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

 

 

 

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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.

 

 

My first Guest Post!!

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My new cyber-friend, Dr. Ryan Gray, invited me to submit a guest post to his blog and podcast site: www.medicalschoolhq.net.  It’s a great resource for premed students who are trying to navigate the pathway to medical school.  Ryan asked me to write a guest post on burnout geared toward premed and med students.  You can find it here.  Thanks for checking it out!

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

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.