Ramsis F. Ghaly
  1. Clinical Professor of Neurosurgery, Anesthesiology, Neurocritical Care and Pain, University of Illinois at Chicago, Chicago, and Ghaly Neurosurgical Associates, Aurora, Illinois, United States.

Correspondence Address:
Ramsis F. Ghaly, Clinical Professor of Neurosurgery, Anesthesiology, Neurocritical Care and Pain, University of Illinois at Chicago, Chicago, and Ghaly Neurosurgical Associates, 4260 Westbrook Dr, suite 127 Aurora Illinous 60504. United States.


Copyright: © 2023 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ghaly RF. Medical care losing doctors and nurses. Surg Neurol Int 22-Sep-2023;14:344

How to cite this URL: Ghaly RF. Medical care losing doctors and nurses. Surg Neurol Int 22-Sep-2023;14:344. Available from:

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Dear Editor,

I watched a man walking hunched over twisted in severe pain! I asked him: “What happened to you? You look like you are in terrific pain. What are you suffering from?”

He replied: “Look at this picture! This was me 4 months ago. I was hiking 11 miles up high in the mountains. Now, doctor, I am miserable!!”

I said: “Just from looking at you. I would think you need a spine operation to relieve the pain!”

He replied: “I did all that my insurance carrier wanted me to do. That included; Physical therapy, epidural spinal injections, and chiropractic care (i.e., a buddy of mine is a chiropractor). Nothing helped. Now they want to give me medications, but I do not want to take the pills they have offered.

I said: “So, have you seen a spine surgeon yet, and what did they say?

He replied: “I found two good neurosurgeons, but neither in my insurance plan. Raher my insurance has identified two spinal surgeons in my plan, but they are 2 h away, and cannot get an appointment for 4 months.”

I said: “It is horrific that you are unable to get help! For someone as vibrant as you, it is just not right that you have to deal with such nonsense! I know there are many spinal surgeons like me out there who could offer you immediate treatment/surgery, offering you immediate symptomatic relief.

At this point, a woman working as a kitchen chef serving us food said: “I was a critical care neuro nurse for 45 years. However, now I have retired, and I will never go back. There is now so much bureaucracy in medicine nowadays, and I just do not want to deal with it. Hence, I quit and said to myself; “enough is enough” I am happier as I have largely eliminated the stress of being a nurse, although I still miss nursing care and helping patients!!”

At this point in the conversation, I offered this gentleman my card and contact information saying; “If you want me to help you, I am all yours.”

He said: “I can’t! You aren’t in my plans, and I have to stay within my insurance! Nevertheless, I will keep you in mind!”

I looked at this individual and said to myself: “Here is a big man who used to be in great health and was never sick in the past. He has continued to pay his insurance dues for decades. Yet, now he is literally brought to his knees unable to get the help that he needs. I would be able to offer him my services, but the insurance bureaucracy will not allow me to treat him!!”

Unfortunately, the News now blames doctors rather than the abundant bureaucracy brought to you by the insurance carriers! Further, there is increasing concern that there is a looming health-care workforce shortage in the US: ‘We don’t have enough doctors!

In fact, there is an extreme health workforce shortage according to data from the Health Resources and Services Administration (i.e., numbers based on data HRSA receives from state offices and health departments). The NY Times examined the truth beyond the so called shortage of doctors and nurses in their article: “The Unspoken Reason Why Many Doctors and Nurses Are Quitting!”

As a concerned solo spinal surgeon, I would like to do more to help, but corporate healthcare now largely controls my practice and referrals. The end result is that we are largely being increasingly forced to practice spine surgery using an; “Electronic Cookbook Medicine” (i.e., one size fits all).

Tremendous loss of Physicians, Nurse Practitioners (NP), and Physician Assistants (PA) since COVID. Nearly 334,000 physicians, NPs, PAs, and other clinicians left the workforce in 2021 largely attributed to due to retirement, burnout, and pandemic-related stress. Physicians experienced the largest loss (i.e., 117,000 MDs) followed by 53,295 departures from NP, and 22,704 PA. Largely, these medical care providers are burned out from bureaucracy and running away from the insurance/medical bureaucrats!

In fact, many doctors, NPs, PAs/others, and nurses would continue to work with patients, but the “system” obstructs them! The result is that many patients are undertreated/or mistreated or not treated at all.

It is incredible that we now live in a time when doctors and other health care extenders still want to help but have given up their positions to avoid delivering substandard medical care.

Today when they are asked, many established doctors and nurses say: “We are lucky and feel grateful as we are on the way out!”

More than 300K health-care providers dropped out of the workforce in 2021, report finds

According to, “Nearly 334,000 physicians, nurse practitioners, physician assistants and other clinicians left the workforce in 2021 due to retirement, burnout and pandemic-related stressors, according to new data.”[ 1 ]

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The author(s) confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.


The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.


1. . Available from: [Last accessed on 2023 Sep 14].


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    Dr. Miguel A. Faria

    Posted September 22, 2023, 12:51 pm

    It is a very sad state of affairs with medical care regression and the lost of the best in medicine — and surgery.


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