Finding Balance

Poise

After taking a thoughtful break from posting (aka being busy and not writing), I find myself today with an unexpected afternoon off, and thought it would be a great time to reconnect with my blog.  Let me start with apologies to a few of you who took the time to get in touch me with me – to say I was “delayed” in getting back to you would be the understatement of the year.  #epicfail.  Hopefully I’ve caught up with everyone at this point.

I find it interesting that I chose to blog today on balance, because I have quite a few “real” tasks staring at me from by inbox with rapidly approaching deadlines.  But I think this illustrates the point of balance precisely, at least in my own experience.  Sometimes achieving balance is committing to things that bring you joy and pleasure outside your job as intently as you commit to work, and knowing when you have the leeway to do so.

In my previous career position as an academic physician, I burned out rather dramatically after only 6 years in an attending-level position.   I’ve now hit the 4 year mark at my current job, and continue to look forward to going into work, taking on new challenges, and investing effort into expanding my program (including training a new advanced practice provider who is SPECTACULAR to work exclusively with me – props to my department chair for hiring her without batting an eyelash when I asked if it was possible).  One of the critical characteristics that I think separates these two experiences is balance.  More specifically, self-defined balance.

In my previous job, I spent a lot of time doing either what other people told me I should be doing, or doing things because I thought I should be doing them out of guilt, obligation, resume building, etc.  Don’t get me wrong – as a newly-minted attending fresh out of residency, a huge part of my job was to say “YES!!’ to work that came my way.

youth-forum-a-new-kid-in-class-japji-kaur-top

 

I’m quite convinced that one of the big contributing factors to me burning out was my lack of balance over time.  And when I really look at how that played out, it was really subtle and quite tricky.  Make no mistake, I am BUSY AS F**K in my current job, and I say yes to plenty of things that come my way.  But how I spend my time is much better tailored to my own preferences.

The nice thing about trying to pick this apart is that at my old job, I was 60% FTE, and that’s exactly what I maintain at my current job (despite intermittent check ins from my chair to see if I maybe want to bump up my time a little…. thank you, but the answer is still no.)  But my balance now is so much more appropriate for me, and the changes may appear small, but have huge consequences.

Where I used to work (which I will henceforth refer to as “Mordor”), I did all sorts of work outside my contracted hours, which seems to be pretty much true for most physicians in the US. I  took overnight call for the clinic a couple of times a month (meh), covered the nursery one week every few months (gross due to the early hours), and took a Friday through Monday call weekend once every eight weeks, which was a F**KING SLEEPLESS HORROR SHOW that was exacerbated by the fact that we had absolutely zero nursing triage, because god forbid that would have COST MONEY.  This functionally translated into EVERY SINGLE CALL from a parent coming through directly to the on-call pager, including the father who called me at 3 am to let me know that HE HAD RUN OUT OF BABY FORMULA.

mordorazog

Needless to say, this was not a great sustainable model for happy employees.

 

At my current place of employment (which I affectionately refer to as CandyLand), I am also asked to engage in activities that are outside my contracted hours.  These include things like developing a lecture series for the department on use of culturally-inclusive language (winning), create a core curriculum in my area of expertise for our residents (also winning), and chairing a community resource multidisciplinary committee dedicated to improving developmental outcomes in early childhood (winningest win!).  I invest quite bit of time and energy into activities like this, but I never feel taken advantage of being asked to do them, mainly because they are things I naturally enjoy.  If you look closely, you will also notice that none of these activities involve taking overnight call, which for me is a personal Dante’s inferno.  Some people really are not too phased by being on call, but I have discovered that I would pretty much rather suck on hot lead than take call.  I even made a personal investment in not taking call by purposefully leaving money on the table when I initially negotiated my contract, stipulating that I wouldn’t be taking call.  And my department was fine with it.  #balance

When I was working in Mordor as a 60% employee, I had most mornings to myself.  Which sounds awesome on paper.  But because the 60% (plus all the extra bullshit overnight call that turned me into a walking zombie) was so draining and I was so unsupported in my role, I didn’t have a lot left to put into the other 40% of my week.  Even things I liked were a chore, because I didn’t have much energy for them. Working out was a necessary evil (and I’m a person who LOVES to work out).  Learning a valuable skill, like cooking, was out of the question, and my husband’s and my diet suffered for it.  By the time I left, I was on medicine for reflux and high cholesterol, and was a borderline diabetic.

Now working in CandyLand, my 60/40 split looks much different.  As fiercely committed to my career, my department, and my patients as I am, I am equally as committed to my own health.  My time away from work, for the most part, remains my time.  Through a series of random events, Crossfit found its way into my life (don’t get me started – that’s an entirely separate blog post).  Now four mornings a week Monday through Friday, rain or shine, I am at the Crossfit box, and absolutely adore it.  And I treat it pretty much as a scheduled standing meeting between me and my health.  I don’t use it as “swing space” to hold extra clinics, meetings, projects, etc.  I also learned how to cook, and make a healthy home-cooked dinner at least four times a week.  My reflux is gone, my glucose is under control, and I have the cholesterol profile of a 16 year old.    #balance

The bottom line is that it took me years to recognize how much the part of my life I’m at work affects the rest of the time I am not, and that I am pretty much the only person who has real power to do anything about it.  It’s kind of like having a really good bed – the 30% of your life you spend in it plays heavily into the 70% of your life that you aren’t.

 

I think we all deserve a good bed.  Best wishes finding yours.

 

~lumi

 

 

 

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

 

 

 

 

 

 

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 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….

Physician Know Thyself

I’ve been thinking a lot about Kathy Caprino’s article that I mentioned in a prior blog post (“Guilt Is Not A Career Platform”). The issue of not knowing yourself really stuck with me. I was actually chatting about it with the hubby the other day, and he asked me, “Well who DO you know in medicine who is really happy with their career and really knows what they want??”

What an outstanding question.

I thought of course I’d immediately be able to come up with a bunch of colleagues that were satisfied and happy in their work. Sadly, as I ticked off the list in my head, I realized that it was much harder than I thought. Most of my friends from my old department were wrestling with a lot of the same things I was, and weren’t winning the battle either.

But finally, it happened.

I remembered the dean of the medical school where I used to work, Gary, who may have been one of the happiest people I have ever met on the planet. This guy literally whistled while he worked. So I asked myself, what was it exactly that he had going on that the rest of us were missing?

And the answer I came up with was that this man took nosce te ipsum to a whole new level.

Gary certainly was as busy as the rest of us, if not more so. In addition to being an extremely active and involved dean (with all of the administration and red tape that comes along with the job), he also still held clinic weekly and carried a regular patient load. Gary had every right to be cranky, put-upon, and unhappy. Except that he wasn’t.

I think Gary had simply found the absolute perfect career for himself.

Gary was the kind of dean who inspired even student he met. He loved to teach. He grabbed teaching moments every chance he got. He personally sponsored an annual award ceremony that acknowledged the best teaching residents in the hospital. Illuminating medical student’s lives was his passion. And he took it upon himself to truly know all of them, every year. They absolutely worshipped him, and he inspired them to become great doctors. But it didn’t stop with his students. He had the same effect on his colleagues. We all wanted to be better doctors because of the way he made us feel. His knowledge and his presence lit up a room.

But medicine was not Gary’s entire existence. He was apparently a real fishing enthusiast too. The only reason I even knew this was because of a random encounter I had with him at the hospital.

I was still a resident, and I had been on call Friday night in the ICU. It had been a really intense call night, and my head had not even come close to touching a pillow. When I was finally free to go home on Saturday afternoon, I stumbled out to the parking garage, squinting in the bright sunlight, to find that my car was gone.

It took me a few minutes in my post-call fog to figure out what had happened, but I finally remembered that I had been forced to valet my car on Friday because the garage had been so packed (this was unfortunately a common occurrence). Over the weekend, that particular garage wasn’t manned, so the valets moved all of the cars over to a central garage where an actual person was working.

I realized I was clear on the wrong side of campus, and started exhaustedly trudging back the way I came, hoping that my car would indeed be in the main campus garage. As I dragged myself back up the hill and passed the Medical School, who should come bopping out but Gary. In full-on fly fishing vest, waders, and floppy hat complete with pinned-on lures.

“Hey Lumi! Where you headed?”

I said I should ask him the same thing.

“Oh, I’m off to go fishing – I go pretty much every Saturday. It’s great just being out there, even if you don’t catch anything!” Truly, the man’s optimism was mildly nauseating.

I asked him what he was doing at the medical school.

“Oh, I like to come in on Saturday mornings if I can, just to get some stuff done. It’s nice and quiet.” (So the man voluntarily comes in on his day off just to catch up on “stuff”.) “So where are you headed? Are you getting out of here?”

I said I was trying, but I hadn’t exactly located my car yet. I told him about the valet situation.

“Yeah, it probably is in the other garage. Hopefully you’ll get home soon – you must be exhausted! But listen, if for some bizarre reason it’s not there, here’s my cell number. Just give me a call and I’ll make sure you get home.”

This is how Gary was every single day. He loved his job. He loved stuff other than his job. And he knew himself. You can’t fake that kind of enthusiasm and kindness for very long without going completely insane.

I drove home from work yesterday after a very long, hard day, and was smiling because I felt so good about my job. For a long time I didn’t realize that you can actually enjoy those really tough, draining days. And maybe you should be able to enjoy some of them. I am knowing myself better every day.

I hope Gary would be proud.