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“For the most highly educated and specialized professional on the health care totem pole, physicians put up with a ridiculous amount of nonsense in the workplace.
You are pressured to see high volumes of patients in a rapid-fire fashion (15 minutes per visit) even when it interferes with the quality of care.
You are expected to complete mundane and excessive administrative tasks and generally are not directly compensated for this time.
You are given very little flexibility from your employers when it comes to rearranging your schedule and taking personal time off.
For the average physician, the working conditions are intolerable at best and inhumane at worst.
So the question is, why is this poor treatment tolerated?”
Chelsea Turgeon is a former OB/GYN resident and can be reached at Coach Chels MD.
She shares her story and discusses her KevinMD article, “Why do physicians stay in toxic work environments?”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Chelsea Turgeon. She is a former OB/GYN resident and now a physician coach, and she wrote the KevinMD article “Why do physicians stay in toxic work environments?” Chelsea, welcome to the show.
Chelsea Turgeon: Thank you so much for having me.
Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?
Chelsea Turgeon: Yes, absolutely. I was a very high-achieving medical student. I was one of those people who was always studying, always in the library, and didn’t really have much of a life outside of med school. I achieved all the things that I thought I wanted. I matched into my top-choice residency, and I thought that all of that was going to make me happy. But as soon as I got to residency and really started practicing medicine, all of that disillusionment kind of caught up to me, and I realized that I had gone into medicine for the wrong reasons, more for the prestige and to impress people. I still wanted to help people in a really big way, but I realized medicine was not the vehicle through which I actually wanted to help people.
So I ended up going through some pretty severe burnout, and I left residency during the second year of my OB/GYN residency. It wasn’t just leaving residency, and I wasn’t leaving because I was burnt out. I really made the decision very clearly that I didn’t want to be a doctor anymore and that I wanted to leave medicine altogether to find a different way to help people.
So I ended up buying a one-way ticket to South Korea, and I taught English. I got a job there in an elementary school teaching English for a year. Meanwhile, I started learning how to make money online through many different revenue streams: blogging, digital products, freelance coaching, and teaching English. Then in February 2020, I became a digital nomad. I started my own career coaching business and have lived and worked remotely ever since. I’ve lived and worked in 11 different countries, and I’m currently in Ecuador.
Kevin Pho: As you know, the medical journey is a fairly linear path. From what I’m hearing from you, you were a high-achieving medical student in OB/GYN residency, a fairly intense residency, and then you made a decision to leave in your second year. I could imagine that was a pretty big decision, a life-altering decision for you. So take us through the mindset during that second year of residency and some of the decision points that led you to this path.
Chelsea Turgeon: Yeah. I actually wrote a book all about it, which became a number one bestseller on Amazon. It’s an e-book called Residency Dropout, and I did have a very intensive decision-making process. There was a time during my first year when I wanted to quit, and I decided to keep going because I didn’t want to leave because of the learning curve. I didn’t want to leave because I was bad at it. I wanted to get to a point where I felt like I was doing a really good job and that I was really making the decision from a place of, “This is just not what I want anymore.”
So I had a process. I actually ended up taking five weeks off of residency. I was able to take a leave of absence from residency, and during that time, I just really connected back to myself and how I wanted to contribute to the world. This goes back to college, initially. I studied psychology for undergrad, and I always thought I wanted to be a psychiatrist or a clinical psychologist and kind of help people in that way, but I just got a little bit derailed along the way. So I ended up going to med school thinking I wanted to do psychiatry, and then I decided not to do that.
So it was really just coming back to my original roots. Psychology has always been that thing. I used to read Psychology Today when I was 16 years old in high school. My friends were reading Cosmopolitan and Seventeen magazine, and I was learning about the evolutionary basis of rejection and all that. So psychology has always been my main thing that’s been super interesting, and it was me just returning to what really mattered to me. Then travel also became this big thing on my heart that I wanted to pursue.
So I did have a decision-making process, and at the same time, my decision still didn’t make sense to a lot of people. What I really did is I followed my intuition. I followed that voice inside of me that was saying, “This is not the path for you anymore. It’s time to try something new.” It’s never going to make sense in a logical way, because I was just following my heart and following my intuition.
Kevin Pho: What was the reaction of some of your peers and family when you made the decision?
Chelsea Turgeon: Yeah, it was so interesting. Everyone had a lot of opinions on how I could find a way to hang in there and kind of tolerate medicine. A lot of people would tell me, “Why don’t you do radiology? Then you can read X-rays on the beach, and you can still travel.” Or my grandparents wanted me to, “What about Doctors Without Borders? Then you could be a doctor and still travel.”
At that point, I didn’t feel the need to hold on to being a doctor in order to go on to my next step. I know I had spent so much time and money training and all of that, and I didn’t feel like I was throwing it away, but I also felt like I was almost complete at that point with the medical pathway, and I just didn’t want to proceed anymore. I didn’t want to keep holding on to something when I was being pulled to do something else.
Kevin Pho: Now, if you were to take this journey all over again, what would you do differently?
Chelsea Turgeon: I love where I am, and I’m actually super happy for all the experiences that I had. If I really could go back to maybe college, I think what I would potentially do differently is do a PhD in clinical psychology and pursue that route instead. But at the same time, that’s me knowing what I know now. The Chelsea in college, in undergrad, was dead set on going to vet school, and I would not let anyone tell me differently. I didn’t even really enjoy shadowing much, but I kept telling myself, “It’ll be different once I get there.” So yeah, I think you can have this hindsight and look back, but at the same time, really remembering where you were at that point, I would not have been told differently at that time.
Kevin Pho: All right, let’s talk about the KevinMD article that you wrote. It’s titled “Why do physicians stay in toxic work environments?” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Chelsea Turgeon: Yeah, exactly. As I said, I’m a career coach, and I work with a lot of physicians and other burnt-out health care professionals. In my work, I come upon so many people who are fairly miserable, but they’re kind of putting up with these horrible working conditions. For me, it was a shock, because I always thought once you finished residency, you’re the big boss in charge. But now, as I work with my clients who are full-fledged physicians, and they are the ones who are at the top of the totem pole medically speaking, I see that there are so many other people who run the show, and there are so many other pressures and factors that influence their day-to-day life. There are RVUs and productivity metrics and admins putting pressure on them to open up slots to see more patients.
So there are all these factors pressing on them, and I was just wondering, why are people who have trained so long and have gone through so much school kind of tolerating being in these working environments that aren’t really serving them and that aren’t allowing them to practice medicine to the best of their abilities? Why are they staying in these kind of miserable conditions? I know not everyone is miserable, and that can be a little bit dramatic, but a lot of the people I work with are in that place where they don’t feel great. So I was sitting with this question: Why do they feel so stuck? Why do they feel so trapped?
Then I remembered this dog experiment from my psychology background. I’ll just walk you through the experiment, which illustrates this point of learned helplessness. A researcher back in the ’60s was doing research on classical conditioning. He put a dog in a crate, and the dog could not escape. He was in this crate with no way to escape. He would ring a bell and then administer a shock. He would do that a number of times, and before long, he would just ring the bell and the dog would react as if he had been shocked. That’s the classical conditioning piece.
Then he put the dog in a larger crate where one side was electrified, but the other side wasn’t. So essentially, the dog then had an escape route. He administered the shock in the same way, and he expected the dog to jump into the non-electrified side and escape the shock and escape the pain. But the dog didn’t do anything to escape. He just lay down and gave up and kind of accepted the fate of the shock. Obviously, it wasn’t just a one-time experiment. They tested and validated this in other ways. But this whole concept is called learned helplessness. It’s where you don’t try to remove yourself from a negative situation because the past has taught you that you’re helpless.
So I believe, and I know there are many, many reasons, and I don’t want to simplify this and say this is the only reason physicians stay in toxic work environments, I’m just adding one explanation to it, but I believe our medical training in a lot of ways teaches us that we’re helpless. There’s this narrative that the training process is supposed to be really hard and difficult, and we’re supposed to suffer, and you’re just supposed to put your head down and power through. So you’ve learned that when things are hard and difficult, when they kind of suck in your training, there’s nothing you can do about it except power through it and keep going. I think we just carry that with us throughout the rest of our medical careers, and that’s one of the reasons we have this learned helplessness and one of the reasons why we feel stuck in these toxic work environments.
Kevin Pho: So give us an example of what this learned helplessness would specifically look like. What is the story that you typically hear as a physician coach of this learned helplessness, this kind of inaction?
Chelsea Turgeon: Yeah. It’s just accepting that you have to see a certain number of patients. One of the clients I was working with recently said, “Yeah, well, we’re supposed to see, what, three and a half patients per hour.” You just kind of accept this as a standard that you’re supposed to live by without even knowing where that’s coming from, how that’s going to help anyone, or what that’s going to do. You just operate in this way of, “Even though seeing this many patients at this rapid of a pace is really stressing me out and is making me take all of this work home with me, I can never catch up on my charting and notes, and I can’t keep up with my inbox.” There are all these things that are struggling because of it, but you feel like you have to do it because it’s just kind of a requirement that’s been put on you. So it’s kind of like tolerating the way the system works, because you have this sense that it’s supposed to be really hard to be a doctor. And it is hard, for sure, but it doesn’t have to be so miserable.
Kevin Pho: So what kind of advice do you give these clients who come to you in this scenario?
Chelsea Turgeon: Yeah. A lot of this learned helplessness can be changed by changing the way you perceive situations, and that’s about changing your attributions. Attributions are basically the factors that you hold responsible for certain situations. I’ll just give you two examples of how we can shift certain attributions. You can shift away from an internal attribution to an external attribution, and that’s helpful.
For example, a lot of people who are struggling to keep up feel like they’re drowning in all the admin work they have to do, and they think it’s their fault. They have this internal attribution. They say, “I’m not fast enough,” or “I’m not efficient enough,” or “I just can’t stay focused. I have too many things distracting me.” So that’s an internal attribution: My work conditions are hard because it’s my fault. Then you can shift that to an external attribution and say, “Actually, no, I’m working really hard. There’s only so much focus and concentration and productive work any human can do at any one period of time. There’s actually just too much work expected of me.” So then that becomes an external attribution, and shifting it in those ways can help you see, “OK, it’s not me. It’s not a me problem. It’s a system problem.” Then that puts you in a place where you’re more likely to start looking for solutions, as opposed to blaming yourself.
Kevin Pho: So once a clinician does that and shifts that burden to an external attribution and wants to change the system, what kind of options does that clinician have?
Chelsea Turgeon: It’s hard, right? I kind of started in this too. I was like, “Oh, I want to change the system from the inside.” I was in residency, and I was on the wellness committee, trying to bring wellness into medicine. So it is hard, and you have to decide what battles you want to fight on a systemic level and what battles you just want to fight on a personal level. Sometimes there are a lot of problems, and you can’t take on the burden of fixing all of them. But sometimes just knowing that they’re problems with the system can help you decide, “Well, actually, I’m going to remove myself from this particular work environment, and I’m going to get myself into a work environment that feels better, that meets these criteria,” and start designing and crafting a work environment that actually does work better for you.
So there are definitely systemic things you can start working to fight, but keeping mindful of your energy levels and what resources you actually have available, it’s also important to remove yourself from situations. I know that doesn’t mean you can just up and quit your job right away. It’s going to be a transition process, and it’s not always the right call to just quit your job either. So there are a lot of different processes, but you just have to figure out what’s really going to work best for you long term, and really allow your interests and what is serving you to matter.
Kevin Pho: Now, from your experience as a clinician coach, how difficult is it for clinicians to shift that mindset, to shift problems to an external attribution? How long does that normally take, and how difficult is it for the majority of your clients?
Chelsea Turgeon: Yeah, I love that question. I think it is a process, but sometimes it’s just hearing from other people that they’re struggling with it too that can cause a really lightful moment. I have a podcast as well, and I interview a lot of physicians who talk about, “Oh, I thought it was a me problem, and then I realized this is a systemic problem.” Sometimes when my clients are just listening to my podcast and they get the sense that they’re not alone and someone else is going through it too, it can help cause a pretty quick shift.
Now, there are still going to be times when you’re going to come back and bring it back to yourself, and then that’s a process of bringing awareness to it, and that can take time. But you can have a fairly radical shift pretty quickly once you realize that you’re not alone and there are other people who are dealing with the same thing. That’s why I think talking about these issues is so important, so having platforms like yours to share different topics like this is so helpful.
Kevin Pho: We’re talking to Chelsea Turgeon. She’s a former OB/GYN resident and now a physician coach. She wrote the KevinMD article “Why do physicians stay in toxic work environments?” Chelsea, what are some of the take-home messages that you want to leave with the KevinMD audience?
Chelsea Turgeon: You are not helpless. Maybe you’ve gone through a lot. Maybe your training has really left you beaten down, and maybe you’re burnt out and run down, but you do have power, and there are ways for you to take your power back. You don’t have to put up with working conditions that are not serving you.
Kevin Pho: And how can people reach you?
Chelsea Turgeon: I’m mostly on Instagram, Coach Chels MD. That’s where I hang out the most.
Kevin Pho: Well, thank you so much for sharing your time and insight. Thanks again for being on the show.
Chelsea Turgeon: Thank you for having me.
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