Why business pressure and threats ended a career she loved [PODCAST]

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She loved the job for 20 years. She left anyway. Christine King, certified registered nurse anesthetist, returns to explain what changed in the operating room and what it cost her. This episode is based on her article “Why I left health care after almost 20 years,” published on KevinMD. You will hear why decisions about whether a procedure happens started to feel like insurance decisions rather than medical ones. You will hear what workplace violence looks like in an operating room, where the threats came less from patients than from the people she worked alongside. You will hear why those incidents so rarely get reported, and why she thinks the newest generation of physicians is already different. You will hear what the stress did physically, and what eased when she stopped. And you will hear what she would tell a student choosing between nursing and medical school. Press play for the one thing she wishes she had done more of, and why she thinks the people behind her already will.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Christine King. She’s a nurse anesthetist, and today’s KevinMD article is “Why I left health care after almost 20 years.” Christine, welcome back to the show.

Christine King: Thank you very much. Thanks for having me.

Kevin Pho: All right. Let’s start by, of course, talking about this KevinMD article. Why did you decide to write this in the first place?

Christine King: Because I wanted to just tell people what my experience was. I mean, I had an excellent career. I loved my job, and there were still reasons for me not to do it anymore. Even though I really did get a lot from it over the past 20 years, I just felt like it was time for me to move on.

Kevin Pho: Now, for those who didn’t get a chance to read your article, just share your story again.

Christine King: Sure. I became a CRNA 20 years ago, and the first thing that I did, and I’m not sure whether I mentioned this in the article or not, is I shadowed to make sure that this would be something that I would want to do for the long term. I remember being in the operating room and them telling me, “You really need thick skin for this job.” And I really doubted myself at that point. Could I really do this? I don’t naturally have thick skin, so it was kind of a fake-it-till-you-make-it situation. But I am so glad I did it. I never regretted going back to school.

But over time, some of the things that I got into in the article are just about patient care. The emphasis became more on a business model rather than a patient care model. That really bothered me, and I could see that happening over time. There was the constant stress, the production pressure, and the general disrespect, especially in an operating room. And one of the things that I didn’t even get into was the amount of workplace violence and the fact that hospitals really are soft targets. I didn’t go into that, but that also entered into my decision to leave.

Kevin Pho: So let’s talk about some of those individually. You mentioned business versus patient care. You mentioned workplace violence, and obviously the constant stress. So when it comes specifically to business versus patient care, through your lens as a nurse anesthetist, how did that manifest? What did that look like from your perspective?

Christine King: I just feel like the decisions about whether a procedure should be done or not became more of an insurance issue rather than a medical issue. That really bothered me, because there are people who really do need care, and the insurance companies would deny them the care that they needed. From my perspective as a caregiver, that was a real problem. That’s not why I went into health care.

When I started, I started at a Catholic hospital. It wasn’t affiliated with anything at the time, and the focus was so much on what’s best for the patient. They also emphasized not being wasteful, and I think that for most health care workers, probably nobody wants to be wasteful. Everybody wants to make sure that they do the right thing for their patients and not waste supplies or time. But the focus became completely flipped over the past 20 years.

Kevin Pho: The other thing that you mentioned was workplace violence, and this is a topic that comes up repeatedly on my show, from nurses and physicians who fear for their safety just by doing their jobs. So specifically, as a nurse anesthetist in the operating room, how do you see workplace violence? What are some examples or stories that you could share with us about some of the dangers that you or your colleagues have faced?

Christine King: Right. I’m going to start with the fact that over the past several years of my career, there have been two mass shootings in areas where I worked. One was the Tree of Life shooting in Pittsburgh in 2018, and then five years later, it was in Lewiston. It directly affected the whole community, and of course everybody who worked and helped those patients, the ones who were actually lucky enough to make it to the hospital. There is the ongoing PTSD from facing a situation like that and having to see those types of wounds in a noncombat situation.

In the OR, in anesthesia, I think most people are very happy to see you when you come in the room. But I think there’s a lot of horizontal violence. I think you see more of the public coming in and making threats in an ER situation, but in an OR situation, it comes not from patients as much as from other surgeons, from administration, and even from coworkers. I think it’s more of an issue in that regard.

Kevin Pho: There’s always that stereotype, and I’ve heard stories about what you call horizontal violence: threats and abuse from other members of the surgical team. Is that something that is still prevalent today, again, from your perspective and from what you’re hearing from your colleagues?

Christine King: Oh, yes. I think that is definitely true. Ten years ago, maybe 15 now, there was a surgeon that I worked with at one place who threatened to shoot somebody. That sounds funny, but to be in a situation where someone is threatening to take you out into the parking lot and shoot you, even if it’s not a serious threat, is very threatening and very intimidating. And it was meant to be intimidating.

I think I mentioned in the article the surgeon who whistled “If I Only Had a Brain” from The Wizard of Oz. I was a student at the time. Several months later, I worked with him in an operating room at a different hospital. He was asking me to adjust the bed, apparently I didn’t do it fast enough, and he started to whistle that. And I thought, “You might not realize it, but I know what you’re trying to get across to me. I remember what you said.”

And there are surgeons throwing things. It’s a stressful job. I get that, and I understand that. There are times when you’re in a code situation or an emergency situation where people just aren’t at their best, and I do understand that. But actual physical threats and physical violence are just not OK, and that does happen in the operating room. I do think that because the operating room is such an insular place to work, people think that the standards are different. And they’re not. Well, they are, but they shouldn’t be.

Kevin Pho: Is there any type of recourse, or anything from your perspective, that could improve some of those relationships or at least mitigate some of the abuse that you’re describing? What would you like to see happen?

Christine King: Like I said, most of these incidents occurred probably 10 or 15 years ago. I think a new generation of physicians is coming on board. I think they are being trained to be more respectful, and you can absolutely notice the difference. I think people very definitely hesitate to report it, because you don’t want anything to come back to you, and you still have to work with these people every day. So I do think that holds people back from actually reporting it. But like I said, I do think it’s gotten better with the younger generation of physicians.

Kevin Pho: In your article, you wrote that the culmination of these stresses started to affect your body physically. Talk more about that.

Christine King: Oh my gosh, yes. Absolutely. Well, the first thing I noticed is that I started developing arthritis, and it would flare up when I was in a very stressful situation. I could feel the pain, and this was nothing that I had ever experienced before. The other physical symptom I would get would be intestinal upset. It was very, very real, and when I stopped working, it improved greatly.

Kevin Pho: Now, as you reflect on your career, if you had to do it all over again, is there anything that you would have done differently?

Christine King: Well, actually, I think instead of becoming a nurse, I would have gone to medical school. That was something that I looked into, but I thought, “This is going to take too long.” And I wanted to start my life and start my career. So looking back, I think I would have taken the time and done what I originally wanted to do. But I think I still would have ended up in health care. Like I said, I loved it. I loved taking the biology and the people skills and putting those two things together. I really had a fantastic career.

Kevin Pho: So let’s say there’s a student who’s listening to us right now and is at a crossroads, going down the nursing path versus medical school, where you were. Tell us the type of questions they need to be asking themselves in order to choose the right path for them.

Christine King: Right. I think you need to look at what you want personally out of life. Work-life balance, I think, is a huge issue with that. Because I was a nurse, even though I took call, I was able to really maintain a very good work-life balance, and I don’t know that it would have been as easy being a physician.

I also think about the cost. Medical school is important, but even now, compared to when I became a CRNA 20 years ago, the cost of education is very close to what I would have spent going to medical school. They’ve lengthened the course to three years, and the cost has just gone up. So I think those two things have to be huge considerations.

Kevin Pho: Now, what about your advice to other CRNAs or other technicians who work in the operating room? You’ve seen the abuse that can happen, and you’ve seen the stress. Any advice for those health care workers in the operating room that you could share from your experience?

Christine King: Yeah. I wish I had spoken up more, and spoken up for my coworkers, or had them speak up for me. I think it’s important to say, “We need to stop. This is not OK,” and to not fear for your job or fear calling a supervisor into the room, telling them what the situation is, and helping them de-escalate. I think far too often people, especially in the OR, tend to just ignore it and move on. And I think this new generation of nurses coming up behind me isn’t going to tolerate it either. So I think speaking up, and having people in the room who are allies, is key.

Kevin Pho: We’re talking to Christine King. She’s a nurse anesthetist, and today’s KevinMD article is “Why I left health care after almost 20 years.” Christine, as always, let’s end with your take-home messages to the KevinMD audience.

Christine King: I just think it’s really important that the focus in health care be on the patient and not on business. I also think we need to focus on safeguarding and protecting health care workers, and also be more serious about preventative medicine going forward, especially in the area of vaccines and maternal health. I think all of those things are really, really important.

Kevin Pho: Christine, thanks again for sharing your story, time, and insight, and thanks again for coming back on the show.

Christine King: Thank you very much.