The Most Useful Word in Medicine

One in nine of the physicians in the largest recent study of doctors who left American medicine never practiced it. They finished medical school. They finished residency — eight to ten years, the better part of a million dollars, the eighty-hour weeks, the whole sunk-cost cathedral — and then they did not see a single patient as an attending. They walked out the door they had spent a decade unlocking. You cannot burn out of a job you never started. Which makes the most-quoted word in American medicine, for those doctors, not an explanation but a category error. They did not break under the weight of the work. They never picked it up. They looked at the deal on offer — the terms of an attending life they had watched up close for years — and declined to sign. The correct word for that is not burnout. It is appraisal. They read the contract and said no. Hold that, because the entire conversation about why doctors are leaving is built to keep you from saying it out loud. The consensus…