In this interview, Dr. Ariana DeMers recounts her journey from opening a private practice shortly after fellowship—despite lacking business experience—to expanding it with additional physicians and physician assistants. Overwhelmed by the operational demands, she sold the practice to a hospital, which improved her finances but stripped her of the autonomy she valued. In the hospital setting, she faced bureaucratic inertia, increased patient loads, reduced resources, and a lack of authority to implement changes, leading to severe burnout while also managing nighttime call and a young child. Frustrated, she impulsively quit without a plan, briefly considering unrelated work. Her former staff devised a temporary reduced‑schedule plan (half‑day patient clinics, limited surgeries, no new patients) that she followed for nine months, during which her practice effectively closed and revenue fell, yet the administration remained unresponsive. Dr. DeMers highlights the broader issue of medical culture that trains physicians to compartmentalize personal needs, creating a societal contract that expects doctors to sacrifice wellbeing for patient care, while institutions fail to support mental health or grant meaningful autonomy.
Chapters
I opened my practice, my own practice, a year out of fellowship with really no business experience whatsoever. And I hired a doctor, and then a year later, I hired another doctor, and we had 2 PAs, and we had all of the big practice things. And it was successful, and I was successful, and we were doing great. But It was way too much and it was really taking a toll. So I sold my business to the hospital and that was financially a good decision. And unfortunately, what I've come to realize is it was not a good decision for me personally. So I made more money.
Why was it not a good—
Yeah, I had no ability to make the changes that I was used to making. So, you know, in my private practice, I was used to making those decisions. I was like, wow, we need to change this. And it was able— I was able to change it. And, you know, when I was employed by the hospital and they owned my practice, I'd be like, gosh, you know, we need to change this. Like, well, we're gonna have a meeting about considering about maybe having a meeting about changing some things. And, you know, 9 months down the road, nothing I had changed and I was still pulling my hair out. And it was like, you guys, this is, this is A, important for patients, and B, this system doesn't work for the doctors. You're just making me do more work with less time, less resources, and I still get paid the same. Oh, and by the way, I've got to do it faster because we have to see more patients. And so it was, it was really unacceptable. And I think that was the perfect storm for me to have less autonomy, less ability to make change, to do what I thought was a good job for my patients, and still having this onslaught of work. I was dying. Plus, I was taking call in the middle of the night and I had a small child. And so it was just not conducive to life.
Yep.
And I walked out. The joke is, And so I talked to my friend. He's like, well, you have to have diagnosis. I was like, well, I can't do that. That's not going to work out. And so I went to Togo's to get a sandwich and I ran into my nurse who was on maternity leave. And that was also part of it is like my systems that I had created to survive this, the system of medicine was partly my nurse and she was on maternity leave. And so all my systems kind of broke down. And it was unacceptable. I couldn't do all the work and see all the patients and not be able to be in charge of changing things that needed to be changed. So at Togo's, I said— she's like, um, what are you doing here? Don't you have patients? I said, well, funny story, um, I walked out. I quit. I'm not gonna do this anymore.
She was like, okay, that Now, you didn't have a plan of what you were gonna do.
Yeah.
You didn't have a plan of what you were gonna do. You just walked out, right?
Zero plan. Yep, zero plan.
Yeah, zero plan.
I don't know, I'm gonna go sell flip-flops on the beach, something else, because, um, this is not working. I, I can't do this. And so I was like, oh my gosh, what am I gonna do? So luckily I, um—
So yeah, what happened? So, okay, so we leave, we do the mic drop, we're out, we're gonna go sell flip-flops.
Yeah. Yes. So my office staff, who I had hired previously and then joined the hospital, they all got together and they were like, oh boy, this is bad. And they came up with a plan for me to work. And they said, hey, we have a plan. How does this sound? How about you just work 2 half days in the morning, just patients, 2 half days in the morning. We know you have some surgeries scheduled for the next 6 weeks. And then Don't schedule any more surgeries. Close your practice to new patients. Don't take any new patients. And then let's just see how this goes. I was like, ooh, one day of surgery, 2 half days in the morning. I could do that. Okay, I'll say yes. And so I did that and I was like, this is crazy. I'm going to go broke. Whatever. I don't care. We can at least do this and at least serve my patients. see how this goes. And I did that for 9 months. Um, I had my, my practice was closed. I did not see any patients. Um, I finished out my surgeries and then I kept waiting for the administration to be like, oh, hey, excuse me. Um, we've noticed that your revenue has dropped. Uh, is everything okay? And nothing happened. Uh, that, that—
So the hospital never called and said, hey, we're here. You're having a bad time.
You're burnt out.
We're worried about your mental health. Because yeah, God forbid, you know, God forbid you should be treating patients and in surgery if your mental health isn't like totally screwed on. Right.
I mean, right.
Fascinating.
I mean, yes. So, and people are like, well, that's not safe. And we've been trained to compartmentalize since the time we got to medical school. Um, you know, doctors have been trained to shove aside any personal needs, anything that's going on and compartmentalize that, shove that aside, and focus on the task at hand. And we're really good at that, unfortunately. But ultimately, I think it's been ingrained in us and we care so deeply for our patients that we do shove aside our own needs to be able to care for our patients. And that's kind of been our contract with society is like, you suffer and take care of patients and then you get to be And oh, by the way, we don't think as highly of you anymore because we think that you're in charge of not getting the care because the insurance companies have, you know, not allowed it. And somehow we're supposed to like fix that, but with no autonomy, no ability to make any change whatsoever. So we just put our heads down and like work really hard and hopefully it'll get better somehow. But it didn't.
