“I think I’m done with medicine.”
Finally uttering the words that had been on my mind since my last stretch of work left me with such a sense of relief.
Followed by immediate regret.
This was not the forum for this discussion – girls brunch which included someone I had barely met.
That was a mistake, M. You know she’s a nurse… you just opened up a whole can of worms you don’t want to get into.
But I couldn’t prevent the word vomit from spewing out.
These poisonous words had been brewing in my mind for the last 2 days. Over the last two years, I had kept trying to figure out my next step – find a different primary care position, do hospitalist work or even open up my own practice. Sure, I fantasized about going back to Target but never had I seriously considered a move outside of medicine entirely.
As I spoke the words into existence, I could feel them resonate to my core.
This was a truth I could no longer deny.
“But… we need good doctors!”
Ughhh… of course she’s as virtuous as you feared. Well, maybe this will be good for you to flesh out. To expand on your reasoning, M. If you fail, then you’ll know you just need to take two ibuprofen and a nap.
Suppressing the eye roll I felt coming on, I waited for her to continue telling me why I couldn’t do what I wanted to with my life. Was there anything new in her litany of reasons of why doctors needed to stop leaving medicine?
- But think about the patients! Who will take care of them if you all keep quitting?
- But you worked so hard to get where you are! What a waste of time and effort!
- You know you’d regret it. You were put here on this earth to help people – this is life’s greatest calling. Do you really want to be the kind of monster who doesn’t want to help people anymore?
Yup… nothing new.
Tell me something I haven’t already told myself. Give me something juicy to ponder, because I’m having a hard time finding new and interesting reasons to keep me locked into the medical machine for the remainder of my working life.
Oh, the things I could say in response.
Working my way backward, my mind easily cast aside her reasons:
- I’m not arrogant enough to state that doctors are the only people who help others. Besides, I can honestly say I receive more gratitude holding the door open for random strangers than for what I do on a daily basis in the hospital. Because everyone hates being in the hospital and they’re going to take it out on me. And YOU as a nurse, for that matter. If I decide I’m going to help people again someday, maybe I’ll be a doorwoman.
- Yes, I did work really hard to get here. Thank you for recognizing that. But now that I’m here, I’ve realized I made a mistake. Shouldn’t we learn from our mistakes and move on? If we don’t, that would really be a waste of time and effort.
- I have thought about my patients. And you know what? The medical system is more than happy to replace me with a PA or a NP. In fact, my old practice replaced me with one. So, don’t tell me there’s no one else to take care of these people.
- Yes, we still need good doctors. No argument there.
But who said that has to be me?
Glancing over at the two other ladies sitting across from us, I shot over what I hoped resembled a regretful look. I could go on this war path forever, but what would there be to gain?
There was no point in convincing them of my reasoning – the only person I need to justify my exit from medicine to is me.
“Real medicine”
I returned to the hospital so I could go back to practicing “real medicine”. To justify why I felt spent at the end of my long workdays because I was “saving lives”. But after only 3 months, I’ve come to realize I am merely keeping people in a constant state of illness.
Got a stomach? We can PEG that.
Got a throat? We can trach that.
Kidneys are shot? Welcome to your new life on dialysis.
I spend my days cleaning up the messes of the system, putting people on medications I know they won’t be able to afford once they get discharged from the hospital. Aware of the medication rationing that will occur, the missed follow up appointments and the eventual bounce back to the hospital to clean up the mess yet again.
But at least they get their meds daily for this 5 day stretch under my care while I try to forget the forest for the trees.
I watch as everyone around me busies themselves with “saving lives” yet are unwilling to have the hard conversations about what these people’s lives will actually look like.
We put them on the medical train in perpetuity, salivating over all the newest and greatest fancy medical interventions insurance likely won’t cover and patients bankrupt themselves for. We have forgotten how to look people in the eye and remind them none of us are getting out of here alive, instead keeping them artificially “alive” until the next complication of the things we do to them.
And there will be complications.
In our quest to preserve life with chronic diseases, we have forgotten how to counsel people on how to live well in health. How could we when the system disincentivizes us from spending the time on these discussions, running on a 15 minute schedule with an average of 8 minutes spent with the actual patient in the outpatient setting?
Now we watch with disdain as naturopaths, chiropractors and self-designated “health experts” swoop in to fill the wellness vacuum we’ve created. As we desperately try to retake the role of champions of health we had envisioned ourselves to be, we can’t seem to understand why our patients, the people we worked so hard for so long to help, no longer want to listen.
WE broke that trust when we allowed the medical machine to prioritize pills over healthy habits. Profits over people. Press-Ganey scores over empowerment to tell patients the honest truth, even if they might not like it.
And continuing to work in this system as it stands only makes me complicit in all of this.
“Have you thought about cutting back, M?”
I get asked this question all the time. In fact, it’s something I’ve touted as a solution to this struggle. In a past life, I cut back from 60 hours to 45 in hopes this would save my primary care career. When that didn’t work, I jumped ship into hospitalist medicine to see if working an average of 13 shifts a month would change my outlook.
And yet, still I found myself ruining girls brunch, unable to contain the dark thoughts swirling in my mind.
It doesn’t matter if I’ve been off for 1 day or 7. On my return to work, almost immediately I start questioning,
“What am I doing here? What am I really accomplishing?”
Yes, cutting back will reduce my exposure to this moral injury but it does not restore my disillusionment with medicine.
No amount of time away will change this reality.
What I have seen cannot be unseen.
Vacations, mindfulness and the laughable act of designating a chief wellness officer do not even come close to addressing the demoralization myself and several of my other colleagues face as we decide on whether or not we will stay in medicine.
I may choose to dip my toes into this noxious environment less frequently by cutting back, but it doesn’t change the toxicity level.
So why continue to engage?
Yes, we still need good doctors.
But again I ask, who said that has to be me?
***
I just wanted to take a rare moment to thank you for taking the blog to over 100,000 views (101,658 to be exact)!!
Seeing that I do the bare minimum to get my stuff out there on the interwebs, all of these views have been driven by your willingness to read the blog and share what resonated with you.
Thank you.
I’ll continue to write for as long as this continues to helpful for you to know you’re not alone in thinking these similar thoughts. It’s a dark path but we’ll find our way out. Together.
M
***
Photo taken of me overlooking Mount Rainier at the Mount Fremont Lookout, easily one of the most terrifying hikes of my life.
Couldn’t agree more on the fact that I get more satisfaction doing simple, unskilled things for people (donate loose change, hold door) than I do from doctoring.
Do you think you’ll actually leave medicine? What else have you looked into?
My answer changes multiple times a day.
Short answer: Yes, I will leave medicine.
The question is when? Now or later?
The issue with a career in medicine is the sunk cost: I spent my 20s pursuing this career and $250,000+ in student loans. If I were to embark on a new career, I’d have to start from the beginning again AND potentially get paid significantly less than what I make now. Do I really want to do that?
I would try to leverage my medical degree but not actually do clinical medicine. For instance, I have looked into medical copy writing as an option because I kind of like to write, but the thing is I like to write for me. Then there’s consulting for tech companies/startups, medical informatics, etc. Utilization review is straight out for me because those people created such a hellish experience for me when I practice outpatient medicine.
I think realistically I’m going to do a slow exit from medicine. I’m just going to keep cutting back until I decide I’m done. The alternative is for me to keep going at the pace I’m at now and retire in 15 years or less, but that’s just really not sustainable and it’s not how I want to live.
But I don’t know.. maybe ask again in a week and you’ll get a different answer. I’m definitely all over the place.
Hi M, I’ve not been keeping up with your posts as much lately since I’ve doven into my M3 rotations over the past couple months, where I have been humbled by outstanding displays of kindness and dedication by residents and attendings. Nonetheless, I do deeply resonate with what you’ve said here and worry about what this portends for my future career. One thing I can’t help but notice in your stories is the consistent theme of how private insurance keeps patients locked into an extractive cycle of profit and denying care, and I wonder how much of your moral injury is directed at these forces over the profession of medicine itself? That’s not to say that the richest and most powerful of our colleagues aren’t helping to prop up this dumpster fire of a system too, especially those who feel entitled to high compensation whether or not their patients actually get better or are healthy at the end of the day. At any rate, I’m not here to suggest what is right for you, and I just want to reflect on your story as yet another cautionary tale. Still, I want your thoughts on one more thing: putting aside all of the exhaustive steps and hurdles required to pack up ship and practice in another’s country, do you hold any sentiments or musings about whether other countries’ health systems allow their medical practitioners to address the failings you’ve illustrated on your blog about ours? Do you feel you could practice more comfortably and authentically in somewhere like Canada, just to use an example? Bring whatever prior political or otherwise perspectives you may hold, but I’m really curious about the relationship between the practitioner landscape of a given polity and the more personal values and struggles that individual doctors like yourself try (and often fail) to stay true to.
Really good questions.
You’re right, a lot of my anger is directed at insurance companies and the games they make us play just to get the care that our patients need, but quarterly I read about how the insurance executives keep somehow racking up these bonuses: https://www.modernhealthcare.com/insurance/some-insurer-ceos-see-bigger-paychecks-2018
My favorite one listed there is Molina CEO Zubretsky who made over $15 million in 2018. Molina, the absolute worst insurance company I had to deal with when I was in primary care, who denied prescription coverage for antidepressant capsules because tablets were cheaper but didn’t notify me until AFTER my patient went to the ER with suicidal ideations. You know… things like that just get under my skin. And that was just one instance with one patient. The frustrations like that build up over time.
As for your question about whether or not working in a different country with possibly a single payor system would be different? I honestly don’t know. I’ve gotten messages from people in New Zealand, Australia, Ireland and England who are supposed to be working in these single payor systems that are still utterly ruined by their careers in medicine.
Miko at Mindbodymiko.com is a former surgeon who left medicine in Australia (https://mindbodymiko.com/the-ugly-side-of-becoming-a-surgeon/).
Zed at mindthemedic.com just decided to leave medicine in England.
A common theme is that we’re all being asked to do more with less. More productivity with less manpower. More paperwork with less face to face time with patients. More demands that are unattainable and not being given the tools that we need to meet even half of them.
I’m starting to really believe that in order for things to get better, doctors need to start sidestepping the current system as it stands. Direct primary care is a great example of this movement. Physicians are starting to unionize to so they can have bargaining power or at least a voice at the table before systems just roll out their poorly thought out mandates. Doctors are reaching out to patients directly through social media and educating them.
Not to say all of these things are the right way to deal with this, but it does speak to the level of discontent within the current insurance system in the US. By the time you get out of training, the landscape of medicine will be completely different as well. It certainly has changed since I graduated from med school 8 years ago.
Your biggest strength will be your ability to adapt to whatever comes your way.
Mic drop. Slow clap. M, once again, you have amazed me with your ability to perfectly capture the deepest frustrations of the current state of medicine. (And I agree… the opening the door comment is just SO bang on!!)
Just visited my 11 year old nephew who has been in hospital for a week with osteomyelitis. On admit day 2 when things weren’t getting better, I was panicked. And felt guilty- here was his life in the hands of these docs, while I had given up “life saving” hospital medicine. But then I asked myself- why isn’t it enough that I did do that for almost 15 years? Why does it (still) have to be me? How much of the population has had to ever endure that sort of stress? Why isn’t it enough to focus on preventative health (with my IUC clinic)?
Rex- Canada is no dream land- see my previous guest posts on Physician on Fire, Crispy Doc, and Corey Fawcet’s site, explaining why I quit Obstetrics (and my hospital practice) at age 43.
M- if you run, run like the wind my friend! And don’t stop until you reach that awesome and rewarding “happy place” that you deserve to be. Best wishes as you strive to heal all of your moral injuries (they are real!)
-Kristina
Kristina,
I hope your nephew is better! I think I would totally feel the same guilt as you.. I mean, I certainly didn’t really feel like I was actually contributing to society when I was in outpatient medicine because I wasn’t acutely “saving lives.”
But the things you do matter. You help give women agency over the course of their lives… what could be more impactful than that? And you do it in a way that is kind and respectful, and you find meaning in it! These are all wonderful things. So drop the guilt if it’s still hanging on 🙂
As for me… my emotional self wants to run, but my logical self always wins out. I’m not 100% sure what my next move will be, but I guess the important thing is to just keep moving.
M,
I am sorry, but not surprised, that the transition from outpatient primary care into hospital medicine has rejuvenated your medical career. It certainly was worth trying, though.
When you said, “It doesn’t matter if I’ve been off for 1 day or 7. On my return to work, almost immediately I start questioning,..” it reminded me of my burnout past. It stays with you over time and over distance.
I think that the problem is that you are too kind and too thoughtful a person. Lest you think that I am paying you a compliment (on the surface I am), these attributes are lethal to the career of a doctor. When I look at my doc friends who are most happy and successful, they lack a deep sense of compassion and empathy – they are performing a highly skilled job and retain a healthy (in a professional sense) level of detachment. That’s just not you.
So where do we go from here? I cannot stand to watch your spirit suffer any longer, so we have to find something for you to do that gives you purpose, redefines your identity, and puts you around others of similar values, intellect, and sense of caring. Fortunately your medical degree, work experience, and insanely gifted writing skills will open a lot of doors for you. As dark as you might feel now, that is how bright your future is.
One of the great things about a medical degree is that there seems to be a job for everyone, either with patients or something completely different outside of clinical medicine. Maybe seeing patients isn’t right for you right now and you can use that degree to leverage into a new path. That’s ok. Most of the people who responded already to this thread pursued FI so they could dramatically change the course of their lives. You don’t need to be full FI to do that, just need a little FU money. If the loans are holding you back from exploring a different path then why not get rid of them and be free?
P.s. alternative unsilicited medical job idea…. Have you ever considered working in a newborn nursery? It’s a happy place. A little boring and repetitive but often truly happy.
I have thought about it! I’m actually contemplating leaving adult medicine together and just doing peds. Maybe I’d do outpatient peds again. I do miss seeing the little ones growing up and hitting all their developmental milestones.
It’s ironic – I hated my pediatric clinic SO MUCH in training, but now it’s the thing I miss most. Never happy…
Anyway, the loans will be paid off in a year, hopefully less. I have come up with a a scheme to sell the house, pay off my student loans AND accumulate more FU money in one fell swoop so I can live in a travel trailer parked somewhere on the west coast. I just need to get my husband to buy in…
Ah, that is the tough thing about doing this anonymously. No one can know that I dabble in writing!
I hear what you’re saying about me being too kind and thoughtful being a hindrance to me staying in medicine. It’s not that I can’t stay detached, it’s that I didn’t want to be that doctor. Now that I’ve fully committed to keeping that level of detachment over the last week, it’s really not been that bad.
The reality is, we’re experts at adapting and I realized in terms of self-preservation, I’d have to undergo that hardening process again. It’s not who I wanted to be, but it’s what I’ve had to become to get me through this.
Was it the right thing to do? I don’t know yet.. we’ll see how this goes.
Definitely is a painful journey of posts I read from the moment I first discovered your blog to today’s one.
I was hoping the change of scenery might give you a chance to capture some of that magic that made you want to do medicine in the first place.
Sadly you are truly putting to words what many physicians are feeling but feel trapped and helpless so they can’t do anything about it.
As vagabond mentioned you are certainly capable of pivoting and finding a more meaningful purpose especially with your intelligence and writing skills.
The medical machine spits out another one only to be filled with new meat coming down the pipeline. The trend medicine is taking is disturbing and sad. I am glad I am at the stage where I am close to exiting stage right as well
Unfortunately this trend seems to be accelerating. I get messages from horrified med students weekly who are seeing it coming for them but are so trapped by student loans that they won’t even really starting paying down for another 4-6 years. It is a sad time indeed.
M,
I, for one, want to say that I am NOT sad to hear it. Modern medicine is not healing. If we actually practiced a healing art, I would be sad to hear you were leaving. Modern Medicine is an industry like any other. Sometimes we change industries, whose business is it of others whether or not you get a different job?
Throwing more resources at a bad investment doesn’t make it a good investment, just a more expensive bad investment.
I will say though, who said we have to bear the guilt for the sins of the system? It is imperfect and inhumane, to be sure. But so are a great many systems. Indeed, simply being alive makes us complicit in the sins of human society (environmental, social, spiritual, etc). Humans systems are inherently corrupt, yet also capable of good things from time to time.
We cannot engage with the human world and keep our souls clean. Medicine may not be the place for you to engage, but you do not need to carry the weight of all its sins.
I am only able to bear it by telling myself, “I’m just filling in out here. I am a stopgap measure.”
Good luck, I’m rooting for you.
I’ve been telling myself the very same thing all week. “I’m just filling in here for the next 5 days, then it will be someone else’s issue to deal with.”
It feels awful.. but then when I look at my old list of patients that I left in my colleague’s care 4 days ago and half of them are still sitting there, you realize that some things can’t be fixed. That stroke patient waiting for insurance to authorize placement is just going to sit in the hospital. That eating disorder patient is not going to get better just because I say so. They can be on someone else’s docket while I have a few days off.
It is what it is…
M,
It’s hard to see someone with talent like yours continue to suffer. Sometimes you have to keep throwing things at the wall until something sticks.
I’m going to think outside the box for a moment and ask if palliative care and hospice medicine might be more along the lines of helping people live and die well in the manner that you seek.
Your depth and purpose may ultimately fail to find their ideal outlet within medicine, but I keep thinking there might be something soul nourishing you have yet to discover.
Wish I could think of a way to help you feel less broken.
Sometimes cutting back is a defensive crouch until you figure out your next move. Could you try 6 a month, or job share?
Warmly,
CD
In my effort to come up with all the available options, I did think of returning to fellowship for hospice/palliative care. I just don’t know if I have it in me to return to training for a year, just to have the potential of it not working out like I had hoped. The opportunity cost is too great especially with the loss of income.
I think ultimately you’re right – I need to cut back. Hopefully that would feel less like throwing things at the wall and will allow me to create the illusion of having more control over this situation. I’ve got some things in the works that may help facilitate that.. or it might blow up in my face.
I’ll keep you posted! [Like literally, in a post :)]
I hear you and understand because I am going through the same thing. It is comforting to know you are not the only one. Thank you for sharing.
Thank you for reading and commenting. This is why I continue to write. If it helps, feel free to email at any time!
Really early on in my training I became more disillusioned with medicine when I realised it was all relatively patchwork and there wasn’t much promotion of health in healthcare. That and for some reason society feels like doctors need to sacrifice ourselves and can’t understand why we would choose not to.
I think the more I could be honest with myself, the more I could speak out about it and the more I spoke about it, the less it felt like I was holding onto a dirty secret.
It certainly does feel like a dirty secret, doesn’t it? It’s a secret we all know, but we’re too afraid to acknowledge aloud. Sometimes it just takes one person to say something though to start making changes.
You just need different patients, patients motivated toward wellness not disease or even in spite of disease. You clearly don’t need to be working for someone.
If you could direct me where to find these patients, please do tell!
This is something I’ve been mulling over – how do I practice essentially evidence-based lifestyle medicine? I know the ABLM is a thing now, but to pay for a board certification in something like that seems a little preposterous, plus I haven’t really found a practice model that is actually successful with that. That is probably the direction I ultimately need to go.. just need to figure out how that would actually work.
Look at https://www.cenegenics.com/. Not too hard to get going. I considered this at one point but decided to just retire
I work in healthcare as a neonatal NP (found your site from the happy philosopher) and while I like my job most of the time, I sympathize with your post.
Sometimes it takes more courage to admit when something isn’t right for us and to just let it go completely. I was working on my doctorate and got about a third of it and quit because it was not bringing me joy in my life and I realized I was only doing it because I felt that “other people” expected me to do it. I don’t know what that looks like for you, obviously, but it’s okay to let go. You do NOT owe anyone anything. You are a person first and foremost and your happiness should be an ultimate concern. We get one life in this world.
Have you heard about Miko from mindbodymiko.com ? She is a Japanese immigrant to Australia that became a surgeon. She ended up burning out and quitting altogether early in her career and now writes about lack of protections for doctors & “junior doctors” (those in residency), as well as her trauma associated with working all the time.
Yes, I have heard of her! You’re probably the 5th person to have mentioned Miko to me. I read her harrowing story of what brought her to her edge and what happened to her was absolutely awful. It did make me grateful that my experience was not even close to being that bad!
Your comment makes me smile because I just had someone on twitter lambaste me for “stealing someone else’s spot” in med school and not “paying my debt to society” for wanting to cut back/quit medicine/find something else. People obviously have very strong opinions on what healthcare providers can and cannot do with our lives.
To many, we are only here to serve other people in their time of need. Their happiness is the only thing we are to concern ourselves with. I remember when I was in clinic, I had several patients complain to me when I got back from vacation that I wasn’t there when they needed me. Back then it just piled on the guilt so I didn’t take a vacation for almost a year, but thinking of it now, it just saddens me. Lots of us don’t have the energy to fight that mentality. We just bear it until we break, much like Miko.
I’ve only read a few of your posts so far, but wonder if opening or finding a practice/business that focuses on healthy living and preventative would be a better fit for you? There are patients and families looking for MDs with this focus. From the patient side it is difficult to find. Some of us don’t want to be given a “magic pill”, we want a more natural, health focused solution.
This is something I’ve really thought about in the last 3 weeks. I don’t know what that would look like logistically and I haven’t really found any other MD clinic that’s doing it the way I’d envision myself doing that.
But yes, it would absolutely be a better fit for me. I just need to decide if I’m willing to invest that much of my time/effort/money into something that may or may not pan out. It’s a little terrifying…
M,
Recently found your blog. Your ability to express yourself through the written word is amazing.
Many of your daily frustrations resonate loud and clear with me and most of my colleagues, both specialists and primary care. There are 2 things that comfort me when I feel like leaving medicine:
1) Many of my friends in non-medical occupations experience many of the same frustrations that we face as physicians. These days it seems that more paperwork and bureaucracy is ubiquitous to all professions paying more than minimum wage. Not sure why that is but that has been my observation. This at least gives me some relief to know that the grass is not necessarily greener on the other side and we are not alone.
2) My Faith. I literally have Colossians 3:23 printed out and taped directly in front on my face at my work station so that I can read it while I peck away at my terrible EMR system. I think no matter what we do if we are working for mankind we will be frustrated. I TRY to work for the Lord and consider my daily frustrations with patients, EMR, insurance companies, etc as the cost of discipleship. It is hard, however, to avoid my passive aggressive tendencies.
Thanks again for expressing in your blog many of the feelings us docs are having but are afraid to admit.
I’m not sure what happened, but I found this comment in the trash and saved it! Sorry for the delay in responding to you, and thank you so much for your comment.
I agree, all professions appear to be going down this path as well – I see it with my husband and his frustrations with his work. This is why we’ve been very intentional about becoming financially independent so we can free ourselves from work if we so choose in the future.
I’m glad you have your faith to guide you. I used to have little handwritten notes to myself on my computer to help me when I got frustrated.. maybe I should institute that at my new cubicle!
Again, thank you for your comment and I appreciate you stopping by!
I love the honesty M. I am a strong believer in the philosophy that we do not “owe the system” anything. We trade our time for money in an arrangement that hopefully benefits everyone, and when that no longer serves us it is ok to move on. I hope you find your purpose in medicine, but maybe it lies somewhere else. Sometimes the journey is more interesting than the destination.
M,
I am fortunate to have been introduced to your blog via Physician on Fire’s “Sunday Best”. The way you describe your thoughts and feelings is EXACTLY the same way that I feel. It is so demoralizing to have so much education and training but seemingly few options if you do decide to leave medicine while in your peak earning / practicing years. I finished my residency and fellowship about 7 years ago. I have changed jobs three times – academic, private practice, hospital-based – and I have reduced by FTE from 1.0 to 0.7. Every single day at work I wonder why I keep coming and every Sunday (that I’m not on call) I feel a sense of intense dread… so much so, I wonder how I even climb out of bed before 5 AM on Monday morning. I have an interest in business and so I recently enrolled in an MBA program but it will likely take about 2 years for me to finish that program if I continue to work at the same pace I am now.
Thank you so much for writing your most honest thoughts – they certainly resonate with me.
– S
I’m not sure why your message made it to the spam section, but I just saw this in the trash bin and saved it, so sorry for the delay in replying!
Thank you so much for your comment – I am currently contemplating another job change and often wonder if it’s even worth trying to move on to the next thing. Like would another job really be better? At this point, I’m trying to make it more about the lifestyle that I want than the job because let’s face it – there will always be something about work that I won’t like. But there has to be something else out there that won’t make me question my life decisions on an hourly basis.
I’m finding waiting for the perfect job isn’t going to make things magically happen – I’m going to have to create my own opportunities. I hope you are able to create something that works for you – if not, our earning potential is such that we can create an escape hatch via early retirement in 10-15 years if we’re smart with our money!
Best,
M
Notebook opened. Taking notes. Thanks for the valuable post. I wish more people would talk about this subject as in depth as you.
Hanssen,
Thank you for reading! I actually think people do talk about this subject in depth… behind closed doors, with vetted people they know won’t judge them. No one is really willing to speak the truth, at least not in the open. I don’t mean to point any fingers – after all, I’m doing this anonymously. But it is time to start having these conversations, otherwise nothing will change.
M