They Shoot Horses, Don’t They?

“They Shoot Horses, Don’t They” was a novel written by Horace McCoy in 1935. It tells the story of a group of desperate people who participate in a grueling dance marathon during the Great Depression, hoping to win a cash prize. Over the course of the 1500-hour dance marathon, many couples have fallen but ultimately no winner is named but all have suffered.

The novel was adapted into a film in 1969, directed by Sydney Pollack and starred Jane Fonda. The movie was well-received and earned several Academy Award nominations.

Now, the phrase “They shoot horses, don’t they?” is often used metaphorically to suggest putting someone out of their misery. This usage stems from the practice of shooting horses with broken legs to mercifully end their suffering, as it is difficult and not cost-effective to heal such injuries effectively.

A lover of old movies, I see the parallel of minority physicians in American healthcare with the dance marathon depicted in the movie, as we step over our fallen comrades, ignoring their despair in pursuit of the American dream.

In the movie the opportunistic emcee (played by Gig Young, for which he won an Academy Award) played a pivotal role. The same role the hospitals also play:

1. Exploitation

In the film the emcee Rocky Gravo exploits the desperation of the dance marathon contestants for entertainment and profit.

Similarly, hospital systems exploit minority physicians by placing them in challenging environments without adequate support, expecting them to navigate significant barriers while delivering high-quality care.

Minority physicians often face disproportionately high demands and pressures, like the contestants in the dance marathon.

2. Manipulation

Rocky manipulates the contestants by creating scenarios that increase tension and drama, ultimately benefiting the spectacle of the marathon at the contestants’ expense.

In healthcare systems, minority physicians experience manipulation through systemic biases, such as being assigned less desirable shifts, receiving lower pay, or being evaluated more harshly compared to their peers.

3. Systemic Challenges and Inequity

The dance marathon itself was a microcosm of a rigged system where the odds are stacked against its participants.

Similarly, hospital systems often reflect broader societal inequities that disproportionately impact minority physicians. This includes limited access to mentorship, fewer opportunities for advancement, and the burden of implicit biases and racism within the workplace.

4. Emotional and Physical Toll

The marathon in the film takes a severe emotional and physical toll on the contestants, mirroring how minority physicians often face significant stress and burnout due to inequities. The lack of support and recognition can lead to a hostile work environment that affects our mental and physical health. For me I see that when I begin to lose too much weight; my emotional eating is when I am happy.

The parallels highlight the need for system changes in healthcare, and it must start with shifting the axis of power. Currently the hospitals have all the power manipulating the lives of physicians; culling minority physicians and making us complicit in our own failure as they keep us dancing alone as we move to their music.

So as the year begins for new graduates, now practicing physicians, lets change the music and the dance.

Follow me to my new podcast: WhiteCoatGreenRoom — The Podcast, on Podbean and Spotify, and we can continue the discussion.