Physician Burnout

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On my last post about the Tenth Annual NC Addiction Medicine Conference, I lacked room to write about an outstanding presentation by Clark Gaither, MD., about physician burnout. It was probably the best presentation I’ve heard on the topic.

Providers, meaning not only physicians but also physician assistants and nurse practitioners, are being asked to do more and more in less and less time. Some providers feel like we are working a production line, as if we’re stamping out widgets. There’s not enough time to do what we have been trained to do. This leads to feelings of frustration and burnout.

At his presentation, Dr. Gaither quoted a phrase that resonated with me. It describes the frustrations of being asked to do more and more busy work that takes time away from the real practice of medicine: “A thousand betrayals of purpose.”

Isn’t that a great phrase?

Thankfully, besides giving presentations, Dr. Gaither also works to prevent physician burnout. Besides being the Medical Director of our state’s Physicians Health Program, he still finds time to work with companies and individuals to address burnout, and also has a blog with good information. Here’s his web address: http://www.clarkgaither.com/

I’ve dealt with burnout, too. I’ve written about it on my blog, and even got honorable mention in a physicians’ writing contest for an essay I wrote. The actual topic was about work/life balance, which can be an aspect of burnout. Here’s what I had to say on the topic:

“Every Sunday evening, a blanket of gloom shrouded me as I contemplated my upcoming work week. I felt trapped by my work contract, my financial obligations, and my family’s expectations. I couldn’t envision how I could change my life.

In reality, I was the only person who could make changes.

My inability to enjoy work baffled me. I’d finally achieved what I worked for through college, medical school, and residency. I was a board-certified physician of Internal Medicine, well-trained, and prepared to care for patients in a rural practice setting.

This was in the early 1990’s, and in my area, hospitalists didn’t exist. I saw patients in the office by day, at the hospital by night, and squeezed in a dozen or so nursing home patients during free time. I worked around seventy hours per week as I raced down the road to burnout.

During those years, I was a thirsty person trying to drink from a fire hose. It was good stuff, but too much for me.

Then I developed a medical issue, which in retrospect could have been avoided or mitigated by a less stressful work situation. I took a few years off work to regain my health. What at first felt like a personal health disaster eventually became my opportunity to re-organize my life into a full and happy existence, with time to enjoy everything I love. This included taking care of sick patients.

During my two-year hiatus, I missed being a physician. Though I now had an identity outside of medicine, I missed patient interactions and the intellectual challenges. I wanted to return to work, but in new circumstances.

Initially, I thought the solution was to work part-time. That helped, but though I was well-rested, I was dissatisfied with primary care practice. That’s not where my heart was.

I networked with other physician friends, scoured the internet for different practice settings, and became involved with a physician support group near me. I kept an open mind and considered areas outside of mainstream medicine: occupational medicine, working for insurance companies and drug companies, and doing locum tenens work. I considered new areas like forensic medicine and considered going back to complete a different residency. I made thoughtful decisions based on my research.

Eventually I found my niche in Addiction Medicine, after I agreed to work for a physician friend who was the medical director of an addiction medicine facility. I got additional training and eventually became certified in Addiction Medicine, now a recognized medical specialty by the American Board of Medical Specialties.

Now, I look forward to my work days. I constantly face new challenges, I get paid reasonably well, and I feel like I’m helping not only my patients, but also their families and the community. I feel like I do more good in one day than I did in a month at my Internal Medicine practice, where I treated the sequellae of addiction, but never the cause.

I love the company I work for, and they respect my judgment and support my medical decisions. I work as much as I want for this company and have time for my own small office-based buprenorphine practice.

I feel blessed to have found my niche, but I also had to do some foot work to get to this point. Here are my suggestions for physicians who want to make changes in their work environments:

  1. Decide what parts of your work makes you happy, and what parts are not so enjoyable. Use your imagination and try to picture what your perfect job would look like. You may not recognize your perfect work opportunity unless you have an idea of what it looks like.
  2. Keep an open mind and investigate niches of medicine you haven’t considered. Consider working for a locum tenens company as a way to get paid while you investigate different aspects of medicine.
  3. Adjust your financial priorities. If you want to work fewer hours, you may need to jettison some life luxuries. You can make trade -offs. If you want a vacation home on the beach and a big boat, you may need to work more hours than a physician who is content with a cabin in the woods.
  4. Don’t get discouraged by false starts. More than one practice setting failed to work out for me in the long term. I considered that all part of the learning process.
  5. Remember the lessons you learn and try not to repeat mistakes. Several years after I found an enjoyable work situation, leadership changed. I was told that I needed to see more patients, and that my usual pace of six patients per hour was too slow.I recognized this practice was no longer a good fit for me. By this time, I knew my limits, and knew I wouldn’t be happy trying to meet new expectations. I told my physician employer that I planned to move on, and that he should start looking for my replacement. I told him that I didn’t have the temperament for what he needed in a physician and wished him well. We parted on amicable terms, and I found a place that fit me much better only a few months later.
  6. Expect to feel some fear. Life changes are risky, but we are talking about reasonable, calculated risks. Decide how much risk you can tolerate and proceed accordingly. For example, if financial insecurity would ruin your peace of mind, don’t quit your present job until you find a new one.
  7. Don’t allow your identity to be completely defined as a physician. As good as it can feel to be a physician, remember it’s only a portion of who we are. It’s also essential to cultivate our identities as parents, husbands, wives, and the dozens of other things important to us. That way, we aren’t as dependent on work for our sense of well-being. Particularly in this uncertain age of medicine, we must be grounded in other areas of our lives.

Physicians have more control over our lifestyles than we believe. We may feel stuck, trapped in situations we don’t like, but in truth, most of us have the financial and emotional resources to change our lives into something better. We have survived rigorous training and have skills to continue to change.

Trying something new is uncomfortable and scary, and sometimes doesn’t work out. But if you feel like I felt – that cold blanket of dismay over your shoulders every Sunday evening –doing nothing, staying stuck – that’s the much bigger risk.”

It was on my 40th birthday when my physician boss told me I had to see more patients per hour to keep my job. It didn’t feel like a very good birthday, but that was the day that I decided to look for another area of medicine, so it turned out to be a wonderful gift.

Later that same year, I accidentally worked for a week at an opioid treatment program (long story). I became fascinated with treating opioid use disorder with methadone. I couldn’t believe I’d never been taught about the tons of evidence supporting this treatment, either in medical school or residency. I could see it helped patients so much, but there was so much stigma.

Data 2000 had been passed just the year before, and around 2002 I got my waiver to prescribe buprenorphine from an office-based setting. I didn’t start prescribing buprenorphine until 2006, because I was worried an office-based practice wouldn’t give me enough support. I’d become accustomed to the team-based system of OTPs. But when I did start prescribing, I loved it.

Finding an area of medicine where I could make a difference doused the fire of my burnout.

Not every day is filled with rainbows and roses, but for the most part I enjoy my day, my work, my patients, and my coworkers. I know that I am blessed.

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