Friday, April 8, 2016

Burning down the house, Part IV

A look at mid-career burnout to finish off the series.

Like most medical specialists, my wife works preposterously hard at her job. She has an overfull clinical practice of cancer patients, serves as a residency Program Director, teaches students and residents, sits on all sorts of working groups and committees, has a hand in various research projects, and covers the inpatient ward several times a year. Her colleagues are sympathetic but limited in their ability to lend a hand, as they're just as overworked as she is. The senior administrators are unsupportive, careerist, and obsessed with constipating processes and optics. Many days she comes home frustrated or even downright infuriated, with no reprieve in sight from her bureaucratic headaches and paperwork.

In contrast, I spent the four-and-a-half years that ended this past January in a Community Health Centre as a family doc. I worked banker's hours to accommodate my parenting duties, with on-call demands that I can only describe as innocuous. I had excellent working relationships with my coworkers, and enjoyed some of the most grounded and understanding administrators I've ever met. I formed enduring friendships with the people at work. Despite multiple staffing changes in just a few years, it remained the best health-care setting I've ever worked in.

We took a brief trip over the Easter long weekend to visit my in-laws. My wife was just coming off a particularly brutal few weeks of ward service, that saw her trapped in the hospital for 12 hours each day. After three days of rest, home cooking, and junk food unique to Thunder Bay, Ontario, she was noticeably calm, relaxed, and ready to face the grind of the office.

It's been over three months since I last saw a patient, and two months since I had any patient-related contact with my former coworkers. My biggest headaches these days can largely be blamed on pet cats.

Nevertheless, the thought of working even a walk-in clinic gives me palpitations, much less trying to treat my former patients (that admittedly, were very challenging because of mental health and addiction problems).

Why the extreme difference between my wife and me? She loves the practice of medicine, and I never have.

In my opinion, and one that I'm not alone in having, is that some of us get into medicine for the wrong reasons, without a clear grasp of what the job entails ahead of time. A lot of this is societal, with medicine ascribed a glory that's often wildly at odds with the work.

Even if the reasons are the right ones, there's no guarantee that the aptitude for science needed to get into med school will translate into an aptitude for medicine. The application and interview process is supposed to solve this, but there's an entire industry built around helping people get into med school.

The missing piece of the puzzle is mental illness, which imparts a significantly higher risk of experiencing burnout in health professionals.

So what can be done? Unlike a trainee, someone mid-career is more likely to have mortgages, kids, ailing parents...picking up and starting over isn't an option. Meditation isn't for everyone.

  1. Health professionals should learn to recognize signs of burnout in themselves and colleagues, and help. The reasons aren't just humanitarian. You taking on 10% of your colleague's workload is a better outcome than watching them quit and having 100% of that responsibility foisted on you.
  2. For professionals feeling on the brink of collapse, take time off. Since disability insurers often make life difficult for people with mental illness, unions and medical associations should consider setting up dedicated "emergency savings" pools. This would provide professionals with one-time financial relief to prevent financial crisis. This is analogous to critical illness insurance, but the payout would be modest. The goal is to alleviate financial strain while getting help, or in the worst-case scenario, serving as a bridge over the elimination period for long-term disability.
  3. The regulatory Colleges need to ensure that their "wellness" programs are to help, rather than punish health care workers. 
  4. The Colleges and/or professional associations should develop dedicated services to helping their members find positive directions for a mid-career change. On a similar note, the Colleges taking their lead from the CPSO need to rethink the draconian processes put in place when members want a change. An old classmate I bumped into at a conference described what he went through with the College in leaving the ER for family practice. Supervisors, 10-page forms, assessment fees over $1000...what message does that send to someone looking to practice in a lower-acuity setting?
  5. The schools need to make an intensive effort at better and more creative career counseling for medical students and even undergraduates. It's not about what to expect in med school or residency, but what to expect from a life in independent practice. This is probably less a problem for nurses. After all, would-be nurses apply to nursing school. Would-be doctors apply to undergraduate sciences. The goal isn't to diminish the profession, but to portray it honestly.
My career has been an object lesson in dissatisfaction and burnout. If you or someone you care about is showing signs of the same, reach out. The alternatives mean everyone--colleagues, patients, taxpayers--loses out.

 Yeah, I'm a geek. Sue me.

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