Physician Burnout–The First Step is Admitting You Have a Problem

:::Warning: This blog post is a bit of a Debbie-Downer. But physician burnout is a real  problem, and I’m giving you my take.:::

And with that headline, I’ll get straight to it. I’m burned out. I’m not sure when I recognized that. If I’m really honest with myself, I think I first felt this way in December 2016. I was five months into a Surgical Critical Care Fellowship, and I was really sick of really sick people. To say I needed a break from death is an understatement. I was also 6 weeks pregnant, so I blamed a lot of those initial feelings on hormones. That was bullshit, and I kept telling myself the same BS for another 12 months (because, let’s be honest, postpartum hormones are even worse). I remember feeling like I didn’t want to finish fellowship, and I certainly didn’t want to go back to my old job. I wasn’t cut out for it anymore (I still feel this way some days). That was the point of recognizing my unhappiness, but how long had this been brewing?

I spent most of my childhood telling people I was going to be a doctor some day. I was accepted to medical school when I was still a senior in high school. I finished college in two years and went on to medical school at the age of 20. Towards the end of my third year, I decided surgery sounded like a lot more fun than dermatology.  I remember telling someone “When I’m 65, I’ll be far more sad to retire from surgery than I will dermatology.” In 2009, my white coat gained a couple lengths, my name gained a couple initials, and I was excited to be off on my journey to become a surgeon and starting residency.

Residency. I loved that shit. Sure, I had days that were horribly long and trying, but I ate it up. Intern year taught me just how much we don’t learn in medical school (like how to be a doctor at all). During my second year, I made it through the most grueling 30 hour shifts I could imagine. By third year, I had my first big save. Fourth year, I was humbled by being the chief resident responsible for an entire service of patients at a level 1 trauma center/county hospital. Finally, chief year, I was ready to “get out from under” and “be my own person”. But what the hell did that mean exactly?

“Be my own person”. That sounds profound and exciting. Guess what? It’s also bullshit. You’re never “your own person” in medicine–there’s always someone else to whom you answer. Sure, you don’t have an attending barking orders at you, and you’re not doing their scut work. There are still patients, families, nurses, administrators, other partners making their demands. FOR-EV-ER. The worst part is, you lose the “team” that helps you get through those rough nights and bad cases. The goalie is pulled–there’s no intern fielding the dumbass pages all night and putting in some basic admission orders at 2AM. Your defensemen are out–no 2nd year to do that mundane I&D, no 3rd year to knock out a gallbag or tell you if a patient really can go home from the ED. And your co-captain, that pretty-much-a-chief-4th year, that person you sit and bitch to about the crazy patient you have, or brag about a “I’ve-never-seen-that-before” case with, your two-drinks-and-we’re-drunk post-call buddy who is just as annoyed, stoked, worn out, or exhilarated as you are…THEY ARE ALL ON THEIR OWN too. There’s a lot to be said for the “team” mentality of residency. Whether its just a couple people on the team or a full complement of residents for a service, your comrades are the motivation for getting back up on and on the front lines. Then you graduate, you pass your boards, and you’re finally on your own.

Sure, there are still days where the “team” mentality in healthcare still applies. Believe me, a trauma service cannot survive on a physician alone. It requires competent ER/floor/ICU/OR nurses, good respiratory therapists, excellent physical therapists, patient occupational therapists, astute speech therapists, assertive trauma nurse clinicians, ambitious program managers, experienced PAs/NPs, nurse’s aides, therapy aides, CRNAs, surgical techs, social workers, coordinators, chaplains, volunteers, etc. Yep, there is an entire team involved in providing healthcare, and none of us can do it alone. I am happy to give credit where its due because here I am bitching about my job, and I have all of these people helping me. BUT, it’s not a few other physicians with the same two meaningful initials after their name (or similar ones DO/MD): those two initials that put your ass on the line for everyone else.

Perhaps this is reflective of my group specifically. We try our best to function with just one MD per day and APP for half the day (day time hours only). There are days when we have four patients on the census and its more than doable. Then, there are days when the census is two dozen people long and your trauma team has more people in the ICU than the Pulm/Critical Care team. However, I also did private practice general surgery for a year. The one thing I learned from that is that I should have done Marketing for an undergraduate degree. It is essentially the only way to be successful in private practice because they sure don’t teach it in medical school OR residency. Rather than finding a love for surgery during that year, I found a love for CrossFit, an escape.

So I have to agree with the anonymous poster on KevinMD–this burned out physician was happier as a resident. Back then (4 years ago now), when people asked if I liked my job, I would reply “90% of the time I love my job, and 10% of the time I hate it.” I felt pretty lucky to have that ratio of love/hate in my work-life…

I’m going to be brutally honest here. That ratio is nearly reversed these days. I have an occasional day where I feel like I’m up to the challenge that the next 24 hours will bring. I spend many days dreading dealing with nursing issues, difficult social work situations, the questioning/litiginous families, and every last “BEEP” of the pager. I am currently on a two week hiatus (not by request) from call, and I’m already sad that I only have 8 days left. I definitely think “over-worked” has something to do with it. I should have enjoyed my year of lacking business as a general surgeon a little more than I did (but hey, being in a long-distance marriage made that kind of hard)! I came back to Texas and have been working 10 or more 24 hour shifts a month for 2 years and threw a critical care fellowship (while pregnant) in there. I’ve lost friends. I’ve lost out on opportunities. I’ve lost sleep. I’ve lost my sanity at times.

I could compare the feeling to a number of things:

1. It’s an addiction. Medicine/Surgery is hard to do in moderation.
2. It was my first love. And breaking up is hard to do.
3. It’s like family. You love it, but you don’t have to like it.

But one thing is for sure, every last thought points to the fact that I’m officially part of the physician burnout epidemic. That very fact is a large reason why I’m back to blogging. I’m here to tell you that it’s not all bombshell hair, starched white coats, and gratifying work like I keep seeing on [social] media these days. I never thought I’d be “that person” looking to go part-time after having a child. I was always so career-driven that it never dawned on me, and I had a difficult time understanding the other women around me that finished medical school “just to become a mom” or finished residency “just to become a mom”. After a few years of working my ass off (and my husband doing the same), I’m now working on figuring out how to rearrange our lives and still maintain the books. I’m re-prioritizing. I’ve struggled with work-life balance long enough.

…

If I go with metaphor #1, then there’s a Twelve Step Program for that, right?

Step #1. Check.