I'm starting a series on Docs Who Cut Back, and I'd love to share your story if you have the time and inclination.
The therapeutic window of a drug tends to describe the range of doses in which it has the desired clinical effect. Too little and you lose the benefit you sought. Too much and you might die.
Medicine as a career has a narrow therapeutic window.
Too many shifts in the ED and I become unhappy, numb, a stranger to my kids, a burden to my wife. I grow apathetic as my life grows pathetic. This is not my beautiful house. This is not my beautiful wife.
The brilliant graphic artist and blogger-philosopher-king Waitbutwhy created a poignant and deeply affecting post entitled Your Life In Weeks that provides graphic summaries of a our time on this planet in viscerally intuitive terms. It makes you realize that All This eventually ends, so if you are unhappy with your All This, you'd best change it up as soon as possible.
There are different ways to implement change. Some people adopt radical reinvention: sell the house, sell the car, move to another state and start over. I decided incrementally changing my institutions from within to enable the career I wanted was going to be the best option for my situation.
It took a few years, but I changed it up. The color that had ebbed from my days slowly returned. A weird thing happened - as I cut back, my career in medicine moved from the toxic range back into the therapeutic window.
I genuinely like what I do now, largely because I do less of it more humanely.
I have the time to stay fit(ish), work on art projects or shoot baskets with my kids, and enjoy lunch at home with my wife most days of the week. The Venn diagrams of my actual life and my ideal life share significant overlap.
I'd like to think I'm not alone.
After years of careful looking, I can confirm the existence of a subset of misfits and non-conformists in medicine who have always been there, under the radar, practicing a sustainable brand of work-life balance.
If you are such a physician, and you cut back your clinical commitments as part of effecting this type of change, please reach out to me via the comments below or at crispydocblog (at) gmail (dot) com.
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Days and days go by (after the monies gone). It truly is once in a lifetime. Lol
Great idea for a series. I know that by reducing one clinical day a week (I pay someone to cover for me) I have helped to recharge my batteries more and prolonged my career life drastically as I was getting burnt out before. I would like to reduce it one more day in future and have a 3 day work week which I think would be an ideal balance of work and home life
Author
Xrayvsn,
As a proponent of the one and a half day work week (I’m at 6 shifts per month), let me warn you that clinical reduction begets further clinical reduction.
I went from 12 to 9, then 9 to 6, and I think this could be my steady-state until I opt out of medicine.
I’d love to interview you for the series.
I think we can say that docs who cut back are ensuring it won’t end up being the…Same as it ever was.
Fondly,
CD
I might be on this list someday in the next couple of years 🙂 If/when I cut back (and become the only young male faculty member in my department to do so), I’ll be sending a guest post your way.
It’s all about what you want out of this crazy thing called life, and then fashioning your work to help achieve that goal!
Thanks for being a thought leader in this space.
TPP
Author
The day you join the list, I’ve got first dibs on your interview. I’ve noticed it takes great big cojones to wait until your peak earning years hit their stride and then decide your time is worth more. You, TPP, have precisely such cojones. I’ll break out the streamers and a piñata for when you come over to the dark side.
In the meantime, I’m enjoying reading all about your journey.
Fondly,
CD
CD-I’m over here singing in my head (because no one really should be forced to listen to me singing tunelessly out loud. Then again, no one’s home, so maybe I should belt out…SAME AS IT EVER WAS!) 😉
This is a great idea and I’m looking forward to reading this series.
Now if only we could all work song lyrics into our answers….
I think physician burnout is a matter of the normal distribution. 1 delta toward success is 34.1% into the tail. 2 delta is 47.7% into the successful end of the tail. Twice the effort only 27% improvement. 3 delta is 49.9% into the tail 3x the effort 2.8% improvement. 4 delta blows everybody up. 4 times the work 0.1% improvement. Physicians by their nature live somewhere starting at 2 delta land. Some of us venture into 3 delta land at least in spurts. There is definite pressure however to live a 3 delta life. If your natural proclivity is 2.5 delta, 3 delta is a brutal way to live. The solution is to dare to be average. Dare to climb out of the tail and live further up the curve. Medicine is a burnout gig especially if you’re an employee. The MBA’s have you by the balls. The know the pressure for Dr’s to beat themselves into 3 delta performance and they exploit it. It’s trained into us. We are the guys who don’t lose their heads when everybody else is losing theirs, and we were picked for med school because we would let them beat the crap out of us and still show up the next day at 5:30 for rounds, 100% of the time! The government exploits it. Our groups exploit it. What you need is steel balls. Squeeze steel balls, they don’t give. MBA’s don’t know how to act when the balls don’t give.
I ran a group for 18 years stoking the star making machinery behind the popular song. That was the work I’d taken on. I did my best and I did good business, but everybody’s in it for their own gain, no loyalty, so we were replaced by Blackrock’s version of Medicine. I was FI, but I started a new gig and went into competition with my old hospital as a SDSC and took away the paying 30% of their business. So for me the career change was the same profession but growing a different business model. It was fun. We took away 30% of their top nurses and scrubs as well. All ya need is steel balls, the MBA’s don’t know how to act. They’re mostly just a bunch of ex jocks anyway, all bravado average IQ, sloped foreheads. Even at 50 years old, their fear is losing status at the high school.
Author
Gasem,
My dream is to set your comments to music and create the ultimate subversive album lyrics about medicine. I humbly submit working titles for tracks on A side, derived from the poetry of this comment alone:
1. Into The Tail
2. Three Delta Is A Brutal Way To Live
3. Dare To Be Average
4. Burnout Gig
5. Squeeze Steel Balls, They Don’t Give
6. Star Making Machinery
7. Everybody’s In It For Their Own Gain
8. Sloped Foreheads (Losing Status At The High School)
That’s an album I’ll listen to from start to finish; load onto the kids’ ipods; and give as a gift to all my physician friends.
In January I cut back to three days a week. I dropped my four 0.1 FTE medical directorships to do that. I realized I enjoyed the clinical work more than the administrative work. So I’m now just clinical, but 0.6 FTE.
It has allowed me to continue clinical medicine. I took a pay cut from losing the stipends but having more time for the rest of my life more than makes up for that. I have no regrets about making the downshift.
Becoming FI boosted my confidence to make the change, but in retrospect, I probably should have done it sooner.
Would you like to know more? If so, what?
Author
WD,
That sounds like a great move, and I’d love to hear more. I’ll reach out behind the scenes, but I’d love to have you as a guest interview.
Thanks!
CD
I unapologetically started out at 0.75 FTE right after residency (a cancer diagnosis and disability will change your outlook on how much you really want to work). As things stabilized healthwise, we had a child and also realized we were FI, so I actually cut back even further to 0.5 FTE. It’s the perfect blend of work and play time for me. I don’t dread going back to work after a long weekend or vacation, but my shifts are not infrequent enough to feel rusty… or hungry.
Author
You were on my list of interviewees I’d love to interview – just didn’t make it all the way down my to do list before this published. Enjoyed reading your recent MsBonnieMD feature, and hope hope hope you’ll consider participating in this project. The more we normalize balance in medicine, the more people will come to understand how irrational the expectations of a traditional medical career have been.
Hey Crispy Doc,
I cut back to what would probably still be considered a full-time job. This was done via a combination of dropping the parts that I didn’t like (my outpatient practice) while growing the parts I liked (ICU) when the opportunity arose. Then, further shaping the ICU practice. Like cultivating a bonsai tree. I am now down to about 22 weeks of ICU per year. That is still full-time for ICU, but what made the biggest difference was probably what you eluded to about changing your instution from within to enable the career you want.
I stepped into a leadership vacuum shortly after starting my career. I partly got the job because our practice was eating people up, making for turnover. A decade ago, we had one doc on service covering an overflowed unit for 24h/day seven days in a row which included being in hospital for part of every evening plus the whole night at least once per week. Now, there are three of us on per day, we cover alternate nights from home, give each other breaks, and have separated the inhouse night-time coverage if needed. Those weeks of service are 50-60h (and effectively less with our increased work distribution) now instead of 80-100h and it is very flexible for us to cover each other for family time, academic endeavors, etc.
So, even though I work the number of weeks of a full-time intensivist, it really feels like part-time.
-LD
Author
Loonie Doc,
Going from unsustainably crazy to hectic but reasonable is certainly progress (especially under the siege-like conditions you describe at the start of your career) reflects the spirit if not the letter of cutting back.
It’s almost cutting back – but not quite. Jim Dahle went to 8 shifts a month – that’s amazing, except for his other full-time job at WCI. He’s the first to admit he effectively cut back to only 1.5 times a normal workload.
I’m in awe of you all the same. Specifically, I’d be interested to learn how you went about changing the institutional culture from within – that’s the sort of skill that I try to pick up from others. Have you written, or would you consider writing (or better yet, guest posting! Dibs!) a case study on how you went about doing so, and what variables contributed to your success?
I’m sure many of us would enjoy the tactical approach to which levers you pulled to make your ideal career overlap more with your actual career?
Fondly,
CD
P.S. Should I ever require time in the unit, I hope it’s yours.
Hi Crispy Doc,
Happy to talk about it. It is in my cue to write about also. Happy to do as a guest post here also. Not sure exactly when I will get to it, but will collaborate when I do. Docs and hospital administration are interesting groups to work with and I have learned a number of things from trying to lead change amongst them. Some definitely through trial and error!
I’d be happy to be interviewed; just let me know! Great idea for a series.
I would totally volunteer myself to be interviewed in this series. That is, if I count as a doc who cut back.
In my case, I moonlighted additional hours during my last year of residency and during fellowship to help pay off my student loans while maxing out retirement accounts.
The first three years of being an attending I worked about 1.5 FTE (~60 hours week) to work toward paying off of the rest of the student loans and toward a down payment of a house.
Now that I’m a partner and no more student loans, I’ve essentially cut down to 1 FTE and I’m loving it. But I feel like my career will be like a sine wave. I can see myself going back to 1.25 FTE if I feel like making more money and dropping down to 1FTE when I want to relax. Whatever cycle I’ll be in… it’ll be my choice.
Cheers,
DMF
Author
Interesting, DMF. You are the second person (including Loonie Doc) who has made a point of saying thy “cut back” to a single FTE on their hours. I think after the first few interviews, it might be very helpful to interview so any similar workhorses know that they, too, may one day tire of burning the candle at both ends.
I think it’s a strong affirmation in favor of life when someone realizes they want to spend more time away from work. I appreciate the offer and will take you up on it down the line. I’m sure you’d have some terrific insights to share on what prompted he change in trajectory (I suspect paying off student loans are only the tip of the iceberg).
Thanks for offering, my friend!
CD
Count me in, bro!
I made my FI number after 10 years of work between 26- 36 years old. That was 2004 ish.
Then I stopped practicing until a few years ago when the local licensing body stated we need to practice a bit to stay current. That works out to about a day a week nowadays. I want to keep my license active.
I also want to work more now that my daughter is at university.
I slowed down to hang out with my kids. I’m glad I did.
Folks gotta realize that we can be doctors for a very long time.
Author
Dr. MB,
You are an unusual example of an MD-mother who stopped out completely for years and then resumed practice. I’d love to add your perspective to the series – how does one design a glide path with exit during the family years followed by re-entry? I’d bet the on-ramp after time away is a big concern for many parents who take time away from clinical practice when their children are young.
I had dinner with a friend from residency last night I’d not seen in a decade. He remarked that his medical license was the most valuable piece of paper he had in terms of the earning power it afforded him. Many of us eager to hit our FI number feel ambivalent about relinquishing that hard fought license – PoF being a highly visible example.
Would you consider sharing your story through this series?
Fondly,
CD
Hola CD, dunno if there is room para mí on your list, porque, I didn’t merely cut back, I CUT OFF last month!. I quit my (beloved) 9-5 for what I now call an “accidental passion”. It’s the longest story ever, but also the best, because never in my adult life have I been able to spent time unlimited with mis hijos, but I am doing so now.
I am a BC Pedi mom turned passionate speaker on Bullying, Teen Depression and Suicide. I’d love to share the rest of it…the best of which is getting to meet the man my son has become, because I was home. Holler at me, let’s do this.
PS: thanks for the platform, great idea it is…??
Author
Uchenna,
I’m thrilled to have you participate and pleased to make your acquaintance as a new invisible friend from the web! I impressed at how our Canadian counterparts are leading the way to prioritizing life over work – you and the ER doc behind Big family Small World are setting some terrific examples.
I’d love to hear more of your story and would be thrilled to feature you – you’re in! I’ll reach out soon once the interview has been finalized (i.e., passed inspection by my discerning better half).
From a look at your site, you are doing vitally important work – the reason we try to get our financial lives straightened out is to have time for those priorities that touch lives in ways far beyond the clinic or the hospital, but no less important. I’m so glad you could be present for your son when he needed you most.
Fondly,
CD
I’m a type A.
Became millionnaire at 36 and decaM at 42.
I’m a specialist.
Then disaster hit. In the form of cancer.
I didn’t quit but went to 40 weeks/year to 35 to 30 to 26 to 16 to 15 and now 12 on my way to 10. I’m still alive obviously and well…
I still enjoy the work though hospitals make it harder and harder. Referring docs as well.
I am learning a more lucrative career that hopefully I can pursue in complete independence from employers and geographic limitations.
I may then even fully stop medicine if it becomes a burden and maybe start a mastermind group of the new career with fellow aspiring docs (and docs only)