"It Actually Breaks My Heart" - Why Dr. Johns Left Nantucket Cottage Hospital

For Dr. Alexinna Johns, the opportunity to live and work on Nantucket seemed like a dream come true. She moved across the country in January with her 11-year-old son to join the medical staff of Nantucket Cottage Hospital, and immediately started delivering babies and seeing patients as a primary care physician.

But just 10 months later, Dr. Johns abruptly announced that she was leaving her position, and is moving off-island.

“It actually breaks my heart,” Dr. Johns told the Current. “I’m abandoning a community that I know needs me and it breaks my heart. It was a hard decision.”

On the surface - at least initially - it seemed as if the hospital had hit a home run in its recruitment and hiring of Dr. Johns. She was a young, female physician who had no problem being a doctor in a small community, or the isolation that can come with living on an island. Dr. Johns didn’t mind running into patients at the Stop & Shop, she wasn’t intimidated by the island’s housing crisis, and was excited to practice addiction medicine in her spare time.

“I love the people and the community,” she said. “People say it’s hard to live on Nantucket, but I loved it. I don't mind being stuck on an island. It doesn't feel like being stuck to me. I was made for this job. But we’re all different and my quirks didn’t fit with the hospital. I felt like I caused friction there. I had multiple encounters that had me feeling like I caused friction. It just wasn't a fit. It’s hard to put into words.”

And yet that was the word Dr. Johns kept coming back to as she explained her decision to leave Nantucket Cottage Hospital: friction.

“My way of doing things caused friction,” she said. “Not being me would have made the system happier, but I want to be me.”

It wasn’t one person or one area, she said. The friction, as Dr. Johns described it, occurred with members of her team, as well as nursing and the hospital’s administration.

“My way of approaching things didn’t fit the system’s way of dealing with things,” she said. “There were lots of encounters and interactions where I felt strongly and firmly that it needed to be handled a certain way, and the system said ‘that’s not the way it’s done’. If I have a core belief this isn’t best for the situation, I don’t fold.”

What kind of situations, specifically, was Dr. Johns referring to?

“Patient care,” she said. “My way of dealing with patients didn’t fit the system. And it might not be the way the entire patient care system in America is. I don’t think we can rush through taking care of human beings, and after COVID, you need to take your time to help people find ways to heal. Rushing is not my MO. I’m like a turtle, and that caused friction. But I don’t rush through human beings.”

Dr. Johns, 49, said she had been having difficult conversations with her patients in recent weeks about leaving the hospital and the island. Especially with some of them who have been bounced around between numerous primary care physicians in recent years.

Since 2012, six primary care physicians have left Nantucket Cottage Hospital, including Drs. Greg Hinson, Nicole Steinmuller, Heidi Larson, Kristy Acosta, Joel Hass, and now Alexinna Johns. After decades of relative stability with longtime physicians like Tim Lepore, Diane Pearl, George Butterworth, and Mimi Koehm, the turnover has been jarring. But Dr. Johns emphasized that primary care is in crisis across the country, and many communities are facing similar struggles recruiting and retaining primary care physicians.

“There’s a lot of doctors jumping ship and a huge primary care crisis right now,” she said. “Doctors aren’t able to continue practicing medicine the way it was before. They were already overburdened before the pandemic, and to expect them to continue to practice the way it was, is why doctors are jumping ship. There’s a huge moral injury in the process. I see a human being suffering and I’m expected to say, time’s up. Good luck’?”

“I’m going to give each patient what they need,” she continued. “I was told this was a rule, and I said I’m not going to follow that rule. No one ever said ‘why aren’ you following it’, but there's an undertone of ‘more patients need to be see.’ But I always rise to the occasion, and I try to be available as much as much possible.”

While Dr. Johns repeatedly referred to “the system” in her comments about her decision to leave, she actually praised the hospital’s relationship with its parent company Mass General Brigham. The resources and expertise she had access to were extraordinarily helpful in caring for patients, especially pediatric patients, Dr. Johns said. Additionally, she praised her physician colleagues in the hospital’s group practice and The Birthplace for their collegial relationships, and members of the hospital administration for their patience as they attempted to work through the issues.

“Nantucket (Cottage Hospital) was amazing - they tried not to rush me through it - but I still didn’t fit the mold,” she said. “There were several moments over a couple of weeks, repeated interactions where I got feedback. And I tried to walk my path as an authentic person, even with my vulnerabilities. I had a couple weeks in a row where I would be giving my all and getting feedback that it wasn’t good enough and not acceptable. I was doing my best, and it wasn’t enough. For me it was impossible. I refused. And it caused friction. There’s a time and place to fold and a time and place to stand your ground. I had to stand my ground a lot on Nantucket and it wasn’t received in a positive way. It was received in a negative way.”

While she did establish a relationship with Dr. Tim Lepore, who runs an independent practice as well as the non-profit Addiction Solutions, and had the opportunity to do addiction medicine with him, Dr. Johns said “the offer from the hospital was to do it in my free time, and there wasn’t much of that. What they (NCH) needed was a full-time doctor, and my ability to work with Dr. Lepore would have taken away from that. There wasn’t enough of me. I’m a mom, and I need to be that and I’m a physician.”

Over the next week, Dr. Johns said she’ll be gathering her belongings from the hospital housing unit she was living in to prepare for a move back to Illinois to be with family and take time “to reflect and process.” The transition will be most difficult on her son, she said, but she felt confident it was the right move despite those challenges and her overall affection for Nantucket.

“I’m extremely grateful for the inspiration I got here,” she said. “There’s been so many moments where patients taught me so much about life and courage and strength and grace, I’m never going to forget Nantucket for that, not just the beautiful beaches, but the beautiful people. There's something unique about Nantucket’s people that is authentically beautiful and it shines out of them. I’m very sad to walk away from that.”