When COVID-19 forced Lalita Abhyankar, MD, MHS to face her dissatisfaction working at a federally qualified health center, she knew it was time for a change. After several failed attempts to improve her experience at that job, Abhyankar decided to quit—and she wouldn’t be the only doctor to do so during the pandemic.
A survey published in October 2021 found that 18% of healthcare workers in the US had quit their jobs since February 2020, creating widespread hospital staffing shortages.
While clinicians have valid reasons for leaving their positions in healthcare, COVID-19 persists and healthcare professionals (HCPs) are in short supply.
These circumstances call into question the ethics of working—and quitting— during a pandemic.
Facing public health crises
In training, HCPs are often guided by the Kantian ethical view that their primary concern is to care for individual patients. It follows that physicians are morally obliged to provide care. This duty-based philosophy, however, is complicated by the presence of global pandemics and other special circumstances.
According to an October 2020 article published in the Journal of Medical Ethics, pandemics require doctors to settle into role-related duties based on specialized skills. Because clinicians have a skillset that non-clinicians lack, physicians have a greater moral obligation to serve during a public health crisis than untrained personnel.
Physicians who choose to practice in pandemics—including during COVID-19—are subject to working longer hours and facing increased exposure to the disease. When the circumstances demand it, doctors may also be assigned tasks that surpass their medical competency, prompting legal concerns.
Doctors who are at risk of severe COVID-related illness confront additional challenges.
Clinicians who are older and have one or more comorbidities, for example, may feel that working on the frontlines poses too great a personal risk. The same could be said for doctors who have families to care for and protect from potential exposure.
But, let’s face it: You and your colleagues are operating under enormous pressure right now. And it’s reflected in the nearly one in five physicians and other healthcare workers who are dropping out of medicine. The duty to serve endures, however, and physicians are feeling its weight.
Reciprocity and solidarity
Much hinges on whether doctors are being cared for and protected in return.
An August 2020 article published in the Journal of Medical Ethics argues the importance of reciprocity on behalf of a clinician’s state or employer.
Author David Ian Jeffrey wrote, “While healthcare workers are willing to take necessary risks, they are not willing to take unnecessary ones.” Supplying physicians with PPE to mitigate unnecessary risks is one form of reciprocity to which doctors may be entitled.
Reciprocity also includes access to psychosocial treatment programs, as well as the encouragement to pursue them. The same goes for immunization: Doctors and their families should be among the first populations to receive vaccines as they become available.
Another staple for healthcare professionals working in a pandemic is solidarity.
Keeping mortality and morbidity rates down during a pandemic hinges on solidarity between healthcare professionals, and society.
Doctors who receive public support from friends, neighbors, and governments—even in the form of small acts of kindness—can carry out the Herculean task of working on the frontlines, knowing their communities value and respect them.
Spontaneous applause, banners, and graffiti are all means by which people showed their gratitude and support for HCPs throughout COVID. Whether the thousands of physicians who came out of retirement to help during the pandemic is a result of such visible solidarity efforts is unknown. But those efforts certainly couldn’t have hurt.
The question of opting out
Authors Stephanie Johnson and Frances Butcher wrote in the October 2020 Journal of Medical Ethics article that older doctors with comorbidities who lack access to PPE might consider opting out of work altogether, and should be justified in doing so.
This option is pertinent for clinicians whose training doesn’t line up with the specialized skills needed to handle a public health crisis. For example, an ophthalmic surgeon may be less inclined to work on the frontlines, compared with an infectious disease doctor, whose specialty necessitates the acceptance of risk of illness.
With all of this in mind, physicians should be seen as human beings who have rich lives and are faced with several competing demands. Their decision to opt out of work, while not ideal during a pandemic, can be justified when personal or professional circumstances arise that require them to step away from the frontlines.
If you’re working on the frontlines of the COVID-19 pandemic, don’t shy away from asking your employer and government for what you need.
Whether you’re short on PPE or in need of a vaccine, you are entitled to appropriate care as you work each day to treat patients.
In Abhyankar’s case, staying at her job wasn’t an option for several reasons. For clinicians who may be in a similar situation, Abhyankar offers guidance.
“Remember who you are,” Abhyankar writes in a blog post published by the American Academy of Family Physicians. “While our interests may have shifted since we began our pre-med courses, there was a kernel of truth to whatever big picture goal existed for us then. There is a good chance that we lost touch with it in the weeds of training."
"Take some time to remember and rebuild your passions and interests that may have been stripped throughout training."
— Lalita Abhyankar, MD, MHS