Primary Care Doctors, Overwhelmed

More from our inbox:

  • Italy’s Far-Right Turn
  • The MAGA Threat
  • How Lobster Traps Imperil Whales
  • Don’t Exploit Carriage Horses

Dr. Kimberly Becher left a meeting at the Braxton County Health Department in Sutton, W. Va. in July. One of only two family doctors in the county, Dr. Becher was diagnosed with a stress-related heart condition during the pandemic.Credit…

To the Editor:

Re “But Can She Cure Her Ailing Heart?” (Science Times, Sept. 20), about a rural doctor who developed a heart condition brought on by her work:

As a primary care doctor, I was particularly moved by the story about Dr. Kimberly Becher and felt heartbroken that she had to largely leave her practice. Unfortunately, it is a familiar scene. But rather than describe her experience as “burnout,” as though this circumstance were a failing of Dr. Becher’s, the better description is “overworked,” an egregious failing of the system.

In the past 15 years, the practice of primary care has nurtured the potential for moral and physical injury for practitioners unable to practice at the pace required by the systems that employ us. Every day we must choose between working according to our professional standards or taking care of ourselves, potentially failing at both.

Many factors — including heavy caseloads, the electronic health record and a slew of administrative responsibilities — have lengthened our workdays, and fewer providers are now willing to practice outpatient medicine.

Healthy communities require sufficient numbers of primary care providers who, in turn, require far more support and resources than are currently available, to all our detriment.

Cheri Forrester
Sausalito, Calif.

To the Editor:

The heartbreaking story of Dr. Kimberly Becher is a devastating reality of the American health care system, but the challenges she faces ripple far beyond rural West Virginia. Globally, frontline health workers face burnout at alarming levels, and the systems they hold together are on the brink of collapse.

In countries with clinics and hospitals already underfunded, Covid-19 has left staff members without safe working environments, resulting in patients without access to the safe and quality medical care we all deserve.

From rural Uganda to the bustling streets of Haiti’s capital, medical teams are overwhelmed and forced to make daily choices affecting who can receive critical lifesaving care. We tend to focus on our patients’ stories, but the need to honor and recognize health workers is just as important.

Robust, immediate investments are needed, including expanding access to mental health services for patients and providers, adequately staffing facilities and compensating health workers, building bridges for comprehensive community support systems, listening to local leaders to ensure that their voices are included in decision-making, and investing in the next generation of health leaders who can in turn serve their own communities.

Mackinnon Engen
Madison, Wis.
The writer is executive director of, a tech nonprofit for global medical crowdfunding.

To the Editor:

Do we need to add to physician stress and burnout the reporting requirements of meaningless quality measures and expect nearly impossible score improvement? Or do we rely on physicians’ intrinsic motivation to improve the health of their patients?

After reading about Dr. Kimberly Becher, I think the answer is easy.

How many more physicians will we lose to administrative or other nonclinical fields, only exacerbating the crisis in the availability of primary care? It is no wonder that many medical students shun primary care.

Connie DiMari
New York
The writer is an ophthalmologist.

Italy’s Far-Right Turn

Giorgia Meloni is set to become Italy’s first female leader.Credit…Gianni Cipriano for The New York Times

To the Editor:

Re “Despite Vote, Italy’s Democracy Is Not in Peril,” by Mattia Ferraresi (Opinion guest essay, Sept. 27):

Thank you for enlightening us about Italy’s future under the rule of the most right-wing coalition since Mussolini’s fascist regime. This positive analysis of the issues facing Giorgia Meloni’s government surely calms our fears that she will take Italy down the path of autocracy.

As troubling as the election result is for many of us on the left, I strongly hope that the uber egos of her ruling coalition, those of Matteo Salvini and Silvio Berlusconi, will ultimately lead to political self-cannibalism and enable a more democratic and/or technocratic government to emerge.

Let’s hope that Italy weathers this new political storm and emerges more democratic, as opposed to autocratic.

Michael Hadjiargyrou
Centerport, N.Y.

The MAGA Threat

An appeals court ruling last week against former President Donald J. Trump suggests the benefits of his bid for a special master are eroding.Credit…Hannah Beier for The New York Times

To the Editor:

In any other time, in any other country, a leader who tries to control the military, corrupts the electoral system and attempts to overthrow a free and fair election would be dismissed as a tin-pot dictator, seizing power for self-interest, against the will and benefit of the people he serves.

The Jan. 6 committee presented testimony and evidence that Donald Trump was following the playbook of fascist dictators, attempting to undermine the transition of power to retain the presidency despite losing a fair election.

The rants of Mr. Trump and his MAGA followers simply dismiss facts as fiction, having presented no evidence to justify their allegations of voter fraud. Instead, they counter with absurd, paranoid fear mongering, meant to distract from the reality of Jan. 6, and argue why American democracy is not working.

Any candidate running in the midterm elections under the MAGA banner is actively supporting the collapse of our democratic order, promoting baseless fictions to justify repressive policies that strip away personal liberties and undermine democratic governance and 235 years of constitutional rule of law.

Ken Cohen
Kensington, N.H.

How Lobster Traps Imperil Whales

Seafood Watch red-listed American lobsters, which are fished off Maine, Canada’s maritime provinces and other parts of the Northwest Atlantic.Credit…Robert F. Bukaty/Associated Press

To the Editor:

Re “To Save a Whale, a Call to Leave Lobster Off Menus” (Science Times, Sept. 20), about whales getting caught in ropes linked to lobster traps:

It’s true that eating lobster is no longer guilt-free, as a result of government inaction to protect critically endangered North Atlantic right whales from a top threat of fishing entanglements. Current federal requirements do not go far enough, and now the future of these fisheries, and the whales, is at stake.

The North Atlantic right whale is on course to become the first large whale species to go extinct in our lifetimes. It would be a tragedy to never again see this iconic species swim along the East Coast, but even worse because it would happen with the full knowledge of government experts and officials who are failing the whales … and us.

The “red listing” creates an urgent incentive for the government to take action by creating effective safeguards that support the North Atlantic right whales’ recovery. The fisheries will be rewarded with better markets, demand and value.

But until that happens, many of our seafood choices, including lobster, are too risky for right whales.

Gib Brogan
The writer is campaign director at Oceana.

Don’t Exploit Carriage Horses

Christina Hansen drives her horse, Oreo, across Manhattan.Credit…Lucia Vazquez for The New York Times

To the Editor:

Re “New York Carriage Horse Collapse Renews Long-Running Debate” (news article, Sept. 22):

No amount of regulation or enforcement can make the operation of horse-drawn carriages humane or safe in New York City.

Horses are prey animals. When they spook and bolt, they become dangerous. They are also herd animals, but without a pasture they have no place to interact physically or to graze, and are stripped of the ability to do many of the things that come naturally to them.

Donny Moss
New York
The writer is the director of the 2008 documentary “Blinders: The Truth Behind the Tradition,” about New York City’s horse-drawn carriage trade.

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