Reflections of a Millennial Doctor: Burnout

One of the wonderful things about having a blog is stumbling upon other peoples writing. A few months ago I discovered another blogger writing about burnout and I was intrigued. Her name is ‘M’ and she writes at https://reflectionsofamillennialdoctor.com.  I love her writing, and after reading a few posts I  immediately reached out to her and asked if she would be willing to write a guest post.  She graciously agreed. Her story and background is very different than mine, but her struggles with burnout are familiar.

Enjoy!

THP


 

“You’re all F****** idiots!!!  I’m going to report Dr. M to the state board and get her medical license revoked!  You’re just after our money, trying to make us come back to get re-examined again! You’ve just lost four patients, you F****** M************!!!

To repeat this message, press 7.”

 

I sighed, handing the phone back to my medical assistant.

 

“Well… I guess just try to document that in a phone encounter and censor it a bit.  We still need it for the patient’s chart. Also, don’t delete the message.”

 

Last week was just one of those weeks.  Again. Week after week after week.

 

I kept telling myself it would get better, that situations like this would resolve and I’d be back to some semblance of normalcy.  But, inevitably I’d have another situation pop up, like the next voicemail after the 5 minute cussing spree I just listened to, during which another patient was upset that I wouldn’t increase the dose of his narcotic AND give him a sleeping pill.

 

“I thought you were different and that you cared, but it’s pretty clear that you don’t!  You just lost this patient!”

 

I’m pretty sure if we could still hang up by slamming our cell phones down, both voicemails would have concluded in such a manner.

 

It’s time to face the music.

 

This is my new normal.

 

The hostile work environment, the intimidation, the “I can’t believe someone let you be a doctor” comments even as I’m providing appropriate, gold standard, evidence based medical care.  I had told myself I could put with these issues during residency because things would be infinitely better as an attending.

 

I was wrong.

 

One way or another, I need to get out.

 

 

Burnout

 

This term is everywhere nowadays.  When it’s an entire topic with multiple pages at Huffington Post, you know it’s gone mainstream.  The term “burnout” was actually coined in 1974 by psychologist Herbert Freudenberger in relation to job-associated stress.

 

As described in Psychology Today, burnout is a state of chronic stress that leads to:

  • Physical and emotional exhaustion
  • Cynicism and detachment
  • Feelings of ineffectiveness and lack of accomplishment

 

People like me are at high risk for burnout.

  • Type A personality?   
  • Perfectionist?
  • Healthcare professional?  
  • Too stubborn to admit you’re struggling/ask for help?  

I was pretty much doomed from day one.

 

 

Day 1:

I was the first-born to immigrant Filipino parents who had moved to Canada in the 1980s, with hopes and dreams of building a better life for their family.  The day I was born, those dreams were placed squarely on my little lanugo covered shoulders (I was a ridiculously hairy baby).

 

My mother loves to tell the story of the first time my father and I met.

 

She watched as my father counted all 10 fingers and all 10 toes declaring, “Look at those long fingers!  She’s going to be a pianist!” He stroked my full head of black hair and whispered, “You’re also going to be a doctor.”

 

This was where my script started, and invariably this is something quite familiar to 2nd generation immigrant children.

 

Not one to disappoint, I set off on the fast track to scholastic achievement.  I learned to read at age 3, started kindergarten at age 4, skipped third grade making me even younger than the rest of my classmates, and ultimately I graduated high school as valedictorian at the ripe old age of 16.  Somewhere in there I trained in classical piano, got my certifications through the Royal Conservatory of Music in Canada and moved to the U.S.

 

My father’s dreams became incarnate the day I declared my major as pre-med in undergrad.  By that time, I had internalized his dreams as my dreams too. I was DAMN GOOD at school. There was never any academic struggle for me to learn anything.  If I said I’d learn it, I would.

 

Why wouldn’t I be a doctor?  I had the academic chops to make it.  I wanted to help people – I mean, what kind of jerk doesn’t want to help people?  My path just made sense.

 

 

Except When It Didn’t

 

During the last year of pre-med, I had a crisis – what if I didn’t want to go to med school?  I saw my friends moving on to real adult jobs and I had to look forward to 8 more years of schooling and training?

 

My doubts and I went back and forth until the decision was made for me – I was waitlisted for a year at the med school I was accepted to.  I jumped at the chance to get myself out of my script and out of my parents’ basement (because what parent allows their 16 year old to go live off in the dorms by themselves?).

 

I did a complete 180 and became a pharmaceutical sales rep.  In Flint, MI.

 

My parents’ grief was palpable.  I had cast off all their hopes and dreams in such a selfish gesture.  On top of that, I made them drop me off in one of the most dangerous cities in America where I presumably would learn how to adult by myself.  The icing on the cake would have been the lead crisis, but that was 8 years too late.

 

I completely set myself up for failure as it was a decision based off emotion, not logic, but I learned so many lessons that year.

 

  • I am not a salesperson
  • I detest corporate bullshit and business speak
  • No one should live in Flint
  • I needed to return to the academic safety net

 

So, I planned my exit strategy after a year of sales repping/collecting signatures and quit the Friday before med school started.

 

 

Resuming the Script

 

I was back on track to living out the Filipino-Canadian-American dream.  Go to med school, become doctor, go to residency, become actual doctor. That year lost wasn’t even really lost as I was still one of the youngest med students to matriculate at the age of 21.

 

However, during my medical training I was acutely aware of the life I had turned my back on.  The one in which you only work 40 hours a week. The one that you actually accumulate wealth instead of piling on more and more student debt.  The one that you could turn work off and not allow it to intrude on your personal time. The one where your life’s identity isn’t consumed by your profession.

 

Instead, I had exchanged it for a life and career where unless you were giving 110% of yourself, it wasn’t enough.  In med school and residency, you were always encouraged to take on more: more research and more studying in your free time.  I was encouraged to keep moving onto fellowship because academically I could do it. When I pushed back and made the decision to “just” stay in primary care, I received so many comments on how “unfortunate” it was.

 

“You’ll never be happy with just being a primary care doc,” they told me.  “You were meant to be more than a referral generator.”

 

I ignored them, however, and found myself looking forward to returning to the much easier life I had when I was 20.  Upon completing residency, I came out on the other side and to my dismay, discovered I didn’t like that there was nothing left to achieve.  I was bereft of an academic goal I could move forward to.

 

Yet, I still was conditioned to give 110%, and primary care was more than happy to take it from me.  For 2 years, I ran myself into the ground by increasing my hours at work to the average 50-60 hour physician work week, giving more of myself emotionally to my patients than was healthy, fighting with insurance companies and sometimes patients so I could practice the type of medicine I had envisioned myself practicing, and for whatever reason, refusing to take real vacations.

 

Interactions with patients started to suffer as I became more and more cynical.  My efficiency waned as I began to fall behind on all the documents and paperwork coming into my inbox – some documents 300+ pages long for new patients.  How discouraging it was to get in my inbox down to zero by 7 at night, just to have it pop back up to 20 the very next morning! I started to have weekly sessions with my office manager over patients who were upset with me for a whole laundry list of things:

 

  • Making them come back for a yearly appointment and labs in order to get refills for their diabetes, blood pressure and cholesterol medications – how dare I!
  • Not giving antibiotics for their cold or allergies
  • Refusing to give more narcotics than what their pain contract was signed for
  • A patient infuriated their insurance didn’t cover their vitamin D testing when I explicitly told them it wouldn’t be
  • A mother incensed that I wouldn’t discuss details of her 18 year old daughter’s appointment with her

 

These were things I was never warned of when I started my journey into my medical career.  This wasn’t medicine. This was babysitting. And it was taking up the majority of my day and emotional energy.

 

My personal life suffered.  I didn’t want to engage with my husband when I got home – I had nothing left to give to him since I left it all at work.  I started trying to find excuses to avoid spending time with friends – after hearing people at work complain for 9 hours a day, there was no way I was going to spend my free time with people who had a remote possibility of also bringing up something bothersome to them.  I started to view friends and family as more leeches to make sure I said the the right thing to. My perspective on my life choices that brought me to this point left me even more regretful and embittered.

 

The focus on my hopes and dreams to become a physician was now redirected to paying off my student loans and building up my retirement nest fund as quickly as possible so I could get out of this soul-sucking profession.  The irony was so laughable, it was the only thing that made me smile during those days.

 

 

Approaching Critical Mass

 

As crazy as it sounds, the election in 2016 marked my tipping point.  The swirling cesspool that is political discourse in the media pushed me right over the edge.  It just confirmed what I knew in my heart all along: People are THE WORST.

 

What was the point in going out and trying to save the world when the world has proven itself unworthy of saving?

 

It spiraled out of control during a conversation between my sister, father and I in November 2016.

 

“What is WRONG with people??  When did it become alright to discard entire swathes of the population just because you don’t agree with their opinions?

 

Why did I spend an additional 8 years beyond undergrad to ‘help these people’?  They don’t even try to help themselves, plus they’re all jerks!

 

What was the point of incurring $250,000 in student loans and wasting my 20s under the fluorescent lights of a hospital?

 

What is the point in general?  We’re teaching our children to be bullies and assholes!  The future is lost!

 

We’re all just going to die in World War III from nuclear holocaust!”

 

In between the hysteria, tears and body wracking sobs, I heard my father hesitantly ask, “M… are you ok?”

 

 

I Was Not OK

 

I stepped outside of myself in that moment and realized just how crazy I sounded.  I didn’t recognize myself anymore.

 

Gone was the level-headed, emotionally contained, rational person I knew myself to be.

 

For all my hard work and efforts to push me along toward my “successful” career, I had neglected to take care of my personal self.  And now she was a blabbering mess despite living the American dream – the great career, a wonderful marriage, the 3 bedroom, 2 bath house with stainless steel appliances and hardwood floors – the life of plenty my parents had envisioned for me.

 

It’s been a year and a half since that epiphany, and a long climb up a sand dune to get myself back.  Some days I make progress, other days I careen down the side back to my starting point. It’s a long, awkward fall you can’t help but gawk at, and I’m documenting it all on the interwebs for everyone to see.

 

I’ve done all the things you’re supposed to do – eat well, exercise, practice mindfulness, volunteer, have a gratitude journal, start a blog (apparently that’s what you do).  Finally, I’ve given myself permission to cut back on work which has allowed me to do a lot of philosophizing.  I have considered whether or not this was actually depression vs burnout, but by cutting back on work and seeing myself bounce back with greater gains, it confirms work as the primary driver of my misery.

 

With much introspection, I have been grappling with uncovering my “why” – why did I start on this career path at all?  Was it just me following the script I was handed which also happened to be the path of least resistance? Or was it truly my calling?  Can your calling change over time? If I really didn’t get into this for the sole purpose of helping people, does that make me a jerk?

 

Hopefully one day I’ll be able to answer all these existential questions for myself.

 

First, baby steps.  Currently, I’m on a self-imposed 30 day challenge of restocking my joy fund on Instagram because even now, it is deplete.  My journey is an ongoing saga, but a story that must be told.  With sharing my story, I’ve heard from so many colleagues with familiar feelings of burnout albeit different journeys, and it has been so incredibly helpful and healing.

 

I just want to thank HP for inviting me to talk about my story of my ongoing burnout – his blog is really the first one to speak to me in the midst of my struggle, given me the courage to write and the one I have modeled my personal blog after.

 

Thank you.


It’s my pleasure M. Thank you for taking the time to share with us.

Let’s show M some love in the comments below and check out her blog – it’s good stuff 🙂

THP

23 comments

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  1. Thanks for sharing, M! I am glad that you had enough insight to start to pull yourself away from the much and mire that is burned out medicine.

    You are an example and a light that gives people encouragement. They can know that they are not the only ones struggling through these issues and that physician wellness is a crticial aspect of taking care of yourself.

    Thank you for being brave in sharing your story! I stayed in academics to help teach others how to achieve wellness and avoid the financial aspects that lead to burnout, too. Like you said, being able to step away is really important.

    Now off to your blog to sign up for your newsletter!

    TPP

    1. Thanks for the words of encouragement! It’s been a brave new world to step into the spotlight and allow myself to be vulnerable, but I’m encouraged to keep going when people tell me my account of burnout has been helpful for them as well!

    • DadsDollarsDebts on May 28, 2018 at 6:27 am
    • Reply

    Thanks for sharing. And I know your pain. I followed my father’s dreams and also was in med school at 21. I probably started suffering burnout at 28 when I entered cardiology fellowship and it has been a up and down journey since. I am still trying to find the balance and it is not easy.

    1. I am there with you! I can’t say I’ve found the balance yet, but ironically things have definitely become easier since I admitted to myself that I was NOT okay and needed to make a change instead of just chugging along and pretending things are just groovy.

      Cutting back has been amazing, so if you’re able to do that, I would highly recommend it!

    • VagabondMD on May 28, 2018 at 7:26 am
    • Reply

    Powerful and familiar story, Dr. M., thank you for sharing it with us. I hope that doing so will help lead you to inner peace and tranquility.

    1. Thank you, VagabondMD! That is my hope as well! I read your story so many times in hopes of having my story be as powerful as yours. Thank you for giving me the courage to write my story 🙂

        • VagabondMD on May 29, 2018 at 4:53 am
        • Reply

        All of our stories are unique but share some common elements. The good news is that my story appears to have a happy ending. Yours will also. Peace.

    • hatton1md on May 28, 2018 at 9:18 am
    • Reply

    Dr M beautiful photos on Instagram. I think it is perfectly normal to question your career choice. We can all look back and think what if? At some point you will direct yourself to some other set of goals. Patients will suck out your soul if you let them. I think most docs burn out at some point. You have to identify what about your job is doing it and then eliminate that part. For me I quit doing OB and started to feel like a human being again.

    1. I’m currently going through that process, actually. I’ve figured out that I still love actual medicine (real problems, not the worried well that I currently cater to), so I don’t think I could go entirely non-clinical. But if I could eliminate all the insurance nonsense and the hostile patients, that would be ideal. I’m thinking about direct primary care, but I’m going to have to dig into that deeper.

      Thanks for checking out my instagram as well! Photography has been a great outlet for me while I try to figure this all out.

  2. Lovely raw and honest post Dr. M! Although I am not a doctor, I do work in healthcare and suffer the same infliction of burnout that you discussed. It sucks when all you want to do is help people and all you get in return is a slap to the face. The system is broken, thus the people are suffering, and us healthcare providers are left attempting to glue the pieces back together. Thanks THP for finding this gem of a writer, I’m definitely looking forward to reading more about her story!

    1. I think burnout is a huge crisis we’re facing in all industries. We’ve started to view people as assets, losing their humanity along the way. I just speak about doctoring because that’s really all I know 🙂 Thanks for reading and commenting!

    • Crispy Doc on May 28, 2018 at 10:38 am
    • Reply

    M,

    There are so many resonant echoes in your story – thanks for putting it out there. There’s the second generation immigrant child’s dilemma inherited from our parents’ dreams: “Of course you have choices, you have complete freedom to choose what kind of doctor/engineer/lawyer you’d like to become!”

    Being an overachiever and people-pleaser by nature / reinforced by nurture, it’s hard to feel you have the right to a divergent path to happiness that jeopardizes your family’s narrative of you as golden child / accomplished professional. In the end, your life needs to make you happy (not just make them proud).

    HP is a great resource on how to feel human again – feel empowered to steal from his generously public playbook. There are many docs who decided to cut back early and found that by spending less time in medicine and more time being human, they were able to rediscover a love for the field and even feel replenished by it.

    Instead of an all-consuming career, realize that you are in a privileged position to work much less and, by virtue of the profession, earn generous remuneration for fewer hours. You can leverage physician income to lead an extremely balanced middle class lifestyle instead of feeling medicine has replaced your soul with ash and forever struggling to sustain a rich doctor lifestyle.

    Think of this as a tipping point that kicks your butt into realigning the life you want with the life you lead so those two Venn diagrams overlap more over time (Not my imagery – heard it from either the Happy MD or WCI.).

    Good luck, and know there are many of us in your corner who are cheering for your every small victory.

    1. It sounds a little strange to say it, but I’ve finally accepted the fact that I’d be most happy working a 30-35 hours a week. There’s a lot of guilt that comes with this because of the fact I’m so privileged I’m able to do so, but what I was doing before cutting back was not sustainable.

      I’ve been encouraged by so many others’ stories on various blogs and decided to move from the cheering section to putting my own story out there. Thanks so much for reading and cheering me on!

  3. It definitely took a lot of courage to share that story. I am sure a lot of physicians have similar feelings but like most of us, keep it buried in deep so not to tarnish the white coat image we have been taught to portray to society. It is easy to look on the outside from a non-physician view and say what on earth are these people complaining of? I would love to have that kind of salary, etc. But they have no idea the stressors that we are put under. As physician’s lose their autonomy I am afraid that burnout will continue to get worse and worse. We are no longer captains of our ship and have almost been relegated to pencil pushers that have to seek approval from non-medical people just to order labs and imaging studies. We are always constantly held hostage by reimbursement cuts by Medicare, etc. And as reimbursements continue to fall we are forced to see more volume to just maintain income, leading even further to burnout.
    Not sure what the answer is, but if one is not found soon, the best and brightest in future generations may not want to enter the medical profession at all.

    1. I read somewhere that the biggest thing that contributes to happiness is control of our own fates/environments, or at least the perception of control 😉

      I do think it’s time to take control back of our lives and our careers… perhaps then it will spill over into the business that is medicine. You’re right though – the way it is now, this is definitely not sustainable, especially when young docs like me are planning their exit from the system within 5 years of getting out/

  4. Nice post M! Being a child of immigrants myself, I can relate to the struggles that we face as we have to deal with some pretty high expectations. Now that I’m a parent, I can better appreciate what my parents had to experience- they came here with close to nothing, and the safest way to climb the socioeconomic ladder into a better life was through education. That was all they knew as they tried to navigate and assimilate into society, and like most people, the seemingly picture perfect lives of professionals was something to aspire to. Had I been in their shoes, I may have very well conditioned my own children to follow this script.

    You may have followed a particular script, but you’ve found the courage to now make it your own! I have a feeling that our lives will become much more meaningful and impactful as a result of our own existential crises (everyone goes through this, right? It’s not just me?).

    1. Haha.. my dad told me last night, “You’re such a millennial.. I wasn’t allowed to have such a crisis when I was your age.” It was such an ego check – I definitely am able to have this existential crisis I’m having now because I’ve been privileged enough to live in the U.S. Not many people are afforded the chance to go off and do something else, so I’m going to take this opportunity to be more intentional with the rest of my course and hopefully have more meaningful and impactful experiences.

    • Lil S on May 28, 2018 at 8:26 pm
    • Reply

    Thanks for such an honest post! You are not alone. I hope your situation continues to improve as you cut back on hours and focus on some long overdue self care. I don’t typically call myself burned out, but cried actual tears as the culmination of a solid 24 hours of dread preceding a string of nights (hmm…).

    I look forward to reading more of your writing on the requisite physician blog! 😉

  5. The dread is real! When my husband pointed out I got “grumpy” on Sunday evenings, I knew something needed to change. No real tears on my end, just tantrums. Not really a better alternative!

    Thank you for reading!

  6. Wow, amazing post and great writing. I think burnout manifests itself in similar ways across professions, although the paths to get there can be very diverse. I have a ton of respect and admiration for what you do as doctors, and to me it seems like such an incredibly hard profession to stay in, despite the fact that you’re directly helping people. Good luck, I look forward to hearing more from you going forward!

    1. I agree, there are several paths that lead to burnout and my biggest frustrations with my job may be totally different than someone else’s even within the same profession. There are good moments at work, but human nature is to dwell on the bad, of course, so that’s something I’m trying to work on as well. Thanks for reading and I’m off to check out your blog as well!

  7. You’re an fantastic writer. I’ve no doubt you’re a top notch physician, but most importantly, you’re a human being. I’m so glad you cut back to 30-35 h/week to try and save yourself. Can’t wait to start reading your work!
    P.S. I’m an ER MD. I run away from meetings, extra paperwork, and most especially, toxic people, including bullying patients and colleagues. I hope you will, too.

  8. Haha.. I’m finding that avoidance isn’t necessarily always a bad thing 😉 In all seriousness though, it’s been a huge work in progress to limit my exposure to toxic environments since that’s something that I seem to launch myself into in order to “help”.

    I’m honoured by your compliment especially since you are an accomplished and published writer yourself! I’m very intrigued by your book – I may just have to check it out!

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