An Ignoble Experiment: How My Burnout Led to Rage That Could’ve Ended My Career

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By Anonymous Hospitalist and White Coat Reader, Guest Writer

Rage. Shirt-rending, wall-punching, swear-inducing tears of bitter rage is what I felt as the EMR crashed for the fourth time as I tried to complete my fifth admission in the past two hours. If you have ever experienced similar soul-crushing emotions, you have first-hand knowledge of what burnout feels like. My own experience as a physician has ranged from inexpressible joy to the aforementioned tears of bitter rage. As WCI Founder Dr. Jim Dahle has commented on more than one occasion, the biggest threat to your financial well-being is not being able to continue practicing medicine.

This is a post about one such threat.

Absolute Anger with My Job

I am a traveling hospitalist for a multi-state group. Overall, I have enjoyed this position. I have worked at several hospitals in different states, and while the downsides of traveling are significant, the upsides work for my family and me overall. I have a low threshold for boredom, and traveling to different regions every 3-6 months helps mitigate this. I work a traditional seven-on-seven-off schedule, and every week when I come home, my wife and children are happy to see me. I think of it as "The Prodigal Papa" effect. Indeed, toward the end of my week home, my wife, whom I love more than the stars and the sky, starts giving me a look that clearly asks, "So, when are you flying out again?" My children (15 and 17) are old enough not to need me all the time, but when I am home, I can play chauffeur and be present in a way that helps make up for the week I am away. Additionally, it pays well above what I could make as a local hospitalist: $375,000 to travel vs. $300,000 local.

The downsides are also significant. I have missed multiple piano recitals, award ceremonies, and who knows how many opportunities for what I like to think of as "Peak Parenting:" those rare moments of genuine connection with my teenagers as opposed to the typical pushing of boundaries that are part and parcel of the teenage years. One of the biggest downsides is that new hospitals can be very challenging places. There is a reason that the hospital needs a travel hospitalist. It is often because (and I will not put too fine a line on it) they suck to work at. This leads to high turnover and the inability to recruit enough long-term docs. Those who stay are often overworked and feel trapped—either because they are on J-1 visas or they lack mobility due to family commitments.

My own recent horror story included a poor onboarding process: one hour of training on an ancient EMR, and a full panel of 18 patients on Day 1. The first words of greeting were, "Good morning! You are admitting, and there are three patients waiting in the ER." Understaffing and byzantine workflow followed. Six weeks later, I still did not know where to find an EKG in the EMR. I didn't feel too bad, though—none of my colleagues knew either. During my first week, I stayed several hours each day after the shift ended just to make sure my patients received a minimum standard of care.

Adding to the stress was the knowledge that I was not providing the best care. The volumes were too high (average census was in the low- to mid-20s), and incessant interruptions in the form of external transfers, ED admissions, nursing, and case manager calls made it impossible to complete a thought. A constant stream of swears that would make George Carlin blush emitted from my mouth. I couldn't help but badmouth the hospital, the situation, and the unwillingness of the administration to provide relief in the form of an extra clinician. I found myself raging 10 times a day: I could not take care of patients safely. I would get sued, not the hospital, if anyone got hurt. It would be on my conscience if anyone died, all because the hospital did not give me the support I needed to take care of patients. I believe this is what the burnout gurus refer to as moral hazard.

More information here:

How Can I Make My Terrible Doctor Job Less Terrible?

How Suffering Through Storms, Figuratively and Literally, Has Made Me Strong as Oak

Blasting My Boss to His Face

A word of advice. When the CEO runs into you in the cafeteria and asks how it's going, it is not an invitation to actually tell him. To tell him the truth is, as they say, "A Career-Limiting Move." Well, I made this move. What began as well-intentioned feedback became a bile-laden tirade. I told him in no uncertain terms how unsafe it was to practice at his hospital, that we needed another physician and the unwillingness to hire demonstrated the hospital's priority of profit over safety. An F-bomb may have been dropped. Twice. I became the very thing I swore never to become. I was a "Toxic Doctor." I immediately realized I was out of line and apologized to the CEO, but it was not sufficient.

As you can imagine, this led to a heart-to-heart with my boss and my boss's boss. Fortunately, they were both physicians and understood the dynamic to which I was responding. It is fair to say that my job was on the line. Part of me wanted to rail and scream, "I've quit better jobs than this," but another part of me realized that I had lost all perspective. I had embarrassed myself and my company. Yet at the same time, I was responding to a real dynamic. I was wrong in the way that I handled it, but no doctor should regularly be put in a position where they cannot safely take care of patients.

Physicians have incredible resilience. We take care of the sickest people in society. We deliver catastrophic, life-changing news. We work long hours and treat ungrateful patients. Sometimes we do not have the resources we need to deliver the care that our patients deserve. We lament the dehumanizing healthcare industry that treats us as highly paid but ultimately interchangeable and disposable cogs. At some point, like a rubber band that is stretched to the limit, there is no more give. We can no longer absorb any more frustrations, and we snap.

More information here:

Leaving Dentistry and Finding Happiness

rage burnout

How to Make a Toxic Job Better for You

How can we avoid reaching the point of no return where our limbic system takes over and we find ourselves hurling verbal excrement at every little frustration and inconvenience? I don't claim to be an expert, but here are some ideas:

Talk It Out

Address early with your clinical supervisors what you are experiencing. Your medical director may have remarkable insight into the situation. They can offer guidance, resources, and possible workarounds for the untenable aspects of the job. Even if they only offer bromides, by alerting them to the issue early you are giving them a chance to intervene and they are in a better position to work with you if things do lead to a blowup.

Build Your Resilience

Do not take extra shifts. Cut down to full-time. Make sure you are taking vacations. Identify and address the other stressors in your life. If you have money anxieties (and I suspect many white coat investors do, regardless of their income), take a cold hard look at your budget and make adjustments. You may find that you are in a better position than you realize. In my case, I had been picking up too many extra shifts due to tuition anxiety. My two teenagers will be going off to college soon, and we can expect $0 in financial aid. I did some calculations and realized that I don't really need to pick up those extra shifts.

Get a Paid Friend

Professional counseling or coaching works for many people. The White Coat Investor has resources, but that is not the only route available to you. Therapy via your healthcare plan is another option. A third that many organizations provide is an EAP (Employee Assistance Plan) that is completely confidential (unless you are mandated by your employer because you did something egregious).

Make an Exit Strategy

Start planning your next move. Hopefully, you can resolve the situation through discussions and negotiations with your employer. But sometimes a reasonable arrangement cannot be reached. In my case, I requested that my assignment to the intolerable hospital be limited to three months (typical assignments are 3-6 months). I was told that I would be there for six months or more until they could find a replacement. I knew of at least one other doctor who was quitting as soon as his contract was up, and I realized that this was going to be an open-ended commitment. This feeling of being trapped is what pushed me over the edge into complete toxicity. Once I started looking for other travel jobs, having an exit strategy gave me a goal and dissipated much of my anxiety.

Buzzword Alert: Mindfulness

There. I said it. I am the first to be suspicious of any movement or corporate speak buzzword nonsense that tries to shift the burden of burnout to the employee rather than with the system where it firmly belongs. Having said that, I have started using a meditation app that helps me feel about 10% better. It is no panacea, but every little bit helps.

Apologize

If you screw up and lose your poop like I did, it behooves you to apologize as soon as you have the wherewithal to realize you were out of line. Apologies go a long way to repairing the damage you did. It is also the right thing to do.

Things are much better now. After the blowup, my bosses showed remarkable compassion and understanding and worked out a plan to transition me out of the toxic situation. Unfortunately for them, I had already found a similar job with much better pay and benefits. The threat of burnout and the threat to my financial well-being has been mitigated, but given the ever-changing expectations and demands on physicians, advanced practitioners, and other frontline staff, I will continue to be vigilant and look for the early signs of burnout.

What strategies do you use when you reach limbic overload? What strategies have been most helpful and which have been detrimental? Comment below!

[Editor's Note: The author is a traveling Family Medicine-trained hospitalist with more than 15 years of experience. This article was submitted and approved according to our Guest Post Policy. We have no financial relationship.]

The post How My Burnout Led to Rage That Could've Ended My Career appeared first on The White Coat Investor - Investing & Personal Finance for Doctors.

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