counter the chemo side effects. This makes no sense when so much data is available to show that nutrition and supplements with little or no side effects work so well. Can this lack of care be driven by accountants or just by ignorance?
It sounds like chemotherapy has been really difficult for you. The lowered white blood count can be really hard, and I hope you remain healthy. The good news is that if the chemotherapy is killing your white blood cells (because they are rapidly dividing cells), I hope it is killing the other rapidly dividing cells (aka cancer). Thank you so much for commenting and I wish you the best.
I too found this and in the end found a very good naturopath who worked with me to get my blood looking a lot better. I am in the clear now and to be honest feel better than I have for years even pre cancer - I had head and neck cancer ( Oropharyngeal cancer) no eating via my mouth for 15 months.
I’m very happy for you. My search continues for a naturopath to guide me. I have appointments with 2 next week. Fingers crossed!! Thanks for your comments!
You're alright...you can stay. You're article made me proud of my profession amidst the quagmire of political correctness that has invaded our institutions.
Be very hungry to learn learn learn. This is the fantastic arduous quest but the human race and other earthly life forms appreciate your long term communication and commitments. 🥰👍
Hi Stacy, and thanks for starting a conversation here!
I'm really disturbed by the story of Dr. Li, and inspired by his courage and brilliance.
I am also employed by a large hospital system, but my practice was a small independent one when I started 20 years ago. So I've seen the evolution, the tradeoffs, the good the bad and the ugly.
The most positive aspects of a large system were revealed to me during the early phases of the pandemic. I really feel that having more resources allowed us to keep the lights on, to adapt quickly to telemedicine, and to streamline new protocols for patient safety, infection control, vaccination, testing, and treatment with IV monoclonal antibodies. Communication between specialists and primary care has improved through Epic medical records, and the Philly urban and suburban health care systems are all integrated under the Epic monopoly... which does facilitate better access to records no matter where the patient is going.
For me the negative aspects include the depersonalization that can happen with corporate culture. Many patients complain about how much better the old fashioned days were. With the exodus of physicians you've cited, the older and sicker populations we serve, and the added burdens of quality measurements and benchmarks and chart audits and meetings... it's just such an insane workload some times. I know you've read this post I did back in July about doctors and patients as commodities, but I'll post a link anyway because I think it speaks to the core concern we have as physicians in a corporate model:
And as far as where I was on 9/11/2001 - there is no way you read one of my first posts here on Substack back in 2021, so I'll copy and paste it here! Sorry this is way more dialogue than you bargained for, but I think that's in the spirit of Substack, right?
Take care, and here's my recollection of 9/11/01 that I wrote 9/11/2021:
"When the towers fell I was 26 years-old, in just my third month of residency training at Jefferson Hospital in Philadelphia, doing morning rounds in the hospital at 10th and Chestnut with a team of other young doctors, students, and an attending physician in charge.
As an intern I had responsibility for about 8-10 patients that day, and had started my morning early as usual. By the time the planes were hitting, our group had convened to walk from bed to bed, presenting each case and our assessments, our tenuous plans scrutinized by the more senior residents and attending. The sickening images, and creeping realization that humanity was witnessing an epic tragedy on live television, distracted both the patients and our team from completing our morning rounds. I recall a woman, propped up in bed to help her breathe through congestive heart failure, craning her neck further to keep up with the burning calamity on the screen. It seemed like even the sickest patients were more attuned to the suffering on TV than to their own struggles.
I was having difficulty concentrating, too. There were many planes still unaccounted for in the skies, all over America. Why not send one to Philadelphia, the symbolic birthplace of our country?
“Ryan, please stay focused,” I recall my attending stating firmly. “We have a duty to keep going.”
I did not leave the hospital until late that night, and as I walked to my apartment the streets were eerily quiet, the skies abandoned, our faces collectively illuminated by the wan light from screens, all of us trying to comprehend what had just happened from the safety of our homes.
The feelings of sorrow, isolation, and fear, and the crippling of our freedoms were all such raw and new experiences on a national scale. There was rage. But I think this was only a small preview of the parallels and horrors this pandemic would visit upon us twenty years later.
2,977 Americans died on 9/11, over 6,000 were injured, and many more first responders suffered chronic ailments and premature deaths. Americans were ready to roll up their sleeves by the millions to donate blood, to help do whatever they could to help save the day. In the context of the current pandemic, which has killed over 200 times more Americans than died on 9/11/2001, and in the winter months presented daily death tolls similar to a 9/11 every day, hundreds of millions of Americans have again volunteered to roll up their sleeves. This time they have actually been able to help themselves and one another, receiving a miraculously achieved vaccine. If you have yet to heed the call of 2021, do so now.
And as the twenty year war effort concludes in Afghanistan, we are contending with far greater existential problems - from a virus that is killing millions, to historic climate-driven fires and storms. And yet we see bravery and kindness all around. Our civilization has been propped up by essential workers, many of whom risked and lost their lives for the greater good, like the soldiers who died serving in Afghanistan. As I write this my wife, also a physician, is not home tonight. She is volunteering her time to provide medical care and triage for Afghan refugees, as a fortunate few wearily arrive. Tomorrow, she and I and thousands of other weary medical workers will don our scrubs and masks and head back into small rooms to fulfill our duties.
We still struggle to comprehend human cruelty, and the senselessness of disease and our mortality. The only advice I can offer tonight would be to keep doing what you can to help others and yourself along this unique and perilous journey together. Whether that means trying to understand a national tragedy from a place of humanity over politics, or doing what we can to protect others and ourselves from a much greater foe by wearing a simple mask and getting vaccinated, or continuing to stand up each day, despite the weariness and anxiety… each of us can help the world soldier on."
Great article and thanks for the historical reference.
I guess I’m what you describe as a Maverick. I advocate for doctors returning to practice ownership.
It's so nice to hear your perspective as an oncologist. I currently have leptomeningeal disease, a metastasis to my brain and spine and I'm outliving my prognosis. I've learned a lot about doctors personalities over the last 20 years since I was first diagnosed with bladder cancer. From a community clinic to a large cancer center, from neurosurgeons to small town urologists, from multiple surgeries, treatments, a clinical trial, remissions and progressions, I've learned to adapt to the doctor treating me. I found in the beginning a good bedside manner was paramount. Now, it's all about the science, experience and success rate of the doctor. I was reminded of this yesterday when a met a nephrologist to treat my solo kidney. He was all brain, no heart, but I trust him. I've had 2 oncologists in the last year leave clinical practice for research. I was sad to see them go but maybe they'll be like Dr. Li and find a cure for my type of cancer!
Thanks so much for your insight on this problem. Currently a chemo patient at a local, world respected clinic, I cannot seem to put together any coordinated at this clinic. Diferrent departments do not collaborate, forcing me to go outside my oncology "team" to alternative medical facilities to save my immune system from destruction. Chemo is reducing my tumors, but it is killing all the healthy cells that used to work so well keeping me safe and healthy. There is no interest in this aspect of care. Frankly I do not think my excellent oncologist is allowed to offer me anything but more chemicals with side effects to counter the chemo side effects. This makes no sense when so much data is available to show that nutrition and supplements with little or no side effects work so well. Can this lack of care be driven by accountants or just by ignorance?
It sounds like chemotherapy has been really difficult for you. The lowered white blood count can be really hard, and I hope you remain healthy. The good news is that if the chemotherapy is killing your white blood cells (because they are rapidly dividing cells), I hope it is killing the other rapidly dividing cells (aka cancer). Thank you so much for commenting and I wish you the best.
Thank you your encouragement!!
I too found this and in the end found a very good naturopath who worked with me to get my blood looking a lot better. I am in the clear now and to be honest feel better than I have for years even pre cancer - I had head and neck cancer ( Oropharyngeal cancer) no eating via my mouth for 15 months.
I’m very happy for you. My search continues for a naturopath to guide me. I have appointments with 2 next week. Fingers crossed!! Thanks for your comments!
You're alright...you can stay. You're article made me proud of my profession amidst the quagmire of political correctness that has invaded our institutions.
Be very hungry to learn learn learn. This is the fantastic arduous quest but the human race and other earthly life forms appreciate your long term communication and commitments. 🥰👍
Hi Stacy, and thanks for starting a conversation here!
I'm really disturbed by the story of Dr. Li, and inspired by his courage and brilliance.
I am also employed by a large hospital system, but my practice was a small independent one when I started 20 years ago. So I've seen the evolution, the tradeoffs, the good the bad and the ugly.
The most positive aspects of a large system were revealed to me during the early phases of the pandemic. I really feel that having more resources allowed us to keep the lights on, to adapt quickly to telemedicine, and to streamline new protocols for patient safety, infection control, vaccination, testing, and treatment with IV monoclonal antibodies. Communication between specialists and primary care has improved through Epic medical records, and the Philly urban and suburban health care systems are all integrated under the Epic monopoly... which does facilitate better access to records no matter where the patient is going.
For me the negative aspects include the depersonalization that can happen with corporate culture. Many patients complain about how much better the old fashioned days were. With the exodus of physicians you've cited, the older and sicker populations we serve, and the added burdens of quality measurements and benchmarks and chart audits and meetings... it's just such an insane workload some times. I know you've read this post I did back in July about doctors and patients as commodities, but I'll post a link anyway because I think it speaks to the core concern we have as physicians in a corporate model:
https://mccormickmd.substack.com/p/doctors-and-patients-as-commodities
And as far as where I was on 9/11/2001 - there is no way you read one of my first posts here on Substack back in 2021, so I'll copy and paste it here! Sorry this is way more dialogue than you bargained for, but I think that's in the spirit of Substack, right?
Take care, and here's my recollection of 9/11/01 that I wrote 9/11/2021:
"When the towers fell I was 26 years-old, in just my third month of residency training at Jefferson Hospital in Philadelphia, doing morning rounds in the hospital at 10th and Chestnut with a team of other young doctors, students, and an attending physician in charge.
As an intern I had responsibility for about 8-10 patients that day, and had started my morning early as usual. By the time the planes were hitting, our group had convened to walk from bed to bed, presenting each case and our assessments, our tenuous plans scrutinized by the more senior residents and attending. The sickening images, and creeping realization that humanity was witnessing an epic tragedy on live television, distracted both the patients and our team from completing our morning rounds. I recall a woman, propped up in bed to help her breathe through congestive heart failure, craning her neck further to keep up with the burning calamity on the screen. It seemed like even the sickest patients were more attuned to the suffering on TV than to their own struggles.
I was having difficulty concentrating, too. There were many planes still unaccounted for in the skies, all over America. Why not send one to Philadelphia, the symbolic birthplace of our country?
“Ryan, please stay focused,” I recall my attending stating firmly. “We have a duty to keep going.”
I did not leave the hospital until late that night, and as I walked to my apartment the streets were eerily quiet, the skies abandoned, our faces collectively illuminated by the wan light from screens, all of us trying to comprehend what had just happened from the safety of our homes.
The feelings of sorrow, isolation, and fear, and the crippling of our freedoms were all such raw and new experiences on a national scale. There was rage. But I think this was only a small preview of the parallels and horrors this pandemic would visit upon us twenty years later.
2,977 Americans died on 9/11, over 6,000 were injured, and many more first responders suffered chronic ailments and premature deaths. Americans were ready to roll up their sleeves by the millions to donate blood, to help do whatever they could to help save the day. In the context of the current pandemic, which has killed over 200 times more Americans than died on 9/11/2001, and in the winter months presented daily death tolls similar to a 9/11 every day, hundreds of millions of Americans have again volunteered to roll up their sleeves. This time they have actually been able to help themselves and one another, receiving a miraculously achieved vaccine. If you have yet to heed the call of 2021, do so now.
And as the twenty year war effort concludes in Afghanistan, we are contending with far greater existential problems - from a virus that is killing millions, to historic climate-driven fires and storms. And yet we see bravery and kindness all around. Our civilization has been propped up by essential workers, many of whom risked and lost their lives for the greater good, like the soldiers who died serving in Afghanistan. As I write this my wife, also a physician, is not home tonight. She is volunteering her time to provide medical care and triage for Afghan refugees, as a fortunate few wearily arrive. Tomorrow, she and I and thousands of other weary medical workers will don our scrubs and masks and head back into small rooms to fulfill our duties.
We still struggle to comprehend human cruelty, and the senselessness of disease and our mortality. The only advice I can offer tonight would be to keep doing what you can to help others and yourself along this unique and perilous journey together. Whether that means trying to understand a national tragedy from a place of humanity over politics, or doing what we can to protect others and ourselves from a much greater foe by wearing a simple mask and getting vaccinated, or continuing to stand up each day, despite the weariness and anxiety… each of us can help the world soldier on."