Dear community, I am writing to you from a liminal state, between worlds. I am making a transition from my work as a primary care doctor with Coastal Health Alliance, now Petaluma Health Center, to respond to my calling to bring healing work more closely attuned to nature. It is a poignant moment, between a familiar but unsustainable reality and a future reality that is unknown but ripe with possibility. I’m writing with an invitation to meet me there.
Working as a physician in our community health center for the past 15 years has been a rich blessing. I’ve been of service as best I could, holding space for healing within the context of relationship and community, even if only for 15 minutes. Even now as I write these words, the thought of leaving this role brings tears. I truly love my work, my patients and my community.
Here is the hard truth: It has been increasingly difficult to stay in my integrity as a healer while practicing in our health care system. Don’t get me wrong—essential and good work is done there. Our clinic is a precious and vital resource, but there is a gap between what is done there and what can be done to support wellbeing and healing.
Our health care system is structured around certain biases, many of which have been introduced and upheld by the pharmaceutical industry. Our medical education, literature, treatment guidelines and quality measures have a biased set of assumptions. The technological science of medical interventions that drives profits for corporate interests so often trumps the art of healing.
Despite massive expenditures, our country’s health outcomes and life expectancy are abysmal. Medical errors and harmful effects of pharmaceuticals are a leading cause of death. This risk is made worse by short appointments, especially for elders with complex conditions and on multiple prescriptions. If it was a country, western medicine would be the fifth leading emitter of CO2, a result of its focus on energetically costly downstream interventions. It is thus imperative that we work to prevent and even reverse chronic conditions, to make intensive interventions less necessary and, whenever possible, to avoid risky medications—appropriate use of technology, in permaculture parlance.
Under these conditions, the risk of burnout for health care providers is high. Like many, I prefer the term “moral injury” to describe the heartbreakingly untenable situation we find ourselves in—being called to do healing work while working in a system that makes healing energy difficult to bring forward. We know we do harm by rushing through appointments. We are exhausted by ever-increasing administrative tasks that take many hours after a day’s work seeing patients. It is no wonder that somewhere between 50 percent and 70 percent of providers in primary care experience burnout and a desire to leave medicine. Many commit suicide. It is time for meaningful change.
Incremental change can be made by tinkering with reimbursement approaches and incentives. But ultimately, we need systemic change. We can begin by having an honest conversation about our goals and the effect of the pharmaceutical industry on our sacred healing art. And if we really want to reclaim our agency as healers serving at a time when healing is needed on all levels, a paradigm shift is essential. We must reconsider what we are doing, and how and where we do it.
I hold these animating questions in my heart: What is mine to do? How does a healer show up in whatever space she is in? How can we reorient our work toward allyship with the natural world and the profound energies found there? How do we ensure that all people have access to restorative, healing experiences and counsel, and how is this financially supported? How do we leverage the medicine of social connection, and of reciprocal relationships with the natural world? How do we demonstrate improved outcomes and bring alternative paradigms to scale?
I have carried these questions while stewarding the Commonweal Garden and bringing Natura Institute for Ecology and Medicine into being. The land is ready to hold people in healing work, in relationship with each other, with food and plants, with community and nature. My prayer is that my capacities to serve as a healer in this village will be deepened and that you, beloved community, will meet me here.
To learn more about how to engage with or support this work, please join a community dialogue on Zoom on Thursday, Sept. 5. You can email me at [email protected] for the link. Or, even better, come to an in-person introduction to the land, vision and pathways to engage on Sunday, Sept. 8, from 1 to 3 p.m. RSVP to my email.
It will be beautiful. Providers in the Coastal Health Alliance will continue to do the important and heroic work that can be done in the system. Let us ease their burden and reclaim our agency in doing the deep work of healing in community and with all of life.
Anna O’Malley, M.D., is an integrative family and community medicine physician and founder and director of Natura Institute for Ecology and Medicine, located in the Commonweal Garden in Bolinas.