Dear readers, for this blog edition one of my clients shares her career transition story with you. This post is longer than usual, but there is so much here of value that I have posted the piece in its entirety. Down the road we will check in with Danielle to see how she is doing in her new career. Comments are welcome.
“Hello. My name is Danielle and I am a recovering Primary Care physician. After two years of post- baccalaureate education, four years of medical school, three years of residency and four years of clinical practice, I found myself in a very desperate, empty place devoid of enjoyment, purpose and happiness and I knew I needed to fix it. I hung up my stethoscope in search of a saner, fulfilled life.
At this point, I have transitioned out of clinical medicine and thought I would translate my journey into steps. They are not successive steps, but more of an outline of the necessary tasks to complete my “recovery.” Hopefully, some of you will identify with pieces (or all) of what I am saying. When I started this process, I felt extremely trapped, isolated and ashamed. I hope that you will feel a sense of comfort in my words if you are in a similar place in your life.
My 10 steps to recovery (still in progress):
- I had to get honest about WHY I was so unhappy at work. How did it come to pass that I had worked so hard to be in a career that made me so miserable? I had reached the pinnacle of Mount Everest and felt like I had descended into hell. Why was I so unhappy? Well, for starters, I felt like I worked 24 hours per day, 7 days per week. My actual clinical hours amounted to about 55 hours, but I could not leave work at work. I would continually think about my patients, about what was going on, how I could fix it, what I could do as a next step. It was as if I was walking thru life with a clinical cloud around my head. There was no shut off valve and I felt suffocated. Life was a process of moving from one fire to the next and never having enough time to fully extinguish any of them. Fall behind for one second in any of the day’s tasks, and I paid for it exponentially. My life was a finely placed house of cards. If one card was slightly askew, the house collapsed. It was go, go and go faster. I was a “part-time” doctor by hours. I was paid for 26 “patient care hours” per week, but had to work 55 hours per week to stay afloat. I started getting up at 4:30 in the morning to work electronically and remotely on the day’s appointments in an attempt actually be “on time.” Nothing like staring at a computer screen at o-dark-early trying to find the date of your 10:00 patient’s last colonoscopy buried in a torrent of scanned documents. I would work from 4:30-7:00, then put on my mommy hat and get my daughter clothed, combed, teeth brushed and top off the morning’s fun with nothing more than a Pop Tart in her belly. I would wait for the school bus with blood in my eyes. If it was 2 minutes late, it was less time I had to get to work. Once at work, I would drink from the fire hose of primary care. Endless streams of patients with “lists” of complaints and 6 chronic problems to address in 15 minutes. Don’t get me started on prior authorizations, writing scripts for OTC medications for FSA accounts, endless lab and radiology results and cap that off with the 20+ phone calls per day with various complaints ranging from “I’m not better after 12 hours on my antibiotic” to “I don’t want to come in, so can you just treat my unilateral weakness and facial droop over the phone?” Let me also give a shout out to the legal profession here. I have been “served” legal papers twice. The knock on the exam room door saying “you have someone here to see you and it is important” and the explanation that there is a process server waiting behind the counter probably shaved 20 years off of my life. In both instances, it was for a custody case! That walk from the exam room to the front desk, opening the envelope- it was like waiting to hear my execution date. Working at a pace that is superhuman, dealing with the tiniest of details that could kill someone if one mistake is made with the constant threat that if you are human and actually err, you will pay dearly for it left me intimidated and constantly fearful.
- I had to get honest about why I was so unhappy with myself. On a deeper level, I was not the person, wife or mother I wanted to be. I spent my days in a constant state of rush, rush, rush never smelling the proverbial roses. I never had time to do anything for myself and could barely manage to provide basic care for my daughter. As for being a wife, I was just a moody cow most days. I neglected my own needs routinely. My last physical and blood work was 1999. My hair got professional attention approximately once per year. Exercise? What the hell was that? I would make half-hearted attempts to play with my daughter all the while thinking about a patient’s illness and what I could have done differently, what I should do now, who I should consult, etc, etc, etc, and it felt so dishonest. I could never be “present.” When I was at home, my brain stayed at the office. When I was at work, I struggled to go quickly so I might have a chance of getting home at a reasonable hour to be “present.” I ignored hurts or boo- boos because they certainly paled in comparison to the flesh wound I saw at the office. My poor husband could not be spared my time to be taken to the ER for a large laceration. Instead, I only had the energy to sew him up at the kitchen table with expired and ineffective lidocaine. At 103 degrees, with my husband out of town, I pumped my child full of Tylenol and prayed not to hear from the school nurse, that the typical 4 hour acetaminophen duration would somehow bring me the 12 hours I needed to cover for the school day and of course, after-care. I routinely sacrificed her comfort, her time with Mama so that I could go take care of other (sometimes less) sick people. I sacrificed everything to go to work, to be a doctor, to keep myself on this trajectory to hell and I hated myself for it.
- I had to figure out how I ended up here. How did I end up in medical school anyway? Was it because medicine enthralled me? Was it because I saw someone I love get very sick and felt powerless? Was it because I “wanted to help people?” No, no and no. I examined my initial motives. This was a very telling bit of information once I was willing to be frank and honest with myself. I came to the conclusion that it was a perfect coalescence of poor self- image, the brain power to accomplish the task and a bank willing to lend me enough money to feed a starving nation. On the first element, let me just say that I came by this honestly. I was taught that I was “not enough” at a very early age. I will refrain from pointing fingers, because this is my journey and responsibility now, but my childhood left a lot to be desired. It was filled with insecurities, neglect, intermittent showing of love for accomplishments and overall inconsistency in parenting. Yes, I have been to this place and I have the T-shirt and the therapist to prove it. The answer to this question for me was that I desperately wanted approval, respect and love. I wanted someone to be proud of me. Ouch. Not the best reasons to commit to years and years of self-sacrifice and delayed gratification.
- I had to find help. On a dark fall morning at 4:00 am, I could stand myself no longer. I was miserable. I found no happiness in the impending sunrise, in my daughter’s smile, in the love of my husband. On a daily basis, I vacillated between tearfulness and anger. I cry now for this person. She hurt so deeply and felt completely alone. I wish the person I have become now could travel back in time and hug her. In desperation, I typed “non-clinical medical jobs” and sent it out into the Google abyss. What a Google search returned to my laptop that morning was going to be a key ingredient in the recipe for my salvation. I found Doctor’s Crossing and Heather Fork, M.D. Thinking back on this now, I had cast a desperate message in a bottle out to sea and it returned to me filled with the answers, like balm for my burnt soul. I also started seeing a therapist to address the self-esteem issues that were the root of my discontent and current station in life.
- I had to hatch an escape plan. So, In order to get out of my current state of misery, I had to find a way out. The bills would still find their way to my mailbox, so I needed to find some way to make enough money to live. Frankly, I didn’t know what was out there. I thought about a gig as a Wal-Mart greeter, but the pay was not quite enough. I knew I would not last much longer in primary care without a major breakdown, but I didn’t know (and still don’t) what my “dream job” would be. In working with Heather, I learned of a vast number of options for non-clinical jobs. I interviewed in November 2011 for a position reviewing medical records and got the job. I was not sure it would be my “forever job,” but it certainly would pay the bills and keep my medical muscles flexed. It would also allow me to work for 24 hours per week for roughly the same salary I made working 55. And, I can do it in my pajamas. In order to escape before knowing my “true calling,” I had to find a bridge position. This is mine and so far, it is working out swimmingly.
- I had to tell my family and friends. I remember a friend referencing my “glamorous life” and I suppose this is how it might look to others being a doctor and all. But, how glamorous is a prostate exam? That about sums it up for me. For my parents, friends and acquaintances, it was not so easy to understand. Having to explain your misery just makes you sound like a whiner. My approach to telling my parents went a little something like this: “I’m going to live for myself now.” My father took it like a trooper and encouraged me to do whatever I wanted, mainly because he’s at a point in his life where he wished he had worked less and spent more time with his family. My mother has still not come to terms with my decision. She mainly deals with it by ignoring it (picture fingers in ears saying “la, la, la, la…”). Nevertheless, I have made it clear that this is my story and now I am the author. As for friends, the important ones accepted this in stride and have been incredibly encouraging. My medical friends are living vicariously through me as the discontent with medicine is more widespread than I had suspected. My husband could not have been any more supportive in this process, but that is mainly because he saw the day in and day out carnage. Let me also say a word about what people suspect about a doctor leaving medicine. Can you guess? Yes, they assume you have been sued. I have run into this more times than I care to admit. I still feel compelled to let people know that this is not the case, but I’m leaning toward telling them to kiss off. In truth, the only respect I need at this point is self-respect and I am caring less and less about what other people suspect or think of me.
- I had to tell my employer. Not so easy in a small practice setting. have the deepest respect for the practice partners that employed me. They took me right from residency and showed me the ropes. They invested a fair bit of time in my career and I felt like I was letting them down. As a first step, I asked to have a meeting with them. I told them I was “tired” and that I didn’t know how much longer I could last. Because they are also “tired,” they understood and I received absolutely no criticism. In fact, they immediately suggested ways to lessen my load. However, the fact remained that I was quite done and I gracefully declined. I also told them that I knew it would take months and months to find my replacement and that I would hang on as long as I could. I did not want to repay their kindnesses by darting out the door with 3 months notice (as is required by my contract). I knew that it took 1.5 years to find the last practitioner, so I felt compelled to give as much notice as possible. They took my cue and immediately started searching. It took 7 months, but they found a doctor to replace me. They frequently express their gratitude for my long period of notice. I still speak with them occasionally and let’s just say, the bridge is not burned. I have been offered an opportunity to return at a moment’s notice should I desire. Unlikely, but very flattering.
- I had to tell my patients. I expected patients to respond with anger. Nothing could have been further from the truth. My script went a little something like this. “I have something to tell you. It is not easy to say this, but I am leaving the practice.” There were shocked, jaw-dropping faces on the other end of those sentences. It was hard to utter these words, but it got easier from this point in the conversation. I then went on to say that unfortunately, the hours and commitment were not sustainable for me in the setting of trying to raise my family. I spoke of how I loved being a doctor, but right now, while my 5-year old still likes me, I want to spend time with her. Out of the hundreds of patients I had this conversation with, only 3 responded poorly (and I could have predicted it ahead of time, so I was prepared). Being honest, but positive was my approach. I did not say, “I hate this place” or “I’m just so overworked” or “Patient demands stress me to the hilt.” I just said how I found it incompatible to be a family practice doctor and raise a healthy family. More times than not, patients said “Good for you!” “Wow! Fantastic!” or “I’m so happy for you!” and I think they genuinely meant it. By the time I started telling patients, the new doctor was hired, but not working for several months. I was, however, able to tell patients a bit about him and that seemed to allay some fears of the unknown. As time marched on, my office was flooded with gifts, flowers, cards and well-wishers just stopping by for a hug. I thought I had done a good job for my patients, but they really proved it for me in the end. In sum, I left on the highest cloud. My patients were wonderful!
- I have to keep working on my sanity. Just because I have removed a major stressor does not mean I am an inherently different person. I am still wired to be anxious, to delay gratification, to look for the catastrophe in any situation. But, I am trying to address these things with therapy and my continued relationship with Heather. I am reading books on many religions, I am getting my hair done, I have seen a physician and I am going for a monthly massage. I am trying to be present in most interactions with my daughter. I am trying to be a less distracted and moody wife. I find moments of progress here and there. For instance, I saw an unmade bed yesterday and thought it looked like a perfect trampoline and asked my daughter to join me. The previous me would have seen another task on the “to do” list. Now, I have some room to breathe and dream. Overall, the changes are great, but I am still me and there are deeply seated things that did not vanish the moment I hung up my stethoscope. I am a work in progress.
- I am finding my passion. All things told, I should have gone to art school. I am exceedingly creative and I LOVE to make something from nothing. Give me an old dingy wall, a couple tubes of paint and two hours and you will have a mural. Give me an ugly table and some broken tile, and you will have a mosaic masterpiece. Creativity for me comes in quiet times though. So, I am creating quiet and letting the passion bubble to the surface. I heard once that an artist is the inner child that survived. She’s in there and I am searching for her every day. If I let my mind wander, I think about opening a do-it-yourself art studio. I also make soap as a hobby, so maybe I will get a soap company off the ground. We’ll see. But, whatever I do, it will be with motives that represent my needs and desires, not those of others.
There was a fair bit of shame for me in this process initially. I also felt exceedingly trapped. Please know that new career possibilities are out there and that you are not damaged goods if you leave clinical medicine. In writing this piece, I hope that you will find some comfort in knowing that you are not alone, that there is nothing shameful about leaving clinical medicine and it is completely possible to do so. It is YOUR life and it is short. Be proud of what you have accomplished and equally proud of yourself for realizing that there might be something else out there for you. The only shame in medicine is staying when your mind, body and soul want to be elsewhere.
My deepest gratitude to my husband for loving me through the bad, very bad and down-right ugly times even when I made it impossible, to my daughter for forgiving my shortcomings and loving me blindly and without reservation and to Heather Fork M.D. for shining the light so I could finally see myself and my potential. ”
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