Who is changing healthcare for the better, and how do I do that too?
October 5, 2023 2:49 PM Subscribe
I am an RN who is running HARD into a wall of moral injury (I refuse to call it burnout) at work. Who is doing viable work toward changing *flails* all of this? Do those people have any use for a clinician with no policy background?
I am currently in a sort of care coordination/light data crunching hybrid role, in a non-hospital setting, in a large, deep-blue US city within a purple state. Things I dislike about my current role
-Having a boss who is years removed from any clinical experience and has literally stated that she does not know what I do day to day.
-Having every decision I or my direct care colleagues made scrutinized for cost at the expense of patient safety.
-Being caught in the middle when people above me on the chain move sloooowly in making critical decisions about care, and then having to answer for said idiots when hospitals call me wanting answers.
I am starting to apply for new jobs, but given the state of healthcare in the US I expect to encounter similar problems pretty much anywhere. I feel like I’ve poured tons of effort into everything I can do both individually and in my current workplace to both change the work culture, take care of myself, and advocate for what broader changes I can. I spearheaded union organizing efforts at my work that are ongoing. I vote for the most progressive politicians I can on the local and national levels, and have dabbled in canvassing. I tried to get involved in the healthcare organizing group of my city’s progressive political organization—it fizzled without doing much. I take all the vacation days I have. I have a good therapist and am on psych meds. I have good social supports and a pet.
None of this changes the fact that everybody is forced to be cheap as hell when every health system is run for profit. I understand the value of separating your career from being completely ideologically fulfilled, but it would be nice if it didn’t feel like I do everything I do in order to placate the worst kinds of stingy MBA vultures either.
I write pretty well. Have a lot of experience taking care of people in multiply marginalized groups seeing the barriers to care they face, and describing those barriers for more privileges audiences of the sort who are sympathetic but clueless. Am not afraid of public speaking—if anything I desperately crave an audience and a chance to be taken seriously for what I know. Have some specific clinical expertise in geriatrics, psychiatry, and drug policy/harm reduction. What I don’t have is any specific political or policy experience, or any connections in those fields. Also, for better or worse, I have very little filter at this point and am afraid that I lack the diplomacy and tact it would take to succeed in government.
Even taking all that into account…is there anyone doing real work toward single-payer healthcare or other solutions to the current US insurance clusterfuck that might have a space for me? Is there anywhere where my being a belligerent loudmouth is an asset? Am I just stuck beholden to insurance ghouls forever?
I am currently in a sort of care coordination/light data crunching hybrid role, in a non-hospital setting, in a large, deep-blue US city within a purple state. Things I dislike about my current role
-Having a boss who is years removed from any clinical experience and has literally stated that she does not know what I do day to day.
-Having every decision I or my direct care colleagues made scrutinized for cost at the expense of patient safety.
-Being caught in the middle when people above me on the chain move sloooowly in making critical decisions about care, and then having to answer for said idiots when hospitals call me wanting answers.
I am starting to apply for new jobs, but given the state of healthcare in the US I expect to encounter similar problems pretty much anywhere. I feel like I’ve poured tons of effort into everything I can do both individually and in my current workplace to both change the work culture, take care of myself, and advocate for what broader changes I can. I spearheaded union organizing efforts at my work that are ongoing. I vote for the most progressive politicians I can on the local and national levels, and have dabbled in canvassing. I tried to get involved in the healthcare organizing group of my city’s progressive political organization—it fizzled without doing much. I take all the vacation days I have. I have a good therapist and am on psych meds. I have good social supports and a pet.
None of this changes the fact that everybody is forced to be cheap as hell when every health system is run for profit. I understand the value of separating your career from being completely ideologically fulfilled, but it would be nice if it didn’t feel like I do everything I do in order to placate the worst kinds of stingy MBA vultures either.
I write pretty well. Have a lot of experience taking care of people in multiply marginalized groups seeing the barriers to care they face, and describing those barriers for more privileges audiences of the sort who are sympathetic but clueless. Am not afraid of public speaking—if anything I desperately crave an audience and a chance to be taken seriously for what I know. Have some specific clinical expertise in geriatrics, psychiatry, and drug policy/harm reduction. What I don’t have is any specific political or policy experience, or any connections in those fields. Also, for better or worse, I have very little filter at this point and am afraid that I lack the diplomacy and tact it would take to succeed in government.
Even taking all that into account…is there anyone doing real work toward single-payer healthcare or other solutions to the current US insurance clusterfuck that might have a space for me? Is there anywhere where my being a belligerent loudmouth is an asset? Am I just stuck beholden to insurance ghouls forever?
Here is a sample link to the UCSF program. Clinician Support Systems There are a bunch of other seminars under this topic under the Osher Mini Medical School for the Public or UCTV, all free and top notch.
UCSF is pretty committed to using modern technologies to support health care providers. The Grand Rounds had a session with five doctors trying out Chat GPT to assist them with Electronic Health Record problems, and the Cardiology Division is conducting data gathering with an Apple Watch program; link on YouTube is called "Alcohol, Caffeine, Atrial Fibrillation and Apple Watches" by Gregory Marcus,MD.
Anyway, I hope you find some useful ideas and resources to pursue your interest.
posted by effluvia at 7:27 PM on October 5, 2023
UCSF is pretty committed to using modern technologies to support health care providers. The Grand Rounds had a session with five doctors trying out Chat GPT to assist them with Electronic Health Record problems, and the Cardiology Division is conducting data gathering with an Apple Watch program; link on YouTube is called "Alcohol, Caffeine, Atrial Fibrillation and Apple Watches" by Gregory Marcus,MD.
Anyway, I hope you find some useful ideas and resources to pursue your interest.
posted by effluvia at 7:27 PM on October 5, 2023
If you wanted to do something less insurance based, there is some interesting programs for care coordination and access for immigrant populations both on a hospital level ( charity care programs) and a bit higher in some of the medicaid plans depending on state.
There's a bunch of barriers but it can be more helpful to be a part of a program that say is a grant to help place individuals in long term care facilities who are undocumented or pharmacy discount programs, or programs dedicated to providing DME or other stuff so you are doing more yes you can get this work and less no-for-profit work.
posted by AlexiaSky at 8:20 PM on October 5, 2023 [1 favorite]
There's a bunch of barriers but it can be more helpful to be a part of a program that say is a grant to help place individuals in long term care facilities who are undocumented or pharmacy discount programs, or programs dedicated to providing DME or other stuff so you are doing more yes you can get this work and less no-for-profit work.
posted by AlexiaSky at 8:20 PM on October 5, 2023 [1 favorite]
You want to be a public health nurse.
Seriously, they're awesome, often work with specific populations to get care/get treatment/ complete treatment/understand dz and tx. I'm most familiar with PH nurses in the context of TB, where they do all of those things and tons of education, but I know that is by no means the extent of the awesomeness of ph nurses!
I'll put in a plug for PH (outside of informatics, IT or PMs/admin) being a welcome respite from moral injury. We have our own problems with burnout (doing too much with too little for 20+ years because that was all we could do), and a kind of moral injury when we're forced to do the wrong thing for political or optics reasons - I find informatics, IT, and large systems projects are where leadership needs to have a "win" of doing the decades overdue upgrade in the worst way possible because it's fastest and data nerds saying "you're doing it wrong" messaging doesnt land with those magical thinking types in leadership. That's not unique to public health, it's just the place I see my friends go through the moral injury meatgrinder.
That's nothing on dollar-driven patient care moral harm but i want to be transparent that PH isn't utopia, but DAMN are they the best humans to know and work with!
posted by esoteric things at 8:36 PM on October 5, 2023 [8 favorites]
Seriously, they're awesome, often work with specific populations to get care/get treatment/ complete treatment/understand dz and tx. I'm most familiar with PH nurses in the context of TB, where they do all of those things and tons of education, but I know that is by no means the extent of the awesomeness of ph nurses!
I'll put in a plug for PH (outside of informatics, IT or PMs/admin) being a welcome respite from moral injury. We have our own problems with burnout (doing too much with too little for 20+ years because that was all we could do), and a kind of moral injury when we're forced to do the wrong thing for political or optics reasons - I find informatics, IT, and large systems projects are where leadership needs to have a "win" of doing the decades overdue upgrade in the worst way possible because it's fastest and data nerds saying "you're doing it wrong" messaging doesnt land with those magical thinking types in leadership. That's not unique to public health, it's just the place I see my friends go through the moral injury meatgrinder.
That's nothing on dollar-driven patient care moral harm but i want to be transparent that PH isn't utopia, but DAMN are they the best humans to know and work with!
posted by esoteric things at 8:36 PM on October 5, 2023 [8 favorites]
Peste Magazine might be a place to start.
posted by spamandkimchi at 8:38 PM on October 5, 2023 [1 favorite]
posted by spamandkimchi at 8:38 PM on October 5, 2023 [1 favorite]
I’m a researcher working with journalists if you’re interested in speaking.
posted by pearl228 at 10:05 PM on October 5, 2023 [2 favorites]
posted by pearl228 at 10:05 PM on October 5, 2023 [2 favorites]
The Death Panel podcast is going to be indispensable in case you haven’t discovered it already. The show’s guests and its Discord community are chock full of the energy and perspective that you’re craving.
Getting my ass kicked by long COVID would have sucked a lot worse without their voice. Thank you for being willing to do what you can.
posted by yumpsuit at 10:16 PM on October 5, 2023 [2 favorites]
Getting my ass kicked by long COVID would have sucked a lot worse without their voice. Thank you for being willing to do what you can.
posted by yumpsuit at 10:16 PM on October 5, 2023 [2 favorites]
I am skeptical that tech will save us. It might make some of the clerical/repetitive parts of the job easier, but the unholy alliance between tech, capitalism, and "metrics" is what got us here in the first place. (I am stuck right now in an ideological impasse with an engineering colleague who wants to transmogrify people with Parkinson disease into AI-parseable widgets, while totally ignoring the complexity of both the disease and the complexity of being a goddamn human.)
Check out the work of Wendy Dean and Tate Shanafelt, if you haven't already. They are both physicians but have been deeply involved in moral injury (Dr Dean) and systems change (Dr Shanafelt) long before anyone else.
The thing that saved me, before and especially during the pandemic, was narrative medicine. If you are a writer, this may appeal. Be aware that some programs talk of "narrative medicine" as solo journaling or Balint groups; it sounds like what you want is the more community-oriented, "make good trouble" version. Memail me if interested.
posted by basalganglia at 2:39 AM on October 6, 2023 [5 favorites]
Check out the work of Wendy Dean and Tate Shanafelt, if you haven't already. They are both physicians but have been deeply involved in moral injury (Dr Dean) and systems change (Dr Shanafelt) long before anyone else.
The thing that saved me, before and especially during the pandemic, was narrative medicine. If you are a writer, this may appeal. Be aware that some programs talk of "narrative medicine" as solo journaling or Balint groups; it sounds like what you want is the more community-oriented, "make good trouble" version. Memail me if interested.
posted by basalganglia at 2:39 AM on October 6, 2023 [5 favorites]
Check your memail.
posted by headnsouth at 5:32 AM on October 6, 2023
posted by headnsouth at 5:32 AM on October 6, 2023
It sounds as if you are doing everything right! I’m so sorry you’re dealing with this frustration— so understandable, so maddening— and thank you for being a nurse!! I’m a teacher who definitely was burned out: I took a sabbatical abroad and then changed employers. I agree that you’ll keep running into a lot of the same bullshit in other positions but a new job with a better, even a slightly better, employer really can make it all much, much better. It has been for me!
posted by smorgasbord at 10:18 AM on October 6, 2023
posted by smorgasbord at 10:18 AM on October 6, 2023
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posted by EllaEm at 5:57 PM on October 5, 2023