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.

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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.

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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.

 

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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

 

 

 

 

 

 

Mi loca, tu loca

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For some reason, I spent the entire bulk of today fending off the phenomenon I refer to as “mi loca, tu loca”.  Which translates roughly to “my crazy, your crazy (and that plus asking for the check at dinner is just about the extent of my Spanish.)

The MLTL experience is one of the things in life that truly, deeply gets under my skin.  We all have experienced this at least once.  If you haven’t, you either live under a rock or have a life that is so pleasant that June Cleaver would shank you out of pure jealousy.  MLTL happens when someone else tries to make their crazy your crazy.  And I am not talking about garden variety attempts to convince you to see their side of the story.  No, this is actually infecting you with their particular delusion so that you begin to not only question your own logic, but the rules of all known social engagement.

People who are capable of this “talent” tend to be a) grossly incompetent and acting defensively to protect the shrine of inadequacy they have spent a lifetime building, b) smart and manipulative, or c) both.  Meeting someone who is both incredibly smart and grossly incompetent is indeed rare – it’s a bit like seeing a unicorn, except from what I have heard that tends to be a lovely experience of which many first graders enjoy drawing pictures.

Unfortunately, I spent the majority of my life dealing with mi loca tu loca from my family, although for the first 15 or 20 years I didn’t really understand what I was up against.  Regardless, you would think that would make me somewhat of an expert on how to deal with it.  Sadly, I don’t think it does, mainly because the laws of human interaction don’t apply to these soul-suckers, so often there is no rational way out.  The only benefit I can see at this point is that I am a master MLTL detector.  I am a f**cking bloodhound when it comes to identifying these folks.  The feeling is always the same – a few minutes into a conversation, I get the distinct feeling that I am the unwitting victim of a Vulcan mind meld, and that a complete stranger is somehow brainwashing me into thinking that, even thought pure logic and reality would dictate otherwise, that somehow I am in the wrong or owe them something.

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Normally, I can deal with these people on an occasional basis.  But somehow, today was the perfect storm of  folks who kept assaulting me with their voodoo magic in the hopes that I would suddenly agree that the sky is green and has three suns.

It started with a computer training that I had to complete for my new job.  Mandatory, of course.  Knowing how much I just love CBL experiences, I dutifully cancelled half a day of work to schedule a three hour training session.  And as a freelancer, that cost me.  People with full time jobs don’t always realize that taking off work for us consultant folks hits us right in the wallet.  But I didn’t mind – it’s just one of those things you do and get on with your life.

Turns out that I was the only one scheduled for this training, which meant I had the full attention of the instructor for three hours.  Initially I thought this wouldn’t be such a bad thing, as I could monopolize her with my individual questions and not feel guilty for hijacking a class.

As the session went on, however, I quickly realized two things.  The first was that this woman was truly from a computer based learning cult, and she had drunk the Koolaid.  I’m not sure how many times she waxed ecstatically over the program’s “exciting features” and “thrilling application potential”, but 30 minutes into it I was already exhausted, and she might as well have had pom poms and been wearing a cheerleader outfit.

The second, and more important, was that she clearly had an agenda for the afternoon that didn’t involve me.  I had been scheduled from 1pm-4pm, and she informed me after we were an hour into the training that there was some sort of departmental meeting that was happening that day at 3pm.

That’s when the Vulcan mind meld started creeping in.  Her tone changed ever so subtly as she told me that it was very possible that we would finish in 2 hours (fat chance), and that if we did, she could attend the meeting, but that she certainly didn’t want to shortchange my time.  And she would be more than happy to schedule another session with me at a more convenient location for me so we could complete the training and give it the full attention it deserved.  And that way everyone could get all the information they needed.

My thought process, already blunted by the assault of computer program information that had no real meaning for me yet, reflexively shifted over and I started mentally thumbing through my calendar, wondering if I could find a chink in my schedule to meet her at a local Starbucks for an hour.  mindmeldmindmeldmindmeld

Luckily, all those years of family training kicked in, and I startled back into reality.  Sorry, didn’t I already take off half a day of work to meet your training schedule, and now you are asking me to kick off an hour early and take off more work to reschedule with you so you can make some dumb meeting?  And implying that I would be selfish not to?

Hell no lady.  I politely but firmly informed her that this was the only day off this week that I was able to schedule this session (which was true), and that rescheduling for one hour of training simply wouldn’t be possible.  She said of course she understood, but her expression completely conveyed the opposite.  And she couldn’t resist one last dig (mindmeldmindmeldmindmeld) when she said she was pretty sure she could get the critical information she was missing from a colleague.

Once I had completed ALL THREE hours of training (with her becoming increasingly flustered after all that song and dance at actually being time pressured to finish), I was happy to get home and relax.   Yet almost immediately, I got sucked into a ridiculously lengthy email exchange with an agency that had hired me for some consult work, accepted my terms of service, and then negged on paying my full invoice, claiming that reimbursement for travel and overtime had not been preapproved.  The pinnacle of this asshattery was an email from the SENIOR accounting manager, who actually said, “I don’t know you at all….but c’mon….we’re all Human.”  I mean, who talks like that?  As if I am somehow going to suddenly bolt upright (mindmeldmindmeldmindmeld) and say, “By golly, you’re right!  Who cares if you bilk me and all your other contractors out of money we are owed and propagate ethical fraud on the professional community at large?  I mean, c’mon!  I must have been crazy to complain to you!”

C’mon is right.  You can keep your !@#$%^& loca to yourself.  🙂

~lumi

Thanks Maya

I’m currently out of town at a conference and am looking forward to posting another blog in a few days when I get back home.  Yesterday I attended a lecture, and was reminded of a wonderful quote by Maya Angelou that I thought was worth sharing:

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

I realized that Maya’s wonderful observation doesn’t just apply to people, it applies to everything you do in life, including work.  It’s not the work you do, it’s how you feel about the work you do.  And right now, I’m feeling pretty amazing about my work.  Thanks Maya.

See you soon……

~lumi