Loyal to Whose Fault?

OK friends, Romans, countrymen…let’s go back a not so long time ago, to a galaxy not so far away…

Who remembers the “good ol’ days” of medicine? I’ve always liked that phrase—no matter how old we are, most physicians can remember a time when there were just a few things that were just the way we liked them. Maybe that’s because we’re all a little high maintenance, with a little OCD, who work our tails off and want a chance to breathe, too. But what makes dermatologists unique from other physicians? The majority of us don’t work in hospitals and are often defined by our clinics, where many of us will spend the bulk of our careers.

Dermatologists as out-patient specialists pride themselves on their clinics…the way they are decorated, are set up to attract business, and—especially for an aesthetic clinic—are positioned to set a tone for a welcoming atmosphere for “customers.” But even more important in the days of old, when solo and small group dermatologists ruled the world, was the loyalty of team members to one another in a practice. Most receptionists were the faces and voices of the shop, the usual nurses knew the usual patients, and everyone could read each other’s minds, especially the doctor’s, in order to make things run as well as possible. Dermatology was also one of the biggest family operations in medicine, where spouses ran the show behind the curtain and nepotism meant that the junior partner son or daughter would eventually take the wheel.

Unfortunately, for many, it seems as though the virus has not only wiped out sanity, but has done a number on loyalty, as well. As so many of us have noticed, regardless of how big or small our clinics are, hiring and retaining good staff during the pandemic has been a challenge, to say the least.

Many of us have shared some pretty rough stories about nurses, receptionists, research coordinators, and even clinic managers either abandoning ship for other jobs or being hired to fill those roles despite being underqualified to serve them. This has left many of us overworked, short-staffed, and feeling the effects of burnout. (Our own clinic among many other research sites has experienced quite a bit of turnover during the pandemic, and hopefully this new group we have on board will stick around for a while and enjoy the ride.)

But the big picture in all of health care is not only about burnout from the pandemic; it is about what’s causing burnout and staff shortages and the effects on the sytem. According to a recent New York Times article¹ (https://www.nytimes.com/2021/08/21/health/covid-nursing-shortage-delta.html), “burnout and poaching by financially flush health systems have hobbled hospitals during the worst public health crisis in living memory.” The article quotes that “Our nurses are at their wits’ end…They are tired, overburdened, and they feel like forgotten soldiers.”

Even more concerning are the stories of health care workers being marginalized in systems, where dermatology continues to enter despite the resistance to consolidation. A report by the Brookings Institute² paints a grim picture of the place of health care workers in society: “While most news coverage highlights only the risks to nurses and doctors, PPE shortages are also a matter of life and death for millions of health care support, service, and direct care workers on the COVID-19 front line. These workers are at a lower priority for the already-insufficient supplies, meaning that hospitals and health care facilities sometimes overlook their safety as they ration PPE and prioritize vulnerable clinical staff who treat infectious patients.” Given those headlines, who would want to pursue a career in health care in the first place? Hence the risk of not only a shortage, but of employee retention.

But what is the answer? Is it an adaptation by employers to further value employees despite the risks of entrenchment or entitlement? Or is it surrender to systems that turn small clinics into corporate and unfriendly work environments? Or is it time to retire? Only the shadow knows…

But in all seriousness, have you experienced staff shortages or significant turnover? Have you found a solution to retain staff and combat burnout for yourself and your staff? Share your story and tips with us at editor@bmctoday.com.

1. Andrew Jacobs, https://www.nytimes.com/2021/08/21/health/covid-nursing-shortage-delta.html

Published Aug. 21, 2021 ‘Nursing Is in Crisis’: Staff Shortages Put Patients at Risk”

2. https://www.brookings.edu/research/essential-but-undervalued-millions-of-health-care-workers-arent-getting-the-pay-or-respect-they-deserve-in-the-covid-19-pandemic/