8:23 am
*Buzz buzz*
Rolling over in bed, I grabbed my phone and saw an incoming text message alert. (S/n: One of my greatest joys since finishing residency is staying in bed for as long as I want on the weekends!)
“Hey M. Check out this quick read and the comment after the post. I think he’s dissing you!”
Intrigued, I quickly made my way through a fellow physician FIRE blogger’s post which I thought actually had several fine points:
- Doctors should choose our words with care
- Doctors should remember our privilege when we discuss our finances because we do VERY well for ourselves compared to the rest of the world
Seemed reasonable and certainly a good reminder for me.
So where was my friend going with this?
Then I saw it →
The comment
“I read a blog last night by someone who is a primary care med/peds doc and it was a non stop bitch a thon about how she’s getting gypped¹ that she has to work 45 hours a week seeing patients AND AND the paperwork sucks! My only response was DUH!
As I thought about it more I decided she’s in a kind of 7 stages of grief over becoming an adult.
Pediatric primary care as near as I can see is a specialty done by a PA. I’m not dissing the dignity of the work, but that seems to be the reality. Part of the gig seems to be living a victim life.
…
If you’re bitching about being a low paid doctor, look out you’re likely soon going to be a “not paid” doctor with your skill set falling to a PA, or a janitor with a cell phone.”
Interesting
This certainly did sound like a diss, and it definitely felt directed at me with so many identifiers matching up with my blog.
90 seconds, M. It just takes 90 seconds for an emotion to pass.
At least that’s what my Calm app tells me. I’m still hopeful mindfulness is going to save my mind.
3… 2… 1… Now you’re allowed to pick up your phone and respond.
First word:
“Haha..”
Well, that was unexpected. So was the rest of my response where I pointed out both the blogger’s and commenter’s valid arguments. My friend seemed more affronted than I was at this jab at my honour, and maybe even more confused that I was not interested in doing anything about it at this very second.
“I just need some coffee to wake my brain up and then stew on this til lunch, overthink things and then get really mad later,” I offered.
Haters gonna hate
I’ve been expecting this day for a long time. I’m even surprised it took so long.
When you open yourself up in any arena, whether that be in real life or on the internet, you invite commentary.
Your inner thoughts are no longer sacred and safe from harm.
As someone who has spent my entire career in STEM where facts and data rule the day, transitioning to this new creative role of story teller has been a thoroughly foreign experience. I started off telling the stories of my patients, but as I have become braver and willing to be more vulnerable, I’ve allowed myself to bleed on the page along with them.
I knew at some point, someone was going to take issue with that and it would feel very personal.
As the day went on and this person’s comments started to marinate into a noxious stew, I went back and forth on how to respond.
Would I take the high road and how would that even look like? Or would I lay utter waste to his comments?
It would not be a difficult thing to do – as someone who has been able to see others’ fault lines easily and knowing enough about him from his previous comments on other blogs, it could be quite satisfying to tear that rift apart. The ensuing word war prodding him to the edge of the hole he would dig himself would leave him in a precarious position – would he jump in himself or would he try to save face and back away?
Was this a game I even wanted to engage in?
As I pondered this, a message from my childhood best friend came in just in time to save me from doing something stupid.
“Hey M! I’ve just been catching up with your blog, and… it’s kinda weird to say, but I hear you in your writing.
Your compassion is amazing.
Like that girl you were talking to about loving herself. That was something I needed to hear as a kid, and you said that to her.”
Immediately the furious storms were swept out of my sails.
Getting into an all out brawl with this individual was not me (at least not anymore). I chose to not engage and blow up my colleague’s comment section.
In the age of the internet, it is amazingly easy to seek connection amongst like-minded individuals. But while it’s easy to have a monologue here, fostering true connection is a much more difficult feat that requires respectful exchanges of ideas and experiences. Ultimately, those who choose to seek connection by denigrating others in a group setting will eventually find themselves living a solitary existence.
It saddens me to think perhaps this is the primary method in which he gains points in his social meter.
With that being said, I would like to address some issues he brought up here today.
1. My non-stop bitch-a-thon²
He was on point with this.
No argument here – I have complained. A LOT. 20 posts about burnout to be exact, excluding this one.
In my defense I’ve been trying to space this out over the last 9 months, and he likely just blasted through all the burnout posts in one fell swoop.
The fact that he continued to read after realizing it was all just millennial doctor whining and tantrums, then felt compelled to talk about it on someone else’s forum rather than addressing it on this blog is fascinating to me.
I appreciate the irony in the specific forum he chose to air his annoyances with my complaints of a 45 hour work week (cut down from the typical 50-60 hour work week, mind you) – a FIRE blog meant for people who are looking to cut back on work early through financial independence.
Of all the places on the internet, I would expect to find support in that community but there was none to found in his commentary.
2. 7 stages of grief over becoming an adult
If by grief over becoming an adult he meant the slow death of a young adult’s idealism, then yes, he is correct.
Why shouldn’t you grieve the fact that maybe your hopes and dreams were smoke and mirrors put up by people who sold you a bill of goods, just to realize your only worth to healthcare is to be put on a schedule of 15 minute increments – just enough time to physically be in the room with patients but not enough to actually listen to their concerns in order to provide some healing? When your intention to go into medicine to help people is thwarted by the broken healthcare system every day, how do you not become worn down?
You’d better believe I’m grieving my idealism.
Looking at the long view of most people’s lives, lives I have the privilege of peeking into for a living, I am aware most people’s scripts will go as follows:
Childhood → Lose your joy and excitement for life to head into… → Adulthood → Wake up, go to work, come home, eat dinner, watch tv, go to bed → Lather, Rinse, Repeat → Wake up in your 40’s to 50’s to the realization you’ve just wasted the best years of your life in monotony → Have a mid life crisis → Your body fails you → Everyone you know is dropping like flies → You die alone in a hospital bed, clothed in an over-washed hospital gown and suffocated by your regrets
After transitioning into adulthood, this is what we have to look forward to.
If you haven’t thought about it like this yet, You’re welcome.
In my less cynical moments, I like to think I’m halfway through my journey scaling up and down a mountain – now at the pinnacle, I’m watching the sun set on my youth. I’m merely enjoying the 360° panoramic view of where I’ve been and where I’m going, contemplating the manner of my descent as I wait for the sun to rise again.
3. Disappointment
Ultimately, the overarching feeling I have for this entire situation is disappointment.
In addition to the grief over my fading idealism now being overrun by cynicism, I am also grieving over the realization that a person who was supposed to support me and my millennial peers as fellow colleagues in medicine just equated us to being janitors with a cell phone.
His disdain for janitors, PAs and pediatricians in one fell swoop is disappointing.
The realization that the adults I used to hold in such high regard would just cast us aside is disappointing.
Perhaps the biggest disappointment of all is that I expected this from someone such as him. A doctor who has reached retirement age and is now spending said retirement reading, then complaining about my blog.
The generational disconnect is palpable. I feel it and my peers feel it. It’s no wonder that my last post Career Lifespan of a Millennial Doctor: 10-15 Years MAX is the most read post on this blog, more than 2000 times since I released it into the internet 5 days ago.
But it’s much more than that
It is the insidious lack of respect in medicine in general. Primary care doctors fighting with specialists. Nurses fighting with doctors. Surgical specialties fighting with non-surgical specialties. Emergency Medicine fighting against, well, everyone.
We have become poisoned from within, weakened so much by our lack of professional camaraderie that opportunistic organizations have swooped in and taken over the reins of medicine.
Unless we figure out how we became so disjointed, the climate of what medicine has become will never change.
Burnout is ugly
Perhaps the thing that offends this commenter so much is that someone is talking about their feelings on the internet, something physicians were never supposed to do. It’s certainly not something I had expected to do.
But after 3 years of working in primary care trying to effect change, I have come to realize most people move to action from a place of emotion. Later, they try to justify their actions using logic.
If I wanted to make it to the other side of burnout, my emotions had to be dealt with because logic-ing my way through wasn’t working. It’s been an internal fight with myself, every single step of the way.
How to build a life without regret³: Own your story
I am all for open discussions with different viewpoints and perspectives, and yes, even criticism. But only if the criticism is constructive and not intended to be malicious or hurtful.
With that being said, if reading through my story has only brought about feelings of consternation and irritation, then this blog was never meant for you.
I assure you, there are plenty of other sites and blogs on the internet to satisfy any interest – you no longer need to waste any more of your life here.
I will not be made to apologize for creating a little corner on the internet to document my journey through my struggles and frustrations with medicine.
I will not be silenced for stating what many of us wish we could say without fear of backlash and repercussion from naysayers. If I have to take it so others may have a voice, so be it.
I saw a need for someone to put their journey out there for others to see they were not alone, and for every one random disparaging comment that comes to my attention, 20+ have come in, thanking me for putting my story out there.
To be honest, I only needed one thank you, from a treasured friend who remembers the person I was before my tragic descent into “adulthood”.
True help and progress only happens when you meet someone where they are right now and walk with them, offering support and encouragement until they get to their next destination.
I have been fortunate to have met so many new people on this blogging journey, all in different stages of their own burnout stories.
This space is for you, for us, to meet and walk along our paths.
***
Photo taken at Silver Star Mountain with mountain views x 3: Mount Hood, Mount Jefferson and Mount St. Helens.
I can’t help it. I tried taking the high road, but I just had to put the snarky, childish comments at the end.
- Gypped:
- Just… not cool, dude. Swindled/robbed/cheated are fine alternatives. The fact that it was spelled in this way makes me infer that he knew it was an ethnic epithet against gypsies.
- Non-stop bitch-a-thon:
- I just wanted to point out the properly inserted hyphens in the heading as opposed to the actual original comment. If you’re going to insert a space, there’s gotta be a hyphen, man. If there were no spaces, then bitchathon would have been appropriate (please refer to this Wiktionary article). At the very least, for future reference I would like to be insulted with proper grammar please.
- Regret (not his comment but mine):
- I really wanted to put “regert” here. But it would have taken away from the statement. Please enjoy it here now.
I saw the post, I do not remember where, I contemplated a response, and decided it was better to leave it alone. I am truthfully surprised that he would even know about your blog. He seems to be more into the nitty gritty money stuff, not so much the humanism and emotional side of physician wellness.
As I have said before, you are doing a terrific job with your blog. But you will not please everyone. Most people who read your blog are moved, and it is serving a higher purpose for them (for us). Keep doing what you are doing, and you, and I, and the most of the rest will continue to benefit.
“Listen to the fool’s reproach! It is a kingly title!”
— William Blake
Thank you as always, VBMD. I think the commenter may have found it through the PoF’s Sunday Best since he’s so prominent in the FIRE community.
I went back to the original blog post to see if there were any responses, and it appears everyone else also chose to refrain. You just never win when you get into battles such as those. I prefer to get my wins elsewhere 🙂
+1 to Vagabond’s comment, M. I’ve had more practice than you – with respected to being hated – so let me just say it gets easier to resist the temptation to engage, with repeated exposures. But I love your snark, nonetheless, so I’m glad you included that at the end!
So funny thing… I had deleted the snark last night but apparently forgot to save the updated draft, so it got published despite my better judgment. So much for taking the high road.
Also, just found out I sent out the email newsletter notification with broken links. Successful all around, I’d say.
M,
I think your point about grief is valid and true. As you might imagine, I have been doing a fair bit of work with grief, both personal and professional. It is hard to stomach the idea of someone dismissing something BECAUSE it is grief. Grief is the emotion that tells us that we have lost something that we loved. If a physician does not grieve the current state of healthcare in this country, I think there are only two explanations: 1 – they are in some sort of luckily protected bubble where American healthcare is not a giant machine squeezing money from human suffering. Or, more likely in my opinion, 2 – they never ACTUALLY loved medicine and humanity in the first place, so they have nothing to grieve. In which case, I wonder if they should have ever been physicians in the first place.
Also, I think that older physicians who were not saddled with our loan burden forget that the deal of signing up for medicine was not “I will take the loan burden now in exchange for earning potential in the future,” but rather “I will make enough money to easily pay back these loans by doing something worthwhile and meaningful that I love.” So, when we only get the earnings and the calling is being destroyed from within, OF COURSE WE FEEL CHEATED, but also cheapened. Because every day our presence enables a system that degrades our sacred calling just so that we can pay off debt.
“Grief and love are sisters, woven together from the beginning. Their kinship reminds us that there is no love that does not contain loss and no loss that is not a reminder of the love we carry for what we once held close.”
― Francis Weller, The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief
Yes, yes and YES to everything you just said.
If you haven’t read the STAT news moral injury article, it is well worth a read: https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/
“Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand. Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful. These routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care.”
I feel like we’re starting a book club 🙂
M
Go get ’em!
Proud of you for sticking up for yourself. I’ve said it a lot, but I completely relate to your writing and find it to be extremely helpful. All of the positive comments put the bad ones in their place.
You are doing great things.
Keep it up.
TPP
You’re one of the major contributors to those positive comments, so thanks 🙂
I read that same comment and was stunned by its malice and self-righteous and arrogant disregard for half of our medical brethren. That was the first truly negative comment I’ve read on any of our blogs and it has no place here.
We always read that social media is a den of bad behaving, ad hominem wielding cave trolls. I too am new to Twitter and find it somewhat mysterious, I first loaded it up 3m or so after starting blogging. I’ve been pleasantly surprised that the personal finance and financial independence space is largely devoid of such adolescent outbursts.
In my eyes, M, you are quickly becoming one of the voices of our generation. Keep on kicking ass.
You just keep giving me vocabulary gold! Ad hominem is now added to the growing list.
I am a little unsettled about the thought of being the voice of a generation, but I suppose I signed myself up for that when I branded the blog. To be honest, I hadn’t really thought about what would happen if people read my writing… I just wanted to complain about stuff, and I’ve always been told I do it well 🙂
I didn’t really think people would read this at all, so this has been a strange experience to say the very least. As long as I get to keep “kicking ass”, I guess I’ll keep going!
M, as a 34 year old female physician assistant, and bread-winner of my family, and mother of 3, I completely relate to ALL of your posts regarding burnout. Some of my reasons are the same as yours. Others, relate to a tyrannical supervising physician.
I did want to comment that your critic, who clearly needs a brush up on grammar, has offended not only you by comparing you to a PA, but also me, by leading his “audience” to believe that PAs are not highly intelligent, (we are trained under a medical school model), governed (in most states) by the Medical Board of said state, and equipped with skills very parallel to physicians themselves, when the PA in question is dedicated to continuous self-improvement and life-long learning.
In my 7 years of clinical practice, I have acquired experience in Pulmonary and Critical Care/ICU, Cardiology, Family Medicine, Chronic Pain Management, and Orthopaedic Surgery specializing in total joint replacement of the hip and knee, and sub-specialized in Orthopaedic Oncology. I have patients that refuse to see my supervising physician, and only wish to see me. I have patients who drive 2 1/2 hours one way, just to receive steroid injections into their knees for osteoarthritis, because “their PCP gave them a couple times and it hurt so bad they couldn’t stand the pain, and well J, I just love you and you don’t hurt me a bit, and I always just feel so comfortable coming in to see you, I actually look forward to it!”
There are brilliant physicians in the world. There are also brilliant physician assistants in the world. Some of us, could’ve/would’ve become amazing physicians and/or surgeons, given certain opportunities in life. As a PA, I also have 6-figure student loan debt….inconceivable? No, not when you become a single mother in your senior year of undergraduate school as a Chemistry Major, and financed not only tuition, but also the bare necessities of life (also with the assistance of HUD housing, food stamps, WIC, and Medicaid) caring for a newborn baby girl whose daddy decided to run off 3 months into the pregnancy, all the while going through a rigorous and very intense academic program, and praying to pass national board examinations which covers all organ systems of the body.
Having experienced the burnout you have described so accurately, and having been denigrated by my supervising physician for the past 4 1/2 years, despite excellent patient satisfaction scores, and the fact that his generated revenue has nearly tripled, yet to no credit of my own obviously, because I’m after all, “just a PA”, I was actually offered a position working less stringent hours, with a pay raise, largely setting my own schedule, in the world of academia, and building a new PA program at our University as a founding faculty member. I wasn’t looking for a new job, I just signed up to participate in curriculum committee, and advisory board meetings. At my first personal meeting with the founder, I was hit with, “You are spectacular. You are exactly what this program needs in regards to gaining accreditation, and educating PAs to graduate performing at the highest level in the country. We will beat your salary, you can set your own hours, we will pay for your Ed.D, and you can still work one day per week clinically, for additional income if you desire, as I can tell you have built strong rapport with your patients. You will be in charge of writing approximately 36 syllabi, creating Clinical Medicine I, II, and III courses and being instructor of each and any others you feel compelled to teach. You will be an advisor to PA students, and likely speak on behalf of our PA program in the years to come at State and National levels. If you need time to think about it, that’s completely fine. But, in the meantime, I will go ahead and schedule a meeting between you and the Dean of the School of Medicine, as he will sign off on the formal offer letter I am drafting for you to join us.”
I guess my point is, I don’t approve of this person’s view of physician assistants. Some are better equipped to care for patients than the physicians who supervise them. But just like in any profession, including the physician profession, there is a spectrum of excellence. One who would stoop to such a degrading level of commentary only leads me to believe this person likely falls on the lower end of the spectrum. A high score on the boards doesn’t ensure that a physician possesses empathy, which in my opinion, is a requirement for the delivery of effective health care to our patients. I feel sorry for this “critic” that they are so closed-minded as not to see the potential that lies within each and every one of us, regardless of what our “formal title” may be. I admire you for choosing to be vulnerable, and have been inspired to try out that concept in my own life as a result of reading your posts. Please, continue. We, equipped with empathy, are still reading and learning. Thank you!
J,
Wow, I am just blown away by you and am excited for you in your future endeavours! Sorry for the delay in getting back to you on this comment as I was without reliable internet for a while, but I do have a few things to say about this.
Here’s the thing with people who are on the higher end of the spectrum of excellence in terms of our careers, our relationships, our lives – we have learned to stand in and know our worth without feeling the need to push down others to make ourselves seem bigger than we are.
That requires empathy and compassion, and yes, vulnerability. Because if we shut ourselves down to all criticism, there’s no way to for us to see our blind spots so we can continue to grow. But, I always assess the criticism with this filter: Is it true, is it helpful and what can I learn from this? If they are none of these things and there is no lesson to be had, then I just go on my merry way. If the criticism is persistent from the same person, then that says more about them than it does about you. It sounds like it’s time for you to move on to bigger and greater things!
I’ve worked with and learned from awesome PAs in my medical career, and I have cringed at and been appalled by some horrendous physicians. We all have roles to play and ultimately the in-fighting amongst ourselves really has done nothing but tear medicine from the inside out.
Don’t let other people who are afraid of your worth keep you small. And J, you are a badass woman! You’re going to do great things. Keep me updated on your progress!
Best,
M