During more than 30 years as a physician and an officer in the U.S. Air Force and Air National Guard, including deployment in Iraq, I have witnessed trauma and battle fatigue up close. I have seen the immense toll that unrelenting physical and emotional stress takes on the minds and bodies of soldiers — people in peak conditioning.
It worried me to see that same fear and exhaustion in young physicians recently as I completed a 100-hour, seven-day teaching rotation in a small community hospital near my home in coastal South Carolina. Fueled by the deadly Delta variant and a low vaccination rate, the fourth wave of the pandemic is punishing my beloved home state, pushing the local health system to its breaking point. Our community hospital has been operating above 100% capacity for the last month, an all-hands-on-deck moment that means long, intense days with clinicians and other health care workers often working extra shifts to cover staffing shortages.
Hour after hour, day after day, patients with Covid-19 fill the hospital’s intensive care unit. Critical care beds overflow into hallways. The young physicians and residents in my group worked tirelessly and rose to every challenge thrown at them. But the enormity of this health crisis has been impossible to escape, and despite our best efforts to lean on one another for support, the mood is somber.
For the first time in this pandemic, and for the first time in my nearly four decades in medicine, I worry about the future of medical care in the U.S. I worry about what we have asked young physicians, residents, and even medical students to shoulder the last 18 months and the lasting impact of the physical and emotional trauma they are experiencing.
Most of all, I worry that an entire generation of young physicians, faced with the horrors of this ever-changing virus up close, will at some point rethink their commitments to medicine and choose careers that aren’t as emotionally taxing.
Almost two years into this pandemic, no one can say with any certainty what the ultimate impact of Covid-19 will be on medicine, on the U.S. health system, and on the national psyche. But it’s impossible to experience it on the frontlines and not come away with feelings of awe and dread for the entire health care workforce — physicians, nurses, respiratory therapists, lab and X-ray technicians, food service providers, security personnel, housekeepers, and everyone else staffing the nation’s hospitals.
Physicians were under tremendous strain long before the arrival of Covid-19. More than 4 in 10 doctors will be at retirement age in the coming decade — including me — a time when the baby boomer generation will require more intensive, long-term care. Compounding that is exorbitant medical student debt and a steady rise in physician burnout stemming from excessive regulation and other ever-increasing obstacles to patient care. It’s no wonder that the nation faces a shortage of as many as 124,000 physicians by 2034.
The same concerns can be raised about the country’s chronically overworked nursing community as well, nearly 4 million strong, which has shouldered so much in this pandemic and faces its own severe staffing shortages over the next decade.
Years from now, I fear that Covid-19 will be seen as having been a major flashpoint for medicine, widely cited as a reason why physicians, particularly those in high-intensity hospital settings, left the profession. Consider that the number of Covid-19 patients in my community hospital in South Carolina grew from zero on July 1 to an average of 50 in the past three weeks. The vast majority of them — all but three — are not vaccinated against Covid-19, and the surge of patients has forced the hospital, once again, to delay or cancel all non-essential surgeries and procedures.
The number of deaths is also growing: people in their 40s, 50s, and 60s, many of them without serious underlying conditions. Much has been learned from the early stages of the pandemic about the care and treatment of Covid-19. But if someone isn’t responding to the proven treatments that exist, there is almost nothing else that can be done but gather their loved ones — fully garbed in gowns, masks, face shields, and other personal protective equipment — for a last goodbye.
These heart-wrenching scenes play out in hospital ICUs every day. And while physicians are well-trained to cope with the death of a patient, what we cannot bear is the fact that the vast majority of these deaths would not have occurred had the person been vaccinated. Science has given us weapons to fight the SARS-CoV-2 virus, yet far too many Americans are choosing not to use them. It’s difficult to watch, not only for surviving family members but for the physicians, nurses, and others who must attend a multitude of bedside memorials each week.
Our best chance to ease the burden on health care workers is to continue to build vaccine confidence, one individual at a time. But that’s not easy, even for physicians like me who know half of the Covid patients entering their hospitals. These are people and families I have helped through other medical emergencies or I’ve met at social events around town. Or, in the case of one unvaccinated, 40-year-old man with Covid-19 who I intubated last month, someone for whom I had served as a commanding officer in the National Guard. He died three weeks after being admitted.
Trying to puncture the misinformation bubble about vaccines is emotionally draining. Trying to reach people who would take your medical counsel about any subject except Covid-19 vaccines is exhausting and frustrating.
But what choice do physicians have? We are duty bound to be advocates for science and sound medical care, but we must also listen to our patients and their concerns. It can sometimes be an untenable position to be in.
One thing is for certain: We must support one another, particularly the young physicians who are bearing the brunt of Covid-19, and continue to be the leaders our colleagues, and our nation, need in this most urgent hour.
Gerald E. Harmon, a family medicine physician, is president of the American Medical Association.
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