Confessions of a burnt-out physician

I don’t harbor any illusions about how hard ob-gyn residency will be, let alone with a young child. But this physician’s story only reinforces my belief that I made the right choice — an intensely personal choice that was the right choice for me — to start our family while in medical school. I need to learn how to live with balance now, so that I can draw boundaries when necessary for my own health, and so that I can thrive in the face of career challenges as before.

Thanks Jenny for sharing. Reprinted below in its entirety.

I’ve wanted to be a physician for as long as I can remember. As a teen, the choice to become a doctor seemed to perfectly meld my affinity for science, academics, and helping others. Better yet, pediatrics offered the ability to work with families and children of all ages and developmental abilities.

For fifteen years, I lived, breathed, and worked toward my goal to become a pediatrician. In college, I studied the foundational cornerstones of science and humanities and focused on how health impacts the rest of our lives. In medical school, I learned about different aspects of each organ system and marveled at the miracles of the human body. During residency, I walked the halls of hospitals during the wee hours of the morning. I rubbed the sleep out of my eyes as I provided artificial breaths to a dying infant and smoothed the crinkles in my yellowing white coat as we brainstormed why another child was brought to us at death’s door.

When I finally achieved my goal to call myself a board-certified pediatrician, I beamed as I walked into my new office space that had my name posted on the wall outside exam room doors.

Despite my lofty dreams and expectations, practicing primary care pediatrics was nothing like I hoped it would be. My days were filled with opportunities to meet and grow with patients and families, but my tidbits of time were sliced into 15-minute increments. As my practice size increased, I was persistently pressured to add extra patients over my lunch hours, before the day started, and into time slots already booked with other patients. The need to move increasingly efficiently sparked anxiety within me — I was halfway through greeting one patient before I was also surreptitiously listening for the opening and closing of the next exam room door to signal that another patient was waiting.

The physical and emotional work of completing a visit every 15 minutes repeatedly refreshing my smile before I burst into the next room began to make me feel like a machine. As a robot in the factory of medicine, the demands of my job pulled at my greatest skills of empathy and compassion, two of the character traits that made me most suited for primary care. Try as I might, it was hard to feel compassionate for the mother of a child with a mild cold when I was already ignoring my raging headache, need to urinate, and fatigue. Despite my gut instinct to address the “one last thing” that patients often bring up at the end of a visit, the pressure of metrics that detailed my length of visit and wait time for patients coerced me to ignore their concerns, even if my actions translated into another office visit, another co-pay, another day.

When I did have time to sit down, I was crowded into the corner of a small office shared by two other physicians. When we all were present and trying to make phone calls, type office notes, and converse with staff, the cacophony rose. My brain and my inner self was desperate for peace, though I knew it would be only moments before the next patient was ready in a room to begin again.

By the time I got home each evening, I was a deflated emotional balloon, sucked of energy and ambition and left with little to share. When my own children rushed to greet me, I offered them a quick hug and kiss and then silently wished they would quiet down. After dinner and bedtime stories, I rested with them until it was time to open my laptop again and work through additional charts, emails, and work tasks. My husband personified my laptop as a bedfellow in our marriage. I struggled for the emotional energy to make my steadfast lifetime partner feel loved.

As a part of the middle management administration at my health care organization, I sat in meetings week after week where the physicians in the organization were referred to as “lazy, whiny, irresponsible, and unmotivated.” I gazed through the picturesque windows in the large administrative offices and chuckled at the irony that money is too tight to upgrade or expand space in clinics to improve the workplace environment. I seethed quietly as I listed to the mantra that we need to see more patients, more efficiently, and work longer hours as if I were listening to the drumbeat at a funeral march.

The articles on physician burnout cite the need for physicians to develop coping strategies to deal with the daily stressors incurred in the office. We are tasked to learn and practice mindfulness, meditation, and regular exercise. While I make exercise a priority, I simply can’t find the time to learn the other soul-saving techniques in my current work environment. I think it is not only a physician’s responsibility to take care of ourselves, but the scaffolding of the health care system needs allow for practices that will sustain those of us at its very core.

Last week, I submitted my resignation from medicine.

Many have asked me if I will ever come back, but I’m not sure. I am jaded by the push to provide efficient and effective health care for others while ignoring my own personal needs. I am saddened by the palpable wounds that I have left my children through lack of energy, lack of engagement, and inability to be there when they need me. I am discouraged that despite 15 years of focus and sacrifice, Dr. Google has become a smarter and more esteemed physician than I. I am worried that the advent and elevation of pseudoscience has led to increased vaccine resistance, re-emergence of previously eradicated diseases, and hours of time spent fruitlessly discussing why the opinions of thousand physician researchers should outweigh the thoughts of one or two dissenters.

I have heard that it costs up to $10,000 every time my organization hires and trains a new physician. It costs patients and insurance companies each time I ask a patient come back to discuss other concerns I didn’t have time to address. Every time I order a diagnostic test that is not medically warranted but desired by a patient that has Googled their symptoms, costs increase.

The United States spent approximately $8,895 per person for health care in 2012, which is higher than any other developed country but is among the worst health outcomes. If we want to decrease the cost of American health care, it will be imperative to make efforts to retain primary care physicians, decrease administrative costs and overhead spending, and put back some autonomy in physician’s hands so that customer satisfaction does not override the importance of good patient care.”[sic] In addition, health care companies and patients need to recognize that those of us who chose to study medicine are not merely well trained machines but humans who strive to deliver care with compassion, empathy, and expertise.

I don’t know what my next career will be, but for now I will work on regaining what made me chose[sic] medicine in the first place. As I cultivate the human that has been suppressed by the robot that provided medical care, I look forward to regaining the health and happiness that we seek for all.

The author is an anonymous pediatrician.

Confessions of a burnt-out physician.

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