I’ve watched enough television shows to know what a burned-out physician is supposed to look like: crying in the stairwell, head hanging dejectedly, knees bent; the downward spiral into drugs and alcohol that leads to a near-miss in surgery; or the final, explosive monologue that alienates the doctor in front of patients and peers. A once-solid doctor now broken.
Mine didn’t happen that way. It was far more subtle and insidious, an accretion like the slow and steady drips that build stalagmites.
Drip: Twelve years of hustling at a hectic pace in a private pulmonary and critical care practice covering three busy hospitals and intensive care units, packed emergency rooms, understaffed floors, and overworked staffs.
Drip: The never-ending clicks to provide documentation in the electronic medical record that was designed to maximize reimbursement, not facilitate communication.
Drip: The frivolous lawsuit I was dragged into by virtue of having been on call for the hospital one night, along with the multiple depositions I gave and read and reread, combined with more than four years spent anxiously preparing for a trial from which I was dropped without ever taking the stand.
Drip: The challenges of being emotionally and physically available for my family. Trying to be actively engaged in the lives of my wife and children with half my brain still in the hospital and the other half fighting the weight of cumulative fatigue.
A physician’s slow burn is often masked by his or her defense mechanisms and denial. But it eventually becomes apparent when something loved becomes something tolerated; when the excitement and potential of each new morning is replaced by the dread of what might lie ahead; when problems that were once challenges to be solved become roadblocks and barriers seemingly designed to thwart and frustrate; and when it feels as though patients and staff are no longer expressing themselves but are instead complaining and whining.
I found myself becoming exhausted at work. I became more callous, impatient, and terse with my patients. With residents, medical students, nurses, and my physician partners. With friends. And with my family.
I wanted to find a reason for this, a fixable external problem like the lawsuit, or being short staffed, or becoming more efficient with the electronic medical record. Because if those weren’t the cause of my problem, maybe I needed to look at myself.
Was I too weak? Did I not have enough fortitude, endurance, or grit? With those thoughts of weakness came feelings of shame.
That surprised me, because I don’t consider myself to be a weak person. I’ve completed six Ironman triathlons. I’m a water polo goalie, a position that gets a lot of physical abuse. I survived four years of medical school and four years as a resident in internal medicine and pediatrics, enduring countless sleepless nights on call that were often calmer than nights at home with two young children. I asked my residency program for help just twice during that time, once on the day my wife miscarried and once for 72 hours after the birth of our second child.
I pride myself on taking challenges head on and standing tall and strong on the other side. But I wasn’t able to do that with the cumulative burden and increasing stress created by working in medicine.
I started talking with my wife about taking a break or cutting back. I envisioned teaching science at a high school and coaching water polo. I thought about going back to school to figure out different ways of using my knowledge and skills. I thought about spending more time with my family and having the emotional and physical energy to be patient and present, not irritable and dismissive. I thought about patients who had made a tremendous impact on my life, of decisions made and opportunities missed, and the challenge of finding balance in my life.
And then, instead of talking and thinking, I made a move.
I hedged a bit at first, cutting back to half-time with an option to return to the status quo after a year. I dipped my feet in the water. It felt cold and chilly, and I was not quite ready to dive in.
A few months later, I jumped in all the way. I sold my partnership and with it my safety net. And as I made that leap, I felt weightless, a fluttering in my chest, like driving fast over a rise in the road.
It has been approximately nine months since I started working part-time for my practice. I am still getting used to it. There’s more time but far less income, as my wife, Becky, doesn’t work outside the home. Combined with some large, unplanned-for bills, financial choices are harder and retirement less certain. There’s more freedom, but maybe not enough structure.
This approach certainly won’t work for all physicians who are burned out. But it’s working for me.
As I adjust to my new normal, I am also adjusting my sense of self. Before, I was a partner in a successful though crazy busy practice, providing for myself and my employees. I was a teammate with seven other doctors, taking on challenges as they came. But now that I am no longer that partner, that provider, that teammate, did I fail?
I don’t think so, but that’s something I am still processing.
And as I do, I am enjoying being a parent taking my kids on college visits. I am applying to study health policy and management at the Johns Hopkins Bloomberg School of Public Health, where I hope to start next January. I am a high school water polo coach, working with an amazing bunch of teenagers, and a goalie for my master’s team. I am a triathlete training for another Ironman this fall. I am a husband celebrating and tackling these midlife challenges, together with my wife.
And I am a part-time doctor who still loves the challenge and privilege of taking care of patients when they are at their sickest and most vulnerable.
I am not broken. I am just getting started.
Jeremy Topin, M.D., is a part-time pulmonary and critical care physician at Northwest Pulmonary Associates in Chicago. An earlier version of this article appeared on his blog, Balance.
Thanks for your story so well written Dr Topin.
I have been a hospitalist for the last 14 years. I feel physicians are abused and wrote this up as an op-ed after two very unpleasant incidents working as a locums. No response from the oped people in the local paper. Besides, two friends do not agree physicians are abused. They encounter overwork, lack of autonomy, unsafe patient practices ( too many patients in 1 12 hour shift to do justice to many) and other forms of corporate dictatorship but do not think that is abuse. Just one question to the readers and Dr Topin : are physicians abused ?
Very proud of you! It takes Ironman to figure all this out and make a move! I know you as a great doctor. Now I know you as a brave heart! Enjoy your life! Whatever you do, you make changes in people’s lives for better!
Hey, You didn’t fail. As you said, you are just getting started. Thanks for inspiring us. We each have our own story on how we are adapting our lives. Thanks for telling yours. Best, Natalie
– A beautiful description of burnout and survival.
I am with you. The shame of not giving all of your time using this privileged knowledge to help patient after patient is the hardest part. But the shame itself is a waste of time. Thank you for sharing.
Could not relate more. I am a solo practioner in a busy Podiatry practice. I find that I am overwhelmed. I am exhausted and cry frequently. I am seriously contemplating taking on an associate but that adds additional costs and responsibilities.
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