The doctor’s bag now sits in his closet gathering dust. He lost his stethoscope somewhere in the house — a familiar weight that sat on his neck for two decades.
It’s been months since Justin Meschler, 48, practiced medicine. And he wonders if he ever will again.
He quit his job as an anesthesiologist during the pandemic last spring when fear began seeping into every part of his life. And what began as a few months off has now turned into something much longer.
“I feel guilty for leaving. I think about the others who stayed on. I think about the patients I could have helped. I feel like I abandoned them,” Meschler said. “But mostly, I feel relieved.”
A year into the pandemic, many others are joining Meschler at the door — an exodus fueled by burnout, trauma and disillusionment. According to a Washington Post-Kaiser Family Foundation poll, roughly 3 in 10 health-care workers have weighed leaving their profession. More than half are burned out. And about 6 in 10 say stress from the pandemic has harmed their mental health.
In wrenching interviews, nurses, doctors, technicians — and even administrative staff and dental hygienists who haven’t directly treated covid-19 patients — explained the impulse to quit and the emotional wreckage the pandemic has left in their lives.
It’s not just the danger they’ve endured, they say. Many talked about the betrayal and hypocrisy they feel from the public they have sacrificed so much to save — their clapping and hero-worship one day, then refusal to wear masks and take basic precautions the next, even if it would spare health workers the trauma of losing yet another patient.
“You feel expendable. You can’t help thinking about how this country sent us to the front lines with none of the equipment needed for the battle,” said Sharon Griswold, an emergency room doctor in Pennsylvania.
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“Most of us got into this to save lives. But when death is blowing around you like a tornado and you can’t make a dent in any of it, it makes you question whether you’re making any difference,” said Megan Brunson, a night-shift nurse in Dallas.
The Post-KFF poll found a majority of health-care workers say they feel respected by the general public and patients they interact with. At the same time, about 6 in 10 health-care workers say most Americans are not taking enough precautions to prevent the spread of covid-19, and about 7 in 10 say the United States has done a “poor” or “only fair” job handling the pandemic.
Many traced their disillusionment to how the pandemic exposed and magnified the broken parts of America’s health-care system.
“You look at staffing, preparedness, what the priorities were for many hospitals during the crisis, and it’s clear the industry is driven by profits rather than well-being of patients or health workers,” Meschler said from his home in Louisville, Colo. “It makes you question the whole system.”
As he intubated covid-19 patients last spring at his hospital, Meschler kept imagining himself joining their ranks.
He had asthma, high blood pressure, a heart condition and was overweight. He also had two young daughters and a wife he worried he might infect and kill every day he came home from work.
He deliberated the decision for days with his wife. He looked hard at their finances and the amount still left on his medical school loans. And one morning in his living room, he banged out a letter to his bosses: “It is with deep regret that I must give my required 120 day notice …”
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Even before the pandemic, the country was facing a looming shortage of doctors and nurses. Additional losses to the medical workforce could spell dire consequences for U.S. health care. Because of the training required, it takes years of investment for the pipeline to produce a single doctor or nurse.
Experts warn the looming lack of medical professionals could make health care more expensive, less accessible and worse in quality as those remaining are asked to do more in an already overtaxed system. According to studies and industry estimates, as many as 1 million nurses could retire by 2030 and the country could be short an estimated 130,000 doctors by then.
The large numbers of doctors and nurses wanting to quit are also the early warnings of festering, unaddressed psychic wounds among health-care workers.
If left untreated, experts worry they could lead to widespread incidents of post-traumatic stress disorder, anxiety, depression, substance abuse and suicide for a group that has already sacrificed so much to get the nation through this pandemic.
“We need to stop treating them like heroes and start treating them like human beings,” said Mona Masood, a psychiatrist who has counseled dozens of doctors in mental crisis in recent months. “I keep telling them, ‘You don’t have to set yourself on fire to keep other people warm.’ Health care can’t just be about making patients well. We have to care for the healers, too.”
Taking one day at a time
For Celia Nieto, the breaking point came suddenly this fall while she was driving to a dentist appointment.
She had spent so many months fighting as an intensive care nurse — for her hospital to give her N95 masks, for families so they could see their loved ones before they died, for her kids so they could get the schooling they needed at home even as she was dealing with a torrent of despair at work.
In the silence of her SUV on the way to the dentist, Nieto, 44, began sobbing uncontrollably. Then came racing thoughts she could not quiet or control — worries about the future, her career, her kids, their school.
It had been happening a lot lately, thoughts coursing through her so intensely she couldn’t sleep or eat or sometimes even speak. But on that October day, one thought surfaced that filled her with fear: She wished another car would run into hers and send her into a coma.
“It’s not that I wanted to die per se. I just wanted all of it to stop: the crying, the racing thoughts. That’s when I knew something was wrong,” said Nieto, who lives in Henderson, Nev.
She called her insurance’s mental health line and started therapy.
In the months since, Nieto has lost two fellow nurses on her unit — one to covid-19, and the other to suicide.
“I love my job. I love that on the worst day of someone’s life, I can be the person who helps them through that,” she said. But she also said she has begun to question whether the job is a good fit anymore, and if so, for how much longer.
“It could be a matter of months or years,” Nieto said. “One thing I’ve learned from therapy is to take things one day at a time.”
Many health workers say they feel trapped by their job. For doctors especially, the massive loans required by medical school make the idea of quitting seem impossible.
In March last year, Philadelphia psychiatrist Masood saw increasingly anguished posts on Facebook groups for doctors and began organizing a grass-roots support line for physicians — similar to the suicide hotline that serves the general public.
She asked whether any psychiatrists would work with her to answer the calls. Within days, her inbox was bombarded with messages from more than 200 volunteers.
“As psychiatrists, I think we were all seeing the warning signs. You had doctors suddenly writing their wills, talking about how they felt abandoned to die, how the only choice they faced was being called a hero or coward,” Masood said.
In the year since, the Physician Support Line she created has fielded more than 2,500 calls. But what worries Masood most is what will happen once the pandemic ends.
In her private practice, she has treated many soldiers returning home from war.
“When you’re in the danger zone, all you’re focused on is surviving. It’s not until the afterward that you start processing the trauma, grief and things that you saw,” she said. That is when people are most vulnerable mentally. “And if you don’t have a way of coping with that, you start looking for other ways — drinking, self-harm, apathy.”
‘Many are suffering in silence’
After the 9/11 terrorist attacks, the government created programs and funding to help first responders with its lingering effects. The military invested resources — though advocates say not enough — into the mental health of veterans returning home from Iraq and Afghanistan.
For the pandemic’s health-care workers, however, that infrastructure of support doesn’t yet exist.
It has been almost a year since Lorna Breen — an emergency room doctor in New York — died by suicide. In the months since, her sister and brother-in-law, Jennifer and Corey Feist, have worked furiously to prevent further deaths by creating mental health resources for health workers.
They created a foundation in her name and last year got a bipartisan bill called the Dr. Lorna Breen Health Care Provider Protection Act introduced in the Senate. Some provisions of the legislation were included in the American Rescue Plan relief bill recently signed by President Biden, including $140 million allotted for medical training, hospital programs and a mental health awareness campaign.
But without language — from the still unpassed portions of the Lorna Breen Act — specifying how that funding must be used, Corey Feist and others worry the money will not be effective in addressing the crisis to come.
Since Breen’s death, Feist and his wife have received hundreds of emails, messages and calls from health workers struggling with stress, burnout, suicidal thoughts and the difficult decision of whether to stay in health care.
“Many are suffering in silence because of the huge stigma that remains in the industry,” said Feist, who also oversees 1,200 doctors and health workers as head of the University of Virginia Physicians Group.
Even before the pandemic, roughly one doctor in America was dying from suicide every day — a rate more than double that of the general population. Beyond the stoic culture of doctors, Feist said, the industry needs to overhaul policies that strongly discourage doctors from seeking mental help for fear of risking their medical licensing or malpractice insurance.
Feist also pointed to the snowballing cycle of burnout and workforce shortages. “The more people quit, the more you exhaust the ones left behind and push them to quit,” he said.
‘I’m not ready to give up yet’
For years now, Sharon Griswold and her husband — both emergency room doctors in Hershey, Pa. — have been feeling the fraying symptoms of burnout.
After the death and chaos of the pandemic, both have seriously contemplated leaving medicine. Griswold’s husband was the first to take the plunge, giving his hospital notice this winter.
But Griswold said she just can’t bring herself to quit.
Research has shown health-care workers are especially prone to burnout because of the workload, pressure and chaos that they deal with. Such burnout, studies show, can result in increased risks to patients, malpractice claims, worker absenteeism and billions of dollars in losses to the medical industry each year.
For Griswold, being a doctor has been such a huge part of her identity — saving lives and training new residents to do so. She has trouble seeing herself doing anything else as fulfilling.
But at the same time, Griswold said, she has grown increasingly angry.
As the country’s health-care system has become increasingly dysfunctional in recent decades, the bulk of that dysfunction has landed on health workers — resulting in long hours, mounting paperwork and bureaucratic hurdles, fear of malpractice lawsuits and insufficient resources.
Griswold is profoundly frustrated with the system. “Health care’s become a system run by insurance companies, pharmaceuticals and private equity. There are so many patient decisions that aren’t up to doctors anymore, and it creates moral conflicts you wrestle with every day. It can be exhausting.”
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She’s also frustrated with the public. “It’s hard to let go of the anti-mask thing,” she said. For months now, she has tinkered with an op-ed she hasn’t yet submitted to her local newspaper, pleading for people to wear masks so that she doesn’t have to keep watching patients die.
“The worst thing is the panic you see on dying people’s faces when they realize this could be it. You sometimes see regret in their eyes, a feeling of not being ready,” she said.
All those deathbeds she has witnessed, they take a toll, she said. “But I’m not ready to give up yet.”
‘I have no idea what I’m going to do’
Recently, Meschler, the Colorado anesthesiologist who quit in the middle of the pandemic, got an email from his malpractice company.
The insurance agent wanted to know whether he really was leaving medicine for good or just taking a break. Leaving would require a complicated cancellation of his policy, the agent explained.
It was a question Meschler had been mulling for months.
He thought back to a car crash he witnessed as a teenager and how the medics asked him to help as they tried to save a woman struggling to breathe. He remembered how good it felt then to help another person.
He thought about his years in med school, sacrificing sleep, friends and any semblance of a balanced life.
Then, he thought about the anger he felt in the early days of the pandemic when it became clear his hospital hadn’t prepared the necessary policies to keep him safe. He thought about his growing frustrations even before the pandemic, about the direction of American health care and his waning ability to make a difference.
He thought about his two daughters and the joy in recent weeks, dropping them off at school and being there when they got home. And he thought about the obituaries he had been reading lately at night in his living room — all the doctors and nurses lost in the pandemic.
“I have no idea what I’m going to do, to be honest,” he said. “But I’m incredibly lucky to be alive, to even be in a position to walk away.”
Meschler told the agent he didn’t need the malpractice insurance anymore. He was leaving for good.
Scott Clement and Emily Guskin contributed to this report.
If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741. For doctors struggling with burnout and mental health, volunteer psychiatrists are offering free peer support at the Physician Support Line at 888-409-0141, seven days a week from 8 a.m. to 1 a.m. Eastern time.
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