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From Burnout and Bureaucracy, a Rock Star Doctor Rises

Doctor's office

It would have stunned any child. Rebekah Bernard was 12 years old when her mother was diagnosed with severe bipolar disorder. Before falling ill, she was a registered nurse and the woman who kept her rural South Florida family functioning. That stability gave way to suffering, mania, and isolation.

“When you’re a kid, you don’t really understand what’s going on,” Bernard recalls. “You just know that your mom is locked in the bedroom and you hear crying. You know she can’t do what needs to be done.”

Bernard’s father, also a nurse, was busy working to make up for his homebound wife’s missing income, but the lack of her cheerful presence around the home left a void. Someone had to keep the household running, so Bernard began cooking dinner and doing laundry for her siblings. All the while, she struggled to make sense of what was going on with her mother.

“It was hard to know from one day to the next what was going to happen,” Bernard says. “My mom had some episodes of mania. Sometimes it was scary, and it made me grow up very quickly.”

The one thing that Bernard knew was that her mother loved her. No one, however, knew how to help the woman reclaim the life she once had.

Bernard responded to the confusion by throwing herself into schoolwork and drama club. If she studied hard enough or exhibited enough empathy to get into character, she could escape her home life. She could take control. She could shine.

By the time she entered high school, Bernard knew she wanted to help people — people like her mom, whose out-of-the-way zip code limited her ability to get the support she needed. Bernard’s good grades got her into a health career camp, where she met medical school students and residents who were only a few years older and no more intelligent than herself. She always imagined becoming a doctor, though she viewed herself as a small-town girl from a working-class family. Becoming a physician seemed unrealistic, but her time at health career camp proved that she belonged. She could help. She could make consequential decisions. She might just have a shot at becoming a physician.

More than 30 years later, Dr. Bernard is best known as the author of “How To Be a Rock Star Doctor,” which she wrote to help physicians achieve clinical fulfillment, financial success, and work-life balance. During a long trudge through burnout and bureaucracy, she kept faith in her independence and commitment to the well-being of others, traits she picked up as a kid caring for her family. Her story stands as a testament to both the stress placed on physicians and the promise of a better career, if only they take the risk to grasp it.

“Take control of your own destiny,” Bernard says. “Give it a try.”

Burning Out

After seven years of medical training and all the wide-eyed idealism she could muster, Dr. Rebekah Bernard was crushed. She had finally settled into her first primary care job in a federally qualified health center whose patients lived each day wondering whether they would make rent. They needed Dr. Bernard like her mother once had, yet she felt powerless to help them. When she proposed changes to bureaucratic processes, her supervisors shot them down. They made it clear that she was there to treat patients as quickly as possible and leave the practice’s strategic and operational challenges to the suits. She grew tired of sowing trouble and instead adopted a new plan: show up, see patients, go home.

“It was really sad for me because I always dreamed of working with the underserved,” she says. “It broke my heart to find that the work wasn’t what I hoped it would be.”

For years, Dr. Bernard had considered the physician’s work not only integral to society, but also fulfilling to the individual. Now, she felt more like a DMV employee than a physician. She had no autonomy and only precious minutes to spend with each patient. She was burning out, a sad reality shared by more than 40 percent of physicians today.

Dr. Bernard spent six years in that low-income clinic, just long enough to satisfy the requirements of her medical school scholarship, each day growing more disillusioned. When she left, she joked that she was headed to the dark side: a for-profit health system in Naples, Florida, one of the richest areas in the nation. Her new patients were well off, but they also needed care — and perhaps their privilege would enable Dr. Bernard to spend more time with each patient. If she were free to solve big problems and build meaningful primary care relationships, she might find happiness in medicine.

Instead, she found a bureaucracy where financial metrics reigned supreme and red tape and substandard technology hampered care.

“I got really burned out,” Dr. Bernard recalls, “because I realized that I was facing the same exact issues that I saw in the federally qualified health center. This was a systemic problem, and that was the biggest shock to me.”

Rather than give up, she developed workarounds. When software slowed down her workflow, Dr. Bernard created new forms that slashed documentation time. When she noticed issues that hurt patient satisfaction, she fixed them. Every day, health system administrators sent an email noting the most productive physicians, and she routinely topped the list. Dr. Bernard was trying to be happy — to be a physician who made a difference — in a system she considered cold and driven by productivity metrics.

Five years had passed when another health system bought the clinic. Administrators were planning to implement a new electronic health record system, and they requested assistance from Dr. Bernard. At first, she felt excited to be part of a group that had a chance to change the lives of physicians and patients. But in a meeting, administrators told Dr. Bernard that she and her colleagues were expected to input all existing data into the new system manually. She envisioned a future in which she once again felt like a DMV employee, a data entry clerk, not a doctor. She fumed.

“I thought about all the time I had volunteered to try to make the system better only for them to scrap the whole thing and say there was nothing we could do about it,” she says. “It was like a knife in my heart.”

She resolved in that moment to never again work for a large, faceless corporation. The job was never worth her despair.

“It was really sad for me because I always dreamed of working with the underserved,” she says. “It broke my heart to find that the work wasn’t what I hoped it would be.”

A Bustling Business

Dr. Bernard was tired of letting other people run her life. After exiting the health system, she joined a small clinic where she fell in love with medicine again. But the company never figured out how to make money, and in two years she found herself out of work. She thought about what she liked about being a doctor: face time with patients, customized technology and workflows, and honest, empathetic relationships with patients and colleagues. If she couldn’t find that in an existing practice, she would start her own.

“I was always content to work for somebody else, and suddenly I have no job,” she recalls thinking. “It seems daunting, but this is the time if there ever were a time. And if it didn’t work out, I could just go work for someone else again.”

Dr. Bernard had already spent hours reading about direct primary care, the arrangement in which patients pay monthly fees to doctors in exchange for unfettered medical access, more personal care, and no insurer involvement. She dug deeper into the literature and spoke with local direct primary care physicians. Something clicked: This model was for her, and she didn’t want to waste any time second-guessing her decision.

She jumped into action. Dr. Bernard hired an office manager and bought inexpensive office space, an exam table via Craigslist, and an old EKG machine from a retiring plastic surgeon. She was nervous, but she moved too quickly to doubt herself. In less than three weeks, her independent practice, Gulf Coast Direct Primary Care, was ready to accept patients.

“I still can’t even believe it,” Dr. Bernard says. “But that’s how it can go when things are meant to be, you’re motivated, and you have the education.”

At first, she felt underwhelmed. While she was accustomed to a stacked schedule of patient visits, her direct primary care practice was in its infancy. Dr. Bernard used social media and word of mouth to recruit patients, with a boost from a local newspaper story. In two months, she reached 100 patients. That covered the bills and brought some relief.

But time moved slowly for Dr. Bernard. Gulf Coast Direct Primary Care’s patient list was still far from capacity. What if the market wasn’t ready for this sort of practice? She relied on the only person she could: herself. She spent more time treating and building trust among her existing patients, hoping they would continue to spread the word. Anxious as she was, Dr. Bernard found solace in practicing medicine her way. She also began thinking about writing, a childhood passion of hers. And within a year and a half, she had signed on a full roster of 600 patients.

“I never thought that I could have my own business. I didn’t have the skill set or the knowledge or the acumen for it,” she says. “As doctors, we demand so much of ourselves. The idea of failure is just something that fills us with so much fear, and I’m like that, too. We just need to say to ourselves, ‘Well, it’s possible that I’ll fail, but I might also succeed and be really happy.’ Now, I know.”

Well, it’s possible that I’ll fail, but I might also succeed and be really happy.

As Dr. Bernard continues to build her direct primary care practice, she regularly writes to help dissatisfied physicians find well-being and a rewarding career. While there’s no guarantee that direct primary care will work for everyone, she says doctors who check these boxes could save time and anguish:

  • The right patient demographics. Dr. Bernard’s community includes many blue-collar workers, who don’t always have access to health insurance, and patients who haven’t benefited from Medicaid expansion. Those missing links make direct primary care all the more appealing. If she had opened elsewhere, it might’ve taken longer for the practice to thrive.
  • Extensive research. Dr. Bernard studied the direct primary care model and reached out to successful practitioners. This helped her anticipate problems and avoid paying consultants. Further, she performed market research that offered a glimpse into her potential patients and their needs.
  • Face your fears. Doctors might not be entrepreneurs by nature, but they are problem solvers. Running a business means dealing with challenges every day. If anyone can take on that task, it’s a physician. But Dr. Bernard says many doctors underestimate their abilities. If they’re willing to live with risk, physicians can make independent primary care work for them.

When Dr. Bernard’s mother was diagnosed with bipolar disorder, the young girl was forced to provide for herself. When she became a doctor, she found dissatisfaction not in her patients but within the system. Now, through direct primary care, Dr. Bernard has created her own system — one that requires only the two elements she had always counted on in her search for gratification.

“To open a practice,” she says, “you just need yourself and a patient.”