How I Broke Down 4 Obstacles to Cutting Back

I did it.

I cut back today.  Again.

I marched into my office manager’s office and declared, “I need to go back to 4 days a week,” daring her to tell me I couldn’t.

Instead, what I got was, “Ok.  When would you like that to start?  2 weeks or 3?”

Well, that was a bit anticlimactic.

It just shone a spotlight on who was actually holding me back.

It wasn’t my work.  It wasn’t my husband.

It was ME.  Again.

The Art of Self Sabotage

The physician owner of my private practice has been trying to convince me for months to cut back.

“You’re burning yourself out!”, she told me.

After every complaining session, my husband J would say,

“You know, you can cut back.  I’m GIVING YOU PERMISSION to cut back.  We don’t need the money.  So if you’re asking for my permission, you have it.  But you really don’t need it, you know.  Just do it.”

And yet, I hesitated.

I am the worst

I counsel patients to cut back all the time.  I tell them they can’t expect to live well balanced, present lives when they’re working 50-60 hour weeks, then sit in 10-15 hours of traffic just to get home.  They can’t expect to have time to invest in themselves to exercise, eat well and cultivate relationships between their significant others and children.

I pride myself in being able to say I eat relatively well and exercise.  I’m no hypocrite!  I wouldn’t ask people to do what I can’t bring myself to do.

But cutting back??

Yeah… total hypocrite.

I had cut back to 4.5 days alternating with 4 days every other week back in January,  averaging 45-50 hours a week despite my hopes it would get me to 40.   Here’s the rub: I knew it wasn’t going to be enough when I made that decision, but I still couldn’t bring myself to go down all the way to 4 days a week then.

So what’s holding me back?

After focusing solely on my medical career for so long, I have forgotten that I am more than just a doctor.  My time for hobbies, family and friends had been stripped from me for so long I started to only identify myself by one thing: Doctor.

If I stop doctoring, then what good am I?

I need to make a mind-shift.

Am I not more than a doctor?

I’m a pianist, photographer, runner, occasional yogi, dark beer aficionada, aspirational polyglot, crochet and needlepoint artist.

I’m a wife, friend, daughter and sister.

All of the above are worthy and deserving of my time.  I do not need to be defined solely by my day job.  So, with that in mind, I’ve listed the actual excuses as to why I wouldn’t let myself cut back + the reasons why they’re garbage.

1.  My patients need me

NOPE.  That’s my inflated sense of ego talking.  Sure, my patients would like to see me because I know their medical histories and family dynamics.  But they don’t need ME at all times.

When I go on vacation, I should be ok with leaving the work computer at home and not logging in to work.  My other colleagues will provide care coverage for me.  That is, if I actually take a vacation.

But, I haven’t NOT logged in to work on my vacations for over a year, and that time I was out of the country without consistent internet access.  Any domestic travel plans and my work computer is glued to my fingers.  Those prescription requests can’t be refilled by someone else when I’m in the country, God forbid!

This is not a 2 way street, I’ve found.  If my patients can’t get in to see me that very same day, instead of waiting til the next day when I have openings, they’ll just run to urgent care or the ER.

My loyalty to them ≠ their loyalty to me.

And yet the guilt of not being available for my patients eats me every time I’ve thought about cutting back or not taking my work computer on my vacations.

2.  I have a moral obligation to keep working

Where along my journey into my medical career did I pick up this notion it was my moral duty to keep working?

Perhaps it stems from my Papa who always said,

“If I had the resources that are available to you now versus when I was a child growing up in the Philippines, I would have been a doctor so I could help people.”

The guilt always starts in childhood.

If people have the means and ability to help others, then they should.  I’m not trying to argue that point.  But where do you draw the line?

Does this mean I should actually work more?  If I’m not working, I’m not helping people.

Should doctors be allowed to retire early if they still have a few more good working years to help people?   There is an impending doctor shortage, after all.

If people had the ability and the standardized testing skills to make it into med school but chose to go a separate way and work in the finance sector, for example, does the moral obligation extend to them?

What of other people in healthcare like nurses and surgical techs who also participate in patient care – do we start asking them to work more and more and not retire?

Where does it end?

Do I not have the right to now spend my time cultivating the other parts of me that have been left neglected?

Do I not have a moral obligation to myself to engage in self-care?

3.  But my student loans!

Nonsense.  I can pay off my student loans just fine even with cutting back, it may just take a little longer than my 5 year plan.

Fellow doctors – if you can’t find a way to eek out a living and pay off student loans with what we make as attendings, you need to figure your shit out.  People take care of families on less than a third of what we make.

Don’t forget the privilege that we have.

I can cut back on expenses and/or make more frugal decisions.  In fact, most of us have so much excess we could do away with half of what we own and still be just fine.

4.  If you cut back, you’re weak

Here it is – the real crux of the matter.

I was strong enough to survive residency, and now I can’t handle a paltry 50 hours a week?  What’s wrong with me?

A couple of angry patients shouldn’t be enough to derail me – I’ve dealt with much worse.  Have I gotten soft?

I wanted to cry and/or punch a wall from being overwhelmed during lunch today… really?  This from the same person who would complain about my interns crying in the middle of the work space.

I wish I could say I was just hangry as I hadn’t eaten for 6 hours at that point, but really I needed a break.

So I shut my computer down, walked out of my office, through the double doors out of the building, to the parking lot, across the street and into the Thai place next door.

Phone encounters, refill requests, unfinished notes – they could all wait 30 minutes while I ate my feelings in the form of a delicious Pad See Ew.  Through the sweetened soy sauce and broccoli, I had my moment of clarity:

I’d rather be “weak” and emotionally stable than power through and lose my mind.

When I came back, I told my office manager I was cutting back.

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A friend’s recent life-altering diagnosis has shifted everything into perspective – if I knew my timeline was changing and the end was near, what would I regret most?  I talked about this when I had my experience with anaphylactic shock, but it’s been a while since I’ve been reality checked with my own mortality.

Would I regret not working more?  Would I regret not seeing one more patient so I prove to myself I am a good, morally sound person?

A resounding NO.

Would I regret not paying off my student loans sooner?

Wouldn’t even be a thing I’d worry about.  I’ve already made sure I signed with a lender that would forgive these if I were to pass prematurely.

Would my patients be there for me in the way I expect myself to be there for them if something were to happen?

No, they would find it sad, then transfer to another provider.  They would not cry for me in the way I’ve cried for them.  In the meantime, I will have alienated my husband, friends and family – the exact people I would want surrounding me during tough times.

Things I would regret:

• Every time I’ve muttered, “Just give me FIVE minutes!” upon arriving home when J asks what I want for dinner and if I would like to participate in meal prep.
• Not getting to marvel at all the places J and I have dreamed about seeing: Arches, Glacier National Park, Australia, New Zealand, Reykjavic, Ireland… the list goes on and on.
• Not keeping in contact with the friends most important to me because work got in the way

My decision to cut back should be a no-brainer.  In writing, it seems even more obvious.

But to cut back means I’m admitting I made a mistake.  Maybe I shouldn’t have increased my hours when I did.  Maybe I shouldn’t have gone into primary care.

Maybe I shouldn’t have become a doctor.

I’m probably not in the state of mind yet to start thinking that one through, but hopefully I’m setting myself on the right path to get there.

We all sabotage ourselves in some way or another.

We all feed ourselves excuses that actually sound pretty good and legitimate.

But what we end up doing is throwing up obstacles to our better lives.

I, for one, need to stop doing that.

It starts today.