The Power of Part Time

 

Part time Draper

 

So….it’s been almost TWO YEARS since I last posted.  (No, I don’t count the intro blurb I wrote to Fiona Scott’s kind guest post more recently.)  Part of me feels pretty bad about that.  I enjoy writing immensely, but I have enjoyed even more hearing from readers who have chosen to share their own experiences, and being constantly reminded that as alone as physicians burnout feels, we are in (shockingly) good company.

But at the same time, there is a part of me that is admittedly quite pleased I haven’t posted, for the simple reason that I have been BUSY.  And not busy-work busy, or toxic miserable crazy busy.  I have been busy with really, really good and satisfying work that I am extremely passionate about.  So at least I have a somewhat decent excuse for my lapse in blogging.

Lately, I have found myself perusing other blogs that focus on physician burnout.  I’m not completely sure why, but I know that I have a definite sense of having escaped something, and I feel like in some way I need to remind myself of how bad things were, so that I don’t let the edges get fuzzy with the passage of time and become complacent about how good I have it now.  One thing is for certain though: I am absolutely, positively convinced that my current happiness and job satisfaction have a tremendous amount to do with the fact that I work part time.

Now let’s be totally clear about one thing: the physical rules of the time-space continuum simply do not apply to those practicing in the medical field.  I suspect there are other career paths that also suffer from this wormhole phenomena, wormhole but medical practice is the one I am intimately familiar with.  It is very important to make the critical distinction between a part time contract, and part time work.  Take my contract for example.  On paper, I am contracted and paid for 60% of an FTE (Full Time Employment) position, which constitutes 5 clinical sessions a week plus one half day for “administration”.  This amounts to 24 contract hours a week.  In actuality, I work much, much more than that.

For one, my admin time (as I suspect is the case for most other practicing physicians) is a nice euphemism for “anything that is not direct clinical patient care”.  This includes reviewing charts for my upcoming consultations for the week, teaching medical students and residents, chairing committees, writing and publishing articles, completing charts on my finished patient visits, answering barrages of emails, training, etc etc etc.  Does that fit nicely into a 4 hour block every week?  F**k no it absolutely does not.  Then add on when patient care becomes more complex than predicted, and you have a setup for potential disaster.

Except that, until recently, I have never had an issue with the spillover for two reasons.  One, I have built in buffer in that I don’t work 40 hours a week, so if I have a particularly demanding week, I have some wiggle room.  Two, I simply ADORE what I do, and the people I work with.  So when a week is hard, or long, or maybe even just sad, I can still step back and not lose sight of what an absolute privilege it is to hold the position that I do.

This was how things were chugging along anyway, until a few months ago.

I managed to catch whatever hellish upper respiratory infection was floating around, and I got sick.  Like SSSSIIIIIIIIIICCCCCCCKKKKK.  Like febrile and coughing so hard I thought my uterus was going to fall out on the floor.  The kind of sick where I actually had to CANCEL THREE DAYS OF WORK.

 

sick

 

Unfortunately, this also went down the week before I had already scheduled a makeup clinic for when I had been out of town at a conference.  I didn’t really pay attention to this small fact when I rescheduled all my missed clinics from being out sick for the following week when I got back.

What this ended up translating to was a regular work week, with four full makeup clinics scheduled on top of it. Essentially, I had scheduled the equivalent of shoving 20 pounds of crap into a 10 pound bag.

And as you can imagine, it absolutely SUCKED.

My admin day was doubled since I had to chart review twice what I normally do in a week.  I ended up staying until about 8 or 8:30 each night finishing my charts since I had seen twice my normal patient volume.  For the first time in three years, I found myself at the end of the day feeling utterly sapped and not at all looking forward to coming back to work.

But the effects went beyond work.  Absolutely nothing got done that week.  NOTHING. No laundry, no food shopping, no workouts, zero.  My husband and I ate out five nights in a row because there was simply no time or energy for anything else, and by the end of the week that wasn’t enjoyable either.

I don’t mean to be melodramatic.  I totally survived the week.  But that’s pretty much because it was one week, and I knew it wouldn’t last.

Most importantly, that week was looking an awful lot like the first job that I eventually walked away from.  It was a great reminder of how I did not want my career, or my life, to look anymore.

My contract may say part time, but my work life is quite full.  Physicians by the very nature of their mission are vulnerable to the threat of becoming “overfull”.  And when we are unable to take care of ourselves, it becomes virtually impossible to take care of others.

#justsayingnototwentypoundsofcrapinatenpoundbag

 

~Lumi

 

 

 

 

 

 

I’m baaaaaack…..?

http://muzicmunchies.com/wp-content/uploads/2012/08/shining_nicholson.jpg

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.

http://www.sodahead.com/living/miley-cyrus-brother-braison-cyrus-lands-modeling-contract-will-he-make-a-good-model/question-3357417/?link=ibaf&q=images+happy&imgurl=http://upload.wikimedia.org/wikipedia/commons/e/ec/Happy_smiley_face.png

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 https://www.neon-das.com/cgi-local/store/commerce.cgi?product=EFOthat 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.

~lumi

Making the Jump: Part 1

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.

THE PAST

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.

THE PRESENT

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….