Totally Burned Out...and less than a decade in. What's next? [VENT]

[sas5814]

One of the 5 UCs I work in is similar to what you describe. It is depressing to sit in that walk in closet for 12 hours at a time. I have the ability to walk around the clinic and the nurse sits in the closet with me. I have had several conversations about moving us out of the closet but nothing has changed yet.

I think you have pretty good insight. My job too has a wonderful bunch of people to work with and the nearest management to me is great. They just aren't in charge of anything. They have no more power and get no more information than we do.

I'm well paid and treated well and BS exists everywhere so changing jobs would only make sense if it would change some aspect of my current situation that I'm unhappy with.

Isolation sucks. I don't have any great suggestions other than get out of there as often as you can and maybe have a conversation with someone about getting you a different work space.

Lastly get out of your own head. If you constantly worry about how much things suck and worry it will never get better you are just making yourself miserable.

 

[Guest HanSolo]

Have you thought about moving into some sort of specialty care or inpatient medicine? Might be a big change and may even have an initial pay cut, but I think you need to get yourself out of the window-less cubby of sinusitis. Perhaps out of that particular realm of medicine entirely. 

[rev ronin]

No such thing as burnout.

https://zdoggmd.com/moral-injury/

[Karma]

A friend and fellow PA just sent this to me.  It embodies everything so many of us are experiencing.  it's E-VER-Y-WHERE

 

[EMEDPA]

Preach Zdogg! I love this....

[ventana]

57 minutes ago, Karma said:

A friend and fellow PA just sent this to me.  It embodies everything so many of us are experiencing.  it's E-VER-Y-WHERE

 

Amazing and true.   Shared already.  

[BruceBanner]

Great video, I saw it on the reddit PA forum. 

So pertinent and true---burnout is everywhere. But so many of us suffer in silence. There is a sort of professional pride in medicine where you just keep taking it until you are at a breaking point. The culture of "see more, chart more" is everywhere. It's in academia, it's in commercial medicine, it's in private practice. 

And I might revise my statement earlier in this thread about not caring about patient's problems. I want to--especially when it counts for someone. But the demands make almost impossible sometimes. You cannot see 30 pts a day, or 5 an hour, and care about each and every one of them. You are just trying to survive. You get calloused, angry, bored, cynical, resentful. 

Cutting back my hours has really helped, but this is a systemic sickness in western medicine. I'm not sure what it will take to change the culture. We cant all go part-time or just "find new jobs".

[GetMeOuttaThisMess]

Emailed it to my wife (dental hygiene professor) as well.  So stinkin' true.  Hey privileged administrators from employers to healthcare systems to insurers!  BITE...ME!  My solution is retirement.  You know who else needs to hear this?  The darn patients who think that they know everything and think that they're entitled.  Between having to have gotten up at 2 a.m. this morning to go see my elderly, becoming demented I suspect, mother and then come back and deal with patients during a normal day, I'm already fatally injured.

Here's another step along this line.  What about the damn guilt that one feels when you can't be superman or superwoman to all parties (work, home, extended families) so that they all get the short shaft?  You want consistency?  THERE'S your consistency.  Everyone gets the same short shaft.

[Cideous]

I've got to be perfectly honest.  This is the first time I've seen this video and it brought me to tears.

Nothing else to say on it.

[CAdamsPAC]

On 3/14/2019 at 5:32 AM, GetMeOuttaThisMess said:

Emailed it to my wife (dental hygiene professor) as well.  So stinkin' true.  Hey privileged administrators from employers to healthcare systems to insurers!  BITE...ME!  My solution is retirement.  You know who else needs to hear this?  The darn patients who think that they know everything and think that they're entitled.  Between having to have gotten up at 2 a.m. this morning to go see my elderly, becoming demented I suspect, mother and then come back and deal with patients during a normal day, I'm already fatally injured.

Here's another step along this line.  What about the damn guilt that one feels when you can't be superman or superwoman to all parties (work, home, extended families) so that they all get the short shaft?  You want consistency?  THERE'S your consistency.  Everyone gets the same short shaft.

I hear you loud an clear!! I am down to my last few weeks of work. Leaving standing tall and a bit bloodied but walking away on my terms with my dignity intact.

[PASamsOTHERacct]

Thanks all for your responses.   Sorry I cant address each response, but I am reading them all, it's nice to know I'm not alone with this.

@Sas, thanks for the comments. Yeah, unfortunately the place is the way it is...torn between the two ends.  Sitting outside in the sun today, absolutely dreading another 12 hour shift in the cubby, I feel like..I think I know which of the two i like better...I think i may have to choose non-isolation over good job (on paper)...

@Han, well, never thought too much of the specialties...I worked in cardiac diagnostics briefly but it was busywork.  Yes, of course, i'd have to find a place that would be willing to (re)train me and probably a pay cut, don't mind the pay cut as much as being a total novice, but I guess that would be the cost of a change...any specialties you or anyone reading might recommend?  I'm wondering about family or primary, but from what I understand, those are 4+ patients-per-hour cattle mills now too...

@revronin, nice new picture, and yeah....gosh, that video says it all.  Unfortunately, ain't nothing going to change...this is, as we know, the new normal of medicine. My primary care just joined some membership-only medical franchise that charges a $2000 "buy in" for patients, but guarantees them time to sit and talk to the doctor, and not be rushed through like cattle. I'm intrigued by the idea, had never heard of it, and am curious if I MYSELF could find such a place to work!

@BruceBanner no, I get you. Honestly...I don't care about the patients anymore either, not a darn.  In fact, I absolutely HATE them for bothering me with their obviously viral URIs all day long. I see them, literally, as nothing more than annoyances that not only FORCE me to document, but KEEP me from documenting as well. Literally, in my head, with every patient, i'm thinking "shut the **** up, i don't care, just answer my yes/no questions, let me pretend to smile and care, give you my long-ago-memorized speech about sinus infections, then prescribe you ABX anyway because you will demand it, ok, now shut up and get out of my exam room and stop wasting my time and energy.... because you  decided to pretend DayQuil doesn't exist, and come in with this B.S., I have to spend twice the time I am spending with you charting your nonsense."  I guess I'g getting burned...I mean morally injured. Truly...it does feel like PTSD.  Every time I see my work clothes, my ID, my work bag...I get queasy and tense.

To all...what do you think might be a good fit for me, as a UC PA with some limited Cardiology (diagnostic) experience, where I can actually have a workload that is paced moderately enough, and interesting enough, so that i'll actually give a damn again?

[Cideous]

I am actively planning early retirement.  I have crossed over from wanting to get out, to needing to get out.  

My advice to young PA's is this:

1.  Get out of debt as fast as you can, period.

2.  Do NOT get back into debt buying a big house and an expensive car.

3.  Save Save Save.  Max your IRA and 401k each year and learn to live with what is left.

4.  Retire early before your moral and physical injury becomes permanent.

 

It is too late for a lot of us, but not for you.  It's no coincidence what this profession does to your physical and mental health.

[UGoLong]

Thanks all for your responses.   Sorry I cant address each response, but I am reading them all, it's nice to know I'm not alone with this.

 

[mention=113028]Sas[/mention], thanks for the comments. Yeah, unfortunately the place is the way it is...torn between the two ends.  Sitting outside in the sun today, absolutely dreading another 12 hour shift in the cubby, I feel like..I think I know which of the two i like better...I think i may have to choose non-isolation over good job (on paper)...

@Han, well, never thought too much of the specialties...I worked in cardiac diagnostics briefly but it was busywork.  Yes, of course, i'd have to find a place that would be willing to (re)train me and probably a pay cut, don't mind the pay cut as much as being a total novice, but I guess that would be the cost of a change...any specialties you or anyone reading might recommend?  I'm wondering about family or primary, but from what I understand, those are 4+ patients-per-hour cattle mills now too...

@revronin, nice new picture, and yeah....gosh, that video says it all.  Unfortunately, ain't nothing going to change...this is, as we know, the new normal of medicine. My primary care just joined some membership-only medical franchise that charges a $2000 "buy in" for patients, but guarantees them time to sit and talk to the doctor, and not be rushed through like cattle. I'm intrigued by the idea, had never heard of it, and am curious if I MYSELF could find such a place to work!

[mention=77160]BruceBanner[/mention] no, I get you. Honestly...I don't care about the patients anymore either, not a darn.  In fact, I absolutely HATE them for bothering me with their obviously viral URIs all day long. I see them, literally, as nothing more than annoyances that not only FORCE me to document, but KEEP me from documenting as well. Literally, in my head, with every patient, i'm thinking "shut the **** up, i don't care, just answer my yes/no questions, let me pretend to smile and care, give you my long-ago-memorized speech about sinus infections, then prescribe you ABX anyway because you will demand it, ok, now shut up and get out of my exam room and stop wasting my time and energy.... because you  decided to pretend DayQuil doesn't exist, and come in with this B.S., I have to spend twice the time I am spending with you charting your nonsense."  I guess I'g getting burned...I mean morally injured. Truly...it does feel like PTSD.  Every time I see my work clothes, my ID, my work bag...I get queasy and tense.

To all...what do you think might be a good fit for me, as a UC PA with some limited Cardiology (diagnostic) experience, where I can actually have a workload that is paced moderately enough, and interesting enough, so that i'll actually give a damn again?

 

You’ve established a great reason why your job isn’t for you: the isolation. At least you know now.

 

But you’ve seemed to have stacked up reasons not to change: all jobs are the same, I’d have to take a paycut, I’d have to learn a lot of new things, my only other specialty job was busywork, etc.

 

Get a job without isolation; that’s important to you. Get a job rounding in the hospital, for example. I round in several, have to drive around a little, and have friends all over town. Not all jobs ARE the same.

 

Advice: get out of your head and start looking. Just the “starting” part will make you feel better.

 

 

Sent from my iPad using Tapatalk

[PAinPenna]

I agree with UGo Long- A hospitalist position may be a good fit for you. Lots of walking around, social interaction, variety in your day. 

You are not crazy for wanting to see daylight in your workday. I'd be insane if I couldn't. And hospitals have lots of windows!

I have to tell you I was feeling the same way, and posted something similar a few months ago. I transitioned into Addiction Medicine. While it's certainly not for everyone, these patients WANT to get better, and there is true reward in seeing a patient go from rock bottom to functioning well in a job, marriage is better, etc. And hey- you flunk your drug screen 3 times you're out. It's great to have "rules" to back me up, so there's no room for the back and forth bs we see with chronic narc users. 

AND- no "list" of complaints.  We are there to get them off opioids or ETOH and that's it. 

Other issues go back to PCP.  Of course we help facilitate as needed, but there's an office RN for that. 

It's invigorating to practice medicine the way I imagined. 

I highly recommend to those of you who are considering it! 

[PASamsOTHERacct]

I actually started in pain management / addiction medicine...wasn't a good fit, the job was mostly about loudly scolding and verbally threatening grown adults who were struggling with addiction...not my cup of tea...

I was wondering though, how hard would it be to transition into family medicine? I have, at best, a rudimentary understanding of typical long-term medical problems that I am always telling my UC patient to "follow up with their PCP about"...and know absolutely nothing about HTN and DM management.  My brain has been wired for urgent care for a long time, and my primary care rotations were lousy and long ago.  Would it be a terribly uphill battle?

[PAinPenna]

Wow- I could not imagine loudly scolding or verbally threatening a patient who comes to me seeking help to recover from addiction.  Addiction is not  a moral failing- it's a disease. Sure, bad choices play into it- but don't all of our greatest health problems in the U,S. ie DM2, CAD and HTN?  Medication Assisted Treatment (MAT) using medications like Suboxone and Vivitrol can turn lives around, and we see it every day.  It appears to me you may have been involved in more of a "pill mill" situation than a true recovery model. 

I'm sure you are well-qualified for Family Medicine, however choose very wisely, as the burnout is real. Read the boards here. 

And best of luck with whatever you choose . It will get better for you. 

[kargiver]

On 1/22/2019 at 8:56 AM, sas5814 said:

"Someone recommended "The Subtle Art of Not Giving a Fuck" to me to read so I did. Then I read it again. Then it was like an ice flow breaking up and moving off.

Read the book....."

Best book about how to deal with life... sits on my nightstand and gets read often.  Highly recommended.

You have a lot of options.  You are just too beat down to see it.  Lots of great advice here though.  

 - VA (or a job that is not insurance for profit i.e. urgent care)

- Teaching

- Family Medicine (you'll see a panel and throughput will be expected, but its a different kind of environment.  At least everywhere I have worked and overlapped with the FP folks - they all love it, even during the height of cold and flu season

- Hospitalist positions 

You got options... let the book be your guide

If you are willing to move you have a lot more options than you think.

G
 

[Cideous]

On ‎4‎/‎4‎/‎2019 at 8:24 PM, kargiver said:

Best book about how to deal with life... sits on my nightstand and gets read often.  Highly recommended.

You have a lot of options.  You are just too beat down to see it.  Lots of great advice here though.  

 - VA (or a job that is not insurance for profit i.e. urgent care)

- Teaching

- Family Medicine (you'll see a panel and throughput will be expected, but its a different kind of environment.  At least everywhere I have worked and overlapped with the FP folks - they all love it, even during the height of cold and flu season

- Hospitalist positions 

You got options... let the book be your guide

If you are willing to move you have a lot more options than you think.

G
 

I just ordered the book off Amazon.  Will update after I read it....

[Ryanseacrest]

That is a great video, in the sense that it addresses a real problem adequately, primarily healthcare providers being too stressed.

The part that I don't understand is why healthcare providers unduly stress themselves out? If your required to see 4 patients an hour then you can only spend 15 minutes with them...8 then 7 minutes...etc. Who cares if the patients healthcare is jeopardized that's not your responsibility anymore unless you own your own clinic. If you are employed then it would be your employers responsibility. Furthermore, a lot of people would rather spend 500 on a new TV then 500 going to see a doctor..or 5 bucks on fast food then 10 on quality food.  

I guess I see it as fighting capitalism itself. Perhaps naturopathy or public health would be a better line of work for those who take issue to the this or working in a 3rd world country. 

As far as actual burnout...simply establish what can be done and what cannot be done with employer or patients and call it a day? If the terms are not what you like then just find a different employer or job.

[MT2PA]

23 minutes ago, Ryanseacrest said:

The part that I don't understand is why healthcare providers unduly stress themselves out? If your required to see 4 patients an hour then you can only spend 15 minutes with them...8 then 7 minutes...etc. Who cares if the patients healthcare is jeopardized that's not your responsibility anymore unless you own your own clinic. If you are employed then it would be your employers responsibility. Furthermore, a lot of people would rather spend 500 on a new TV then 500 going to see a doctor..or 5 bucks on fast food then 10 on quality food.  

 

And if you think that will hold up in a court of law you are sorely mistaken.  Anyone who can sleep at night by saying to themselves 'Welp I only had 15 minutes with the patient so if I missed XYZ that could lead to serious harm or death...not my problem' is someone who should not be working in medicine.

At the end of the day we are responsible for what we do or do not do regardless of the unrealistic expectations set by employers or corporate America.  

[EMEDPA]

2 hours ago, MT2PA said:

And if you think that will hold up in a court of law you are sorely mistaken.  Anyone who can sleep at night by saying to themselves 'Welp I only had 15 minutes with the patient so if I missed XYZ that could lead to serious harm or death...not my problem' is someone who should not be working in medicine.

At the end of the day we are responsible for what we do or do not do regardless of the unrealistic expectations set by employers or corporate America.  

yup, that's the nice thing about working in the ED. If I think someone needs a 2 hr work up , they get it. If I think they need 2 minutes they get that too and GTFO. 

[sas5814]

20 hours ago, MT2PA said:

And if you think that will hold up in a court of law you are sorely mistaken.  Anyone who can sleep at night by saying to themselves 'Welp I only had 15 minutes with the patient so if I missed XYZ that could lead to serious harm or death...not my problem' is someone who should not be working in medicine.

At the end of the day we are responsible for what we do or do not do regardless of the unrealistic expectations set by employers or corporate America.  

I totally agree. That is why I am working on a position paper about holding individual administrators individually legally responsible for policies that put patients and the licences of providers at stake.

I get sued because, at least in part, because my administrator thinks 50 patients a day is reasonable? I sue them. Individually. Not under the protection of their organization.

Imagine the paradigm shift that would occur the very first time this happened. Suddenly administrators have to think about much more than $$$ and they have some skin in the liability game.

I'm still working on it but I'm not getting much interest. It seems too "out there" for most people.

[ohiovolffemtp]

Scott,

How about consulting attorneys who file and defend medmal cases?  From what I've seen, the employers: hospitals, physician groups, etc are sued as well as individual providers.  This may well be to add more sources of payments as defendants, but usually the allegations have to do with the policies those organizations set.  I've not seen any cases where individual administrators who set those policies are named.  Perhaps the attorneys could articulate why that is.

[Ryanseacrest]

On 4/7/2019 at 11:52 AM, MT2PA said:

And if you think that will hold up in a court of law you are sorely mistaken.  Anyone who can sleep at night by saying to themselves 'Welp I only had 15 minutes with the patient so if I missed XYZ that could lead to serious harm or death...not my problem' is someone who should not be working in medicine.

At the end of the day we are responsible for what we do or do not do regardless of the unrealistic expectations set by employers or corporate America.  

If the legal responsibility is on the provider, then the provider is free to go at their own pace? 

[anewconvert]

Get to the inpatient world!

 

I see my patient load at my pace. I eat when I get hungry. I talk to colleagues when I need their help. I talk with patients when they need to vent or need to understand. No one rushes me out the door. No patient expecting me to respect “their appointment”.  Admits sit in the ER until I can get to them. Discharges sit in their room until I can discharge them. I respond urgently to two groups of people: sick patients and scared nurses... otherwise I move at my pace and have my entire day to get it done. When I am done I go to the OR and assist with zero expectation that I have to be there because I am handling the stuff the surgeons don’t want to be bothered with. Sometimes I even just stand in front of the window and take a couple minutes to talk to no one  

 

 

Hospitalist work is similar without the OR and wound care demands of my job. Find a community hospital, sell your years of UC experience, and then start seeing patients.