“For what it’s worth: it’s never too late or, in my case, too early to be whoever you want to be. There’s no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. I hope you live a life you’re proud of. If you find that you’re not, I hope you have the strength to start all over again.”
– Eric Roth, “The Curious Case of Benjamin Button”
“I would like to focus on my international work.”
That was the talk track, the explanation I gave when people asked why I had resigned from my job. It is a respectable explanation, one that makes people feel good. If you repeat something enough, everyone, including the speaker, starts believing it. While the statement is true, it is incomplete. The decision to leave my job was much more complicated and difficult than the talk track would imply. The fact that I left without any definite future employment shows how untenable the work situation had become.
On my last day at work, the orthopedic staff and physicians gathered at a local Tex-Mex restaurant for a farewell happy hour. My mood was a bit melancholy as I reflected on the previous two and a half years. I had been so optimistic when I joined this practice. I hoped that this would be my last job. I could finally do what I trained for, focus on hand surgery, be in charge of my staff and schedule, and make enough money so I could work in the developing world every few years. In his book Outliers, Malcolm Gladwell talks about the three things people need to be satisfied in their job: doing complex tasks, having autonomy, and feeling properly compensated for their efforts. In my practice, I had lost control of my schedule, my staff and my time in the OR. I was told how many patients to see, when to see them and how I should always say “yes.” And I was starting to dip into my savings. I was working harder and earning less. At the end of two years, I was 0 for 3. That’s when I realized it was time for me to go. I figured if I was working for free, at least I could do work that was satisfying to me.
At the core of why I became a physician is a very simple desire: I want to help people. Becoming an orthopedic surgeon meant I could fix limbs, alleviate pain, restore function, and improve quality of life. Over the last 15 years of clinical practice, my very particular set of skills have become obscured by layers of less impressive skills. There is the charting, dictation, billing and coding, legal work, paperwork and emails taking up several hours a day, time spent after I am already fatigued from patient care. I worry about the payer mix and poor reimbursements which do not nearly compensate for the baseline level of risk and stress. There is the threat of malpractice, the surgical complications, the severely injured or unhappy patients. There is the emergency call, with all its unpredictability and adverse effects on schedules and sleep.
At least with call patients, I was treating real emergencies such as infections, fractures and lacerations. The vast majority of patients I was seeing in clinic did not have surgical problems. As primary care physicians are increasingly pressed for time, and often inadequately trained in orthopedic issues, they sometimes refer anyone with a musculoskeletal complaint to a sub specialist. Patient visits thus revolve around managing pain issues and expectations, instilling coping mechanisms and minimizing catastrophizing behaviors. While I am qualified and competent to provide behavioral health counseling, it can be emotionally draining when it constitutes the majority of my practice. All these factors mentioned above felt like death by paper cuts (or mosquito bites or any other innocuous insult which when compounded become intolerable).
Almost every physician I know is considering making a change. Whether working fewer hours, retiring early, or leaving the practice of medicine altogether, doctors are doing what they need to do to survive. There are entire courses devoted to physician wellness. There is much talk of work/life balance, mindfulness and stress reduction. There is an entire industry built on nonclinical careers for doctors. The attrition of physicians is a public health epidemic. I do not pretend to speak for all physicians. I can only share my experiences.
What lies ahead is still unknown. I am fortunate to have the means and opportunity to take a break. The Buddhist term “bardo” refers to the intermediate state between death and rebirth. It can refer metaphorically to times of suspension or transition. This in-between state is both frightening and exhilarating, akin to standing on the precipice of a cliff. To gain clarity, I have increased my journaling and meditating. I read voraciously, an activity which is my default coping mechanism in times of uncertainty. I have enlisted the help of a career coach to assess my professional and personal goals. He was the one who encouraged me to blog.
In the immediate future, I plan to teach and work overseas. As a member of Orthopedics Overseas, I will volunteer in Malawi and Myanmar. I plan to support myself doing limited chart reviews and independent medical exams. I am considering locum tenens work when I return from my travels. In what capacity I will return to clinical medical practice in the U.S. remains unclear. I still love being a physician and a surgeon. I just need to create a life where my vocation can fulfill me.
Divya Singh is an orthopedic surgeon who blogs at Divya’s Blog.
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