My new cyber-friend, Dr. Ryan Gray, invited me to submit a guest post to his blog and podcast site: www.medicalschoolhq.net. It’s a great resource for premed students who are trying to navigate the pathway to medical school. Ryan asked me to write a guest post on burnout geared toward premed and med students. You can find it here. Thanks for checking it out!
Happy New Year! Nothing says a fresh start to 2013 like a closeup photo from The Shining. :)
But I am back. Part of me wants to hedge and say “well, I am back….but sort of”, or “well I’m just part-time.” Until I quickly realize that those are old, familiar, ridiculous cultural scripts that I have been purging from my life for the past three years. That crappy mantra that you spend a good chunk of your life training for a profession that you truly have no idea what will look like over the course of your life, and then you get a job and stay in it for the remainder of your career come hell or high water.
What a crock.
For those of you who regularly read my blog (and a very special Happy New Year to all 33 of you!), you know that roughly three years ago I essentially walked away from more than a decade in clinical medicine to reclaim control over my life and happiness as a consultant. It’s been a wonderful and powerful growth experience, and a great exercise in trimming the b.s. out of my life.
So I was understandably surprised at myself when I decided last year to get back into clinical practice. (For the gory details, feel free to visit my post “Dipping a Toe Back in the Pool“). I’ve now been back in academic clinical medicine for roughly 3 months, and a few of you have asked me for an update on how things have been going. So here it is:
Keeping in mind that I am still in my honeymoon phase and I have yet to experience all of the crazy politics and administrative pressure of being back in clinical practice……I am over the moon, deliriously, spectacularly happy.
I don’t think this is an accident. I think this is an amazing combination of right people, place, and time. Specifically speaking:
1. My chairman is a god. Ok, well that’s exaggerating. Mostly he’s a simply fabulous guy who has managed to become a very skilled administrator while maintaining his coolness as a human being. He hired me for a very specific role, and since my arrival has not for one minute started piling on “other duties as assigned”. In fact, there is no such clause in my contract (this being my second time around at this particular rodeo). In fact, the person who is putting the most pressure on me to be productive is me. As far as he’s concerned, my first year of salary was a line item in his budget, and he is constantly reminding me not to put too much pressure on myself in my “ramp-up” period. He also tends to hire lovely, energetic, passionate physicians, so I am surrounded by a department full of (mostly) amazing and happy colleagues. Yes, I think he is part alien. He also had a charming accent and likes to put “eh?” on the ends of his sentences, even when they aren’t questions. Lovely.
2. I am protected from the aspects of clinical medicine I found most damaging in my previous existence. Really this boils down to three things. First, I don’t take any overnight call. NONE whatsoever. Some docs don’t really mind overnight call. For me, it made me beyond miserable. To be fair, my last incarnation of overnight call was in the most dysfunctional model you could ever imagine: in an outpatient practice that received 35,000 patient visits a year, we had NO nurse triage to screen overnight calls. ANY parent that called into the clinic was routed directly to the on-call physician. Which meant we were answering parents calling us at 2 in the morning to let us know that their child has had a mild cough for the PAST THREE WEEKS and what should they do about it right that instant? My favorite was a parent who called me at 4 am to tell me they had run out of baby formula. Clearly, I went to medical school so I could direct people to look up their local all-night drugstore.
Second, since I don’t have any call, I HAVE NO PAGER. For those of you who have never carried a pager so long it has actually melded with the flesh near your right hip, you won’t totally get how important this is. I nearly broke out into a little dance in my chairman’s office my first day at work when he looked at me in his thoughtful way and said, “No, I don’t think you need a pager….not at all, eh?” My colleagues and my administrative staff all know how to get hold of me through email or my cell if it’s urgent (which it rarely is). Getting rid of that piercing electronic tumor at my waist has been a very liberating experience.
Third, I have SUPPORT. A LOT of it. I have an administrative assistant who handles all the scheduling and paperwork nightmare that I used to have to do for myself. I have a coordinator who schedules all my patients, takes care of all the insurance approval, and vets me through the right offices for any need I have. I have a dedicated nurse in clinic who knows exactly how I like to see patients. And most importantly, all of them are HAPPY to do their jobs. It’s a miracle.
3. I am part time. I cannot stress enough how this has been the cornerstone of my happy return to clinical care. I spent the last three years developing a thriving and satisfying consulting practice, and there was no way I was going to walk away from that. I’ve started back clinically working one day a week. Realistically, I work a little more than that in that sometimes I have to take care of some occasional communication or patient followup a different day of the week. Which, when you love your job, is not a resentful situation at all – it’s part of building a practice. But it allows me to grow at a unhurried pace and not have any anxiety about justifying my salary. Plus we have already planned for adding in a second day if (when?) my practice gets too big for one day a week. Mostly though, being part time protects me from the institutional and administrative politics that I found so damaging in the past. Working once a week, there is no expectation that I will sit on multiple committees, attend numerous staff meetings, or get sucked into university service I have no interest in doing. The things I get involved in I do by choice, and make sure they are projects I want to be part of.
4. I am valued. In this disposable day and age, it is simply miraculous to work in a place where you get to provide a unique service that no one else does, and people actually tell you how grateful they are that you are there. The fact that I view this as miraculous is sad, but it’s just a fact.
I know how fortunate I am to wake up pretty much every day of my work week now and look forward to what the day has in store for me. I also know it’s not luck – a lot of work went into making this happen, and still does.
In the spirit of moving forward in a new year, I’m including a link to Kathy Caprino’s most recent article, “The 8 Most Damaging Excuses People Make for Their Unhappiness.” I have always found her insights to be spot-on when it comes to getting unstuck and allowing yourself the opportunity to have a happy and healthy career.
As always, thanks for reading.
For some reason, I spent the entire bulk of today fending off the phenomenon I refer to as “mi loca, tu loca”. Which translates roughly to “my crazy, your crazy (and that plus asking for the check at dinner is just about the extent of my Spanish.)
The MLTL experience is one of the things in life that truly, deeply gets under my skin. We all have experienced this at least once. If you haven’t, you either live under a rock or have a life that is so pleasant that June Cleaver would shank you out of pure jealousy. MLTL happens when someone else tries to make their crazy your crazy. And I am not talking about garden variety attempts to convince you to see their side of the story. No, this is actually infecting you with their particular delusion so that you begin to not only question your own logic, but the rules of all known social engagement.
People who are capable of this “talent” tend to be a) grossly incompetent and acting defensively to protect the shrine of inadequacy they have spent a lifetime building, b) smart and manipulative, or c) both. Meeting someone who is both incredibly smart and grossly incompetent is indeed rare – it’s a bit like seeing a unicorn, except from what I have heard that tends to be a lovely experience of which many first graders enjoy drawing pictures.
Unfortunately, I spent the majority of my life dealing with mi loca tu loca from my family, although for the first 15 or 20 years I didn’t really understand what I was up against. Regardless, you would think that would make me somewhat of an expert on how to deal with it. Sadly, I don’t think it does, mainly because the laws of human interaction don’t apply to these soul-suckers, so often there is no rational way out. The only benefit I can see at this point is that I am a master MLTL detector. I am a f**cking bloodhound when it comes to identifying these folks. The feeling is always the same – a few minutes into a conversation, I get the distinct feeling that I am the unwitting victim of a Vulcan mind meld, and that a complete stranger is somehow brainwashing me into thinking that, even thought pure logic and reality would dictate otherwise, that somehow I am in the wrong or owe them something.
Normally, I can deal with these people on an occasional basis. But somehow, today was the perfect storm of folks who kept assaulting me with their voodoo magic in the hopes that I would suddenly agree that the sky is green and has three suns.
It started with a computer training that I had to complete for my new job. Mandatory, of course. Knowing how much I just love CBL experiences, I dutifully cancelled half a day of work to schedule a three hour training session. And as a freelancer, that cost me. People with full time jobs don’t always realize that taking off work for us consultant folks hits us right in the wallet. But I didn’t mind – it’s just one of those things you do and get on with your life.
Turns out that I was the only one scheduled for this training, which meant I had the full attention of the instructor for three hours. Initially I thought this wouldn’t be such a bad thing, as I could monopolize her with my individual questions and not feel guilty for hijacking a class.
As the session went on, however, I quickly realized two things. The first was that this woman was truly from a computer based learning cult, and she had drunk the Koolaid. I’m not sure how many times she waxed ecstatically over the program’s “exciting features” and “thrilling application potential”, but 30 minutes into it I was already exhausted, and she might as well have had pom poms and been wearing a cheerleader outfit.
The second, and more important, was that she clearly had an agenda for the afternoon that didn’t involve me. I had been scheduled from 1pm-4pm, and she informed me after we were an hour into the training that there was some sort of departmental meeting that was happening that day at 3pm.
That’s when the Vulcan mind meld started creeping in. Her tone changed ever so subtly as she told me that it was very possible that we would finish in 2 hours (fat chance), and that if we did, she could attend the meeting, but that she certainly didn’t want to shortchange my time. And she would be more than happy to schedule another session with me at a more convenient location for me so we could complete the training and give it the full attention it deserved. And that way everyone could get all the information they needed.
My thought process, already blunted by the assault of computer program information that had no real meaning for me yet, reflexively shifted over and I started mentally thumbing through my calendar, wondering if I could find a chink in my schedule to meet her at a local Starbucks for an hour. mindmeldmindmeldmindmeld
Luckily, all those years of family training kicked in, and I startled back into reality. Sorry, didn’t I already take off half a day of work to meet your training schedule, and now you are asking me to kick off an hour early and take off more work to reschedule with you so you can make some dumb meeting? And implying that I would be selfish not to?
Hell no lady. I politely but firmly informed her that this was the only day off this week that I was able to schedule this session (which was true), and that rescheduling for one hour of training simply wouldn’t be possible. She said of course she understood, but her expression completely conveyed the opposite. And she couldn’t resist one last dig (mindmeldmindmeldmindmeld) when she said she was pretty sure she could get the critical information she was missing from a colleague.
Once I had completed ALL THREE hours of training (with her becoming increasingly flustered after all that song and dance at actually being time pressured to finish), I was happy to get home and relax. Yet almost immediately, I got sucked into a ridiculously lengthy email exchange with an agency that had hired me for some consult work, accepted my terms of service, and then negged on paying my full invoice, claiming that reimbursement for travel and overtime had not been preapproved. The pinnacle of this asshattery was an email from the SENIOR accounting manager, who actually said, “I don’t know you at all….but c’mon….we’re all Human.” I mean, who talks like that? As if I am somehow going to suddenly bolt upright (mindmeldmindmeldmindmeld) and say, “By golly, you’re right! Who cares if you bilk me and all your other contractors out of money we are owed and propagate ethical fraud on the professional community at large? I mean, c’mon! I must have been crazy to complain to you!”
C’mon is right. You can keep your !@#$%^& loca to yourself. :)
My apologies for falling off the face of the earth for the last few months. Work has been very busy (hooray!), and quite a bit has happened. Perhaps most importantly, 2 1/2 years after leaving a career in clinical medicine, I find myself dipping my foot back into the pool to test the medical practice waters. (WHAAAAAAT????) This actually comes as quite a bit of a surprise to me as much as anyone else. Since I left clinical medicine, I have found more happiness and job satisfaction than I ever thought possible. I had virtually zero intention of getting back into any sort of clinical practice.
So here I am, wondering what happened as I sit filling out a credentialing packet for a major academic medical center that is thicker than War and Peace, and am tentatively scheduled to start seeing patients in a few months. Like the rest of this career process I’ve been through, I thought it would be helpful to really reflect on what has taken place over the past few months and break it down academically.
First, let me say right off the bat, I am in NO WAY leaving my current career track to suddenly shift back into clinical medicine full-time. I seriously doubt I will ever let that happen. I am going to start one day a week, and simply see where it goes. I cannot tell you how many people have asked me if I’ll be going back to clinical medicine full-time when they find out about my new job. It’s funny what a reflex assumption that seems to be for everyone. People, I have drunk the freelance Koolaid, and there is no going back to turning over my schedule to someone else.
Here’s what I came up with when I really looked at what has tempted me back into the world of clinical practice:
1. This is the right department – even though I am trained as a generalist, I’ve actually been hired by a surgical department to function as a consultation specialist with a specific group of patients that I have quite a bit of experience with. This so far appears to be a much better fit for me than trying to cram my work profile into a general pediatrics department. I am thrilled at the prospect of leaving the primary care stuff up to my peers (who enjoy it and therefore probably do a much better job of it than I would anyway), so I can focus strictly on the specialist issues.
2. This is the right place - when my husband and I arrived here 2 1/2 years ago, we moved into a neighborhood that just happened to be located almost exactly halfway between two major cities, both with very strong academic medical centers. I certainly couldn’t tell one from the other when I arrived. Having worked in both communities over the past 2+ years, it’s become extremely clear which center my philosophies and ethics align with better. Lucky for me, the one I’m going to be working for is a little closer and has a much better traffic pattern, among other things. :)
3. This is the right time – I’ve had over two years to establish myself and build my reputation in the community, as well as make strong connections with other resources. This job is a natural segue into continuing to build on those connections, and establishing a bridge between the center and the community that currently doesn’t currently exist. I’ve also had time to recover from the worst aspects of my previous job, and actually miss what I did love about practicing medicine. This opportunity really arose very organically – I certainly didn’t force the issue when the time wasn’t right.
4. These are the right people – I suspect that this may be the most important factor of all. The people who have hired me already had an interest in starting up a program, and just didn’t have the right manpower on hand to do it. They clearly want this to work. They recruited me (nice dinner with wine included), met all the requests in my proposal, and have already designated support including a dedicated coordinator, dedicated nurse, designated exam room, and corner window office, despite the fact that I have yet to sign my contract. And just for the record, I signed on for 40% more than I was making at my previous hospital. I realize it’s not exactly an “apples to apples” comparison since my job description will be radically different, but in the end it’s still me bringing home a paycheck that’s a lot less anemic than before. My chairman is also very laid back – he’s the kind of guy who hires talented people to do their job and then backs off and lets them do it. So far everyone I’ve met in the department is a clear testament to this, and have been nothing but lovely.
Of course, it’s still the honeymoon period – we’ll see how I feel when I’ve actually been working for a few months. But it’s certainly a very healthy start.
More to come…..
It has been several weeks since I posted Part I of this blog – I have been traveling on business quite a bit, and have finally gotten the chance to stop and catch my breath. And see my husband. And go to the gym. No complaining here: I love the work I’m doing now, but I will admit that sometimes is it a bit of a roller coaster, and it’s nice to get off once in a while and just sit on the bench nearby with a sno-cone.
Last I checked in, I had just called my husband to tell him I could not take work one minute longer. I didn’t want to get into details with him on the phone, as I still had a full afternoon of patients left to see and I didn’t relish the idea of being an emotional wreck for the rest of the day. I simply said that I really needed to talk to him that evening, so if he could dodge the Friday happy hour at his firm and come home, that would be great.
I thought long and hard on the drive home exactly how I was going to put this to him. It was no secret that I had been becoming steadily more unhappy over the past few years. But thinking about quitting your job and actually doing it are two completely different things. By the time he arrived home, I had a fairly well-rehearsed speech ready for him.
He walked in the door, took one look at me, and said, “I don’t know what kind of song-and-dance you had prepared to share with me tonight, but if you need to get the f**k out of that place, then just quit.”
This is why I married my husband. He knows me almost better than I know myself. He is a gift, and I am thankful for him every day.
I talked with him about giving my department three months notice, even though I was technically only part-time faculty, since it would give them the most time to create a smooth transition for my patients.
Ever the pragmatist, my husband looked at me narrowly and said, “You won’t make it three more months without frying. Give them two.”
And he was right. Getting through the final two months once I had given my notice was nothing but an exercise in exquisite torture. My meeting with my chairman was nothing too terrible. Perhaps sad and somewhat pitiful, yes. My chairman was sad to see me go, but knew that he didn’t really have anything to offer me that would convince me to stay (and certainly not any additional money), and he didn’t even try. it was more of a formality than anything.
No, the worst part was seeing my patients over the next two months and have each one of them react to the news of my leaving. There was disbelief, tears, and even some anger at the department (which I of course did not encourage but admittedly took some small delight in). Every day was a soap opera, and it became exhausting. But eventually, I did get there. My last day of work, the department threw an anticlimactic little cake and cookie social in the resident lecture room. I was happy at least to see it was well-attended.
I essentially took the next 6 months off. Mostly because I could. My pitiful salary, while welcome, wasn’t exactly dictating our standard of living, and so it wasn’t missed much. Which is why I wasn’t in a desperate rush to run right out and find another job. I slept. I worked out. I slept some more. I had sex with my husband. I planted some flowers in front of the house. It was glorious.
The funny thing is that once you give yourself permission to do something absolutely crazy, like quit your academic physician position after 11 years with absolutely nothing lined up to do after, it creates a bit of a domino effect. I later learned that four other faculty left my department in the six months after I resigned.
It can also affect your loved ones. My husband has also been fairly miserable at his big-city firm. He had a wonderful run there, but had specialized in a part of the law that his firm didn’t really support. He was respected, but his work was being de-valued, and he felt like he was going through the motions to pull in a paycheck. He had also been mildly entertaining the idea of joining a small company in the south that had been trying to recruit him for several years.
We were talking one night at dinner. Having gotten ten hours of sleep and a two-hour workout in, I felt like a goddess. My husband felt like a doormat. We talked about how fed up were were having lived in an East Coast big city all our lives, and wouldn’t a change be great?
I looked him dead in the eye and, almost without even thinking, said, “Well, how about that company that’s been trying to recruit you? We could go there.”
Just like that. Clearly, I am not a change-adverse person. Plus, we had entertained the idea several times before, just not seriously. I was thrilled at the possibility of seeing another part of the country, and even happier at the prospect of moving to a place where winter doesn’t really exist. I could never see another snowflake in my life and be just fine with that, thank you very much.
And within three weeks, my husband had given his notice, let the new company know he was coming, put our house was on the market, and found a house about 15 minutes from his new job. Just like that.
The move was even easier. We sold one of our cars, packed the other with as much of our stuff as it would hold, hired a moving service for the rest, and drove the 1,497 miles to our new life. We pulled up to our new house the evening of the third day, and were immediately greeted by our next door neighbor, who brought us over homemade dinner. Welcome to the South.
Within two months of our arrival, just when I had started getting the itch to go back to work, I got a position as a medical consultant doing peer education and policy development in outreach communities all across the state. It was uncanny.
I’ve thought a lot about why this move was so simple, when it scared the crap out of many people we knew. I think it’s because on the surface, it certainly appeared as though we had woken up one morning and had decided to abandon our lives and head for greener pastures. Certainly, for people who didn’t know us well, that’s exactly what it looked like. The reality is that it had been something we had been talking about and planning for here and there for years before. When it was the right time, all the pieces fell into place.
If I had to make a list of the things and resources that helped us along our way, I’d start with Kathy Caprino’s article in Forbes: The Five Biggest Mistakes That Career Changers Make. I actually didn’t find this article until after I relocated, but I had already addressed several of the things she mentions in the article, and I thought it was a nice summary of some of the common pitfalls of career change that are easy to get sucked into.
Here are some other important factors that played into our smooth transition:
1. We moved to a lower cost of living area. I cannot emphasize enough how awesome it was to move from an expensive city to a not-so-expensive one. For the money we got for our old house, we bought a house that was 1200 square feet bigger, complete with renovated kitchen and pool, and were able to furnish it too. Mind blowing.
2. We had no consumer debt. This certainly was a huge help in allowing me to take the time I needed to find a job I really wanted, instead of taking the first thing that was available that came my way and getting right back into Misery Part II.
3. I am not tied to career identity. This gets back to really, truly knowing yourself. I was never exclusively wed to the idea of being a clinical physician, so when another opportunity came up that was related to my field but was something new, I jumped at the chance. If you are one of those people whose career title is critical to your identity and self-worth, a sudden career change that you have not explored fully can feel like suicide.
4. I had multiple interests that I cultivated along the way. I did quite a bit of public speaking and advocacy/policy work during my academic tenure, and discovered that I liked them tremendously. I honed these skills, and was able to develop them into work. This is not something that happened overnight. I also was fortunate enough to grow up speaking a second language, and had done some informal interpreting her and there for many years. Part of the time I was between jobs I spent time working with an interpreting mentor and became nationally certified as an interpreter. I figured that it would be great transition work while I was looking for a new job. What I never counted on was how quickIy I would develop a tremendous passion for interpreting, and that it would become a significant part of my new working life.
5. I was (and am) willing to hustle. Functioning as a freelancer with multiple income streams, I have to be willing to work and to travel to do so. Luckily, this clicks very well with my life, my personality, and my marriage. If you need a steady income stream, or crave the reliability of a full-time single site job, this way of life is not for you.
The bottom line is that, while people may think we are career nomads floating wherever the wind takes us, my husband and I were very deliberate about the choices we made, and did a lot of work assessing ourselves and what we really wanted out of life.
Go get ‘em.
I took this photo from the window seat on a flight I was on last year. I don’t remember where I was going or why (I fly a lot these days). I just remember looking out my window and seeing this spectacular cloud line that looked so solid, it was almost like you could step out onto it and not fall through. Kind of like a leap of faith, if you will. ( I settled for grabbing my iPhone and snapping a picture.)
I’ve had a number of blog followers at this point ask me to write about my experience in making the jump and leaving clinical medicine. Which of course prompted me to think about exactly how it happened. That’s the one thing about blogging – you really have to go back and mentally trudge through the muck again if you want to be able to write about it in any convincing detail.
I think it’s important to say before I start any of this that my story is definitely not some sort of equation for escaping a career that makes you miserable. I had a very specific set of circumstances (some fortunate, some created very deliberately) that allowed me to make a break from an eleven year career and start over. While I certainly hope there are pieces of my experience that you may take away that allow you to gain some insight into your own lives, by no means is this a “Lumi Says” advice column.
In thinking a lot about what exactly led me to leave my career, I thought a lot about the factors that went into that decision. I found myself going way back into much earlier parts of my life – parts that I though wouldn’t necessarily have any bearing on my adult decisions now. What I realize is that, essentially, my decision to leave clinical medicine boiled down to an absurdly simple math equation:
Past Choices + Present Choices = Future
I know, this is about as satisfying as when the supercomputer at the end of the Hitchhiker’s Guide to the Galaxy, after 7.5 million years of calculation, spit out the Answer to the Ultimate Question of Life, the Universe, and Everything as….42.
I think the reason that this equation is so important to me is that I’ve noticed as a work culture, we put a tremendous amount of stock in our present choices, and woefully ignore the impact of our past actions. That’s not to say that you can’t escape a terrible childhood and grow up to be a successful adult. I just think that when we feel stuck, we tend to focus almost exclusively on our present circumstances, and not what led us to this place. Our past, while in the past, has consequences that actively affect us in everyday life, and to ignore this fact leaves us with a very incomplete (and unsatisfying) picture of our life situation.
In my situation, there were two major factors that had a tremendous impact on my flexibility in changing careers.
1. My husband and I have no children. For those of you who either have no children or have been living under a rock your entire lives, children are a very real responsibility in life, both personally and financially. If you are considering making a large career change, it is obviously much less risky if you are only accountable for your own expenses than if you are supporting five children under the age of twelve and simultaneously trying to save for college. That is not to say that it can’t happen. It just requires much, much more in terms of planning. And by the way, there is nothing more that I resent than hearing someone scoff at my situation and say, “Well, that’s easy for you – you don’t have any kids.” Please don’t use your kids as a weapon – it’s disgusting and not very parent-like. And while we are at it, unless you had an extremely traumatic experience in your life, I seriously doubt anyone held a gun to your head and forced you to conceive a child. Again, these are past decisions that factor enormously into present circumstances. More about that in a minute….
2. My husband and I are both very judicious about money. More importantly, we were long before we ever met each other. We both attended in-state schools undergrad, which back in the early 90′s meant our parent could actually afford to pay for our education without taking out school loans (I know kids, times have changed.) We also both attended an in-state school for our graduate studies: him on an educational trust from his grandmother that completely covered his costs since he was an in-state student, and me with an educational grant that I had applied for and won at the beginning of medical school. What this boiled down to is that neither one of us brought any real educational debt to our relationship when it started.
Flash forward to out lives now. I said we were judicious, I didn’t say we were cheap. The bottom line is that through our entire relationship, we have talked openly about what we want financially in life, and have helped each other to make good decisions all along the way about saving and investing. Also, while husband loves cars, his “fantasy” car is more along the lines of a Mustang than a Porsche that costs as much as a house. And I am definitely not one of those girls with a closet full of Jimmy Choo strutters. It’s just who we are. Not only are we compatible, we are financially compatible. So the compounding of 16 years of collaborative good decision-making has left us with a house paid-in-full, two cars paid-in-full, and absolutely zero credit debt. We pay off our credit card balance every month. This is not all just luck. This is a combination of fortunate circumstances and hard work. Our past financial choices have led us to a present that allows us an extraordinary measure of flexibility when it comes to things like career change.
The bottom line is that our past choices were influencing our future long before we ever knew they were. You of course can try to tell kids this, but they have to figure it out for themselves a they grow up. I happened to meet a life partner who was extremely sensible about money, and together we made even more sense as a couple. We’ve made some good financial investments together, and live a very comfortable, debt-free life. This is not just chance, or something to get angry over if it is not your particular situation. It is a critical combination of fortune and wise choices. And it definitely played into my ability to change careers eleven years into the field.
So this is the meat of the story. Two years ago I decided to leave my position as an academic physician at a well-known University hospital. At the time, my present day (which was, as we’ve established, an outgrowth of my past experiences) was an interesting amalgam of situations. I had no children, and while I was a physician, my husband was clearly the primary breadwinner in our relationship, complete with insurance coverage. Financially, I was certainly in a place where if I needed to make a significant change, I could.
My dissatisfaction with my job had building at a slow burn for several years. I started bright-eyed and shiny coming out of residency, as most of us do when we finally finish all of our training. I was working in academic medicine, which I cherished as an opportunity to work with students and residents and have teaching be a regular part of my job. I had my own clinic, and it grew and grew over the years.
Eventually, though, the shiny wore off, like it does for all of us, and was replaced with a cold dose of reality. In my case though, I also happened to be working in an extremely dysfunctional system. All systems, to some effect, put the “fun” in dysfunctional, but my hospital was a really unique place when it came to devaluing its faculty. The hospital functioned in an “eat what you kill” model, so primary care departments like mine suffered. The surgical subspecialties were constantly bringing in money hand over foot, and therefore had budget to actually pay their faculty what they were worth (or close to it). Primary care departments NEVER make that kind of profit – our value lies in that we provide a solid patients base so that the specialists have patients to work with. But that doesn’t translate into direct dollars for administrators, and so we are left to work with whatever marginal profit is left at the end of the year, if any. In the six years I was an attending physician at my last hospital, I (along with my department colleagues) received a TOTAL of a 4.4% raise. There was no cost-of-living adjustment for us. That was it because that’s all the department had to work with. Not a really sustainable economic model for retaining staff. Especially at an institution that already paid us on average 37% less than our colleagues across town (MGMA 2011 Physician Compensation Survey).
So as my clinic grew and the department continued to cut staffing more and more, I found my daily job description looking less and less like medicine, and more like administrative work I certainly had not trained for in medical school. I spent hours arguing with insurers, as we only had one managed care specialist for the entire general and subspecialty clinic. We switched to a new EMR system that, despite having a tremendous amount of input from the faculty about what they needed, was one of the oldest, cheapest, and inflexible systems available. I spent many nights charting at home until 11:00pm so that I wouldn’t get too far behind. Our scheduling system was from the dark ages, and constantly ended up with patients overbooked, bumped, or just dropped from the system. Angry patients were a given that we walked into work ready to face every day.
I would say I tolerated and tried to internalize this every-growing disintegration of the job I loved for a good two or three years. After all, guilt and sense of obligation can go a long way, and as physicians we often have an overdeveloped sense of both. But I was unhappy. I started resenting having patients on my schedule (wasn’t that the whole point of me being there?) I would secretly rejoice if a patient didn’t show up for their appointment, as it would free up my schedule for a few blissful minutes.
The day I decided to resign was one of those days where I experienced what can only be called a shocking moment of clarity. I was running around as usual, doing things that weren’t medical, getting yelled at by patients that weren’t even mine, and trying to keep my hair from completely catching on fire. In the midst of all this chaos, I got a message that one of my patient’s parents had frantically called saying that they were at their child’s specialist appointment now, but the authorization form I was supposed to fill out for them hadn’t been sent to the specialist, and now they were in danger of having to pay for the entire visit themselves or lose their spot.
I knew I had filled out the form personally several weeks before the appointment date, and had placed it in our “Stat Fax” box (STAT in this case usually meaning “Some Time After Tomorrow”). Still I figured a 2 week heads-up would have been enough. I went to talk to Miss Lucy, who was the staff person who had been working in the department for the past 30 years. Miss Lucy had essentially been marginalized to running the fax machine as her entire job, rather than develop a plan for her resignation when it was realized that she could simply not keep up with all the technological changes that were happening in the department.
I asked Miss Lucy what happened to the fax I put in the box two weeks ago. She stared at me blankly.
I asked her again, and let her know that now this had become my problem as I had a panicked parent on the phone at the specialist office right now.
Miss Lucy went over to a three-foot stack of papers on her desk, and started muttering, “I’ll find it for you, I’ll find it for you.”
I’m sorry Miss Lucy, is that pile of papers stat faxes you HAVEN’T SENT YET?!?!??!?!?!
It most certainly was. Apparently, Miss Lucy’s method for dealing with faxes that needed to be sent out immediately was to move them out of the box and onto her desk, which would at least make it look like something had been done with them.
I nearly swallowed my tongue. How much other time-sensitive information was in there?
Seeing as how I had no assigned staff to help me, I had to try to coordinate the specialist office sending me another authorization form so I could fill it out on the spot and send it back. While I was doing so (and getting more and more behind on my patient panel), Miss Lucy suddenly burst out of the back with the paper and a triumphant smile on her face. ”I got it, Dr St Claire, I got it!”
Wonderful. Give it to me.
“Oh don’t you worry Dr St. Claire, I’ll take care of this for you this afternoon.”
THIS AFTERNOON?!!?!!!?!?? Clearly, despite the numerous conversations I had with her about the time-sensitive nature of this issue, she was going to go PUT IT BACK IN THAT GOD-FORSAKEN STACK OF FORMS.
I told her to please give me the form.
Again, the blank stare.
“Miss Lucy, your lack of organization has made this my problem, and it stops now. Please give me the form.”
Slowly, she handed it over to me.
I walked over to the fax machine, fuming, punched in the numbers, and sent it myself. It wasn’t that this task was “beneath” me – I’ve self-faxed more times than I can count because it was just easier and saved some time where it was needed. This was different. This was how my clinic ran every single day. And it was at the expense of its patients and its physicians. And it was just supposed to be ok with everyone.
I sent the fax, and spent the rest of the day trying to dig out from getting behind on my patient panel.
I then walked into my office, shut the door, and sat down in my chair.
I tried to envision myself working in that system for the next twenty years. It made me sick to my stomach. Literally. I couldn’t even envision myself there for the next two. How was I supposed to make a career out of this, when I was constantly being punished for the most trivial molehill inadequacies blowing up into mountains every day? How could I run a clinic that grew and grew every day, and yet my support staff had already become nonexistent due to “budget constraints”? How could I thrive in a place where my administration really didn’t care if I lived or died?
I sat in my chair for what felt like a long time.
And then I picked up the phone and called my husband….
After almost two weeks and lots of “chats” with TwitterHelp, my accidental suspension was lifted and I have officially been paroled! Apparently, the combination of having a new account and simultaneously having my blog go live on KevinMD and getting retweeted by a bunch of other accounts got me mislabeled as a spammer. Today we are back in business – feel free to tweet me: @lumistclaire
As always, thanks for reading!