Transition Out of IM Subspecialty as an Attending?

[insearchofwisdom]

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Hello, I am currently an internal medicine subspecialist and have been an attending for 3.5 years. I am quite unfulfilled at my job, physically/mentally/emotionally worn out. I have been trying to pay close attention to what is making me feel this way because hard work is not something I have trouble with and have come to really identify it truly is patient interactions/expectations. If I'm honest with myself, in hindsight, I've been burned out since right after intern year and have not really enjoyed talking to patients. I thought residency and fellowship and being a new attending were "supposed to" feel like this but I'm realizing I think I'm ignoring a problem that's very real. I love talking to people but I can't stand person after person complaining 90% of the time and dealing with entitlement/anger/depression/anxiety/noncompliance. It's exhausting and it's not fair to the patients I treat that I feel this way. Of note, I am already on to job #2 and actually feel worse despite the job itself being great.

I have contemplated a switch into a different specialty but the only one I can think of without substantial direct patient care is radiology. I'm actually considering this which is crazy because it's 4+ more years of training. Also considering pharma, consulting, healthcare administration, advocacy work, other non-clinical careers.

Any suggestions or thoughts about things that would help me figure out what to do next? I sort of don't want to leave clinical medicine but if I keep doing what I'm doing now, I will soon develop health issues. Is switching to radiology crazy? Is it better to considering non-clinical careers? Is there something else I should be doing first?

Thank you in advance.

 

[Gastrapathy]

I think the first question is whether you can be happy if you work half time. Cutting back dramatically and giving yourself a couple years to recharge and then reassess. You could pursue non clinical options at the same time but without dropping out completely and with some cash flow still coming in. The reality is that a 50% physician job is still a high paying job. Maybe work 2 days a week. See what happens.
Best of luck

 

[chessknt]

Agree that burnout can cloud judgement significantly, try taking a few months off or cutting to 5 days per month or something of that nature and see if you still feel that way. There is no easy transition to non clinical careers as a physician without the right connections

 

[gutonc]

Agree with cutting back your time to get some space for rest/reflection.

If you came to me with this concern, and I thought you were a solid member of my staff, I'd rather have you work PT to help you get your head straight and figure out what the best way forward is for you, than have you crash and burn leading to patient, physician and staff dissatisfaction in the office.

I would also suggest that you would benefit from spending some time with a therapist. I have found it immensely useful myself and I can easily tell you which of my physicians see a therapist and which ones don't.

 

[insearchofwisdom]

I can’t really work part time. I have a lot of student debt and own a home and as you know, endo salaries aren’t exactly lucrative. Even if I did for a few weeks and felt better, when I go back to full time, it would be the same way. I can’t not work full time to have reasonable finances.

 

[CCM-MD]

I can’t really work part time. I have a lot of student debt and own a home and as you know, endo salaries aren’t exactly lucrative. Even if I did for a few weeks and felt better, when I go back to full time, it would be the same way. I can’t not work full time to have reasonable finances.

You're saying you can't afford to work part time but would be willing to consider committing close to 1 million dollars in opportunity cost while training in a new specialty.

 

[gutonc]

You're saying you can't afford to work part time but would be willing to consider committing close to 1 million dollars in opportunity cost while training in a new specialty.

Horse to water man...horse to water.

 

[insearchofwisdom]

You're saying you can't afford to work part time but would be willing to consider committing close to 1 million dollars in opportunity cost while training in a new specialty.

Haha, very well pointed out. Well temporarily I can. If I took a significant pay cut for a better future, yes, I'll figure it out. Also, I've done the math and if I did certain other paths, I could make up for the reduced salary after working for a few years. But to cut back on hours knowing that I'm not actually changing anything and considering only a part-time job for the rest of my life... honestly, that doesn't make sense and it's not who I am. I want to work full-time but just am not getting fulfillment in talking to patients all day. The only suggestions I've been given is reduce your hours or work part-time and I know reflection is part of this but that's not really a solution if my options become work part-time and maybe feel more content or work full-time and be burned out.

Also, btw, this should be a helpful forum. Physicians are supposed to help each other out, not try to make others feel worse for being honest about their concerns. Feel free to point things out but if you're looking to taunt, please don't contribute to my question.
Thanks for anyone who is trying to help.

 

[PugsAndHugs]

If I took a significant pay cut for a better future, yes, I'll figure it out.

I think becoming part time (and taking the pay cut) so you can focus on yourself for a short time can also lead to a better future, but in a different way. Having that extra time for yourself will definitely help with the burn-out that you said you’ve felt since the end of intern year. This is definitely a less abrupt than doing a complete career change. I think trying this out first can be the best option, and if you still feel the same way you feel now, then consider your other options. I am sorry that you are going through this, I am actually going into IM and am most likely going into Endo so this upsets me to read. Good luck!

 

[rokshana]

Haha, very well pointed out. Well temporarily I can. If I took a significant pay cut for a better future, yes, I'll figure it out. Also, I've done the math and if I did certain other paths, I could make up for the reduced salary after working for a few years. But to cut back on hours knowing that I'm not actually changing anything and considering only a part-time job for the rest of my life... honestly, that doesn't make sense and it's not who I am. I want to work full-time but just am not getting fulfillment in talking to patients all day. The only suggestions I've been given is reduce your hours or work part-time and I know reflection is part of this but that's not really a solution if my options become work part-time and maybe feel more content or work full-time and be burned out.

Also, btw, this should be a helpful forum. Physicians are supposed to help each other out, not try to make others feel worse for being honest about their concerns. Feel free to point things out but if you're looking to taunt, please don't contribute to my question.
Thanks for anyone who is trying to help.

It is a helpful forum, but that doesn’t mean that people are only going to tell you what you want to hear...you must be new to SDN not to know that when people post here, they have to expect all sorts of answers.

What makes you think that you will be happy doing radiology? What happens if you manage to a radiology residency, spend 4 years as a resident and then decide that the grass is not greener.

There are other non clinical jobs that you can do if patient contact is really the thing that is burning you out...pharma, admin, etc...

Agree with gutonc, you really should talk to someone professionally (therapist) to figure out what the real issue is...

Heck work locums endo or hospitalist part time and you can make good money and still have 2 weeks off a month.

 

[rokshana]

I think becoming part time (and taking the pay cut) so you can focus on yourself for a short time can also lead to a better future, but in a different way. Having that extra time for yourself will definitely help with the burn-out that you said you’ve felt since the end of intern year. This is definitely a less abrupt than doing a complete career change. I think trying this out first can be the best option, and if you still feel the same way you feel now, then consider your other options. I am sorry that you are going through this, I am actually going into IM and am most likely going into Endo so this upsets me to read. Good luck!

Most of us are frustrated with the issues that face us as endocrinologists, but no different than the crap every other specialties out there but most of my peers are happy that we are doing endocrine.

 

[insearchofwisdom]

I think becoming part time (and taking the pay cut) so you can focus on yourself for a short time can also lead to a better future, but in a different way. Having that extra time for yourself will definitely help with the burn-out that you said you’ve felt since the end of intern year. This is definitely a less abrupt than doing a complete career change. I think trying this out first can be the best option, and if you still feel the same way you feel now, then consider your other options. I am sorry that you are going through this, I am actually going into IM and am most likely going into Endo so this upsets me to read. Good luck!

I think it's super important to mention that you shouldn't take 1 person's experience and assume it will apply to you. My frustrations are not specific to Endo. They're true all across the board. A lot of friends/colleagues thrive on Endo so you should still do what you're drawn to and hopefully you'll love it more than I do.

 

[insearchofwisdom]

It is a helpful forum, but that doesn’t mean that people are only going to tell you what you want to hear...you must be new to SDN not to know that when people post here, they have to expect all sorts of answers.

What makes you think that you will be happy doing radiology? What happens if you manage to a radiology residency, spend 4 years as a resident and then decide that the grass is not greener.

There are other non clinical jobs that you can do if patient contact is really the thing that is burning you out...pharma, admin, etc...

Agree with gutonc, you really should talk to someone professionally (therapist) to figure out what the real issue is...

Heck work locums endo or hospitalist part time and you can make good money and still have 2 weeks off a month.

Thanks. Like I mentioned above I am very open to insights and welcome them, just not when it's taunting. I didn't necessarily say I know I'm going to love radiology. Obviously, I would do due diligence in exploring that. I don't plan to jump in blindly. Same goes for pharma, admin, etc.
The therapist thing and talking through this - already doing. Haven't found it to help much and if anything is making me even more want to leave as we unfold.
I think I know what the real issue is. It feels like patients have no boundaries and we just have to deal with it. I don't want to. Plain and simple. Physicians don't set boundaries and I don't really want to work that way. We do SO much free work and get negative comments despite this. Lawyers won't write a 2 line letter without billing for it. I spend hours and hours interpreting results, calling patients, answering portal messages, fitting them in because they didn't schedule on time, getting yelled at, being told they're "upset" I didn't respond to results within minutes to hours, getting paged. They'll forward me results ordered by another doctor and I am told I have to just manage them via online portals. All of this is free work. And despite all of that, they still come in being super entitled and tell me I'm not listening enough. I don't feel like dealing with that anymore. Of course this isn't everyone but it's substantial enough that I'm tired of it.

Was just looking for some suggestions/thoughts about next steps but it sounds like mostly it's cut down on hours and reflect.

 

[Chemist0157]

Just my random thoughts.

I would consider transitioning to one of the other paths you already mentioned (administration, etc).

I would consider going back to residency and doing something like radiology as a last, last, last resort. No guarantee you would be any happier and huge cost.

You might be surprised by cutting back time some just to be able to reset better. That's part of burn out, never really having a chance to recover.

I would not consider interpreting results, calling patients, etc as free work. That's part of why you are paid. Some of it can be annoying ("Is Tylenol okay for for GFR 59?"), but some of what you listed is just part of being a physician.

 

[rokshana]

Just my random thoughts.

I would consider transitioning to one of the other paths you already mentioned (administration, etc).

I would consider going back to residency and doing something like radiology as a last, last, last resort. No guarantee you would be any happier and huge cost.

You might be surprised by cutting back time some just to be able to reset better. That's part of burn out, never really having a chance to recover.

I would not consider interpreting results, calling patients, etc as free work. That's part of why you are paid. Some of it can be annoying ("Is Tylenol okay for for GFR 59?"), but some of what you listed is just part of being a physician.

You don’t do clinic work do you? It not compensated work to stay hours after clinic to do these things...though you can now bill for non face to face work as well as addressing portal/email issues...there are restrictions on how often it can be done.

 

[rokshana]

Thanks. Like I mentioned above I am very open to insights and welcome them, just not when it's taunting. I didn't necessarily say I know I'm going to love radiology. Obviously, I would do due diligence in exploring that. I don't plan to jump in blindly. Same goes for pharma, admin, etc.
The therapist thing and talking through this - already doing. Haven't found it to help much and if anything is making me even more want to leave as we unfold.
I think I know what the real issue is. It feels like patients have no boundaries and we just have to deal with it. I don't want to. Plain and simple. Physicians don't set boundaries and I don't really want to work that way. We do SO much free work and get negative comments despite this. Lawyers won't write a 2 line letter without billing for it. I spend hours and hours interpreting results, calling patients, answering portal messages, fitting them in because they didn't schedule on time, getting yelled at, being told they're "upset" I didn't respond to results within minutes to hours, getting paged. They'll forward me results ordered by another doctor and I am told I have to just manage them via online portals. All of this is free work. And despite all of that, they still come in being super entitled and tell me I'm not listening enough. I don't feel like dealing with that anymore. Of course this isn't everyone but it's substantial enough that I'm tired of it.

Was just looking for some suggestions/thoughts about next steps but it sounds like mostly it's cut down on hours and reflect.

Sound like you need a different job...yes you can place boundaries on your patients...and the good thing about being endo ( or any sub specialty) it that if things are not working...you can send them back to their pcp.

Frankly, I rarely call patients...that is what my MA/nurses do...but I also spend time in my visit to explain what we are doing and what the outcomes are and what to expect. They know normal results will be posted or sent to them, but not getting a phone call from me.Otherwise, they are coming in for an appt.
The only refills that are getting done on an emergent or after hours basis, insulin and hydrocortisone, otherwise filled via the refill line.

Other people’s orders,results,Rx...talk to the other person.

YOU have to set the expectations and then stick with them.

While we(endos) are not paid well per se, we are not a dime a dozen...the demand is there (wait times are easily 4-6 months for a new appt)...you need to speak up for yourself.

Sounds like maybe a change in patient demographics could help...I work in places where there is lack of care...patients May travel 1-2 hours just to see an endo...they are generally truly sick and are gratefully for the fact that you are there to see them...knowing that you are appreciated sometimes makes it easier to go the extra mile.

Good luck!

 

[Chemist0157]

You don’t do clinic work do you? It not compensated work to stay hours after clinic to do these things...though you can now bill for non face to face work as well as addressing portal/email issues...there are restrictions on how often it can be done.

I would not comment if I did not do clinic work. I cannot function as a physician without reviewing labs so I do not see that as "free work." MAs handle most of the calls, but I do some calls also if the conversation is more nuanced. Maybe you feel differently about all that.

I was also going to mention that some of this can be billable, especially if something like telemedicine becomes more ubiquitous. I left it out however as I do not have much experience with it.

 

[Gastrapathy]

@insearchofwisdom

the emotional component of your reaction when you didn’t like the advice that was freely given just shows that you really are burned out. It’s the wrong time to make decisions. You aren’t going part time as a long term plan. You are doing it to recharge so the next decision you make comes with a clear head and the best chance at getting it right. Cut yourself some slack and heal.

 

[insearchofwisdom]

@insearchofwisdom

the emotional component of your reaction when you didn’t like the advice that was freely given just shows that you really are burned out. It’s the wrong time to make decisions. You aren’t going part time as a long term plan. You are doing it to recharge so the next decision you make comes with a clear head and the best chance at getting it right. Cut yourself some slack and heal.

Thanks, I had the same thought to feeling a bit sensitive to the comment above. I was trying to understand what going part time would give me but clarity for making the best step makes sense. I appreciate the direct but empathic response.

 

[insearchofwisdom]

Sound like you need a different job...yes you can place boundaries on your patients...and the good thing about being endo ( or any sub specialty) it that if things are not working...you can send them back to their pcp.

Frankly, I rarely call patients...that is what my MA/nurses do...but I also spend time in my visit to explain what we are doing and what the outcomes are and what to expect. They know normal results will be posted or sent to them, but not getting a phone call from me.Otherwise, they are coming in for an appt.
The only refills that are getting done on an emergent or after hours basis, insulin and hydrocortisone, otherwise filled via the refill line.

Other people’s orders,results,Rx...talk to the other person.

YOU have to set the expectations and then stick with them.

While we(endos) are not paid well per se, we are not a dime a dozen...the demand is there (wait times are easily 4-6 months for a new appt)...you need to speak up for yourself.

Sounds like maybe a change in patient demographics could help...I work in places where there is lack of care...patients May travel 1-2 hours just to see an endo...they are generally truly sick and are gratefully for the fact that you are there to see them...knowing that you are appreciated sometimes makes it easier to go the extra mile.

Good luck!

I’m not sure I necessarily want to live in a small town quite yet but I can definitely see how different that is. I’ve been trying to put restrictions/boundaries in place in different ways but our hospital also is obsessed with patient reviews so if I get bad reviews, it just really wears me down even more. Furthermore, reviews can be public and getting told I am “horrible” for the world to see is upsetting.
If some other doc checks your patient’s thyroid labs and they came in 2 months ago, you’ll still make them come in to review?
Also we can’t bill for portal stuff so that’s frustrating.

 

[rokshana]

I’m not sure I necessarily want to live in a small town quite yet but I can definitely see how different that is. I’ve been trying to put restrictions/boundaries in place in different ways but our hospital also is obsessed with patient reviews so if I get bad reviews, it just really wears me down even more. Furthermore, reviews can be public and getting told I am “horrible” for the world to see is upsetting.
If some other doc checks your patient’s thyroid labs and they came in 2 months ago, you’ll still make them come in to review?
Also we can’t bill for portal stuff so that’s frustrating.

I tell them at their first visit, that I’m the only one that should order their labs...that way they come to me to review...if it’s for dose change, then a rx gets sent, if normal, they know that they will get the results, either mail, nurse calling, or portal.
It’s about expectations and setting the ground rules...the pts that think like you will stay...those that “know their body” will leave and those “bad” reviews... they keep those like pts away from you.

 

[insearchofwisdom]

I tell them at their first visit, that I’m the only one that should order their labs...that way they come to me to review...if it’s for dose change, then a rx gets sent, if normal, they know that they will get the results, either mail, nurse calling, or portal.
It’s about expectations and setting the ground rules...the pts that think like you will stay...those that “know their body” will leave and those “bad” reviews... they keep those like pts away from you.

Thanks. I’ve been trying to set more expectations in place but every tip on this is helpful. Maybe I can start telling people that I don’t interpret labs from other docs at my first visit and that can decrease some of that.
Any suggestions on people who make everything your fault? Like if you wanted me to come in 6 weeks later for labs/visit (like my written message recommended), then how dare your schedulers schedule me for 4 weeks? Why are my labs not perfect yet; they “better be” at the next check. How could you not fit me in immediately when I walked all the way here even though I was 25 min late for my visit?
Those types of things...

 

[timpview]

Have the front desk/nurses be the bad guys. If those are your rules they stick to them. You shouldn’t even hear it. It’ll take one round for the patients to get it. If not let them get another doc. Who cares.

i delete, don’t care and don’t respond to anything that I didn’t order. If it’s something trying crazy I might quick text a message to my nurse to call a pt to tell them to speak to their doc that ordered it (some crazy ct finding)

cut back your schedule pts by 5. Do it tomorrow. If you see 23, see 18. Having just a little room can make a huge difference for longER appts, late, walkins. Otherwise stick to rule 1.

I never talk with any pt on the phone. Nurse calls back results. If it’s slightly complicated or requires conversation then another appt is booked

before I switched residencies or careers I would do the above, try locums or even be a hospitalist Which you could easily do with your IM training.

 

[insearchofwisdom]

Have the front desk/nurses be the bad guys. If those are your rules they stick to them. You shouldn’t even hear it. It’ll take one round for the patients to get it. If not let them get another doc. Who cares.

i delete, don’t care and don’t respond to anything that I didn’t order. If it’s something trying crazy I might quick text a message to my nurse to call a pt to tell them to speak to their doc that ordered it (some crazy ct finding)

cut back your schedule pts by 5. Do it tomorrow. If you see 23, see 18. Having just a little room can make a huge difference for longER appts, late, walkins. Otherwise stick to rule 1.

I never talk with any pt on the phone. Nurse calls back results. If it’s slightly complicated or requires conversation then another appt is booked

before I switched residencies or careers I would do the above, try locums or even be a hospitalist Which you could easily do with your IM training.

Thanks. Those are some good ideas.
One question - sometimes I WANT to get out of the room as fast as possible. Especially when people complain about weight gain (but of course they eat "really healthy"), fatigue or hair loss. Also, when they just keep telling me something isn't right or they KNOW they have a hormone problem. Or just when they self-indulgingly have a victim mindset or just want to keep complaining. Technically, they're entitled to this because they're supposed to come in being able to discuss their concerns in a safe space. It literally makes me want to tear my own hair out. Does everyone feel this way? Does that improve with cutting back on hours? How frequently I feel this way in a typical day is what I think is frankly unfair to patients. They deserve a more compassionate doctor. Instead, I don't WANT to be in the room with them any longer. I want them to be reasonable and stop obsessing over fatigue. Who ISN'T fatigued? I feel like patients deserve better than what I can give them right now.

 

[tantacles]

Thanks. Those are some good ideas.
One question - sometimes I WANT to get out of the room as fast as possible. Especially when people complain about weight gain (but of course they eat "really healthy"), fatigue or hair loss. Also, when they just keep telling me something isn't right or they KNOW they have a hormone problem. Or just when they self-indulgingly have a victim mindset or just want to keep complaining. Technically, they're entitled to this because they're supposed to come in being able to discuss their concerns in a safe space. It literally makes me want to tear my own hair out. Does everyone feel this way? Does that improve with cutting back on hours? How frequently I feel this way in a typical day is what I think is frankly unfair to patients. They deserve a more compassionate doctor. Instead, I don't WANT to be in the room with them any longer. I want them to be reasonable and stop obsessing over fatigue. Who ISN'T fatigued? I feel like patients deserve better than what I can give them right now.

What's interesting is that many of these concerns come up during my hospitalist shifts and I feel the same way. They also come up during my primary care visits, and I feel the same way. For me, the feeling of having a patient who is appropriately focused but not fixated is wonderful. That interview will take 5-10 minutes (closer to 5). The patient who has an agenda that I don't care about in terms of their presenting problem takes longer and is clearly the more arduous to interview.

But honestly, some of this is just medicine. Patients aren't focused. There have been many times, and there will be myriad more once I finish my training in three months, where an interview is going too long and the time of the interview does not match the amount of time I have to spend. I sometimes try to redirect the patient. Sometimes that works. "Ok, you've had nausea for 5 days, but what changed today about your nausea to make you come to the ED?", "Well, 20 years ago, I had a thyroid problem, and I have a cousin that had angina last week BLAH BLAH BLAH."

That is to say that many of the problems you seem be experiencing with your patients are just the generalized problems of medicine and the worried well (or sometimes the encephalopathic and worried sick, I suppose . . .). Hard to parse out, though, if the endocrine piece of the puzzle would bother you more or less than being a hospitalist.

So here's what I propose. At the very least, go part time. In that time period, try to get credentialed at a hospital to do some hospitalist work if your job allows, or try to negotiate that with your employer if possible. During your more extensive free time, do a few shifts! See if it's more fulfilling for you.

There are many things you may (or may not!) discover. Let me list some of them!

1. It's not the endocrine itself that's burning you out, but rather the setting you're practicing it is.
2. The endocrine is burning you out, and the setting you're practicing in is making it worse.
3. Variety is the spice of life and doing some hospitalist work in addition to endocrine work is fulfilling
4. Hospitalist work sucks and it makes you realize how awesome your endocrine position is.
5. Hospitalist work is awesome and HELL, I'll just do this for the rest of my life instead of endocrine or until I get bored of it.
6. I just needed time off and hospitalist work is just as bad.
7. I still have no idea what's going on, and I'm glad I took time off.
8. I still have no idea what's going on, and I wish I hadn't taken time off.
9. I'm bored
10. I need to work out more.
11. My butt itches, but I took a shower.

And my personal favorite:

12. I'm just burnt out with medicine. No change in patient population or specialty could actually make this better.

Oh my GOD stream of consciousness lists are SO SATISFYING. GRAH.

And I hope it's not the last one, but I think taking time off and exploring something else within your licensure could provide a lot of perspective.

 

[rokshana]

Thanks. Those are some good ideas.
One question - sometimes I WANT to get out of the room as fast as possible. Especially when people complain about weight gain (but of course they eat "really healthy"), fatigue or hair loss. Also, when they just keep telling me something isn't right or they KNOW they have a hormone problem. Or just when they self-indulgingly have a victim mindset or just want to keep complaining. Technically, they're entitled to this because they're supposed to come in being able to discuss their concerns in a safe space. It literally makes me want to tear my own hair out. Does everyone feel this way? Does that improve with cutting back on hours? How frequently I feel this way in a typical day is what I think is frankly unfair to patients. They deserve a more compassionate doctor. Instead, I don't WANT to be in the room with them any longer. I want them to be reasonable and stop obsessing over fatigue. Who ISN'T fatigued? I feel like patients deserve better than what I can give them right now.

Unless you have found an actual endocrine problem, why are you keeping them and not sending back to their pcp?

For these questionable ( but probably not really) endocrine issues... I say, that I, as an endocrinologist, will look to see if there is an endo reason for your issues...if we find that there is no endocrine issues, then at least we can cross it off the list. It is not that your symptoms are not real or an issue, but this will help your pcp to see if there is something else... Discharge to pcp...done.

Have someone review these referrals And see if these “consults” are legit and if not, don’t schedule them. Endo appts are scarce...they should go to people who actually need them.

 

[insearchofwisdom]

Thanks to both of you and I'm going to reflect a bit because the back and forth is really helpful (so thanks in advance).

I don't keep those patients for terribly long but even that first visit when there's like 4 of them in a day, is frustrating for me now. Also, part of the frustration comes from being TERRIFIED of saying the wrong thing. So many patients give bad reviews that if I don't bend over backwards to satisfy that I'm doing EVERYTHING I can possibly think of, they write some offensive review about me and that makes me then literally cry (because I genuinely feel like I'm trying my hardest). I did ask our staff to cut out "fatigue, weight gain" as visits but still get them under the pretense of hypothyroidism/Hashimoto's or other things.

The idea of being a hospitalist is what makes me grateful for my job. Again, I don't think my job is bad. It's actually GREAT. I'm super lucky. I just don't know that it's for me anymore. That's the part that I'm struggling with. When people tell me about their inpatient work or hospitalist job, I'm like DAMN, I'm SO lucky to be where I am. I'm not trying to sound like a Debbie Downer and complain boo-hoo my life is so hard. I am blessed with an awesome practice and a good clinic and I'm lucky a thousand times over. I think what's hard for me is that I fully recognize the beauty and despite that, I still feel this way. Admittedly, part of me is afraid to make a change BECAUSE I understand my practice is great. I thought about doing some moonlighting for some supplementary income and it feels a bit like punishment.

The funny thing is the world has already granted me reduced time at work whether I want it or not. With all this stuff going on, a lot of patients are dropping off the schedule so I am seeing significantly less patients. I know this is not a "normal time" but it's proving to me even more that I should make some kind of change. I talked to 3 patients today and literally couldn't believe they were focused on how tired they are or other relatively benign issues. It just feels like I'm meant to do something else. I'll give it a few more days, of course, but it's kind of funny that I am actually getting the very thing everyone above recommended.

Thanks for your help guys and letting me be honest.