A Millennial Doctor’s Burnout – Part One

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.

I wrote about making the “crazy” decision to only work 40 hours a week, but that was admittedly a little white lie.  I did start off  in private practice working 4 days a week from 8 to about 5:30.  Lunch was 12 to 1:30, but as with most doctors I know, I worked through that time to finish up patient notes, go through phone messages and sift through lab results/documents.  My day “off” was Tuesday, but I would usually log in for 2-3 hours to catch up on my to do list and answer phone messages, otherwise Wednesday morning would be miserable.   All in all, my work week was about 40 hours a week, a far cry from life in residency.  I was living the dream and it was AMAZING!

As I became more efficient at seeing patients and doing paperwork, I found myself spending more and more time watching Youtube videos on Game of Throne spoilers and Last Week Tonight during my lunch.  I thought to myself, “Well, this is ridiculous.  If I’m going to be sitting under these fluorescent lights in my windowless office anyway, I might as well get paid to be here.”  A side note about doctor salaries, or at least those of us in primary care – we’re typically paid based on something called patient contact hours, meaning I only make money when I’m face to face with patients.  Not seeing patients = not making money.  I’m all about maximizing efficiency, so why would I be at work for an additional hour a day watching Youtube videos and NOT make money?  Also, Tuesdays off were a little weird – it’s not like I could hang out with anyone on a workday, so I’d spend it cleaning or binge watching my sci-fi guilty pleasures: Ancient Aliens and Killjoys (only watched away from J’s judging eyes).

For all these reasons, I changed my work schedule.  After a little over a year of working 40 hours a week, in November 2016 I added in a half day on Tuesdays and reduced my lunch to 12-1.  That change resulted in an increase of patient contact hours from 29.5 to 35.5.  Just 6 hours.  Easy peasy!!  This was going to be brilliant.  I’d be able to pay off my student loans a lot faster, max out my 401k/HSA AND still have money left over for vacations.  Living the dream just became bigger and better!

Wrong.  SO WRONG.

As soon as I opened up my work hours, a flood of new patients came in.  With new patients came along SO MUCH PAPERWORK, on average 250-300 pages of old records to leaf through for my adult patients apiece!  There is a huge shortage of Internal Medicine doctors in my community, so when these new adults came to see me, they dumped 5-10 years worth of medical problems for me to address all at once in our 30 minute visit.  Depression is also very prevalent in the Pacific Northwest, so hour after hour of counseling depressed people started to leech the empathy out of me.

Instead of leaving work at 5:30, I left at 6 or 6:30 every night.  My “half day” on Tuesdays morphed into full days.  My concentration and focus started to wane, and I became less efficient and productive.  Since I couldn’t keep up when I was actually at work, I started working an additional 4-5 hours on the weekends.  My 35.5 patient contact hours in reality translated to 50-55 hours a week.

But, I was making more money and achieving my financial goals so I chugged along.  If I admitted I was in over my head, that would be admitting failure.  I am not a quitter!!!  But, after 6-8 months, it all caught up with me.  I’d come home exhausted, emotionally and physically.

Everything sucked.  Medicine sucked.  I was fantasizing about the day I could quit medicine, and I had only been in primary care for 2 years!  Going back to cashiering at Target would be better than this!  People sucked.  I was so drained I started to avoid spending time with my friends, because if they started talking about their problems I started to associate them with my patients – just another leech to make sure I say the right thing to.

Despite all that, I thought I was hiding it pretty decently.  I’m the type of person that doesn’t let anyone into my head unless I give them permission; years of practice of putting up barriers was working well for me, I thought.  That is, until it got to the point where it spilled over into work.


Since she was born, I have taken care of a mischievous toddler with the best scowl I have ever seen on a 2 year old.  At every well check at 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months AND 18 months, her father would start off strong about how he didn’t even want to talk about vaccines for his precious baby girl, because you know, autism and chemicals.  He’d rail against the entire western medical system for the whole visit plus 10-15 minutes beyond their allotted time.  Every single appointment, I politely ended the discussion with, “I respectfully disagree with you.  Agree to disagree,” then run out of the room to apologize to the next patient for being late.

At her 24 month check, he started off in his typical fashion about aluminum and the fallacy of evidence based medicine, but that day my usual patience for this was at ZERO.  I interrupted him saying, “Yes, I have heard your objections to vaccinations before, and my disagreement with that hasn’t changed.  I don’t think this is something we will be able to agree on moving forward, so I want to discuss something that we both can agree on.  You know cigarette smoke introduces way more toxins and chemicals to your baby than vaccinations, right?  Let’s talk about your smoking habit around your toddler.”

Silence.

And in that moment, I allowed myself to savor the glee I felt in his shame.  This reckoning had been coming for 2 long years.  And damn, it felt good.  He had been trying to pick a fight with me every time I saw his child, and I bided my time to finally select the one I was going to win.

Eventually, his stuttering reply of sad excuses ended my moment.  And the guilt came crashing down.  What was I doing??  Was the first time I actually felt joy in several months due to me causing someone else discomfort?  What did I have to gain from filleting his shame and guilt open for everyone to see in their full glory?  It’s not like my comment would finally convince him to quit a habit he’s been doing for 20 years.  This was not the doctor I wanted to be – to engage in fights with unsuspecting people and jab at their most shameful and hidden secrets.

Most importantly, this was not the person I wanted to be.  I didn’t want to be so burned out from work I was unable to practice the compassionate medicine I had set out to do when I went to med school.  I didn’t want to avoid being with my friends that I love and care for, for which I am grateful they entrust me with their problems.  I didn’t want to be so exhausted at the end of the day I didn’t want to spend time with my husband who without complaint lovingly picked up my slack, cooked dinner every night for probably 2-3 months, did the dishes and laundry, and made breakfast for me every weekend.


Something needed to change.  I needed to admit to myself that this attempt to maximize efficiency, productivity and money was an epic FAIL.  Because if with every failure there is a lesson, I needed to find that lesson and fix this.  Admitting I made a mistake has been incredibly hard and something I still struggle with, especially since that mistake comes along with a significant positive dollar amount.

Sometimes though, some things are not worth the price.

For Part Two CLICK HERE

***Main photo taken at Hallstatt, Austria.

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