Doctors: Fight burnout like it’s the plague

Doctors: Fight burnout like it’s the plague

When I was a med student, the thing I loved most about primary care was continuity of care. I loved feeling like I had a sense of my patients’ lives, of the intimate details of their day to day, of their fears and dreams. I thought that this connectedness was all I needed to have a successful career as a primary care doc.

Fast forward to two years later when I am in the depths of internal medicine residency. With two years of training behind me, I’m in what is known as the post-honeymoon phase of medical training. I’ve been a ‘real doctor’ long enough to see that primary care is just plain hard. I’m the “fall-back” doctor. My patients go to a specialist and when they need a letter for disability, they come to me for all the paperwork. Orders for commodes, bed rails, and insulin needles pile up in my mailbox. Medical equipment reps send me endless faxes to sign off on automatic scooters for patients who we know can walk just fine. Simply put, my to-do list never seems to end.

No wonder the rate of burnout is so high, I think to myself sometimes as I rush from my inpatient hospital duties to a clinic session overbooked with sick patients, some of whom have been waiting months to see me.

Certainly, this model of care in which a sole clinician is responsible for all the patient’s needs is not sustainable. It’s simply too much work for one person to shoulder. Doctors who sign up for this do it for some years, tire and leave, all the while watching their specialist friends enjoy the simple pleasures of more free time or fat paychecks or both. For these reasons, recruiting new doctors to primary care becomes more difficult each year, an issue that will come to a head as the Affordable Care Act expands access to preventive care for millions of previously uninsured Americans.

Still, none of the challenges or uncertainties of primary care practice make me any less certain that my choice to enter this field was absolutely, 100% the right one. All the paperwork and hurdles aside, my patient encounters are better than I dreamed. From counseling a family to obtain hospice care for a dying loved one, to helping a woman overcome her deep fears of discussing a history of sexual abuse, to working with newly released ex-convicts at key moments in their lives, I could not ask for more meaningful work. I feel sad for doctors who are so jaded by the system that they cannot enjoy beautiful encounters like the ones I get to partake in on a daily basis. So no, despite its hardships, I wouldn’t trade this job for the world.

I will, however, offer some advice on how to make this whole business of being a primary care doc something that most of us young people will want to do for a long time: Fight burnout like it’s the plague. Force yourself to take a break even if it means asking for time off, to have wellness days when you simply pamper yourself, and to seek activities that make you happy. For residents, this may mean opting for a research month rather than a specialty elective, allowing yourself a slower pace to work and play—it certainly won’t affect your career, but it will enhance your happiness.  For me, when I started practicing yoga again, seeing my family more, and sometimes even leaving work early to go home and take care of my personal wellness, I felt more like the person before residency who knew that primary care would be fulfilling and worthwhile work. The things that were hard were still hard, but they were no match for the parts of preventive medicine that I adored.

As residency draws to a close, I look forward to a long career in primary care, likely focusing on primary care for HIV- and hepatitis C-infected patients in an urban setting. But most importantly, I look forward to a life in which I allow time for nonprofessional development, in order to ensure that burnout cannot take hold. For me this may mean taking time off to work in primary care in Ghana, spending time on hobbies like cooking and yoga, or simply working in a smaller, non-academic setting that allows for more personal time. Whatever the decisions are, I will make them knowing that primary care work is a marathon, not a sprint, and the road to longevity begins with self-care.

Stella Safo is an internal medicine resident who blogs at Primary Care Progress.

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  • buzzkillerjsmith

    Doing HIV and Hep C work is not primary care. It is very focused specialty care and as such it is much, much easier than what we real PCPs do. A few drugs, a few protocols. A couple months to master the field, tops.

    So, tell me, should someone who is abandoning the field of battle lecture us about courage?

    • Barry Nuechterlein

      Dr. Smith,

      I’d advise you to stop slagging this young doctor’s career plan. Sure, she might find it difficult to integrate Medicine with yoga and travelling the world to do primary care in developing countries. Balancing that with loan payments is no cakewalk, but she’ll figure that out. She’ll make her own life decisions, and if she forgoes mortgages, fancy cars, and children, that may be very possible for her. It’s her life.

      It’s not as though treating this difficult, generally economically disadvantaged, and very complex population is a cop-out. This doctor is going to be very busy, will deal with some really tough Medicine, and probably is not going to become wealthy doing it.

      “A few drugs, a few protocols.” What a shameless, ignorant comment. Have you ever really seen what HIV can do to a person? Have you seen a patient whose presentation with HIV is otherwise-inexplicable renal failure, or dealt with someone who is blinded by CMV retinitis? How about managing a depressed HIV sufferer’s suicidal tendencies? Helping them deal with chronic diarrhea from the meds? How about dealing with the glucose intolerance and metabolic problems caused by some antiretrovirals, and balancing diabetic management with a serious, chronic infectious disease?

      Or, do you refer your HIV+ patients to a doctor like her to devise a cocktail and deal with those issues, because it’s “not primary care?”

      Get off your high horse. You need a lecture about respect and professionalism, not courage. I respect any doctor who is honest, competent, and willing to work for his/her patients.

      • buzzkillerjsmith

        High horse. Good one. This doc is telling us all about how she is going to do such a great job and avoid burnout—by pulling the plug before she even starts.

        People can do what they want, but I will call her out on the conceit.

        Ignorant comment. Nope. I managed HIV pts in LA and the Bay Area starting in the 80s and continue to do so, with phone ID consults from Spokane and the Univ. of WA. It is true in these parts that most pts self-select to get their primary care from ID docs. I have indeed seen its ravages. I recall one guy, one of my favorite pts, who died of Crypto meningitis with a temp of 106.

        I’ll say it again. Managing one or two disease in a specialty clinic is butter compared with what we real PC docs do every day. You’d know that if you were a physician.

        • Barry Nuechterlein

          You, sir, are the one filled with conceit. Go on feeling self-righteous and deluding yourself that asking for a more reasonable lifestyle or focusing on one subgroup of patients is “wrong.”

          In the “good old days,” docs had a disappointingly high rate of social pathology, divorce, and self-medication. If someone wants to take a pay cut and live a more reasonable life, good on them!

          Doctors who act as though other doctors in other specialties “have it easy,” and only they are the pure martyrs with a good work ethic, are a danger to the profession. I was once advised by a wise teacher never to complain about the money another doctor makes, the lifestyle another doctor has, or the nature of another doctor’s work. One of the reasons the profession is getting ravaged, right now, is that people like you are making “divide and rule” so easy.

          I am a specialist (not a partialist, as I also take care of the whole patient, just under different circumstances), but I have great respect for the wonderful, devoted work that generalist physicians do. It takes a great deal of intelligence and education to do a Family Physician’s job. You’ll never hear me say a bad word about ANY specialty.

          I’ll say again, you need an attitude adjustment. Implying that I’m not a physician is childish. You can Google my name any time and see how wrong you are.

          Again, get off your high horse. Nobody is impressed when you act grumpy and denigrate a colleague. You just make yourself look bitter.

    • Tom Garvey, MD

      Read the post. It says, “focusing on primary care for HIV- and Hep C-infected patients. . .” How is that “abandoning the field of battle?” That’s not even specialty care. It’s primary care for some of the most challenging group of patients in the field. We are lucky that there are still idealistic new doctors willing to tackle such important work despite its immense difficulties. Go for it, Dr. Safo!

      • buzzkillerjsmith

        Nah. HIV care is plug and chug. Midlevels can do it just as well as we can. I’ve done plenty of HIV care. Not that hard.

        • Barry Nuechterlein

          Doing HIV care well is sometimes quite hard. Your attitude is frightening.

  • Guest

    Hard to take this very seriously coming from a resident. Also, I have to agree with Buzz that your focus is not primary care at all.

    Get back to us once you are practicing in the real world and have a mortgage, car payments, student loan payments, malpractice insurance, private school tuition, childcare, and the like to pay for. Hard to jet off to Ghana with all that to deal with.

    • Barry Nuechterlein

      Mortgage–choice. Car payments–choice. Private school tuition–choice. Having children–choice. If she chooses a simple, childless lifestyle, instead of chasing the “dream,” she can do what she suggests she will. I chose to live simply, and forego those things, and I am much freer than most of my colleagues. I’ve been practicing for less than ten years, and am debt-free, without any of those chosen obligations.

      Just because you’ve been taken in by the “American Dream” doesn’t mean everyone is, or that turning one’s back on endless debt peonage/the machine is impossible.

  • Anthony D

    Hard to believe that from a so-called doctor.

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