Dr. Benoit Desjardins, M.D., Ph.D. on Medical Professional Balance

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2024/08/26

Dr. Benoit Desjardins, M.D., Ph.D., FAHA, FACR, FNASCI, CEH, CISSP, is an Ivy League physician who is a world leader in three different fields (cardiovascular imaging, artificial intelligence, cybersecurity) and recently left the U.S. after significantly traumatic events.

Scott Douglas Jacobsen: Previously, you told a heartbreaking story of anxiety, stress, and degrading health, as with many American medical professionals. Does this start in medical school?

Dr. Benoit Desjardins: I am extraordinarily lucky to be alive today to let the readers catch up on the story. As you know, a few years ago, on a Friday afternoon on my 97th hour of work as a U.S. physician, at the end of a week during which I was not allowed to sleep much or eat much, and on a day which I was forced to do the workload of six doctors, the combination of lack of food, lack of sleep, and massive overwork made my body permanently fail. I almost died from a catastrophic medical condition caused by the work conditions and became handicapped for life. This was not the first time that I was physically hurt by these work conditions and not the first time that they almost killed me. But it was the first time that they caused permanent, severely limiting lifelong damage to my body.

To answer your question, I attended medical school in Canada, which has strict rules and laws on basic human rights, including those of physicians. In the U.S., physicians’ working conditions are massively out of compliance with safe labour laws from all other industries. In 2019, Dr Pamela Wible published a book listing 40 categories of documented human rights violations towards physicians in the U.S. (“Human Rights Violations in Medicine: A-to-Z Action Guide“). This included sleep deprivation, food deprivation, overwork, exploitation, bullying, violence, etc. I have experienced most of those as a physician in the U.S. Since around 2014, the U.S. has been well-known for the inhumane work conditions of its physicians, killing and disabling its physicians by the thousands and burning out its physicians by the hundreds of thousands.

After medical school, I came to the U.S. in the early 1990s to pursue a PhD degree. I was initially a graduate student in the U.S. I was treated like everybody else. It was a rude awakening when I started in the U.S. medical system after my PhD. Here is one of many examples of what I faced: As a medical post-graduate trainee, I had once been forced to work at the hospital for 58 consecutive hours without rest and then drove back home. As my exhausted body crashed into my bed, I received a phone call from the chief resident asking me why I had left the hospital as I was apparently on call again for a third night in a row. He ordered me to get back to work. I drove back to the hospital, completely exhausted. I could have easily been killed in a car accident from exhaustion, like what happened to two of my immediate radiology colleagues. After arriving at the hospital, I was forced to work ten additional consecutive hours (for a total of 68 consecutive hours without sleep), until I crashed on the call room floor out of exhaustion. They found me unconscious later that morning. This is one of many examples of the work conditions of physicians in the U.S.

Jacobsen: When medical professionals enter into medicine in Canada and the United States, what are the contrasts in treatment and the similarities in treatment of medical professionals?

Desjardins: There are huge differences. We can divide this treatment into the public, employers, and government.

(1) by the public: In Canada, the public is respectful of physicians, of expertise and science, partly because the population is well educated and scientifically literate and partly because access to healthcare is more restricted, and patients are very happy when they can access a physician. Canadians understand that physicians are human beings. In the U.S., the public has no respect for healthcare professionals, expertise, or science. Physicians and nurses regularly get attacked by patients, and sometimes get killed by them. One physician in Philadelphia recently got stabbed in the face by her patient. Also, physicians in the U.S. are viewed as lottery tickets. The strong anti-science culture in the U.S. has people making irrational cause-and-effect magical expectations of doctors. Any bad medical outcome, a regular part of medicine, almost invariably leads to a lawsuit that can produce a multimillion-dollar award.

(2) by employers: In the U.S., this was nicely summarized by the 2019 New York Times op-ed article “The Business of Health Care Depends on Exploiting Doctors and Nurses” by Dr Danielle Ofri. She discussed how the U.S. healthcare system involves massive exploitation of healthcare workers to stay in business. The nature of the exploitation depends on the environment, either academic or private practice. In academia, physicians are salaried and academic hospitals maximize the work done by physicians to avoid bankruptcy and maintain their razor-thin profit margins. The amount of work never stops increasing. Private practices are being bought one after another by venture capital firms, whose only goal is to maximize short-term profits for their investors, by forcing physician employees to do a massive amount of work with the lowest resources while disregarding quality of care. In Canada, almost all physicians are government employees, which is very different and will be covered next.

(3) by the government: In Canada, the government is the main employer of physicians and exerts very strict control on the location of physicians’ practice to ensure adequate distribution throughout the country. However, besides these limitations on their practice, physicians are treated like human beings by the government, with strict laws and rules on basic human rights and physician work conditions that must be respected. The treatment of physicians by the government in the U.S. is well illustrated by the recent scandal of the PHPs (physician health programs). If, for example, a patient sees a physician drink a glass of champagne at a wedding, she can report him to the U.S. government as an alcohol abuser. Then, under the threat of losing his medical license, the physician gets forced by the government to attend an out-of-state “addiction” government therapy program, costing tens of thousands of dollars. This has led to several bankruptcies and dozens of suicides of physicians while in those PHP government programs. This included prominent doctors, such as a visionary in a pediatric field, who helped thousands of pediatric patients. He committed suicide after a government PHP program ruined his reputation and career. He had been forced into this PHP program by his employer after he reported dangerous local work conditions putting patient lives at risk.

Jacobsen: The conditions at your prior job sound slavish. Is there a cycle of entrapment and overwork among medical professionals?

Desjardins: When you get a job as a physician in the U.S., you get a state license enabling you to practice, which is a long process. Then you get installed, your spouse gets a job, and your kids attend local schools. You become locally established, and relocation becomes a major hassle for the physician, his spouse and kids, so the threshold for relocation is very high.

When I got to Philadelphia in the late 2000s, things were tolerable. However, the situation for physicians worsened progressively. It’s like being a frog in progressively warming water. 2014 was a turning point in Philadelphia for two independent reasons. First, as I already mentioned, the U.S. has inhumane work conditions for its physicians. This became public knowledge around 2014, when the American Medical Association started its first three Physician Wellness programs to try to address the problem. Second, Philadelphia became known as having the most massively corrupt, scientifically illiterate medico-legal system on the planet. This is beyond the scope of this interview. But it’s the last year we could recruit any radiologist in my section and the year when physicians started leaving Philadelphia by the boatload. Before 2014, we individually read about 15,000 images per day. Now, it’s sometimes up to 250,000 images per day.

One of the advantages of my field of radiology is that we do not need to be close to patients. We can read medical images remotely. We took advantage of that during the pandemic, as most radiologists could do their full work shifts from home, without needing to enter the hospital and be exposed to COVID.  This gave many radiologists an important escape route. When remote work became a viable option for radiologists after the pandemic, many entrapped in Philadelphia abandoned their local jobs and signed remote work contracts with out-of-state hospitals while remaining in Philadelphia. The workload for radiologists who did not abandon Philadelphia hospitals rapidly increased. We are living in the absurd situation of being surrounded by dozens of local radiologists whom we desperately need but who refuse to have their names ever associated again with Philadelphia hospitals. When we tried to do the converse and recruit out-of-state radiologists to work remotely for Philadelphia hospitals, we learned that most radiologists in the country refuse to ever have their names associated with hospitals in Philadelphia because of medico-legal reasons. The long-term implications of this situation are unclear but frightening.

Jacobsen: What health problems arise in this context?

Desjardins: We recently discussed extensively the healthcare effects of excessive workloads on human beings, which can lead to all sorts of chronic medical conditions and even death. I refer to this link to our recent In-Sight discussion.

Jacobsen: Whether by death, health injury, or moving away, medical professionals do leave those conditions, as you recently informed me–with a perceptible tinge of elation as if a proverbial sigh of relief. How did you begin to find a way out?

Desjardins: I’m an Ivy League physician and a world-leading expert in my medical and scientific field. I used the same approach to solve all my scientific and clinical problems to find a way out. I was forced to continue working under the same work conditions that had almost killed me and disabled me for life. I needed urgent action. I selected a combination of two basic moves: (1) increase my protection and (2) remove myself from the toxic environment. To increase my protection, I started being closely monitored by a team of three physicians and taking protective medication to decrease the chances of recurrence of the event that permanently disabled me.

Removing myself from the toxic environment was more difficult. Physicians cannot change jobs easily. If you try to relocate locally, you face non-compete clauses preventing access to jobs at other institutions. If you try to relocate to another state or country, getting a new practice license for that new location takes months, and time was not on my side. Abandoning the medical profession was also an option, recently taken by thousands of physicians. I did not consider that option, as I am a world leader in academic radiology. My field needs me, and I have a lot more to offer to my field.

I initially secured a quick research sabbatical at Stanford, giving me six months out of that toxic environment. This gave my body time to cope with my new handicap and time to plan my long-term escape from Philadelphia. This was near the end of the pandemic. During those six months of sabbatical, I interviewed widely and secured four U.S. academic positions away from Philadelphia and was working on securing two positions in Canada. However, the work conditions of U.S. healthcare workers during the pandemic resulted in a massive exodus of healthcare workers from the profession, with even more planning to exit in the short-term future. Under these circumstances, I felt Canada offered a much better future.

Canada has a mechanism to recruit Nobel Laureates and international scientific superstars called the “Distinguished Professor” pathway. There are other mechanisms to recruit regular doctors. To be recruited under that pathway, one must be a world luminary in a specific field. I’m a world luminary in three different fields. However, this pathway takes one year to receive government approval. When Canada found out that I had been almost killed and had become disabled for life by the work conditions of U.S. physicians and that I was still forced to work under these same conditions, they granted me a humanitarian exception and my “Distinguished Professor” pathway was approved in one week, instead of one year. This is how I got out.

Jacobsen: You mentioned some in the previous interviews. What happened to earlier professionals who did not get out and were trapped, in essence, in these areas? Those continuing to undergo harassment and threats, violence, including nurses.

Desjardins: Those who are still trapped are currently abandoning the medical profession by the boatload. In my previous U.S. department, we had a deficit of 43 doctors due to departures and difficulties in recruiting replacements. One of the four academic medical centers in Philadelphia (Hahnemann) collapsed and permanently closed under similar conditions.

In other countries, it is illegal to treat human beings the way the U.S. treats its physicians. No other industrialized country forces its workers to work up to 120 hours per week and up to 72 consecutive hours without rest, like the U.S. does to its physicians. Since the pandemic, 30% of all healthcare professionals have left the medical profession, and an additional 30% are expected to leave in the next 2-3 years. The U.S. cannot recruit fast enough to recover from these massive levels of attrition, which is a global phenomenon while acute in the United States. The up to 60% deficit in healthcare workers will never be fully replenished, and massive shortages of U.S. healthcare workers will become chronic.

There are two ways to increase the number of U.S. physicians: recruit them from other countries or train more physicians at home. Both are a huge problem. The work conditions of U.S. physicians are now well known since 2014, and even more since the pandemic. Physicians from Europe and Canada could be recruited to the U.S. but they no longer want to come. The U.S. can however still attract physicians from third-world countries. Furthermore, there are more and more books, articles, blogs, movies, TED talks, and news clips about the U.S. treatment of its healthcare workers. The medical profession is much less attractive than it used to be to the best and brightest undergraduate students at home. This will continue to decrease the pool of top U.S. applicants for the medical profession. More than 60% of physicians currently highly discourage their children from entering the medical profession, and an even greater percentage of younger physicians who never experienced the good old days of the medical profession strongly advise their children NOT to enter the medical profession.

Jacobsen: When getting out, what area of medicine and geography in Canada did you choose? (And why those?)

Desjardins: In terms of areas of medicine, I needed to continue in the same field, as I am a world leader in that field. I have been responsible for determining the standards of practice in that field for the past 20 years, and it made no sense at this point in my life to change my area of medicine.

Regarding geography, I could have worked anywhere in Canada, but I wanted to be close to my family in Montreal, so I focused on academic places within two hours of Montreal. My top choice was the CHUM, Quebec’s crown jewel of medical centers, in the heart of Montreal, at my alma mater. I ended up working there. It was a fantastic decision. I even have several medical school classmates working in my department or at my institution.

Jacobsen: What was the feeling and process of transition to new work and more reasonable work conditions?

Desjardins: At this late phase in my career, relocating was expected to be very difficult. But against all odds, things worked out very fast, and I was able to leave the U.S. I’m still in disbelief, thinking I will wake up and that this is all a dream. I suspect I’ll remain in a phase of disbelief for a while.

Expats U.S. physicians often describe their newfound freedom as like being released from U.S. prison. This is, of course, a ridiculous comparison, as U.S. prisons don’t kill and disable their prisoners by the thousands as the U.S. does to its physicians. But there are nevertheless many similarities between the two situations.

I now work 40 hours per week instead of 80+ hours. I am on call every eight weeks instead of up to 22 times per month. My daily workload is up to 6 times less than what it was in the U.S., and I have 6 times more vacation than I had in the U.S. This is almost unbelievable, but this is how physicians are treated outside the U.S. I maintain many work collaborations with the U.S., as an international leader in three fields.

I still need to get used to the new freedom. I had not been allowed to take many vacations in my last 20 years as a physician in the U.S.; when I did, it was to travel to see my family in Canada. Now, I live 10 minutes away from my family and see them every weekend. I have yet to schedule a big trip. Switzerland? Australia? Italy? The Greek Islands? An Alaskan cruise? There are so many good picks! I’ve travelled extensively for scientific meetings, but never for pure pleasure outside work.

Jacobsen: How has this better balance affected your life with family, as a husband–including treating her like a queen–and father, and in your ability to treat patients with full focus and care–not sleep deprived, overworked, and stressed to the point of high detriment to personal health?

Desjardins: Well, I now have a family life. I can now eat dinner with my family, spend weekends with them, and go on vacations. This is very liberating. I had always treated my wife like a queen and my kids as best as possible, but I knew my availability was very limited. Now, I am making up for lost time.

I am much more rested during my workdays. There is a massive difference between 4 hours of stressed-out sleep and 7 hours of relaxed sleep. My body feels the difference already. And since I do up to six times less work every day, I get to spend four times longer interpreting each study (8-hour workdays instead of 12+ hours workdays), dramatically increasing the quality of care I can provide. Workdays are not insane marathons anymore; they are normal days with normal work. Patients benefit from this process by accessing more rested, less stressed-out doctors in a better-quality healthcare system. This might partly explain why the Canadian healthcare system currently ranks 32nd in the world, compared to the U.S. ranking of 69th. Canada used to be much better than 32nd, but its waiting lists for care currently hurt its rankings.

Jacobsen: Why have the problems you described in the U.S. medical system not been solved? Why the hiding of physician deaths and suicides?

Desjardins: U.S. physician work conditions are now a very well-known problem. Books, documentary movies (Do No Harm, Robyn Symon), TED talks, publications, and numerous blogs exist. The American Medical Association is aware of the problem and has implemented solutions. Since 2014, Physician Wellness has been a major focus of discussion in medical centers, conferences, blogs, and medical schools. Most people in the public are not even aware that almost every U.S. medical center has a Physician Wellness program to try to stop U.S. physicians from dying by the thousands and burning out by the hundreds of thousands. These programs, which teach physicians resilience rather than improving their work conditions, have been compared to distributing Yoga mats to prisoners at Auschwitz during World War II.

Publicity on this topic is blocked by hospitals. Hospitals in the U.S. are businesses. They must hide the negative consequences of physician work conditions to be able to stay in business. If a hospital disclosed to the news media that three of its physicians jumped to their death from the roof of the hospital within a month of each other, like what happened recently in a New York hospital, this would affect the hospital financial bottom line. After these three New York physicians jumped to their death, their bodies were simply covered by tarps, and this did not even make the local news. Their colleagues at the hospital were threatened of dismissal if they reported the deaths to the news media and were even forbidden to discuss the death among themselves or even to hold a funeral. Patients of the dead physicians were told that their physician had left the hospital.

Jacobsen: Is the lack of reportage on those who care for us in times of need showing a lack of care for them in their times of need across political party lines and media platforms?

Desjardins: Absolutely. The profession is crushed from all sides and getting no sympathy from anyone. The only reason the U.S. healthcare system has not yet collapsed under these circumstances, is because of the endless professional ethic of medical staff members, a resource that seems endless and that is currently massively exploited by the public, by corporate medicine, and by the government.

Jacobsen: Thank you for the opportunity and your time, Benoit.

Desjardins: Thank you for discussing this important topic.

Bio: Dr. Benoit Desjardins, M.D., Ph.D., FAHA, FACR, FNASCI, CEH, CISSP, is Professor of Radiology at the University of Montreal. He recently retired from the University of Pennsylvania after 16 years on faculty. He is an international leader in three different fields: cardiovascular imaging, artificial intelligence, and cybersecurity. He has given over 200 invited presentations nationally and internationally in those three fields. He was co-leader of the Arrhythmia Imaging Research Laboratory at Penn. His research involves cardiac MRI and CT in electrophysiology, focusing on the relation between cardiac biomarkers such as myocardial scar, with pathways of abnormal electrical conduction in left ventricular arrhythmia. He is funded by the National Institute of Health and is very active in national scientific societies. He has extensive expertise in artificial intelligence, the field of his PhD. In the spring of 2022, he has spent six months at Stanford as Visiting Professor and Associate Scholar of the Stanford Center for Artificial Intelligence in Medicine and Imaging. He is a reformed hacker. He has several certificates in cybersecurity and has done research and published on the cybersecurity of medical images. Outside work, he is a Black Belt at Tae Kwon Do, an ex-Boy Scout Leader, a competitive marksman, and a FPV race drone pilot. He is also a member of the prestigious Mega Society and Prometheus Society.

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