T

he hold music on the telephone cut off abruptly as the doctor I was trying to reach picked up the line. “Yes?” she said curtly.

“Hi, this is Erin Barnes,” I said. “I’m calling from Temple University Hospital in regard to one of your patients. She was admitted last week with anemia. We were initially concerned about a gastrointestinal bleed given her history …”

“I’m sorry,” the doctor interrupted, “who is this I’m speaking with?”

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I felt my face start to flush.

“Is this a resident?” she asked. I could hear the anger in her voice.

“I … no, I’m a sub-intern.”

A sub-intern is what you call a fourth-year medical student on an advanced rotation. It is a monthlong dress rehearsal that is supposed to prepare us for a residency program, the three- to seven-year apprenticeship for new doctors. Sub-interns answer pages, run to rapid responses, take overnight shifts, and write lab and medication orders. A physician signs off on everything we do, but the pseudo-autonomy helps us learn how to act and think as if we were the ones in charge. We also make a lot of phone calls to coordinate care.

I started my sub-internship in May, at the beginning of my fourth year in medical school. This was my second day.

“You have got to be kidding me,” the doctor continued. “A student? You’re a student calling me? Wow.” I held the phone away from my ear, as if it would somehow protect me from her verbal assault.

She was just warming up.

“Well,” she said, “Let me tell you about this patient. She is a lazy [expletive]. She will not do in-home rehab. She will go home, dismiss the services, and then end up back at my office or your emergency room. It is ridiculous. I’m sick of it. Tell her she needs to be sent to a nursing home. I’m done with her.”

When she paused for breath, I tried to tell her that the patient needed some lab tests because we would be sending her home with some potentially harmful medications.

I don’t remember how the conversation ended. I just remember that when it finally did I was struck with the horrifying thought: What if I end up like her?

This doctor was once a student like me. Now she is using vulgar language to describe a patient and flying into a rage because a sub-intern called her. The interaction shook me, mostly because I knew I wasn’t immune to becoming a doctor like her.

I started looking for answers about how or why this transformation takes place.

An abundance of articles in medical journals made me realize that the health care system can be harmful to doctors’ mental health. Burnout affects all medical specialties, at rates climbing higher than 50 percent. Doctors get worn out by daily battles with insurance companies, cumbersome electronic medical records, and increased patient caseloads. The lack of job control coupled with low reward and high demands increase exhaustion.. As burnout rates rise, physicians are more likely to perceive their patient care as inferior, report symptoms of major depression, and end up in car accidents.

I know that happy doctors exist. But how do they remain content? Journal articles suggest ways to prevent burnout — decreasing work hours while encouraging exercise, mindfulness training, and the like — but I wasn’t satisfied with these nostrums.

I came up with a plan to learn more about physicians who are satisfied with their work and their careers. Fourth-year medical students like me spend most of the fall and winter interviewing for residency training programs. So as I traveled the country and met with dozens of doctors, I asked them, “What advice do you have for young physicians to avoid career dissatisfaction and burnout?”

Many mentioned that their residency programs are infused with wellness education, including meetings to air grievances, formal mentorship assignments, and even camping retreats. These are part of a broad attempt by the medical profession to help young doctors become aware of burnout and avoid it. Definitely an encouraging sign.

What I got the most from were personal strategies shared by doctors. They ranged from learning to prioritize and not taking everything on at once to combating clinical time constraints on an institutional level, building support networks in and out of the hospital, and simply taking more time to reflect, rest, and enjoy personal life.

But one strategy stands out most. After listening to my question about burnout, this doctor smiled and leaned back in his chair.

“A lot of people emphasize work-life balance to prevent burnout,” he said, “but I am terrible at it. This is something I have a hard time with because, as you know, I’m a pediatric neurologist. I think if your kid is having seizures, it’s a pretty scary thing. So I have a tendency to give my personal cellphone number to parents so they can always reach me. Like right now.”

He held up his phone, “A parent is texting me about her child, who has been having up to 50 seizures a day. I couldn’t imagine not letting parents have access to me. I wouldn’t feel right about it. But that is just how I prefer to practice medicine.

“The way that I avoid burnout,” he continued, “despite my terrible work-life boundary, is to remind myself of everything that I do for people. I have a binder that is filled with my own notes on patient successes and thank you letters from families. It is amazing to look at, especially now after years of practice. When you see it all there you really can’t help but be proud of the career you chose, the work you’re doing, and the difference you are making in patient’s lives.”

Looking back, it is clear that the doctor who screamed at me on the second day of my sub-internship did me a favor. The homework that I did has better prepared me to protect myself from burnout and to begin the meaningful and satisfying career I imagine.

And I have a new binder to fill with the little victories I hope will come.

Erin Barnes will graduate in May 2017 from the Lewis Katz School of Medicine at Temple University and then begin an internship in internal medicine followed by residency in neurology at Boston Medical Center.

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  • Frankly, there are a lot of physicians who need to “burn-out” and get the hell out of medicine. They’re killing too many people that do not need to die.

  • A book I haven’t yet read but plan to addresses issues of physician morale in an underresourced system: https://www.amazon.com/Heart-Work-Journeys-through-African/dp/0226893278/ref=sr_1_1 A Heart for the Work: Journeys through an African Medical School “Wendland, a physician anthropologist, conducted extensive interviews and worked in wards, clinics, and operating theaters alongside the student doctors whose stories she relates. From the relative calm of Malawi’s College of Medicine to the turbulence of training at hospitals with gravely ill patients and dramatically inadequate supplies, staff, and technology, Wendland’s work reveals the way these young doctors engage the contradictions of their circumstances”

  • I think this is a WONDERFUL strategy. There’s a lot wrong with the settings in which doctors have to practice and the constraints, but the triumphs are why it’s worthwhile, both when doctors fix problems that formerly could not have been fixed (cataract surgery) and when doctors cannot fix problems but can ameliorate them and provide support and help people cope. It’s important and the best suggestion I’ve ever seen about burnout.

    I try to let my doctors know when they have done a super job and how much I admire them when I do, in spite of our mutual frustrations about the system.

    Thanks for the fine article!

  • Strong work Erin! I hope this is the first success you put in that binder. ( The first of many). Congrats and good luck. Pat Gardner, RN

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