These last 11 months, I’ve been telling my story of burnout, but I suppose I should rename it Death of a Primary Care Physician's Career. I’m letting go of the person, the doctor, I wanted to be. Ironically, she is the person who dug this 6 foot hole for me, and now I’m laying her in it after 3 long years.
As a millennial physician, I grew up in the world of team-based care, evidenced based medicine, and "To Err is Human." Â I graduated a rigorous, work-hour rule bending residency program that still managed to provide a supportive environment filled with camaraderie. We celebrated success and newfound skills together. Â We also suffered, grieved loss and failures - together. The togetherness gave it meaning. I was eager to join the community of practicing physicians. On the other side of board certification, I found no such community. Â Rather, I found merely a group physicians in close proximity doing similar tasks, but in pursuit of individual and often disparate goals. In my search for community, I found myself alone.
"You know your job is killing you, right?" Startled, P's back stiffened, gaining him another 2 inches of height as he sat up straighter on the exam room table. Gah!! What is WRONG with you!? You don't have time for this pandora's box today. You're not Dr. Now from TLC's My 600 lbs life! Ugh.. fine. You're in too deep now.
"How do you keep doing this every day, patient after patient and still keep saying the right thing?" A thousand thoughts raced through my mind. Do I demure and say what I'm supposed to say? "Oh, this is all just part of being a doctor! It's such a privilege to be allowed to enter into someone's fears and emotions. Everything is awesome. Just living the dream." Or do I say, "I'm fine. You're fine. We're all fine. Please stop asking questions for which you're not prepared to hear the answer to." Or perhaps the truth, "I'm actually not fine. Thanks for asking. The only thing that's allowing me to make it through the day is that I've formulated an exit strategy, because I can't take this anymore."
Mom nodded, eyes glazed over from the bombshell I just threw her way. Taking and squeezing her clammy hand in mine, her attention returned back to the room from reeling into the land of "What if's?". "Mom... it's going to be ok. O's going to be ok. I just need you to get him to the hospital. Can you do that, or do you want me to call 911?" "No... I can do it. It's only 5 minutes away. It'll be faster if I take him now," the determination grew in her voice.
"I love my doctor! She's the best." "Aww.. thank you! You're going to set some unrealistic expectations for him from the get-go... see you next time!" Turning to A, my new scribe, I pondered out loud after exiting the room, "I don't know what it is about having you here, but all of a sudden people are coming out of the woodwork saying nice things. It's to fill the awkward silence of having someone new in the room, I think. This is not typical. AT ALL. You can't ever let this stuff get to your head, because it just makes the bad days worse." Watching A nod his head, probably in an effort to patronize me, I couldn't silence the inner monologue. You're just teaching him foreboding joy*, M. Don't pass on your maladaptive coping skills way before his time. Â
"M, what do you think about a scribe? You said you'd be open to that in the past, and I have just the guy for you. He's the son of a friend, and he wants to get more clinical experience before he applies to med school next year." My partner looked expectantly at me, waiting for my response. "What's his background? Pre-med?" "No.. an engineering background. So you'll have to train him, but he's a smart kid and I'm sure he'll pick up quickly!" 3 weeks later and I was shaking said kid's hand in my office manager's office. So earnest, so excited. So... pure. This was a mistake, M.
I had been on edge the entire morning. I even caught myself looking around my office in between back to back Follow up mood appointments, trying to figure out how I could slowly pack up all my things without anyone noticing. Because if I was going to have a dramatic exit, nothing would suck the victory out of it more than having to sneak in 5 minutes later to collect my stuff. Maybe one book a day, I settled on. On second thought, I didn't need the books. Or my medical degree and diplomas on the wall, for that matter. I'M OUT.
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.
Millennial doctors are declaring our career lifespans to be shorter than our predecessors. At first I assumed it was selection bias due to reading all the physician FIRE blogs when starting my burnout journey. But, among my cohort of millennial doctors comprised of Emergency Medicine, Pediatrics and Med/Peds physicians at this unofficial reunion, NONE of us are planning on having a lengthy career in medicine. 4 years of pre-med. 4 years of med school. 3-4 years of residency. All that training for us to then make enough to pay off the 6 figure loans, stockpile our money and GET OUT in just about the same amount of time it took for us to get through training to begin with.