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The emotional, physical, and financial costs of being a Memory Specialist

Updated: May 11, 2020

Many of you were patients of mine at Memorial and may have been surprised that I suddenly left and started my direct pay practice, charging patients directly for my time. I would like to take the time to write this blog entry as a means for explanation and hopefully understanding from you, my patients who are the most important to me. Throughout my career, it has been idealism about helping people which I have so forcefully defended throughout my medical training education and job positions, against much resistance and private and professional criticism.

I experienced severe moral injury as a result of my residency and corporate position. I witnessed several traumatizing experiences and deaths of patients that I had cared for with little to no discussion of our emotions about death, little to no supportive care for the psychological well-being of its residents, and was left to fend for myself during highly critical situations in the intensive care unit with little to no training in essential life support measures, no support from my attendings and was discouraged from calling them in the middle of the night. I was encouraged to lie on my duty hour journals, in order to comply with the 80-hour work week law, when in fact I had worked over 80 hours consistently for several weeks in a row. I also routinely worked 33 to 36 hour shifts every fourth night and was expected to drive home. Thank God I got into no car accidents. I was called an “arrogant bitch” by the ER attendings in front of an entire room full of patients and nurses in the ER for being assertive about what we needed to do for a patient who was dying while they were criticizing me and refusing to do nothing.

By far the most traumatic experience for me during my residency training as well as my time in my corporate job was the overwhelming influx of patients we were demanded to see despite having only 5-15 minutes to tell a family that they had a fatal diagnoses such as Alzheimer’s or ALS, while I heard another chart slammed on the door signaling that there were six more patients waiting for me. I could not mentally handle the idea of seeing 18 patients a day with critical, life-ending diagnoses, while not being able to eat, take a break due to having a migraine, or knowing I would come home with a severe migraine and that my entire weekend would be spent recovering from the emotional effects of work. I was criticized in my residency for talking too much to patients and being “too compassionate“ and I was criticized at for being "lazy" by my physician boss for needing to take walks after giving a fatal diagnosis to my patients. I was disparaged and disrespected by doctors and administrators who had no medical training in my field whatsoever for not bringing in enough money by asking for more time with my patients and was forced to see dementia patients at the rate of 20 minutes per patient which I thought was unacceptable. I sent several emails and discussed several times with the leadership at Memorial that I was physically, mentally, and emotionally drained from the schedule and that I could no longer sustain this volume of patients. I received absolutely no response from any leadership including physicians who were working with me or directly above me. And I received no response that they were willing to increase the duration of my visits to 30 minutes or even one hour which was I was asking for. I felt the need to order unnecessary tests in order to delay a diagnosis because I could not explain a fatal diagnosis within 20 minutes, knowing that six more patients were waiting for me and I may not be able to eat for the rest of the day. And the patient would have to wait another three months for the hopes of a longer 40 minute visit, during which I might be able to sit down and explain the fatal diagnosis, hoping they hadn’t mistakenly booked me a 20 minute visit yet again. I was betrayed by several of my colleagues who had to undergo call whereas I negotiated no call in my contract, as well as berated in front of the administration by colleagues for doing my own cognitive testing, since I was not satisfied with the quality of cognitive testing done by a particular professional in our group. I was berated by primary care physicians for using layman's terms in patients' notes and presenting it to them so that they could understand their plan, and was undermined by one of my colleagues for giving patients informational packets about dementia that the corporation had not approved ahead of time and not gotten the publishing rights to.

In my practice now I have focused on healing my mind and body after at least nine years of moral injury, abuse, bullying, intimidation, sleep deprivation, migraines, insomnia, neck pain, extreme fatigue, and constant criticism from others and from myself. I have started by seeing one patient per day for two days in a row and having one day to myself for answering messages, doing continuing medical education, and writing my blog/book. I want to let you all know that I have been diagnosed with posttraumatic stress disorder (PTSD) due to the trauma I experienced for nine years during both my training and position at a corporate health care system.

I also wanted to let you know that in 2019, the first year of my practice, I made $45,000 in salary. I am very proud of this because I was able to pay back $25,000 to the corporate institution for breaking my contract early. Part of the reason for this low income is that I was initially afraid to charge patients $12 a minute for paperwork, and I did not want to make it seem a surprise the first couple times I sent you bills for the amount of time I spent doing paperwork and phone calls for you. My income has recently increased because I have been more confident in the value of my work and honest about the amount of time I have spent, but I do not want to lose any patient due to difficulty paying bills, and I’m more than willing to negotiate the payments on the bills. I am still able to pay my mortgage and bills and live in my condo in Miami. However my goals have changed and I no longer feel the need to live in a city and am purchasing land in Clewiston, Florida with no mortgage in order to sustain a more simplistic economic and emotional life.

I am letting you know this because I hope you understand the necessity for my billing policies and my need not to deal with insurance companies, administrators, unnecessary paperwork, or limitations on what I can and cannot prescribe and recommend by people who don't understand or who are less trained than I.

I am also letting you know as an empathetic physician that I have personally gone through traumatic experiences in my life, career, and experienced severe fear and anxiety which is finally improving. I do not believe that this is affecting the quality of my work, but it has caused me to limit my work hours and need to charge for my time to assert the value of my work. So if you would ever like to talk to me about traumatic experiences, emotional issues, and how to deal with them, I am more than willing with an attentive and sympathetic ear to listen and try to help, if you would like, especially by sharing my personal experiences with you and how I am providing the best care and functioning at the highest level possible given what I have gone through.

Please be assured that the quality of your medical care, my attention to detail, my interest in you all as people, and my driving priority in my career to improve every person’s quality of life as much as possible has never changed, and in fact has gotten stronger through these personal trials that I have battled against. Please feel free to share your comments, support, or other information in the posts below.

To spread awareness on the issue, I highly recommend seeing the documentary Do No Harm which is available every Sunday at 8 PM for screenings and panel discussions among physicians who have gone through trauma and about the plans to prevent this at both the medical education level and the corporate level. Please refer to and register on the website The trailer can be seen here on Youtube. There are video rentals available on the website for $4.99 and there is also the ability to register for the Sunday night panel discussions at a rate of $14.99.

Thank you all for listening,

Dr. G

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