Advice for Burned Out in current role?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

insearchofwisdom

Full Member
Joined
Jan 4, 2020
Messages
33
Reaction score
33
I had posted about switching out of my current career role (outpatient subspecialist) a few weeks ago and the main advice I had gotten was to try reducing my hours. Whether I chose it or not, I have had reduced hours/patients during this pandemic time and have been doing telemed from home. I am pretty certain now that I cannot maintain my current career. My practice is awesome and I know how lucky I am to have the job I do, especially at this time. Yet, I'm shocked by how frustrated I get with patients and I know they don't deserve that. It's also not on purpose. I just think this is not a good fit. I've been feeling burned out since residency and I don't think I've been willing to face it head on until now. The constant messages, the phone calls, refills, notes, constant reassurance, inability to take responsibility for their own health, entitlement, pushback, anxiety, patient reviews. I just can't do it anymore. I don't think switching to another IM field is going to bring me fulfillment. I'm also 300K in loans (currently in public service loan forgiveness) so am worried about how I'm going to pay those off. I have thought about nonclinical careers but again, am concerned about loans. I've even thought about going back to residency. I feel a little overwhelmed about how to move forward without feeling like this is how it's going to be forever or how I'm going to pay off loans.
Any thoughts/suggestions?
Thanks in advance.

Members don't see this ad.
 
It sounds like you are really unhappy in your position. Have you ever thought about hospitalist? Deal with more acute issues vs chronic, also probably less patient interaction than endo. Maybe even nocturnist if you don’t want to deal with social issues. If those are not for youthan I would probably consider the non-clinical jobs and take the pay-cut before switching residencies.
 
Last edited:
I had posted about switching out of my current career role (outpatient subspecialist) a few weeks ago and the main advice I had gotten was to try reducing my hours. Whether I chose it or not, I have had reduced hours/patients during this pandemic time and have been doing telemed from home. I am pretty certain now that I cannot maintain my current career. My practice is awesome and I know how lucky I am to have the job I do, especially at this time. Yet, I'm shocked by how frustrated I get with patients and I know they don't deserve that. It's also not on purpose. I just think this is not a good fit. I've been feeling burned out since residency and I don't think I've been willing to face it head on until now. The constant messages, the phone calls, refills, notes, constant reassurance, inability to take responsibility for their own health, entitlement, pushback, anxiety, patient reviews. I just can't do it anymore. I don't think switching to another IM field is going to bring me fulfillment. I'm also 300K in loans (currently in public service loan forgiveness) so am worried about how I'm going to pay those off. I have thought about nonclinical careers but again, am concerned about loans. I've even thought about going back to residency. I feel a little overwhelmed about how to move forward without feeling like this is how it's going to be forever or how I'm going to pay off loans.
Any thoughts/suggestions?
Thanks in advance.


I have friends doing radiology residency after IM residency. Thus there can be zero patient interaction
 
Members don't see this ad :)
Maybe there is something deeper that your unhappiness is rooted in. I agree with trying to minimize work to try and take a breather if you can, but have you considered a therapist?

Medicine is a hard gig and there is a lot of pressure that when combined with other life issues, could easily make it so unbearable.

From reading your post, I think you have some insight that your framing your patient interactions negatively leading to unhappiness. The question is what is troubling you so much that all the interactions are framed in a negative context. It's possible the career just isn't for you, but I think usually it's not the job as much as something else (work environment, loneliness, depression etc...). I think that is key to help you overcome the unhappiness.

Hang in there. We are rooting for you.
 
Maybe there is something deeper that your unhappiness is rooted in. I agree with trying to minimize work to try and take a breather if you can, but have you considered a therapist?

Medicine is a hard gig and there is a lot of pressure that when combined with other life issues, could easily make it so unbearable.

From reading your post, I think you have some insight that your framing your patient interactions negatively leading to unhappiness. The question is what is troubling you so much that all the interactions are framed in a negative context. It's possible the career just isn't for you, but I think usually it's not the job as much as something else (work environment, loneliness, depression etc...). I think that is key to help you overcome the unhappiness.

Hang in there. We are rooting for you.
I came here to say the same exact thing! You need some CBT. And I say that as someone who had pretty bad burnout in the past, but who has now recovered to the point where I actually look forward to work.
You can see that objectively, a lot of things about your job are awesome, but at least part of the problem seems to be an automatic negative emotional reaction to things that shouldn't be so bothersome. CBT is the perfect platform for learning to retrain those automatic thoughts. A therapist would be ideal, but the book "Feeling Good" by David Burns is also really helpful for therapizing oneself.

And about the financial aspect--even on an endo salary, you can easily pay off those loans in 3-5 years if you're really serious about saving. That will give you a lot more freedom to pursue other careers if you need to.
 
  • Like
Reactions: 1 user
The constant messages, the phone calls, refills, notes, constant reassurance, inability to take responsibility for their own health, entitlement, pushback, anxiety, patient reviews.

You're basically describing 21st century medicine, and this is true in many specialties, so I wouldn't switch because you'll likely encounter the same.

If you can find a way to put on the blinders and ignore the bad and the stupid, concentrate on the good, you can make peace with yourself. But you really do have to ignore the bad/stupid. It's hard to ignore, I know. And I don't mean bottle it up inside, I really mean ignore, deflect, don't let it get in your mind/soul. I can't tell you how sick I am of admitting Etoh detox at my hospitals. I spend maybe 2 minutes a day with these worthless people, so that I can spend 45 minutes with my new cancer diagnosis helping her understand what's going on. Yeah, you could accuse me of not having enough compassion for the former, but after the 3rd or 4th repeat admission, I'm done with them. And that's ok. I decide who I have compassion for.

Hobbies help too, you have to find interests outside of medicine. My guitar is never more than 6 feet away.
 
  • Like
Reactions: 1 user
Thanks for the responses. I have plenty of hobbies and do them regularly. That's certainly not the issue. I have really good work/life balance (and I fully recognize that).
"You're basically describing 21st century medicine, and this is true in many specialties, so I wouldn't switch because you'll likely encounter the same."
--> I agree and know this. Hence, why I mentioned I'm not interested in switching to another IM subspecialty (or hospitalist medicine).

Also, I appreciate everyone's response. With all due respect, I'm not particularly interested in the point of view of someone who is a medical student or even a trainee. You guys are absolutely wonderful and I truly appreciate your empathy. You don't actually understand what I'm going through. I know this because I've been in your shoes and I had no idea what it was like on that side (even if I thought I did). I 100% would be judging an attending for posting this when I was a student and think they didn't have it in them. You don't get it. Sorry, but you don't. If "CBT" was the solution to my situation, there wouldn't be a 45% burnout rate among physicians. I've done plenty to address/evaluate my mental health and that's not cutting it as a solution to these frustrations.

Any other thoughts from someone who understands the pressures?
 
Any other thoughts from someone who understands the pressures?
I do understand the pressures. And saying that because there's a high physician burnout rate that intensive therapy, including CBT, isn't "an" (not "the", but "an") answer is a little disingenuous.

I don't think the advice you've gotten from the trainees here is any better or worse than what you've gotten from us "real doctors". You really need to dig deep within yourself to figure out why you're so miserable in your current career, how you might be able to mitigate that and move forward, if mitigation is not an option, how do you see yourself moving forward in medicine, and if you're going to leave medicine altogether, how do you create a successful life for yourself in another career.

You're probably not going to be able to do all that introspection by yourself, so you're going to need to get some help. If that's a CBT therapist, a Freudian therapist, a Jungian or a Peruvian ayahuasca ceremony, it doesn't really matter. But just you and a bunch of internet randos (many of us in therapy of one sort or another) are probably not going to do a great job of moving the ball forward for you.

Good luck.
 
  • Like
Reactions: 1 users
Reviewing your post history, it looks like you're in Endo.

In most outpatient fields, a good number of patients come in with vague complaints that are hard to address. I'm sure in Endo that many patients come with weight gain, and want to know what's wrong with their "glands". Or that they are tired and want more T4, or just plain T, to feel better. This is true of all of the outpatient fields -- Rheum has fibro, Pulm has chronic cough, ID has chronic lyme, etc. Primary care is certainly the same. Many patients don't do what you ask them to do, many will do the exact opposite and then wonder why they are getting worse.

Inpatient fields are honestly not that much different. We have lots of "frequent fliers" with chronic abdominal pain, recurrent CHF due to dietary indiscretion, etc.

So, advice:

1. Find a way to enjoy, even if just a little bit, these routine cases. You know that getting your diabetics to lose weight is very, very difficult. 90%, or more, won't. So celebrate the 5 or 10% who do. Those are the wins you're looking for. If you can really help 1 person out of 20, you're doing really well. Don't get discouraged by those other 19. Hard to do, I know. It's a change in your mindset.

2. Hyperspecialize. If you're able, you can pick one niche and build a panel from there. If you're in Endo, that might be T1DM on pumps, or managing hormone therapy for trans patients, or whatever. If there are certain patients that you do like taking care of, can you find a way to enrich your practice in them?

3. Be creative, work outside the box. You're frustrated that your patients don't lose weight? Fine. See if you can find a solution. Clearly coming and seeing you in clinic isn't working -- that's not your fault, patients are unlikely to lose weight coming to visits. Can you do something outside visits -- short video based visits, shared exercise classes, tapeworms in snacks you put in the waiting room (OK, perhaps that's not a great idea...). I don't know, but maybe you do? It will totally depend upon your environment -- how much support you have, your patient mix, etc.

4. Work part time, and add something else. What else do you want to do? Could be clinical: work in a nursing home, be an expert witness, UR / case review. Or non clinical: Write a book, code a website, build a house. Politics. Stand up comedy. I can't tell you what to do, but safer than giving up your whole clinical practice is downsizing it and adding something else that might become an income stream.

5. If you like teaching, see if there's a way to get a student involved in your practice.
 
  • Like
Reactions: 4 users
Reviewing your post history, it looks like you're in Endo.

Great post, I'm going to add to it and be way more crass.

Many patients don't do what you ask them to do, many will do the exact opposite and then wonder why they are getting worse.

Good, then let 'em go home, whither away and die. If you don't listen do your doctors/nurses/healthcare workers who've tried to take good care of you on multiple occasions, then peace out. And for that matter, stop going to the doctor, what's the point?

So celebrate the 5 or 10% who do.

Absolutely! No only should you celebrate them, but these are the patients you should spend most of your time with. You're more likely to make a positive effect with the patient who's bought off on what you're telling them and willing to change.

Don't get discouraged by those other 19.

Not only should you not get discouraged, you should flat out ignore them. Do what you can from a professional standpoint, make a good first attempt, second attempt, but at some point move on.

3. Be creative, work outside the box. You're frustrated that your patients don't lose weight? Fine. See if you can find a solution.

Certainly make an attempt, but again, at some point, you just have to move on. What causes a lot of burnout in our profession is the relentless efforts that we make to fix people who just don't want to be fixed (whether their issues be social or medical). To our credit, we are relentless, and we work hard, but to our own demise, and this isn't fair to us.

We're not cops---I shouldn't have to interrogate a patient to get him/her to tell me the truth. We're not life-coaches; I don't live with the patient and knock 'em over the head when they do stupid things. That's what your spouse is for.
 
  • Like
Reactions: 1 users
Thanks for all of your responses and for everyone's empathy. I didn't meant to make it sound like the trainees don't have great advice. They absolutely do and I appreciate that advice also. It's just that telling me to get CBT as the answer is akin to hospitals telling their docs that in order to prevent burnout, they should eat healthy/meditate/exercise. It's not cutting it. I actively focus on self-development and self-reflection on a daily basis and it's not helping this situation. Maybe certain jobs just aren't right for certain people? I'm a naturally creative/curious person so have plenty of other hobbies on the side that I engage in regularly.
I appreciate NotAProgDirector's tips and a lot of those make sense to me. The only thing is I think I'm in a place of burnout right now that I have trouble even finding the joy in successful patients. It's not the outcomes that are bothersome to me, it's the way people treat you. I know we're supposed to "get over that" but that's exactly what I'm having a hard time "getting over." The get this done/respond to me "ASAP" mentality, the "you're my doctor so you have to hear every detail of my entire existence" mentality, the I have 3gazillion questions, I get to yell at you and you just have to deal with it, the bullying (yes, bullying), the I disagree with your evaluation so I'm going to complain about you to hospital admin until you agree with my own evaluation (why not just get another opinion?), I'm only willing to get a call back from MD, you need to earn my trust, why can't this just be done through a portal, I'm super late but it's ridiculous you won't fit me in, I don't have time to come in but you still need to take care of me, etc, etc, etc. I've been trying to set boundaries but I'm just done with it. So much of my energy gets depleted just trying to set basic boundaries that I'm exhausted. I think I'm a worse person in regular life now than ever before because I'm sick of dealing with the entitlement, being people's scapegoat/punching bag and it STILL not being enough. We would NEVER accept someone treating us this way in our personal relationships and yet we're supposed to just accept it constantly all day from patients? I don't want to anymore. I fully understand that people have underlying concerns/issues/emotions, etc but I don't think I have anymore understanding/empathy left to give them. I totally get it that this is relevant in most medicine specialties and it's not just me that deals with this. Maybe I'm more sensitive to it than others. Maybe I have higher expectations of common courtesy than others. I don't know if the part of me that expects a basic mutual respect and understanding is ever going to fully excuse people's maladjusted behavior. Which makes me wonder if direct patient care is just not well-suited for me...
 
  • Like
Reactions: 1 users
Thanks for all of your responses and for everyone's empathy. I didn't meant to make it sound like the trainees don't have great advice. They absolutely do and I appreciate that advice also. It's just that telling me to get CBT as the answer is akin to hospitals telling their docs that in order to prevent burnout, they should eat healthy/meditate/exercise. It's not cutting it. I actively focus on self-development and self-reflection on a daily basis and it's not helping this situation. Maybe certain jobs just aren't right for certain people? I'm a naturally creative/curious person so have plenty of other hobbies on the side that I engage in regularly.
I appreciate NotAProgDirector's tips and a lot of those make sense to me. The only thing is I think I'm in a place of burnout right now that I have trouble even finding the joy in successful patients. It's not the outcomes that are bothersome to me, it's the way people treat you. I know we're supposed to "get over that" but that's exactly what I'm having a hard time "getting over." The get this done/respond to me "ASAP" mentality, the "you're my doctor so you have to hear every detail of my entire existence" mentality, the I have 3gazillion questions, I get to yell at you and you just have to deal with it, the bullying (yes, bullying), the I disagree with your evaluation so I'm going to complain about you to hospital admin until you agree with my own evaluation (why not just get another opinion?), I'm only willing to get a call back from MD, you need to earn my trust, why can't this just be done through a portal, I'm super late but it's ridiculous you won't fit me in, I don't have time to come in but you still need to take care of me, etc, etc, etc. I've been trying to set boundaries but I'm just done with it. So much of my energy gets depleted just trying to set basic boundaries that I'm exhausted. I think I'm a worse person in regular life now than ever before because I'm sick of dealing with the entitlement, being people's scapegoat/punching bag and it STILL not being enough. We would NEVER accept someone treating us this way in our personal relationships and yet we're supposed to just accept it constantly all day from patients? I don't want to anymore. I fully understand that people have underlying concerns/issues/emotions, etc but I don't think I have anymore understanding/empathy left to give them. I totally get it that this is relevant in most medicine specialties and it's not just me that deals with this. Maybe I'm more sensitive to it than others. Maybe I have higher expectations of common courtesy than others. I don't know if the part of me that expects a basic mutual respect and understanding is ever going to fully excuse people's maladjusted behavior. Which makes me wonder if direct patient care is just not well-suited for me...
Burnout... All the books, or recommendations that people are throwing at doctors for burnout I am quite skeptical of. At the end of the day, the issues are larger than integrating mindfulness. The Big Box Shops have a bunch of admin that have declared that lack of control in patient management is acceptable. That you are not a physician, that you are a "provider" and interchangeable with an ARNP. You must do what they say and be 110% customer service oriented because you are in the service industry - never mind the fact that you a professional delivering professional services which is different.

Regain your control by opening your own practice. Patients treat you like crap, follow the appropriate protocol by your state medical board to discharge them from your practice. Don't want to take medicare or medicaid? Don't. Don't want to squeeze patients in when they show up late, don't. Want to get back to people in 2-3 business days, do so with a policy and expectations from the initial consultation.

Own and run your own practice, you set the quality, you set the policies. You regain more control of your career, your practice.

For me, opening my own practice its been a massive breath of fresh air. I feel rejuvenated again, and when these dragging situations pop up I'm better able to handle them.
 
  • Like
Reactions: 1 users
Thanks for all of your responses and for everyone's empathy. I didn't meant to make it sound like the trainees don't have great advice. They absolutely do and I appreciate that advice also. It's just that telling me to get CBT as the answer is akin to hospitals telling their docs that in order to prevent burnout, they should eat healthy/meditate/exercise. It's not cutting it. I actively focus on self-development and self-reflection on a daily basis and it's not helping this situation. Maybe certain jobs just aren't right for certain people? I'm a naturally creative/curious person so have plenty of other hobbies on the side that I engage in regularly.
I appreciate NotAProgDirector's tips and a lot of those make sense to me. The only thing is I think I'm in a place of burnout right now that I have trouble even finding the joy in successful patients. It's not the outcomes that are bothersome to me, it's the way people treat you. I know we're supposed to "get over that" but that's exactly what I'm having a hard time "getting over." The get this done/respond to me "ASAP" mentality, the "you're my doctor so you have to hear every detail of my entire existence" mentality, the I have 3gazillion questions, I get to yell at you and you just have to deal with it, the bullying (yes, bullying), the I disagree with your evaluation so I'm going to complain about you to hospital admin until you agree with my own evaluation (why not just get another opinion?), I'm only willing to get a call back from MD, you need to earn my trust, why can't this just be done through a portal, I'm super late but it's ridiculous you won't fit me in, I don't have time to come in but you still need to take care of me, etc, etc, etc. I've been trying to set boundaries but I'm just done with it. So much of my energy gets depleted just trying to set basic boundaries that I'm exhausted. I think I'm a worse person in regular life now than ever before because I'm sick of dealing with the entitlement, being people's scapegoat/punching bag and it STILL not being enough. We would NEVER accept someone treating us this way in our personal relationships and yet we're supposed to just accept it constantly all day from patients? I don't want to anymore. I fully understand that people have underlying concerns/issues/emotions, etc but I don't think I have anymore understanding/empathy left to give them. I totally get it that this is relevant in most medicine specialties and it's not just me that deals with this. Maybe I'm more sensitive to it than others. Maybe I have higher expectations of common courtesy than others. I don't know if the part of me that expects a basic mutual respect and understanding is ever going to fully excuse people's maladjusted behavior. Which makes me wonder if direct patient care is just not well-suited for me...
Wow. This actually made me smile and appreciate being an anesthesiologist.
Many of the reasons I did not go into IM was the stuff you posted. I can’t stand people who don’t take responsibility and that is actually most patients.
Good luck. Sucks that you have such a difficult time. Totally understandable.
Agree with the above poster that if you are an employee, open up your own shop. I don’t understand why so many docs these days want to be employed instead.
 
  • Like
Reactions: 1 user
Thanks for all of your responses and for everyone's empathy. I didn't meant to make it sound like the trainees don't have great advice. They absolutely do and I appreciate that advice also. It's just that telling me to get CBT as the answer is akin to hospitals telling their docs that in order to prevent burnout, they should eat healthy/meditate/exercise. It's not cutting it. I actively focus on self-development and self-reflection on a daily basis and it's not helping this situation. Maybe certain jobs just aren't right for certain people? I'm a naturally creative/curious person so have plenty of other hobbies on the side that I engage in regularly.
I appreciate NotAProgDirector's tips and a lot of those make sense to me. The only thing is I think I'm in a place of burnout right now that I have trouble even finding the joy in successful patients. It's not the outcomes that are bothersome to me, it's the way people treat you. I know we're supposed to "get over that" but that's exactly what I'm having a hard time "getting over." The get this done/respond to me "ASAP" mentality, the "you're my doctor so you have to hear every detail of my entire existence" mentality, the I have 3gazillion questions, I get to yell at you and you just have to deal with it, the bullying (yes, bullying), the I disagree with your evaluation so I'm going to complain about you to hospital admin until you agree with my own evaluation (why not just get another opinion?), I'm only willing to get a call back from MD, you need to earn my trust, why can't this just be done through a portal, I'm super late but it's ridiculous you won't fit me in, I don't have time to come in but you still need to take care of me, etc, etc, etc. I've been trying to set boundaries but I'm just done with it. So much of my energy gets depleted just trying to set basic boundaries that I'm exhausted. I think I'm a worse person in regular life now than ever before because I'm sick of dealing with the entitlement, being people's scapegoat/punching bag and it STILL not being enough. We would NEVER accept someone treating us this way in our personal relationships and yet we're supposed to just accept it constantly all day from patients? I don't want to anymore. I fully understand that people have underlying concerns/issues/emotions, etc but I don't think I have anymore understanding/empathy left to give them. I totally get it that this is relevant in most medicine specialties and it's not just me that deals with this. Maybe I'm more sensitive to it than others. Maybe I have higher expectations of common courtesy than others. I don't know if the part of me that expects a basic mutual respect and understanding is ever going to fully excuse people's maladjusted behavior. Which makes me wonder if direct patient care is just not well-suited for me...

Appreciate your posts as well. Many of us share the same sentiments


Sent from my iPhone using Tapatalk
 
Top