After I posted my burnout story [read Part One and Part Two to catch up], I was dumbfounded by how many people reached out to me. People who I hadn’t spoken to in years, all of them telling me the same thing: “I’m burned out too. And I thought it was just me. Thank you for sharing your story.”
As I’ve reflected on burnout in general for myself and my peers, the thought occurred to me –
Why now?
Comparatively speaking, life as an attending private practice physician is WAY better than it was in med school and residency. During the first two years of med school, my friend described that time as “cramming 5 lbs of sh*t into a 2 lbs bag”. I wholeheartedly agreed then, and I still do now. Information was blasted at you like water spewing out of a fire hydrant daily. There was a time when we would have exams three times a week, with each exam worth about 20 hours of study time apiece. And yet, I still seemed to do ok then (with one exception of a mini mental breakdown in which I wanted to quit med school – but that’s a story for another time).
The last 2 years of medical school were spent doing rotations in the hospital and clinics in different specialties. Every day, attendings and senior residents would carry on the tradition of “pimping” the medical students. For those not familiar with this version of “pimping”, it’s when someone in a position of authority who knows way more than you systematically asks you questions until you run out of answers. It can be done kindly in a constructive way, or it can end in, “I can’t believe they let people like you into med school. We’re all doomed!” And yet, after all that, I was still excited to move on to the next chapter of my career.
Intern year, my first year of residency, was the combination of all of the above. But now, I had actual responsibilities – people’s lives depended on my decisions! By this time I was acutely aware of how much I didn’t know, so I would study intensely to remedy that situation. However, the difference here was the working hours – the time spent at work ballooned up to 60-80 hours a week, depending on the rotation. My chosen area of specialty was Internal Medicine/Pediatrics, which meant I was cramming 6 years’ worth of training into 4, making training that much more intense. At the end of my intern year, I counted all of the weekends that I had both Saturday and Sunday off. Out of 52 weekends, I had only been able to enjoy 13 full weekends. And still, I was excited to move on.
After 4 long years of residency training, I finally made it to attending life! My weekends were my own, I was making more money and there was no one there to “pimp” me anymore (s/n: we need to find a much better term than that). Life by all accounts has been good the last 2 years. So why did my burnout happen now?
Lean on me
Looking back at all the phases in my life, I realize now what protected me from burnout in pre-med, med school and residency: Community.
Every group of friends I made through those times understood we would only be together for a finite amount of time, but we still developed strong friendships and bonds. Somehow, it made everything better to be studying next to someone for the 12th hour, looking over and knowing their life sucked as much as mine did. During our 60-80 hour work weeks, my fellow interns and I became mandatory family since we couldn’t even spend time with our own families. We would bond over mutual dislike of a certain attending who once told me I’d be a horrible pediatrician because I didn’t tell everyone their poop needed to be peanut butter consistency (s/n: True story – I almost walked out of medicine that day too).
But, after moving on to private practice, I’ve been relegated to my own silo of a corner office with 4 walls and no window. Everyone arrives at work, gets their stuff done and scurries home quickly at the end of the day to be with their families. No more commiserating, no more awful things to bond over other than the typical aren’t insurance companies the worst? complaints. No more work family.
One of my friends/senior residents warned me of a phenomenon when her friends graduated from residency. She foretold, “After they graduate, they just move on with their lives. They haven’t once tried to reach out to me. Then it’s just you. It sucks.” I didn’t think it would happen to me, and yet here I was – bereft from my support group and not quite sure how to get it back. Today, updates I get about friends’ lives are exclusively procured from Facebook.
And here was my dilemma – for every stage in my life, I had a built in support group, people who were forced to be in the same horrible situation as me, and together, we waded through the muck. Now, as an attending, I had to find my own support group which meant I had to put this all out there of my own volition.
It has been terrifying
But so necessary. Because sometimes all you need is to hear someone else say that the struggle is real for them too.
When I was talking to J about all this, he said, “Yup. Welcome to what the rest of us had to deal with after high school and college. You just didn’t realize what you had when you had it.”
Daggers straight to the heart. But, he was right – what I’m experiencing is not unique to only doctors. We have just been sequestered into these bizarre circumstances that forced us to have community, and now we have to give it a go on our own, just like everyone else.
This is not the fix for burnout
If you’re still overworking, stretching yourself too thin a.k.a. trying to cram 5 lbs of sh*t into a 2 lbs bag, reaching out and re-establishing your community is not going to be the all encompassing answer. But, it’s a start.
So who will you reach out to today? Who is your community?
Good posts on burnout. The correct answer is the one you reached after part 2. Work less. Make less. Spend less.
Absolutely – still a work in progress, but at least I’m making progress! Thanks for the comment!
Be cautious, M, about reducing work as a cure for burnout. I burned out in year 3 of primary care pediatrics. In year 10, I went part-time. It helped for the next 10 years physically but not mentally or emotionally. Now, I only hate half of my life. The job remains unchanged. The nature of primary care and it’s problems doesn’t change with the amount of time you spend at it. If it sucks 40 hours a week, it will also suck 20 hours a week. Now, I spend part of my week off dreading the coming work week and all of it’s stress and strangulation.
Yes, I found that to be true as well. I ended up “cutting back” from 50-60 hours to a “mere” 40, and it still ended up creeping back up to 45 somehow over the course of several months. Looking back now a year later, I don’t think it was a “cure” per se, but it did allow me to create some space to figure out a couple of things:
1) What was it I really disliked about my job – was it just the hours, or was it the actual work in primary care?
2) Was there anything in my control that I could change?
3) If not, what was my exit strategy?
Because living like that was not sustainable. And now, I start my new job tomorrow… if it doesn’t work for me, then I’ll have to restart the process. But, now that I know I can do it, I’m much more comfortable with that prospect if it arises again.
Cutting back definitely is not the only cure, but it is a step in the right direction!
I agree completely that cutting back allows time to at least think about choices more. I recently dropped down to a 3, 10 hour work day. I feel freer and more relaxed than ever before, but I still dread going to work each day. Now, though, I have time to discuss future plans with my spouse; where we can cut costs, what we may do if I quit work, etc. I also have time to look at what I really would be interested in doing for a living when I no longer have to prove to myself or anyone else that I’m smart enough or strong enough.