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2023 LMS Essay Contest: Medical Student 1st Place

Burnout, Inequity, and Inaccessibility: The Most Important Issues in Medicine Today
By Sasha Sairajeev

Sasha is a first-year medical student originally from Frankfort, Kentucky. She earned by Bachelor of Science in Biology at the University of Kentucky is 2022. She is passionate about health advocacy, research in surgery and emergency medicine, and learning from her experiences in medical school.

I remember when I was 18, volunteering at Chandler Hospital and walking around all doe-eyed, excited to breath the air in my dream workplace. As a pre-medical student, I was deeply infatuated with the practice of medicine, throwing everything I had into my medical school application. While walking through the hospital gallantly, I noticed an older woman was near me, sobbing uncontrollably. This moment became an important turning point for me; while I had spent my life dreaming of spending the rest of my time in a hospital as a physician, for the many patients that are admitted there and their families, it is what they fear most. For many, being in a hospital means that they are experiencing the worst day of their lives—suddenly uprooted by car accidents or by a loss of a family member. I looked back at the woman somberly, wondering what her story was. This instance made me realize the important role I play as a future physician and the sacrosanctity of the physician-patient relationship. Four years later, as a first-year medical student, that infatuation for medicine grew into mature love but my awareness of the issues with healthcare grew with it. The most important issue in medicine today is the threat to the sacrosanctity of the physician-patient relationship, including the dangerous rates of physician burnout, health inequity, and the physician shortage.

            Medical students, such as myself, as well as seasoned physicians have realized that one of the greatest threats to the sacrosanctity of the physician-patient relationship is physician burnout. A couple weeks ago, my doe-eyed self had returned as I entered Kentucky’s Capitol building and was in awe of all of the passionate physicians across the state gathered in the lobby. From the surgeons to the pathologists to the first-year medical students who could not tell their pons from their midbrain, we were all gathered as the Kentucky Medical Association. Three issues entered the forefront of my mind that day: the impact of prior authorization on physician well-being, the stigma of mental illness among physicians, and the government making changes to how physicians treat patients. As I spoke to Kentucky lawmakers, I witnessed physicians from different walks of life discussing the impact of additional administrative burdens like prior authorization on their wellbeing as well as their patients. Prior authorization often delays healthcare to patients and adds on average four hours a week of work to the already busy schedules of physicians. While we advocated for a prior authorization exemption form, the work was not finished to reduce physician burnout. Another bill, advocated for by many physicians I met with, involved allowing physicians to seek out wellness programs and receive other mental health services without disclosing that information to their employers. Fortunately, for my generation, many individuals speak openly about their mental health struggles and are able to receive social support from those they discuss it with. For many older physicians, that was not the case and many suffered in silence. I saw this pain and frustration come out while many established physicians spearheaded the conversation. Physicians are not able to care for patients to their full capacity if they are experiencing burnout. We are losing young physicians to suicide at an unprecedented rate and limiting the ability for them to be able to care for their patients. How is our healthcare system supposed to function without providers who are able to utilize their extensive training to their full capacity?

            Health inequity has threatened the sacrosanctity of the physician-patient relationship through the exacerbation of health disparities by implicit bias. One person who taught me about the detriments of implicit bias was a medical school speaker who was a Black woman suffering from sickle cell disease. Patients suffering from sickle cell disease sometimes experience pain crises or, episodes of extreme sharp, stabbing pain. The emergency department was her only option during her pain crises but every time she sought out help, she was faced with judgement: “pill seeker,” “addict,” “you’re being dramatic,” “calm down.” This is not unique to her but is the reality for Black women across America. For years, textbooks perpetuated the idea that Black people experience pain differently than others. While strides have been made to reduce implicit bias among physicians, more work on education and awareness needs to be done by the new generation of physicians.   

            Physician burnout, health inequity, and the provider shortage are becoming increasingly severe problems that have a detrimental effect on our healthcare system. In a striking provider shortage, we need physicians more than ever to be well and be able to take care of patients effectively. In Kentucky specifically, we have seen the impact of the provider shortage on rural communities. For the physicians that serve rural communities in Kentucky, they are faced with high rates of burnout due to the amount of work they are responsible for. Physician burnout and the provider shortage has spiraled into a feedback loop that is truly a threat to the physician-patient relationship. My doe-eyed self continues to be in love with the practice of medicine but deep down, I fear for the wellbeing of my classmates and I when we graduate. I fear for the physicians we look up to and the unnecessary pain they have to go through. I fear for the patients who are not getting the care they deserve. Despite all of my fears, I have faith that the new generation of physicians will step up to the challenge and begin dismantling these pressing issues that disrupt the physician-patient relationship. We will be remembered as the generation who broke silences and stigma about mental health and served as a voice for those who never even got a chance to have one.