Why doctors can’t rest [PODCAST]

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“I think doctors are just wired that way. We are productive. We get things done. It is expected. We are supposed to do more, do it all, and be all the things to all the people. We come to a point where we try to satisfy this, and then we cannot do enough for ourselves. We cannot rest. We must keep trying to check things off the list to get things done. And it is overwhelming. It does lead to burnout.

I am still a work in progress. I am writing this on a work night because it is burning in my brain, wanting to come out. Perhaps I should be doing nothing, resting for a full day. But if I do that, I will feel guilty that I have wasted this time when I could have been putting my thoughts down on paper. The mind is always going.

This is me, but I think it applies to many other physicians. Look at your habits and see if you have some of my same tendencies. If you do, let’s start talking about how to reverse this tide of overwhelm to create some time for yourself when you are doing nothing and not regretting it.”

Marion McCrary is an internal medicine physician and can be reached at Marion McCrary Wellness.

She shares her story and discusses her KevinMD article, “Why doctors can’t rest.”

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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 Marion McCrary. She’s an internal medicine physician as well as a health and wellness coach. She wrote the KevinMD article “Why doctors can’t rest.” Marion, welcome to the show.

Marion McCrary: Thank you so much for having me and highlighting this important topic. I think that is kind of at the key of physician wellness.

Kevin Pho: And we’ll get into that article in a little bit, but first off, can you share your story and journey to where you are today?

Marion McCrary: I am, as Kevin said, an internal medicine physician. About three years ago, I did training also to be a health and wellness coach for my patients, and then really figured out it’s also great to help physicians who are going through burnout, and for their own wellness. And in doing that, I have just opened myself up to a lot of possibilities of talking about different topics with physicians and non-physicians.

And so with this article, it spoke to me because it was a topic that came up when a very close family member said to me, “You don’t know how to rest.” They had seen me recently transition from a long-term career at an outpatient practice, where I’d been for over 15 years, to coming into a new role that I started in January. And between that time, I took a year sabbatical. A lot of folks came to me and said, “Oh, you’re going to sleep till noon each day. You’re just going to kind of lounge, go to the pool.” The sabbatical was during COVID, so it was definitely a different situation.

But I quickly found that this was my chance to do all the things I never had time to do, that I really wanted to do. And so I started filling up that time, and then those same folks turned around and said, “You know, I thought you were just going to do nothing, and now you’ve got all these projects in line. You’re not even practicing, and you’re spending all this time doing this. You don’t know how to rest.” And that really kind of spoke to me, and I was like, “You know what? I think you’re right.” I think this might be something that a lot of physicians struggle with, and it’s something to talk about. So it really came from my own personal experience.

Kevin Pho: So tell me about some of the other things that you’re doing, some of the other projects that you’ve started during the sabbatical, outside of your clinical medicine role.

Marion McCrary: Yeah, it’s been really fun. Coaching is one piece of that. So I finished my certification as a coach and worked with individuals outside of medicine who were trying to make health changes that they were having difficulties with. I started working with some of the societies that I’m a part of, with the American College of Physicians and the American Medical Women’s Association, doing different wellness projects and coaching in those capacities for physicians who were experiencing burnout symptoms or just looking to make changes in their careers.

And in doing that, it made me more comfortable talking about these topics, so I started speaking about them and writing about them. I’ve been writing for my personal blog, with my company, Marion McCrary Wellness, and also for Women in White Coats. It’s been so interesting just to see the response to one physician talking about something, and other folks saying, “You know, hey, I’ve been through this too. How can we get through this together?” And so finding that community and being involved in that has been really interesting. So it’s just that curiosity to know how you can help someone else, how you can help yourself with that, and just expand things that you’re interested in that really give you a lot of energy outside of your clinical practice.

Kevin Pho: Now, you mentioned that you were an outpatient internal medicine physician for about 15 years prior to your sabbatical. Now, before making that transition outside of that role, was it any singular event that caused you to transition, or was it a buildup of many small events? Tell me about the motivation that led you out of your prior clinical role.

Marion McCrary: Yeah, that, I would say, is probably more of the buildup of different things. There was not that moment of like, “Oh my gosh, I have to leave where I am and go somewhere else.” It was really building out of that curiosity. So I came into medicine with this sense of, a lot of the sense of, “I should do these things to be a good doctor. I should do this so my patients won’t have to.” So there was a lot of “This is the way it is. This is the way I should do it. There’s a comfort level here.” So I kind of learned that state and what I was doing, until it either started to be something that kind of rubbed me the wrong way, or I wanted to do something different.

And it took me a long time to step outside of that comfort zone and realize there may be some other opportunities for me to help patients. I was a lead physician for a while and took on some different roles in that. And although I learned a lot from that, it really led to a time for me of feeling burned out. And so I wanted to kind of pull back and do things a little differently. And when I did that, I started to look at other ways of practicing medicine, other things I could bring into it.

And so with this transition, I actually switched to a different model of practice in a different health system, and I’ve been doing that now for about six months. It’s really been valuable to have a different way to interact with patients, longer appointments with them. It’s a concierge model practice, and it’s just given me a better connection, I think, with my patients, and then the time that I needed to also do the other things that were interesting to me.

Kevin Pho: Now, a lot of physicians, when they’re working at one job for 15-plus years or so, there’s a certain fear about leaving that job and going into the unknown. Because that job, even though you’ve been through it for 15 years, even though it’s burning you out, for a lot of physicians, there’s that level of security, of that comfort, right? Now, when you made that transition, was there any trepidation for leaving the relative comfort of what you were doing for the last 15 years?

Marion McCrary: Oh, you’re speaking to me. That’s exactly it. It’s that fear of, “What happens if I make a change and I don’t like it? What if I’ve made the wrong decision?” You know, how to step out of that comfort zone. And for me, it really started, the decision started. You have to weigh the goods and the bads. There’s a concept in coaching; it’s kind of, “What’s the worst thing that could happen?” You switch jobs and you don’t like what you’re doing? You look at something else.

So I think getting out of that fixed mindset, where this is the way it has to be, to more of a growth mindset, if you’re familiar with that book by Carol Dweck, was really an eye-opener for me. There are opportunities out there. You just have to be open to them, experience them, try them out, see if they’re for you, and then take a leap. And that’s really hard sometimes, particularly for someone who’s been in the same practice for a long time.

I actually wrote an article about that, as we were talking about that interest in writing, just how it is hard if you’ve been at the same place for a long time. I talked about kind of growing up in the same hometown, moving to college, staying there for medical school and residency, and then being an attending. And so for me, that was really a big step out of a comfort zone, to make that first step.

Kevin Pho: Now, you talked a little bit about your article that you wrote on KevinMD. It’s titled “Why doctors can’t rest,” and that resonated with me because my hours were cut during the pandemic, and I realized I had all this time on my hands. And what did I do? I actually started this podcast, and you know, 400-plus episodes and one year later, I’m probably working more after my hours were cut than in my situation before. Now, tell us a little bit more about that article and why you decided to share it with my audience.

Marion McCrary: Yeah, there were actually some funny stories I told about myself in there, about how I studied MKSAP on the beach one year on vacation and wrote Christmas card addresses in July because I had time to do it. That was at a point in time where I really felt that pressure, that I had all these things I needed to do. I felt overwhelmed, and that was the time that we talked about earlier, that burnout.

And so when I learned how to kind of step back from that, actually say no to some of the things I’d said yes to, kind of retreat a little bit, figure out my priorities, and then how to kind of come back out in the world in a different way, I really kind of looked at some of those things, what you were just saying: How can I do that and find this curiosity, put myself back out there, and all these things I want to do, but not get back into that place of feeling overwhelmed again? And so maybe similar to what you were just saying, I’m working harder now than I was when I was just doing clinical medicine, because all these things are exciting to me. They’re energizing. Even though I’m putting more time into them, they’re things that seem to fuel me.

So looking back at that, it’s hard for doctors to rest. I think that we’re driven to do things; we have that passion. What we’ve got to realize is that we have to turn some of that advice we give other people back on ourselves. Give ourselves that permission slip, as people would say, to kind of do something different, to do something where you just stop for a moment, do something for yourself, create some of that margin in your schedule, that white space, you know, between your appointments, and just really start to kind of be mindful of how you spend your time, whether it’s an energy suck or an energy giver for you.

And so those are kind of the things that I have tried to start implementing in my own day-to-day, to really determine how I’m going to spend my time, to prevent myself from getting into that sense of overwhelm or burnout again. And so the article is really more about some of those ideas, not all the solutions that I have just talked about. It’s more to kind of get the conversation started in your brain and help you think about, “How can I rest more? How can I be busy doing the things that I want to do that fuel me?” Whether that’s just sitting on the beach, staring out at the ocean, or whether that’s taking some time to write out your thoughts, because that really is something that you value.

Kevin Pho: Now, can you take us through a case study or an example of some of these concepts, so we can see how they play out in real life? So let’s say that we have a busy physician who sees 30-plus patients a day for the past 15 to 20 years and comes to you for advice. So give some specific examples of how you can guide this physician and use some of the concepts that you just described.

Marion McCrary: Yeah, it’s kind of a coaching part, a coaching role as well. And I think ultimately it’s talking with them first about what’s important to them, what they want to get out of their day. If they’ve been doing this, 30 patients, for 15 years, time goes by fast. Where do they want to look back? And what do they want to look back on when they’re 80 and say, “This was my legacy. This is what I did”? Maybe it’s, “I took really good care of patients, lots of patients,” and that’s what they wanted to do. But maybe they’ll look back and say, “You know what? I did all that, but I didn’t get to do these things.”

So I think the first thing is kind of taking an assessment of how you spend your time. Is that the way you want to be doing that? And if it’s not, then how do we start to kind of pull back from that? So I think priorities are number one. And then once you determine there may be a change that you want to make, how do you actually start pulling back from things?

There’s a strategy, the David Allen strategy, Getting Things Done, that’s the four D’s. So one is just, you made that list of all the stuff you’re doing. If you want to keep doing it, do it. If you’re like, “It’s not for me now; I’m going to defer it to later.” And then you kind of get the things you want to delete and delegate, and get them off your plate. And then once you kind of narrow down the things that fill your day to the things you really want to do, it’s setting boundaries around them and avoiding distractions that kind of pull you away from that.

So that’s kind of a framework that you could use with a person, whatever that situation would be, that you can apply across the board, and something you can start doing today. It doesn’t have to be something you have to think about for years and years before you put something into action and take that first step.

Kevin Pho: We’re talking to Marion McCrary. She’s an internal medicine physician as well as a health and wellness coach. She wrote the KevinMD article “Why doctors can’t rest.” Marion, you mentioned as part of your story that you transitioned into more of a concierge practice. Tell me a little about how that transition is going.

Marion McCrary: Oh, it’s been really nice. I have enjoyed meeting new patients and having some of my old patients come to see me in this new practice. I really enjoy getting to know people and having the chance, in this practice model, to have a longer time with patients in the exam room and have more access. They have more access to me; I have more access to them, I would say. And being able to be the physician when they need something acutely, that I can handle that, and I’m not full with patients who are coming in on my schedule for exams or follow-ups. So it’s really giving me the chance to be the physician for that patient, to help coordinate things for them. So that’s been really nice, to have that relationship with people.

And for me, it’s also been a chance to use some of the skills that I’ve had with coaching and things that I’m doing outside of the exam room, to actually benefit myself and some of the other physicians that I work with in different societies and different systems.

Kevin Pho: Now, for physicians who are interested in transitioning from a traditional model into a more concierge model, what are some of the things that they should be thinking about, or what are some of the red flags or pitfalls they should be thinking about before making that move?

Marion McCrary: I think start talking to people who are doing it. There are several different models. There are some national companies that have physicians all over the United States that I looked into and learned about. A former anatomy partner of mine actually was in one of those practices and really gave me a lot of advice about what had worked for him. I know there are physicians who do a concierge practice as part of a health system; that’s where I am, and they’re a different makeup. So you’re a piece in the system rather than kind of having your own practice. And then there are other physicians who set this up on their own. It’s kind of their individual practice, and they figured out the business model that works for them.

So I first would start with finding someone who’s doing it. Talk with them; see what is working for them. And then, if you’re even thinking about it, it may be worth broaching it with some of your patients. Not necessarily like, “I’m going to do this,” but thinking with them: What do they find most valuable with their relationship with you, and what things are challenging? And if it’s that piece of “You just don’t have enough time for me,” then is there a way for you to create a practice model that actually gives you that time with the patients you want, and that they want with you?

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Marion McCrary: My take-home message is that integrating work and life is, I think, one of the big keys to preventing physician burnout. You’ve got to give yourself that permission to rest, do some things outside of your clinical practice, things that fuel you, setting that margin in your day, having time for yourself, just to keep you going. And if you’re able to rest, be the best person that you can be because you’re fueled, then that helps you take care of patients better. It helps you be more productive. It’s a positive cycle rather than something that pulls you down. So the first step: Spend some time with yourself, just doing what fuels you, rest, and see where that may take you.

Kevin Pho: Marion, thank you so much for sharing your time and insight, and thanks again for being on the show.

Marion McCrary: Thank you so much.

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