Guest Post from Fiona Scott, MD-To-Be

So recently I was approached by a medical student asking if she could guest post on my blog about burnout.  I was more than happy to take her up on her offer, and not just because it has been WAY too long since I have blogged and her timing could not have been more perfect.  It’s easy to forget that physicians in training are not in any way immune from burnout and compassion fatigue that affects so many of us out in clinical practice.  Fiona shared with me that she had recently lost a classmate to suicide – something I unfortunately also experienced during my training when one of my fellow medical students killed himself during our first year.  If anything, the pressures and difficulties have only seemed to have grown during the time between my and Fiona’s training.

I welcome Fiona’s piece on her experiences so far during medical school – while I remember it like it was yesterday, I am far too removed to comment on the current climate in medical education.  Although apparently…some things don’t change.

As always, thanks for reading.

~Lumi

Help Wanted…Inquire Within

by

Fiona Scott

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I did some pretty crazy things to get into medical school (don’t worry mom, nothing illegal). For several years before applying I became a medicine groupie. I read books about being a doctor, watched documentaries about medicine, shadowed physicians for hours on end so I could imagine what it might be like. I watched many a friend go off to med school…and graduate… and I waited, I hoped. I did research (which involved a little too much rat killing for my liking), I worked in a peach orchard to demonstrate my dedication to migrant farm worker health. I became an EMT, I got three master’s degrees. I got as close to medicine as I could. And I wanted it. I wanted it bad.

So when I was finally accepted to medical school at the ripe old age of 27, I was giddy with excitement at my dream finally coming true. So excited in fact that I ate an entire chocolate cake and finished the better part of a magnum of champagne (the hiccups that ensued were horrendous).

When I walked into my very first medical school class, I thought my excitement would allow me to float through the next four years with ease. I was getting my dream, and damn it, it was going to be amazing. And in many ways, medical school has been really amazing. My classmates are wonderful, kind people most of whom I hope to remain life long friends with. The course work in med school was challenging, but paled in comparison to graduate school. I excelled in my classes and it felt awesome.

But then things started to change. I began to see some of the realities of practicing medicine that I was blind to before. My previous ideas about the kind of power doctors had to affect change were shaken by anti- vaccers and insurance companies. Even my very own University shattered my naivety by refusing to care to a patient with cancer seen in one of its well-publicized free clinics. By the end of my first year of medical school, my heart was so heavy with broken pieces of what once was my perfect idea of medicine, I felt like ripping it out of my chest and drop kicking it across the floor. What the hell kind of profession did I just sign up for?

I started to question whether medical school—and more importantly becoming a doctor was really what I wanted after all. And that scared the crap out of me. Did I make a mistake? Why had I never doubted this is what I wanted to do before? Will I be $300,000 dollars in debt before I realize I should have been a real estate agent?

At the end of my first year of medical school I was desperately trying to figure out how to reconcile the immense challenges and problems of medical care with the amazingly wonderful parts. With over 400 physicians committing suicide each year1—the highest suicide rate of any professional group– I was starting to think that medicine had more misery than anything else. Maybe med school applications should come with a warning label.

For now at least, I am well protected from most of the soul destroying realities of the medical profession, ironically by the school training me to enter it. Medical school is for all intents and purposes is a safe haven to which I can retreat deep into my books, where my patients are just actors (paid professionals working as ‘standardized patients’ to help train us for the real thing) and where the excitement of wearing scrubs and carrying a pager never seems to get old. When things get “too real” I cling to the fact that I am just a student, still in school—not yet a doctor charged with caring for real patients within a broken and frustrating system.

But it scared me when I think about what my career in medicine will look like. I imagine my mentors and professors– kind, loving people who believe that I am worth teaching and humbly guide me- even though its more time and hassle to do so. These are the ones I strive to be like– the ones who show up to help, even though they feel frustrated sometimes, even though they can’t always fix the problems in front of them. These are the heroes I look to to remind myself why I signed up for this. I don’t want to watch any of them turn into burned out shells of their former selves. And I fear more and more that this is happening. And I worry most of all that it is happening to me

But I’m too young, you say. Too early on in my training to have any legitimate claim to feeling burned out and disillusioned with medicine. If only that were true. A study of all medical students in the United States found that about 49.6% of medical students met the criteria for burn out2 and 51.3% for depression3. Trust me—its not all from studying, but from being treated like crap, feeling like we can never make a mistake or ask for help and wondering if anything we do will help to change the status quo or are we just cogs in a wheel trying to crush us.

One of my favorite authors, Anne Lamott, says, “Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: you don’t give up.” So here I stand. In the dark, unsure about where the future might lead, but clinging to the belief that medicine will give me joy, and satisfaction and hope—in spite of the drawbacks and hardships.

As I grow into my medical career, others who have gone before me will light the way ahead with “I’ve been there,” “It will be okay” and with “screw this, let’s grab a beer.” There is immense power in showing love and support to others in our profession. Sometimes it’s the most powerful thing we can do and sometimes it’s the only thing we can do. And I know. Because the regular author of this blog reached across the time space continuum of the internet to provide me—a perfect stranger– with the strength to continue on in my medical training. It was her graciousness and honesty that reminded me why I was so taken with medicine from the start. Our voices have the power to change lives and, most importantly, to change our own.

Fiona Scott is a second year medical student who blogs at http://nerdseyeview22.blogspot.com, and can be reached at fscott22@gmail.com.

  1. American Foundation for Suicide Prevention. Facts about physician depression and suicide.http://www.afsp.org/preventing-suicide/our-education-and-prevention-programs/programs-for-professionals/physician-and-medical-student-depression-and-suicide/facts-about-physician-depression-and-suicide. Accessed October 1, 2014.
  2. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and Suicidal Ideation among U.S. Medical Students. Ann Intern Med. 2008;149:334-341. doi:10.7326/0003-4819-149-5-200809020-00008
  3. Iqbal S, Gupta S, Venkatarao E. Stress, anxiety & depression among medical undergraduate students & their socio-demographic correlates. Indian J Med Res 2015;141:354-7
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It’s all about the “V” word……

Wow.

It’ s been over a year since my last post.  Apparently, I am one of the worst bloggers ever.

But you have to admit, it’s a little challenging to have had an active blog about leaving clinical medicine, and then go back to clinical medicine.  It leaves you with not so much to say.  I’ve actually considered stopping the blog altogether, since the entire reason for me starting it has pretty much vanished.

Except that I’ve realized that a) I really like writing, and b) maybe the blog just needs a slightly different focus.  Perhaps a focus on the path out of medicine just needs to be a little broader and include the road back.

So here it is.  I am dusting off some serious cobwebs.

It’s been a year and a half since I came back to medicine.  At first it was very tentative.  I started back at one day a week just to give it a shot, fully expecting that it would be the same misery as before and I would be out within 6 months.  Which is course is not at all what happened.  I’m now at 60% time (with my chairman constantly begging me to do  more) and having to train another provider to help handle my patient volume.  And I actually chose to do this.

I recently finished the longest week of work I have had since coming back to clinical medicine. I had a family emergency and a conference all converge around the same week, and ended up rescheduling two days of missed work into an already full week.  It was long.  It was incredibly tiring.  I was very glad when I finally got into my car on Friday evening to drive home.

And yet, it wasn’t a bad week.  It actually wasn’t even an ok week.

It was a really, really good week.  Yes, I was exhausted and completely ready for dinner out with a self-medicating glass of wine.  But I was just tired from working hard at an unbelievably rewarding job.

I’ve had a ton of time to think about what makes my current situation so ridiculously different from my old job.  I’ve blogged about the concrete differences that make my new life so very different from my old.  It’s very multifactorial, and certainly not simple.

Except that now, having gotten plenty of time and distance from my old job (and really, my old life), it actually is kind of simple.

When I look at all the different factors that are involved in loving my current work, they all have one thing in common.  From a truly exceptional chairman and an outstanding support system and dedicated nurse, to things as simple as having a nice office with plenty of windows and reserved doctor parking in the garage, all these reasons essentially boil down to one simple factor.  At first I thought it was people liking me, but I realized that plenty of people liked me at my old job, and I was a miserable wreck.  I thought it might be that now I am respected, but no, I had plenty of respect where I was too.

Then I realized – it’s the “V” word.

The reason that everything continues to be unicorns farting rainbows where I work a year and half after starting is that, after all this time, I am finally VALUED.

 

And lest I sound the least bit bitter about not being valued at my previous job, I fully realize how difficult this can be to achieve.

I think it’s extremely easy to confuse being valued with other ideals, such as being liked or respected.  They certainly share certain attributes, and we all feel good when we experience any of them.  I recently drank the Koolaid and read Sheryl Sandberg’s Lean In.  For those of you who have only just joined the human race, Sheryl recently became the COO of a teeny tiny social media company called Facebook.  She wrote a very poignant (and controversial) book about women breaking into and taking on high powered positions in major companies.

Did I agree with her 100%?  Of course not.  And there were definitely parts of the book I didn’t relate to, such as having children and balancing all that out.  Which is clearly an entirely different blog for an entirely different person other than me to write.

But Sheryl’s book was amazing.  Some of those pages felt like she was writing them specifically for me and me alone.  I won’t go into excruciating detail if you haven’t read it….ok screw it, I’m totally going to talk about what I thought was the best part of the book. Sheryl has a chapter on career paths, in which she discusses a phenomenon called “The Tiara Syndrome”.  Yes, it does do some gender stereotyping, which Sheryl is very graceful about addressing in her book.  Basically, women in general tend to function similarly when it comes to their view on success at work.  We roll up our sleeves, put our heads down, and do really, really good work.  And we keep doing good work.  And we do some more good work.  We don’t promote ourselves, we don’t draw attention to all the great things we are doing, we just work.  Because if the work is good enough, and we do enough of it, someone will eventually notice what an amazing, wonderful job we are doing, and come over and plop a tiara on our heads to thank us for all of our efforts.

TAAAAAA DAAAAAA!!!!!!    

 

I was absolutely, positively, 100% a tiara syndrome devotee.  And let’s be honest, half of getting through a clinical medicine residency is picking up your pom poms and cheerleading your way through all the fatigue and the stress and the trauma.  We train for YEARS to roll up our sleeves and put our heads down and work.  And when one of our attendings tells us we did a good job, it’s like winning the lottery.

The problem is that the model for getting through residency is nothing close to the model for having a fulfilling and successful career for the rest of your life.

In my old job, I was a total tiara girl.  I started a specialty clinic during my residency and grew it from one family to 5 families to 15 (headdownworkworkwork).  And I stayed on as faculty after I graduated and continue to serve as clinic attending, and taught residents, and published in peer reviewed journals (headdownworkworkwork), and organized conferences, and grew my clinic to 50 families to 100 to 200 (headdownworkworkwork), at which point with virtually NO help and NO support staff and NO meaningful salary, I completely imploded.

Was I liked?  Absolutely.  People LOVED me.  Was my work respected?  Definitely.  The residents gave me teaching awards, students would come back for a second elective rotation with me to learn more, colleagues would proudly laud my achievements to other colleagues.

Was I VALUED?  No.  No sir, I most certainly was not.

Because here’s the thing about being valued.  (And, in general, women tend to do this more than men.)  It’s super easy to confuse being valued with being liked.  We get the warm fuzzies with both being liked and valued.  They can look deceptively similar at first glance.

Here’s the catch.  To put it bluntly, you can be extremely well liked by your colleagues, and still have promises made to you that are going to be broken, be assigned a terrible salary that doesn’t even come close to acknowledging COLI let alone acknowledge the work you do, made to feel like no matter what you do it’s never enough, and be put in a situation with no help and no real way to succeed.  You can be the belle of the ball socially and work can suck suck suck.

As much as we don’t want to admit it, the reality is that it is simply not enough to pat me on the head and tell me I’m doing an exceptional job, and throw me peanuts to survive on.  And for some reason, historically women (in general) have tolerated this much more so than men.

I don’t mean to digress into a gender inequality in the workplace blog (there are plenty of those out there already, and did I mention Sheryl Sandberg’s book?)  This is about recognizing what you need as an individual to succeed.  Personally, it took me quite some time to figure it out.  I need to be truly, honestly, and tangibly valued.

Let me be clear – this is not at all solely about a paycheck.  Ironically, because I’m a generalist who has specialized and am now working in a surgical department, I am BY FAR the lowest paid faculty in the department.  I don’t cut into people for a living (God bless those of you who do and do it well), and my paycheck shouldn’t reflect that I do.  But I will tell you one thing: as an academic clinical assistant professor, I am making a very, very nice salary.  And my chairman is thrilled to give it to me.  It’s like every month, there’s a little subliminal message from my department in my bank account saying “Hey Lumi, you are totally worth it!  Thanks!”

But the salary is the tip of the iceberg.  Ironically it’s the small things that really add up in terms of feeling valued.  When I pass my chairman in the hall and he is talking to someone I haven’t met, it is 100% guaranteed that he will stop me and say, “Oh Dr. St. Claire, have you had the pleasure of meeting so-and-so-chairman-from-blah-blah-department yet?”  And then will go on to completely talk up my work ad nauseam to this poor trapped soul about how special my clinic is and all the innovative things we are doing, etc.  His elevator speech has actually gotten quite good.

Or when my colleagues refer a child to me that they just don’t know what to do with, and tell me how relieved they are that I am here and can help out with complex care coordination that they just aren’t equipped to handle as surgeons.

Or when the medical assistant screening my patient leaves me a little note on the computer in the room that says “Hi Dr. St. Claire – have a super day!”

Or when my colleagues from the community ask me to chair a committee to try to bring resources together to best serve our patients and families.  And then when we have the meeting at 3pm on a Monday, my clinic coordinator naturally assumes I will want it catered, because how on earth am I supposed to host a successful committee meeting without feeding the participants?

Or when our admin sees that I am still in my office on Friday at 5:30pm charting, and runs down to the first floor to bring me a Diet Coke so I can keep working (which may be the reason why I woke up so early this morning thinking about this stuff – caffeine and I are not exactly friends).

I could go on and on with these little encounters that individually could be seen as trivial.  But when every single day at work is FULL of these kind of interactions, you start to feel rather glowy and lovely all the time.  Do I have hard days?  Of course.  Do I occasionally have challenging families or situations that make me sad that I can’t do more?  Absolutely.  But working in an environment where I am not only liked and respected, but valued, makes me finally, finally understand what Confucious was talking about when he said,

“Choose a job you love, and you will never have to work a day in your life.”

 

I get it now.  I just had to find a job that loves me back.

 

 

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

Dipping a Toe Back in the Pool

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…..

Making the Jump: Part 2

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.

~Lumi

Guilt is Not a Career Platform

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Recently, I read a very interesting Forbes.com post by Kathy Caprino, entitled “Why You Remain Stuck in a Career You Hate.” In it, she gives eight outstanding reasons why those of us who are unhappy in our careers remain paralyzed and unable to move. The first reason on her list (“You Don’t Know Yourself”) resonated strongly with me. It took me eleven years in primary care medicine to come to the conclusion that I just don’t like being a primary care doctor. It’s not a good fit for my personality or how I tend to function in a work role. I’m much happier in a “specialist” model – where I can take more time and function in a niche rather than trying to cover a broad range of things in a very limited period of time.

This is just a simple fact I had to learn about myself. It’s not a judgment about the importance of primary care versus other specialities. On the contrary, I have enormous respect for my colleagues who are primary care providers and do it well. I think they have one of the most challenging jobs on the planet.  I just needed to do enough introspective searching to finally admit to myself that I wasn’t in the right field.

But why did it take me such a long time? The immediate obvious answer is that for those of us who spend the better part of our lifetime training for a specific career, it’s a hard pill to swallow to admit that maybe that career isn’t exactly the best one for you. Especially if you are one of those types who was born knowing you wanted to become a doctor/lawyer/etc. But, as I’ve alluded to in some of my other blog posts, I’ve never been one of those people. I’ve also never really viewed being a physician as a critical part of my identity. I am a person first, who practices medicine second. I know that is not the case for everyone, and that’s the point. We are all different.

In really taking some time to figure out what makes me “tick” as a career person, I came to realize something very important in the months leading up to my eventual resignation from clinical medicine. It turns out that I am one of those self-masochists who loves to turn a career’s worth of guilt inward. I was the stereotypical worrier, wondering what would happen to my patients. If I left, who would take care of them the way I did? How would they get what they needed from someone who didn’t know them like I did?” Looking back, these “guilt scripts” held me hostage for years before I finally took a good hard look at what was preventing me from being happy in my work.

It was actually the fiancé of a friend of mine who inadvertently helped me break through the last of my career shackles. My friend was a nurse practitioner in the clinic I worked in, and the two of us developed a friendship borne out of commiseration. We would often get dinner or hit the local bar after clinic was over and just wallow in the injustices of our work environment. We even had our own little book club so we could have some kind of pretense for getting together. We’d talk about the book for about three minutes, and then the conversation would immediately devolve into a first-class bitch session.

One day her fiancé happened to join us for dinner. He listened to us talk about how trapped we were working for an institution that refused to listen to its employees, and imposed all sorts of inappropriate constraints on us. We bemoaned how powerless we were to make change, despite the fact that we were two of the most outspoken faculty in the clinic. We complained about the unbelievable inefficiency and suboptimal level of care in our clinic due to administrative decisions that clinically left our hands tied.

After this went on for about half an hour, he looked at both of us and then asked quite frankly, “So why do you continue to work there?”

My friend and I of course had all sorts of excuses. Our patients needed us. No one else knew the issues our patients faced as well as we did. As I listened to myself spouting off 101 reasons why I couldn’t leave, I realized I had enough career guilt on board to fuel a Catholic mass for three weeks.

His question stuck with me though. He had planted a seed, and over the next several months it germinated into a big, blooming flower. Eventually I had to admit to myself that my patients somehow had found medical care before they met me, and they would after I left . Would it be the same medical care that I provided them? No. Would they get worse care after I left? Possibly. Or maybe someone would come along and do a better job than I had. Regardless, they would not be left lying in a ditch somewhere. Sure, they would miss me. I have several families that I still keep in touch with by email after having left clinical practice, and they do miss me. But they also are very pleased to hear that I am happy and thriving in my new work.

With due deference to Kathy Caprino, I respectfully submit Reason #9 for her consideration: Guilt Is Not A Career Platform. Certainly not for a fulfilling career anyway.

~lumi

RELATED LINKS:

A Good Way to Measure What Works for You

“Just”: The Ultimate 4-Letter Word

Over the past few years, I have realized that I have come to resent the word “just.” Certainly not in the civil sense of the word: social justice is the driving force behind virtually all the work I do these days. I am talking about using “just” as a qualifier. As in, “Oh, I’m just the medical student,” or, “He’s just a nurse.” We use it blatantly as an offense against others, and more overtly to undermine how we feel about ourselves. That word has come to mean that in some way, you are not educated enough, not qualified enough, or not worthy enough.

It has been really interesting for me in the two years since I left clinical medicine to pursue a decidedly non-traditional career path. I mean, who finishes high school, college, medical school, and clinical residency and then eventually leaves the job they actually trained to do? Here’s the secret about all that: your life experience is critical NO MATTER what road you take. I have been extremely successful so far in developing my new career, and I would not be doing nearly as well as I am and getting the high-profile work I am without my past clinical experience. It gives me credibility, knowledge, and perspective that make what I have to offer unique.

What I have quickly come to realize though, is that while I am extremely comfortable with having taken on a new job identity, a lot of my colleagues are not. The “just” word gets batted around constantly.

“But aren’t you bored being just a consultant?”

“Isn’t it weird being just an interpreter instead of a doctor?”

First of all, I never stopped being a doctor. There are thousands of us who have completed medical school and earned our MD degree (and many who finished clinical residency) who have taken detours to explore other areas of work. Usually they are related in some way to medicine, but don’t necessarily involve direct patient care. And guess what? The M.D. Police have still not shown up at my door to take away my degree. The last time I checked my business card, those two little letters after my name were still there.

Secondly, and perhaps this is the social justice beast in me rearing its ugly head, I can’t think of a single meaningful job that I would ever feel comfortable putting the word “just” in front of. Think about what the act of gainful employment provides for us as individuals. It gives us a sense of worth and need. It puts food on the table. For some of us who are struggling with temptation, it keeps us honest and clean and helps us resist activities that might lead us to a place of total self-destruction. Doctors would be nothing without nurses to actually put their plans into real action and physically take care of patients. And just because you don’t like someone’s job or think that it is particularly challenging, imagine what your life would be like if the trash collector simply stopped coming to your house. Not pretty.

I’ve been thinking a lot about “just” in the past couple of years since I switched my career horses in midstream. Not because I’ve had to wrestle with it at all on a personal level. I have more peace and joy in my career now than I can remember over the last decade. It’s really more about the reaction it draws out of other people. Usually it’s people who have made decisions for themselves that they don’t necessarily feel great about. But for whatever reason, they feel compelled to stick with their decisions. I tend to make these people really uncomfortable. I think it’s because my decision to follow an unorthodox path and find my career happiness again forces them to examine their own decisions more closely. And sometimes they don’t really like what they find. Sometimes they are truly stuck because of financial obligations, and are miserable but just don’t see a way out. I make them unhappy just by being me and feeling fulfilled and standing in the same room with them. Sometimes people are stuck out of fear, and my lack of fear and my willingness to embrace risk-taking makes them feel bad about their own paralysis. We are natural comparers as human beings. We are always looking at what the other guy is doing, and constantly trying to see if we measure up.

Mostly though, it’s other physicians who have the hardest time with my decision to leave clinical medicine. I think a lot of this has to do with the fact that there is a strong tradition of hard-won success in medicine. The educational road to becoming a practicing doctor is very long and very hard. For many people, there is also an enormous identity piece. Some people are doctors 24/7. I don’t mean that they live in their offices and never go home. I mean these are the people you will meet at a party (where there are no patients, no white coats, and everyone is drinking wine and eating little puffy hors d’oeuvres), and they will introduce themselves to you as “Dr. So-and-So”. I don’t have particularly strong opinions about whether this is appropriate or not, but it’s something I have never been able to relate to well. I did not come out of the womb knowing I was going to be a doctor. I am not one of those people who absolutely cannot imagine themselves doing any other profession. (Clearly – I have imagined myself right into another line of work.) For some people, being a doctor is the end-all of their identity, and they are not complete people without it and the respect and honor it (rightly) deserves. So these folks are the first ones to ask me how I can possibly be happy just being a consultant, when I could be a doctor?!?

I just came home from a conference where I had the opportunity to escape for lunch with a colleague who is a wonderful friend, and someone I don’t get to see as often as I would like. We were having a very energetic conversation about all the work that lay ahead of us and how motivated we were to be doing it with committed and passionate people. At one point, I was telling her about some of the new opportunities that had come up for me through the conference, as well as some exciting new job opportunities at home, and the fact that I also have been seriously committing time to writing, which has made me eternally happy. I must have looked like some blissed-out kid who had just eaten an entire box of Twinkies (before the vomiting started anyway). My friend looked at me for a long moment, paused, and simply said,

“My dear, clearly you were never meant to be just an MD.”

There it was, that “just” word again. Except this time it had a completely different meaning. It was obvious she hadn’t used it in the sense that being a physician is a lowly occupation, and I could certainly do something more quality with my life. No, she meant it in the purest form of the word. She was talking about scope and self-limitation. Why only be an MD? Why not use your skill set in new and unique ways to address issues of social injustice? It was such a pleasant shock for me to hear someone use that word in such a positive and fitting way, it was all I could do not to leap across the table and tackle her with a huge hug.

Betty Friedan, the famous early feminist trailblazer and author of The Feminine Mystique, once spoke about how different our lives would be if we simply knew early on that we were going to have three or four different careers throughout our lives. If somehow that were the norm, how liberating it would be knowing that at any time, you could go ahead and start gaining the skills and education to do something new and exciting with your life.

I know just how she feels.

~lumi