You’ve probably heard this story before: a young physician, who has spent all of his or her life succeeding and building goals, stumbles into a career without meaning or enthusiasm. Indeed, my story about burnout is much like the rest.
Like so many before me, I entered into a career in medicine motivated and eager to change the world through the care of my patients. I grew up in a family full of physicians, and I saw the cynicism, fatigue, and defeatedness of the generation before me. I told myself, “I’ll never let myself get that way.” Through each challenge, I kept my perspective in knowing that these hurdles were part of the growing pains to become the physician I wanted to be.
When I didn’t get into medical school the first time I applied, I persevered, reapplied and eventually got accepted the second time around. Through the awkwardness that was the third year of medical school and the waves of self-doubt that came with it, I kept my vision and endured.
Eventually, Match Day came around, and it was impossible to forget. There I was, with my closest friends, opening an envelope that held the fate of the next three years of our careers. My face was glowing as I ripped open my envelope. “I’m going home!” I proclaimed. I had matched at my number one choice for residency back in California. It was a dream come true, or so I thought at the time. As we clinked our glasses of champagne together in celebration, I had no clue what I was in for.
On paper, it seemed like the perfect match. I was coming home to train in the same community that I grew up in, at a well-regarded and prestigious institution. I was excited and humbled by the opportunity. The excitement, however, didn’t last long.
I don’t remember precisely when the switch turned from eager and enthusiastic to frustrated and apathetic, but it was at some point late in intern year that I began to lose perspective in my work. While I never lost enjoyment in working through clinical problems and working with patients at the bedside, I spent the majority of my days sitting at a computer relaying information during attending rounds, clicking through buttons and alerts in the EMR, documenting verbosely in patient’s charts to the standards of my attendings and trying to coordinate difficult dispositions. And while I tried to maintain focus that this was what it took to take care of my patients, between the constant pager alerts about order clarifications or requests, I felt more like a secretary than a physician. All those years of struggling to get here, eventually, didn’t seem worth it.
At the same time, a slew of changes were happening in the program itself. We lost a major parking lot to a newly built nursing school, and now all of a sudden I was losing 15 to 20 minutes every morning just to find a place to park my car. The administration decided to turn the resident workroom into a telemetry room. Now I was scrambling every morning just to find a workspace to review patient data. To ensure safe patient care, the program instituted a cap on the number of patients that could be admitted to the academic services. I found myself arguing with the chief residents every call day about who I could or could not admit to my team. And all I could ask myself was, “I’m here to take care of patients, can’t I just take care of patients?” I found myself focusing on these little annoyances and losing sight of my greater purpose. The frustrations reached a critical point.
The first time I seriously considered leaving medicine was in the second year of residency. I remember pulling up a Google search for “alternative careers in medicine” and finding endless links to personal stories about physician burnout. It was scary how much I related. “How could I already be burnt out? I’m still just a resident,” I thought to myself. Moreover, feelings of inferiority crept in as I saw my friends be nominated for chief residency, win awards and match into their dream fellowships all while I was barely finding the will to come to work every day.
From this roller coaster experience, hindsight has taught me many important lessons. First, we are physicians and human beings. We feel fatigue, frustration, stress, and sadness like everyone else. My response to that in residency was to ignore those feelings and to keep pushing myself, whether it was to stay late or pick up projects outside of my role in patient care. Ironically, the feedback I received at the end of residency is that I had an “unproductive” three years. Scaling back when you feel the need to push yourself further is an important piece in avoiding burnout. Career achievement now comes second to peace of mind in my book.
Secondly, we deserve to work in environments that support and motivate us. This is challenging in an educational system where learning is accomplished through service. What that often means is being at the bottom of the food chain when it comes to simple things like parking spots, workspace and, more importantly, an institutional voice. Unfortunately, I chose a residency based on name and location, without thinking about how I would fit within the institution or what my day-to-day life would be like. This matters a whole lot more than I ever imagined. As I move forward in my career, I realize that working at a place where you are respected as an individual is key to tapping your full potential.
I eventually stumbled through to complete my internal medicine residency. My second Match Day wasn’t filled with as much happiness as the first, but I ended up matching into my subspecialty of choice. And after three months of fellowship, I finally feel the inspiration, passion, and intrigue that guided me to pursue a career in medicine in the first place. I am proud to say that now each day brings me a new feeling of accomplishment and pride in my work, something I rarely felt as a resident. I’ve regained the perspective and vision that guided me through the early struggles of my career. And I’m determined as ever to avoid the burnout that almost defeated me in residency.
Saba Mann is a gastroenterology fellow.
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