The Job Is Not My Work
Our profit-driven health care system pushes workers to the breaking point. What would it look like to take back our power?
In an emergency room, there is always work to be done. A toddler requires toys and numbing medicine before I can stitch her forehead, taking care to close the muscles and skin to minimize scarring.
Next door, a stubborn grandfather insists that he be discharged home. I hold his hand and tell him that I respect his wishes and am also truly worried that the blood thinners will turn his next fall into a catastrophic event. I’m interrupted by an ambulance bringing a patient in respiratory distress. She nods yes when I ask if she wants us to place a breathing tube. We quickly bring family to see their mother awake for what might be the last time. In between, the hallways are lined with patients—moaning, vomiting, crying, or just silently waiting to receive care.
This is work that I cherish. As an EMT, then a nurse, and now an emergency physician, I’m satisfied after each shift that I helped relieve some suffering, whether through medicine, a procedure, an explanation, or simply being present for a patient and their family.
But my job is a different matter from my work. I quickly walk past my patients to get back to a computer. I must document that I examined at least eight organ systems so that we can bill for a specific reimbursement code. The antibiotics must be ordered within the next 10 minutes or the hospital will be financially punished by Medicare. The pharmacy is calling because the pre-natal vitamins I ordered aren’t covered by the patient’s insurance. My computer brings a constant flood of emails and pop-up boxes. Follow the protocols. Document everything. Bill as much as possible. Work faster, always faster.
Caring for others is sacred work, but our health care system is profane, deeply broken, and driven by capitalist fear and greed. This system relies on workers with good intentions and deep investment in our work, even if our actual jobs are dehumanizing and frequently traumatizing. We are asked to ignore patients as well as our own basic needs in favor of efficiency, bureaucracy, and sometimes profit.
The coronavirus pandemic emphasized this contrast between our work and our jobs, as patients flooded into hospitals, clinics, and nursing homes. Precautions against spreading the airborne virus became yet another set of tasks squeezed into a hectic day. The computer gained a new set of pop-up boxes. Hospitals canceled sick leave, retirement contributions, and other benefits. And yet, the work has gained new depth of meaning. I counsel parents about how to simultaneously care for their infectious children and their immunocompromised elders. I hold iPhones and hands before starting yet another ventilator. I stay present and apologize when we find an advanced cancer or a heart attack that was missed amid the chaos of the pandemic.
It’s no surprise that workers are leaving health care in record numbers. About one in five left their jobs in the first year and a half of the pandemic, according to a report by Morning Consult. Even before that, there was a crisis of exhaustion among demoralized health workers nationwide, according to the U.S. Surgeon General’s recent advisory, Addressing Health Worker Burnout.
On overnight shifts and in hospital staff breakrooms, there’s constant conversation about this dilemma. To leave would mean reclaiming personal autonomy and dignity, but it would also stymie our deep desire to relieve suffering. “I can’t go on like this,” we say, “but I can’t just abandon my patients either.”
I believe we can regain power by learning to separate our work from our jobs and by engaging critically with the institutions that employ us. I now speed through emails about relative value units and new billing initiatives. The new weekly committee to review pharmaceutical policies is a job task I can decline. Saying no to the bureaucratic demands of the job can free us to invest more fully in our work by giving our full attention to the patient, family, or co-worker in front of us.
At times, we may notice direct conflicts between our job and our work. How frequently am I pulled away from human connection and toward the computer? Are protocols forcing me to provide the wrong care? Does this institution have policies that conflict with my values? Moral injury—the participation in unethical actions—is increasingly cited by health workers as a strong contributor to burnout. If it destroys us to see our good intentions subsumed into an immoral system, then what would it look like to protect ourselves and our work?
Our health care system dehumanizes our patients and our communities as well as its workers. Fixing it will require brave actions and visionary thinking. How could we bring together healers and patients in solidarity? How could we structure our time, our spaces, our tasks?
I still have a job. I punch in, click boxes, respond to emails, and nod during meetings. But I’m clear now that my work is my own. It won’t appear on a spreadsheet or be rewarded with praise from the company, but it has its own rewards for me and the people who need care.