I am a 68 year old family physician in rural Maine. This morning I read yet another article about physician burnout, this time in The New York Times. (I’m not linking to it, because they have a “paywall”.)
I did not end up exactly where and how I expected to be at the end of my career, or life in general to be brutally honest. But I am the happiest I have been since the beginning of my journey in medicine.
I have a balance in my life I didn’t have, or even seek, for many years as I juggled patient care, administration, raising a family and pursuing interests that often brought me away from home.
My days in the clinic are a bit shorter than they used to be, but in the past several years I have had to do much more work from home – even more so in the last two. The “half-empty glass” way to look at this is that work has intruded more into my personal life and my home. The “half-full” view is that I can do my computer work when it suits me the best. For one of my clinic positions, I can do charting on an iPad mini in bed, coffe on my nightstand and sleeping dogs at my feet. The clumsier EMR requires a laptop (which in my view can’t be used the way its name might suggest) I sometimes work on in the barn and sometimes on a picnic table in the grass outside.
Ironically, the pandemic has brought me a peace and clarity I probably wouldn’t have achieved otherwise.
I had thought moving back to Caribou for a position with no administrative responsibilities would open up social opportunities I hadn’t allowed myself for the last few years. I expected to become involved with the Swedish community here, connecting more with neighbors and other horse owners, and so on.
But the lockdown forced me to sit more with my own thoughts, my own feelings and memories. It forced me to consider, not for the first time but again, that in this unpredictable life, the only sure thing is that I am me and I am where I am.
When I, as many other people, realized that this pandemic could wipe out countless people including myself, and completely change the living conditions for those who survived, it completely freed me from worrying about the small stuff. Or, rather, from considering the small stuff, because I’m not really a worrier. I just used to run a lot of what-if scenarios through my head. I used to be several steps ahead in my mind and have not only Plan B figured out. I would have backups to my backups.
Now I fully accept the unpredictability of life and that has freed up a lot of mental capacity and even time for me.
I have published three books and my blog has continued to grow. At this writing I have posted every single day for the last three weeks. The more I write, the more ideas I have. And my writing is inspired by my engagement with patients and the thinking about medicine they provoke in me. My clinic work informs my writing and my writing makes me a more curious clinician. I go to work thinking “what interesting things will I see today?”
How could I feel burnout when every clinic day is where I go for writing inspiration?
The pandemic has also, ironically, brought me closer to friends and family. Pre-pandemic, I felt too busy to connect, especially in person, never liked to talk on the phone, and I was not into social media. Now I text, call or chat often with my children. I FaceTime biweekly with my exchange student year brother from 50 years ago. I email and chat with cousins in Sweden and some of their children are in my Facebook feeds.
I am also more connected to my home. I take greater joy in doing the little fix-ups. In years past, my home improvements were on a grander scale. Now I do the little, low key things with just as much pride.
I only leave the property to work in my clinic (my second job is via telemedicine from my kitchen island) and to go shopping. The animals thrive on being all together and mild summer nights we all sleep in the barn with the top doors open. I love falling asleep to the sounds of summer, the snoozing of dogs and the chomping of hay.
I am so content with my life as a country doctor.
A Country Doctor Writes: 
It was interesting to read your perspective, in fact I did a double take when I read the headline since the majority of articles emphasize burnout as the norm. State of mind, balancing your life, and being happy as you have written, helps mitigate the perception of burnout. How do you teach that to providers who voice how overworked and stressed they are? In some ways it is a personal choice.
I ALWAYS ENJOY READING YOUR THOUGHTS. But it is nice to know that in this troubled world you find contentment. Not everyone can.
Finding a special place to rest is not easy as one grows old. Especially when the mind goes a mile a minute and the body slows down.
Your post and my e-mail friends fill a void that my steps cannot keep up with.
Keep up your inspiration and sharing knowledge with your thirsty friends.
I don’t miss a one. Thank You, Lynne Findlay
I retired from a 40-year career (including 3 years of residency) in Family Medicine in January 2019. I graduated from Jefferson in 1979. Then I did a 3 year FP residency. I became certified in 1982 and recertified as a Family Medicine specialist throughout my career. I did solo practice within a great 4 person call group for 12 years. I formed and then joined a 3 doctor and eventually 5 doctor group practice and worked there for 15 years. We then joined the local healthcare system and I worked in that practice for the last 10 years of my career. We went from dictated notes that were pasted into the paper record to using the Dragon voice ID dictation. Then, while with the health system, we started with Allscripts and then converted over to Epic EHR. I worked harder, and spent more time, and used more of my intellectual capital learning the electronic EHR than I did on learning new things about taking care of my patients. Finally, for the last 4 years of my career, I had a scribe to help me with data entry into the EHR. I paid for the scribe out of my own pocket. That scribe saved me. My spouse insisted on using the money for a scribe. She was right, as usual. I averaged about 70 hours per week at work, but 110 hour work weeks were not unusual. During most of these years, I also served as a Deputy Medical Examiner for the State of Maryland.
In 2005, after one of our partners quit the practice (“burned out” according to him), we began to use the hospitalists for our inpatient care. I did not like it at first, but it was also a lifesaver. Between our own large practice and hospital roster call, it was not unusual to have 10-12 admissions over a weekend call and 3-4 on a weeknight call. Not having that responsibility was life-changing. About this time I also stopped going to 7 different nursing homes to see my own patients once they were transferred there. I stayed with one nursing home and took courses to become a certified nursing home medical director.
At no time did I feel “burned out.” At no time did I fall out of love with my career in medicine. Frustration, anger, disappointment, and occasional disillusionment certainly occurred from time to time but were never a theme or major part of my thinking. My spouse immeasurably helped to ground me from having that happen, just like she did when “we” went through medical school and residency.
I’m glad the doctor here seems to have never had those struggles. I don’t think I ever “burned out”, but I also have never looked back on my career. I believe I always did my best, was caring, empathetic, and went beyond what was needed to care for my dear patients. Now I very much enjoy my day to day “freedom.” I don’t have the concerns about my patients, my decisions, and documenting things that used to occupy a lot of my mental energy. My wife still works full time and I now do a lot of the home duties and find enjoyment in the small things- little repairs, shopping for groceries, cooking, vacuuming, and yard work. I have time to read as much as I’d like to, enjoy my hobbies, and sometimes do nothing! I keep up on medical news and developments. I enjoy visiting Civil War battlefields and their history.
No burnout, but not missing the practice of medicine even the slightest amount.
I would never judge someone negatively who feels like they have “had it” or feel “burned out” with their medical career. There can be and are a lot of challenges mentally, physically, and emotionally as a doctor. I’m just so glad to no longer get that 2 am call from the ER that there is a dyspneic and lethargic 3-month-old with a 103-degree fever there and they need me to “come on in”.
I’m glad our doctor here on this vlog is doing so well. And I send him my best wishes to continue to do so!
“mild summer nights we all sleep in the barn with the top doors open. I love falling asleep to the sounds of summer, the snoozing of dogs and the chomping of hay.” ~ That is amazing. Love reading your your thoughts and stories. Thank you.
In the barn with open doors and the sounds I described this very moment
I agree the EMR is one the reasons for physicians burn outs. Other factors are the complicated credentialing systems, billing systems and prior authorizing system in the USA…I have lived and worked in other first world countries and I know these systems can be made easier for physicians to use and to prevent frauds.
I read this last evening and was deeply touched. I love your resilience and energy. I wish we could help you to go “viral”
larry
Virus-free. http://www.avast.com