Lifestyle / Medicine

Say ‘No’ To Burnout: A Renewed Physician’s Goal for 2016

{Napa, California}

2015 was a year to regroup and reassess my professional goals.  Immediately after residency, I did as most physicians do — apply and hope to get a job that pays well and is in a good location.  Similar to the personalities of most physicians, I am a workaholic and overachiever.  Therefore, since graduating residency, I strove to perform well at my job, treated my patients to the best of my ability, passed my psychiatry board exams, in addition to participating in extra professional activities on the side (gave psychiatry talks, restarted blogging again, enrolled in a psychoanalytic course, etc) while attempting to balance my personal life.  However, after the first two years as a practicing physician, I became disillusioned by the sad reality of our broken healthcare system.

When I first started working, I was an enthusiastic, energetic psychiatrist ready to use all the knowledge and expertise I acquired in my training to make an impact and help improve the lives of many.  But, then I recognized my limitations.  I noticed that the pressures exerted by the system to deliver cost-effective care, see a high volume of patients, and obtain exemplary patient satisfaction scores while maintaining my ideal ways of practicing, were nearly impossible to sustain.  I noticed a decline in my ability to balance life outside of work and took my frustrations out on those around me.  I participated in psychotherapy, group therapy, exercised, went to church, ate a healthy diet — basically, did everything that you’re “supposed” to do to manage stress.  It may have helped for one day, but then I still dreaded waking up the next morning to go to work.  And once I noticed a decline in my passion for practicing Psychiatry, I knew that such a decline in my quality of life was NOT the type of life I deserved after busting my ass throughout college, medical school, internship, and residency.  I deserved to be happy.  I deserved my ideal practice.

I have written posts about my personal experience with burnout, have read numerous articles about physician burnout, yet still struggle to fully describe how debilitating the experience is because it evokes a sense of failure, a “system malfunction” of everything we were programmed to do since day one of medical school.  This article by Dr. Dike Drummond most precisely describes the factors that lead to physician burnout.  As much as I would like to do so, I cannot fully fault my employer because I understand their methods from a business perspective.  In order for the organization to thrive, physicians are key components to meet the organizational goals.  And we allow it.  We adjust.  Most of us don’t know any better.  Medical school doesn’t teach us to be business savvy, nor how to market ourselves, nor give us the tools needed should we decide to venture out on our own to create our own practice.  And most notably, we are not taught how to prioritize self-care nor how to advocate for ourselves when stressed and overwhelmed.  Often such behaviors of speaking up for one’s self are viewed as weaknesses.  To this day, I still have the mentality that I’d need to be on my deathbed in order to miss a shift out of fear of being perceived as less than superhuman by my Attendings and peers.

Initially, I blamed myself for not being able to keep up with the heavy workload and for feeling so defeated.  But then I realized that I had a choice: either 1) Quit and seek my ideal practice, or 2) Adjust to the system and forego any sense of autonomy and watch my passion to make an impact in the field of Psychiatry further dwindle away.

I quit and spent 2015 working a reduced schedule and essentially recovering from my entire medical career thus far.  Throughout the process, I had to re-train my mind to let go of the standards that were ingrained since medical school: the need to be a workaholic, the need to be a genius and know everything (otherwise risk being ridiculed), the need to be superhuman, the need to suppress and hide my struggles, the need to be a perfectionist at all times, the need to function at 110% amidst exhaustion and fatigue.

A patient doesn’t benefit from a burned out physician (in fact, it has been shown to lead to greater medical errors).  And if a fellow physician is struggling to maintain, we must not consider them as weak.  Please understand that they deserve just as much care and attention because they sacrifice their own well-being for the sole purpose of providing care to others.

I will never forget one regretful time that I was on-call:  already worn out from the day’s clinic, I angrily dialed the number on my pager and spoke to another physician on the other line, who paged in hopes of getting advice to help a fellow physician struggling with suicidal thoughts.  My reflex response was uncharacteristic of me, lacked empathy, and to this day makes me cry with regret:

I’m sorry, but I can’t help you.  Tell him to go to the ER.”

I would never even fathom giving such an insensitive response to one of my patients.  Just knowing that I turned my back on one of our own…someone who very well could’ve been me had I stayed and felt trapped in my job…someone who represents the growing number of depressed and suicidal physicians, makes me sick with disgust.  I vowed to never again lose myself so much in a job that I risk losing my empathy and compassion.  However, as I type this, I recognize that as much as I blamed myself, I see how that “programming” from medical school, which taught us that any sign of struggle represents weakness, overrode my empathy.

Therefore, my goal for 2016 is simple: to maintain balance.  For the first time in my life, I feel deserving of breaks and time off, feel open to share my struggles (and view them as signs of strength, not weakness), and feel confident in who I am as a physician deserving of a practice that supports my lifestyle (rather than one that consumes me).

And one last note:  I’ve observed the new class of aspiring doctors, have connected with them via social media, have met with the shining future leaders of our future healthcare system — and they are a population unafraid to support one another and voice their needs.  They are students who are starting to open up about their desire for self-care and balance.  They are students who are championing wellness programs in their medical schools.  They are students who are tech savvy and understand marketing tactics (because they have the tenacity to reach their own international following that closely watches and looks up to them as they develop as authentic role models on social media).  They will detect the bullshit of organizational “wellness” programs and any false attempts at showing they are being “cared for,” when in reality they are being appeased only long enough until thrown back into the same working environment that led to their decline…and the cycle continues.  Although most posts on physician burnout are pessimistic about the potential for change, with what I’ve observed, I have even more hope that our future doctors will come together and do what they can to put a stop to the cycle.

 

Photo by Alex Manipod

38 thoughts on “Say ‘No’ To Burnout: A Renewed Physician’s Goal for 2016

  1. Vania, I’m excited for you!!!!! Different career paths have different expectations, littered with different variations of Bullsh@t. I was 28 or 29 and got to the end of myself (as you so accurately identify and describe the issues that set you up) I am coming up on 30 years removed from that hell-atious wateshed season of my life and I am here to tell you..I have not lost sight of the self care choices I need to keep saying yes to, in order to live what looks like a balanced life for me. I was a first born,card carrying work-a-haulic, and I can now take a nap with the best of them/ no shame/ no problem. Anyway, even though I work in a completely different field, (construction, married and father of 4) I can relate to the inner stuff more than you might suspect.

    • Hi DM! I appreciate u being excited for me!! I already know from your previous posts and comments that the internal workings that came about from your career was quite similar to mine. I’m glad we can connect in that way and that u can empathize with my situation based on your experiences. I’m only on year 1 but I hope to maintain the type of balance that you’ve been able to sustain in your life for the last 30 yrs…I look to u for wisdom esp as someone who made the once extremely difficult choice to prioritize a life of balance (sounds so strange to say we need to make a “choice” to choose something that should be a priority, but I suppose it’s our culture that makes us feel we need to be workaholics in order to be successful). ❤

      • One tip I would have for you, is as the details of your life change..(balancing work with marriage, children, etc. new debt, energy level, etc. you will be forced to revisit this issue again and again in a big way. You’ve come to the end of yourself once now, and it’s a great motivator to not get to that place again…at least it has been for me.

  2. I just wrote in a comment on another blog about my phrase for 2016 being either “balance” or “let it go” so it was interesting to read your post next. I guess balance is on a lot of our minds lately. Here’s hoping we find it!

    • Yes it’s something we all deserve yet soooo hard to achieve probably because we have to individually define what balance means and be able to mentally accept the need to let more things go…so the two go hand in hand! Wishing u a balanced 2016 Carrie!

  3. An excellent message for us all Vania! Thank you for sharing your experience – other physicians will certainly identify with your journey and draw strength from it. I am writing an article right now for a physician newsletter on work-life balance. This is a very important topic to me as I see my husband, also a physician, fluctuate with burnout symptoms from an imbalance in his work. Fortunately I have been able to modify my work as a physician to be more balanced, but I certainly didn’t start out my career that way!

    I wish you a ‘balanced’ 2016!

    Sara

    • Hi Sara! I’d love to read your article on work-life balance when it’s out. My post was shared on KevinMD.com, so I hope that other docs who are going through similar experiences won’t feel so isolated knowing that it’s so pervasive (which is also sad knowing how common it is). Hope your husband will be able to integrate more self-care…it’s soooo hard for us as physicians to let go of our workaholic mentality.

  4. And how’s the “un-burning out” doing?
    Happy balanced 2016 to you Vania.
    Remember, there is no stress that a good walk on the beach can fix. 🙂
    Take care and keep walking.
    Brian

    • happy 2016 to u as well Brian! I’m doing quite well, thanks for asking 🙂 I truly feel like i’m 95% back to my usual (bur more balanced) self again, which is nice. Hope you’re getting some beach time…and if not, find some time to do so this year :).

  5. Amazing writing as always, Dr. M!

    I related to this post in a different way since I’m not a physician.

    I was one kind of person before my bipolar diagnosis. Like you, I was a workaholic and overachiever, but I worked for people/organizations’ passions, not my own. That led to deep frustration and depression long before childbirth triggered my postpartum mania and bipolar, peripartum onset.

    Becoming gravely ill with bipolar, which resulted in my suffering through 7 psych unit hospitalizations, 30+ meds, and two different rounds of ECT all, changed me as you can imagine.

    Being the mother of two little ones (and wanting to stay married to their father!) forced me to change my outlook regarding my identity. I could never again be a workaholic or an overachiever at meaningless jobs. I needed to do what worked for me. It has felt selfish at times. I feel guilty for not working full-time like other moms I know. They do impressive-sounding things such as nursing, working with disabled people, owning their own businesses. But since my dx, I landed two book deals with two separate publishers. Not bad! I’ve had numerous articles published, and became a mental health advocate and a women’s support group facilitator.

    Comparing myself to others is futile. (I still continue to do it, especially with my writing! :0

    Coincidentally, with my first book deal (which I cancelled due to bipolar relapse) I secured Dr. Liz Miller, Britain’s first female neurosurgeon to write the forward. She was featured in Stephen Fry’s acclaimed documentary “The Secret Life of the Manic Depressive”. It turns out that Dr. Miller co-founded The Doctors Support Network (DSN), a confidential self-help group for physicians in the United Kingdom with mental health concerns, in 1996.

    Their mission: “As doctors we are used to supporting patients’ health and well being, but we often neglect our own. Doctors have among the highest rate of mental health problems of any profession, but often feel isolated and unsupported. The Doctors’ Support Network aims to provide support, reduce stigma, and campaign for better services for doctors with a range of mental health problems.’

    They have an interesting website:

    http://www.dsn.org.uk

    On a separate note, my current psychiatrist (who I think is absolutely great!) used to work at a hospital for 30 years. Just from the little he has briefly shared with me, it sounded like it was incredibly demanding and my sense is that he was burned out. His speciality was addiction medicine. Now, he has his own practice. He works only 20 hours a week, rents a cute office at a local, “green” progressive office rental network, keeps all his patient records himself, and has a very full life outside psychiatry. Granted, he’s much older than you (65), but he seems to have found a way that works for him so that he’s no longer burned out and he’s able to swing it financially. (Um, I know that’s a whole other topic!)
    For my sessions I pay $95 (out of pocket as he doesn’t take my Medicare) for 30 minutes/ $135 for an hour – he’s by far the least expensive psychiatrist in this county.

    Sorry to go on and on……your post fired me up! :)))))))
    Thanks for your wonderful writing and insights!!!!!! I look forward to more of them!

    • Hi Dyane! I read your comment several days ago and thought it was so awesome of u to share your burnout story and how u molded your professional life so that it fit the lifestyle that would be best for your family, and especially your own mental health. I didn’t realize u went through 2 rounds of ECT — the fact that you’ve been through so much treatment and have found stability/control of having bipolar, and never lost hope to take control of your life is amazing! And yes, 2 book deals is an amazing feat!
      Will definitely check out Dr. Miller’s site — thank u for bringing my attention to a wonderful resource as u always do!
      And reading your note about your current psychiatrist’s practice made me smile — it’s such a stark contrast to the busy hospital/grueling hours that doctors are expected to do and shows that u can move on after burnout and live a happy, successful, balanced life 🙂

  6. p.s. re: my pdoc fee – I know you must have been thinking he has a trust fund to survive – his wife is a therapist so they are able to live on a combined income.

    • hi dyane, sorry i’m late with it, but i posted your huffpost feature on my FB page and didn’t know how to tag u! anyways, i was so proud of u and your feature that i had to share it some more 🙂

      • You never need apologize I’m truly honored you shared it!!!! I’m on Facebook as “Dyane Harwood” (I forgot & had to check just now due to that long break I took!) Anyway, you rock, and you made me feel great for believing inmate enough to share via your social media channels. Thanks for you email by the way – I loved it. I wanted to let you know I got it; I’ve been distracted by being back on Facebook again so I blame my flakiness on Mark Zuckerman! 😉 (Craig is working on a Facebook project at their campus and saw that crazy roof-top park designed by Frank Gehry- it’s a great idea, I must admit, if you have the $$$$$……) XOXO

  7. Can I ask you where you practice? I have an incredible ‘all cash’ psychiatrist that I met 17 years ago when Baker Acted in Florida. I’m on a lot of meds, have tardive dyskinesia from a year of high dose Geodon and have NOT had to go to the hospital for all those 17 years, antidepressant fatigue and all. My doc is in his later 70’s, no longer does hospital work. I’m in the Fort Lauderdale area. I’m interested in what you are writing about. I write for International Bipolar Foundation, Newlifeoutlook, NAMI.org and Bipolar Hope. Allison

  8. I read this post and Chicago Blues great Howling Wolf’s “Built for Comfort” starts playing in my head, of course replace “girl need” with “life’s needs” in the first stanza and it fits perfectly.
    Love the symbolic picture and the theme of the post, you in the dormant vineyard, both preparing for the new year. In the process of pruning the old growth getting ready for the new to takes its place.
    I still think you should write a text book, on how to become a doctor, it would give a advantage to the young Dr’s in school

    • Ha! Great song Bob. I’m glad you appreciate my choice in picture…I’m always so meticulous in making sure my pics capture the essence of my posts. That text book idea is becoming something i’ve been thinking about more, esp each time u mention it and I also hear it from others. I find it a huge compliment and something I’d love to do, yet am afraid of at the same time! which is even more reason i should consider pursuing it 😉

    • Thank you so much for your comment! Yes, it was actually months before I even recognized the signs of burnout myself. PS: i think i received a msg from u via twitter? if so, will respond soon! 🙂

  9. Vania – this was an absolutely beautiful piece. So grateful for social media that has helped create this little ‘med sisters’ family of ours. Thank you for sharing your journey and reminding everyone that physicians are also humans with needs. You inspire me daily and I’m so grateful that physicians like you exist!

    • Hi Anum! This comment is super late but wanted to let you know I found it so meaningful & appreciated it when I read your comment the 1st time around 🙂 And just FYI — you’re one of the students I thought about when I mentioned that our future physicians are going to change the culture of our broken system 🙂

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