To The Doctor Struggling with Burnout: I See You

My friend,

I remember being where you are, feeling like there wasn’t anyone who could possibly understand the darkness I found myself in.

The isolation.

The inability to explain the full weight of what I dealt with as a primary care physician every day to my very well-intentioned non-medical tribe.

The difficulty reconciling the knowledge that I was “living the dream” but in reality was merely existing in a living nightmare, my own personal hell I had spent my entire adult life trying to achieve.

I resisted for a long time to share my story – it’s not an easy thing to do… it took me 2 years to even admit to my husband that I was struggling, and that in and of itself felt like a failure.

Because we should be stronger than this, right?  We knew what we were getting into, we logically understood that we would see and endure a lot of suffering.

But to know this is different than to live this reality.

When your well has gone dry, it is very hard to see the light at the end of this journey.  It’s hard to see the purpose in what we do.  It’s hard to see the point of everything.

But you are doing GREAT things.

You are helping people through their darkest hours.

And your patients will appreciate what you do.

They may not appreciate the cost to you, but that is something I and your colleagues who’ve been through burnout understand.

We are at baseline caring people, but the system in which we work does not allow us to fully care for the whole person.  The patient-physician relationship has been broken down to metrics and RVUs, checkboxes on a screen and report cards telling us we’re not doing our jobs unless we’re all at the 95th percentile, a mathematical impossibility.

Not all healthcare systems are created equal, and while hospitals and systems are money making machines, perhaps you may find one in the future that has a better culture and actually does put patients first once in a while.  I, too, felt the burden of being responsible for all that was broken in medicine.  It’s part of the reason why I stayed so long in primary care.

But we can only fix what is within our power to fix.  And until you get to a certain position of power, ruminating over how shitty corporate culture is and how they’re hijacking phrases like “patient safety” and “quality” and “standard of care” is not going to do anything except wear you down even more.

It’s moral injury for sure, and it cuts deep.  I want you to attend to your own injuries because if you don’t, you end up in a dark place.

This is not to say we’re giving up and we don’t care anymore.  It’s that we need to regroup and figure out what our next moves are.  I’m taking the next 2 years for my hospitalist contract to figure out what I need to do – possibly infiltrate administration and try to work within the system to help make it better OR leave the system altogether to do DPC.

There will be a reckoning coming – physicians are already mobilizing: Physicians Rise and Physicians for Patient Protection.

Something is going to happen in the next 10-15 years.  And we’re going to need healthy, well but angry and galvanized physicians to lead the cause. 

The only way we’re going to get there is if we take care of ourselves now.

How do you do this, you ask?

That’s the thing with burnout – we’re told that we just need to practice more mindfulness and be more resilient, but the truth is, the first step is that we need to scale back.

Significantly.

I don’t know if you’re in a position to do that though if you’re still in training.  I will say that staying in training will help keep doors open for you in the future, but that doesn’t help you right now when you dread waking up every morning, just to return to a day that feels like just a long continuation of yesterday. 

If you’re an attending, you have more power than you think you do.  You can rearrange things in your life to make things work for you.  If there’s push back from your employer, you can vote with your feet.  It may not be pretty and you may need to cut some things out of your life but YOU get to make those choices.  

In a world where we’re told we can always be replaced, we forget that our employers are also replaceable.

Remember, nothing is permanent.  And we all have the capacity for change. 

The question you need to ask is this: Who will drive this change?  Will you be taken for a ride or will you take the wheel?

Time to think

If you’re ready to take your life back, you first need some thinking room.

What things can you do to create space for yourself to sit down and really think about what you need to make it through each day/week/month for the rest of your training/career?  Even if you need to take a sabbatical to do this, it’s just a blip in the big scheme of things.

It’s alright to take the time for yourself.

You won’t be falling behind.. you’ll be making yourself healthier and stronger.

Replenish the well

Taking care of other people is emotionally draining – I don’t care how resilient a person is, it’s going to take a toll on you.  You need to replenish the well.

Good quality sleep is important, 7 hours a night.  I know that sounds really trite, but it made a huge difference for me.  I personally am really dependent on exercise, and if I don’t do it 3-4 times a week, I can feel that dark cloud rolling in.  Hiking and being in nature is really therapeutic for me as well – perhaps getting out of your apartment/house into some place green without any technology will be helpful for you.  Reconnecting with old non-medical hobbies such as writing and playing piano were helpful for me – rediscover those passions.

Remember to do ONE thing that brings you joy each and every day.  Doing this gave me something to look forward to because even if the day went to hell, at least I had that.  Sometimes it was just cuddling with my dogs for way too long, sometimes it was exercise, other times it was catching up with an old friend on the phone.  Whatever it is, just DO IT.

Even though I’m only asking you to commit to ONE thing, I know it feels insurmountable to commit to something so seemingly superfluous when there are so many other productive things to prioritize.

DO IT ANYWAY.

Do things for the simple joy of doing them.  Do them unapologetically.  Do them not because it will make you a “better” doctor or a more “efficient person, or even to “optimize” your self-care – do it simply because it makes you happy, if only for a brief moment.

Remember what it was like to open gifts on Christmas morning, or to find out that school was cancelled for a snow day or the first time you drove a car – we are allowed to have that kind of giddy childhood joy, even now.

You are worthy of spending time on yourself.

It’s not self-indulgent, it’s necessary.

Reach out and connect

Are you able to reach out to someone at your institution?  Is there someone you trust to share this with?  Have you looked to see if there’s employee counseling (usually free at healthcare organizations)?  If not, feel free to just shoot an email over/DM me on Instagram/Facebook/Twitter if you want to gripe.

Our medical peers are very reticent to say if anything is wrong unless one of us breaks the silence first.  I just wasn’t willing to do that 2 years ago, keeping me in self-isolation.

Simply finding someone who said, “I hear you and I’ve been there,” was so therapeutic, it’s hard to put into words.  Sometimes just knowing you’re not alone in feeling and thinking these thoughts is enough.

So I am more than happy to do that for you now.  I hope you find healing in these words.

I know it’s kind of hard to figure out what your next moves are when you’re in the swamp.

I sat in it for a year and a half trying to figure out what I was going to do with my life.

It’s been a long, painful process. And what I’ve listed above are merely starting blocks… the first steps are always the hardest. 

But you’re not looking for easy, are you?

You know what it’s like to work hard for what you want.  You know there can be catharsis after suffering.  You know what it means to make a commitment to your goals and see it through.  You know how to grit your teeth and make it through with sheer determination.

You’ve got the medical degree.  You’re going through or have gone through some intense training.  You’ve been through the ups and downs of hundreds and even thousands of people’s lives.  

Now it’s time to get your life back.

You got this, friend.

Know I’m here rooting for you every step of the way.

 

Much love,

M

 

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If you’ve been searching for resources to look at specifically for burnout, here are some I’ve come across below that don’t just talk about how we’re going to fix this with mindfulness conferences on our days off and just being more “resilient”:

Podcasts:

The Curbsiders: Episode #129 Depression and Suicide: Occupational Hazards of Practicing Medicine

The Brave Enough Podcast → This one is geared toward women, but I think the strategies Dr. Shillcutt recommends for burnout are applicable to everyone.

Physician Non-Clinical careers with Dr. Jurica if you’re thinking of stepping away from clinical medicine

Websites:

The Happy Philosopher → This is the site that really helped me start on my getting out of burnout journey.

The Happy MD

Pamela Wible → Dr. Wible is one of the leading voices on physician burnout and suicide

SEAK which hosts an annual conference for non-clinical career options for physicians

Facebook groups:

Physician Non-clinical Career Hunters

Physicians to Physician: Healing the practice of medicine

StyleMD → Women only, and if I’m being honest, some of the posts offend my minimalist sensibilities but I do love the camaraderie and supportive nature of the group

FIRE (Financial Independence, Retire Early):

I know you probably can’t even imagine going into work to get a paycheck, but the sooner you gain financial independence the sooner you can be free from all of the stuff you don’t like about medicine.  You can then decide when you want to work, how much you want to work, how much of your life you want to exchange for a paycheck.

The most important thing for me to realize was that I don’t need to feel stuck in a career that I was miserable in because of money.

If you need proof, Crispy Doc has a series of physician interviews of docs who cut back – take some inspiration from them.

The Physician Philosopher, Physician on FIRE and The White Coat Investor have a lot of resources on their sites to help you attain FIRE.  Miss Bonnie MD loves supporting women who are in search of FIRE as well.

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Thank you to the person who emailed me that inspired this post – you know who you are.  

Photo taken at Heceta Beach on the Oregon coast.