Hey everybody. This is Dr. Inc. Bringing you another episode of the truth about employed physicians.
new Series for Young Physicians
I’m really excited this week to start a new series targeting young doctors. In this series, I will introduce you to my son, John, who is a PGY4 medical student at my alma mater, Indiana University School of Medicine. For the next many weeks we will dialogue around subjects that intersect our lives as doctors. I think it’s a series that you’ll find interesting and I look forward to hearing your insights on each subject. The content of this series will be based upon a book that I’m in the process of writing for young physicians that I hope will help them thrive in the new world of medicine. Stay tuned, it will be available on Amazon later this year.
Introducing John
Dr Inc: John’s generation has some interesting views about medicine that aren’t always congruent with what I was conditioned to understand as a physician. I don’t consider myself wrong or right in my baby boomer’s view of medicine, but I certainly have come to understand some things we just don’t see int in the same way. So, John, tell us a little bit about yourself so our audience can get to know you and get to know about where you’re at.
John: I went into pre-med at the University of Alabama knowing I wanted to go into medical school afterward. I got a psychology degree because it was the most intriguing subject that I felt would be applicable to actually practicing medicine, compared to doing chemistry or biology or biochemistry. Because the reality is in most doctors and medical students know that you’re very unlikely to ever use these undergrad subjects again. I felt like it was a waste of my time to study so hard on those traditional science subjects when I didn’t care that much about them, and I wasn’t ever going to use them again. So I went in as a chemistry major and I quickly changed to psychology.
Dr. Inc: But you went to undergraduate knowing you want to be a doctor right?
John: Yeah, that’s true.
Dr. Inc: How did you know that?
John: I think feel like there are a lot of things growing up that added up to me being called to be a doctor. Of course, you get that little bit of extra push and experience when you grow up in the household of a doctor. Since we lived in a small town, I saw you almost always being “on” whether that was at Lowe’s, church, or on the sideline of the high school football game. I remember hanging out in the doctor’s lounge while you delivered a baby, or rounded at the hospital. I guess most of the average 10 to 15-year-olds don’t get that experience even if they think they want to go into medicine. I had the luxury of seeing what a real doctor’s life was like. So, I think I had a little bit of an advantage because I knew what I was getting myself into as far as the time commitments and the importance of prioritizing balance in your life as much as possible. My up-close exposure was helpful.
The Doctor’s Life
Dr Inc: I love the life that I have as a doctor. I’m so fortunate and really consider myself very blessed to be a doctor. I am hopeful that most medical students are anticipating the good life that their profession is going to give them. What were some of the things that made you say that you aspired to have the doctor’s life and what were some of the things that made you question if you really wanted to be a doctor?
John: Some of the advantages of being a doctor I’d say are just the constant learning and intelligence that it takes. I think that there’s a lot of critical thinking and problem-solving. That’s not necessarily true for a lot of jobs. It’s a lot more mental labor than physical labor. I think that I’ve always had a greater strength in problem-solving and thinking through things. So that was always appealing to me
I think that the ability to live a moderately nice lifestyle with large paychecks is great as well.
Serving as a valuable member of society and using your social power for the benefit of your community is a significant part of the altruism found deeply within doctors. This is unique to our profession and makes it special. You have open doors and trust from community members that you can leverage into social capital to do a lot of good things.
Being a kid in a doctor’s home gave me a perspective on people of all walks of life and the importance of respecting people as equal human beings regardless of any differences that exist. You learn to walk humbly and live modestly while you assimilate into your community.
The Challenges
Dr. Inc: So you didn’t find it to be a negative experience growing up as the doctor’s kid in terms of the expectations, perceptions, and biases that others may have had against you?
John: I don’t feel like I did. I don’t think I ever struggled with those things really that much. I didn’t really feel those pressures. I guess maybe this is one of the things that it takes to go into medicine you see something that’s challenging and you take it on. I feel like I enjoyed the benefits of being a doctor’s kid, but never really felt much of the pressures associated with it.
Growing up in a doctor’s home, there is always an unpredictable schedule that impacts a kid’s world. That was not always enjoyable, but it is a reality that you have to learn to accept. You understand that your parent can be dutifully called to take care of a sick person and that will result in him/her missing your personal event.
Dr Inc: Did anything else stick out to you in terms of your own personal experiences that you saw as being challenges associated with the doctor’s life? I certainly feel like the opportunities that are created by my profession and the economic forces that go along with it provide security and provide resources that easily outweigh most of the negative elements associated with the doctor’s life. The biggest evolution that has happened for me in the past 25 years is the movement away from unpredictable clinical time to predictable clinical time. Outpatient-only practices have emerged, and hospitalist services and shift work have become the norm. I think these shifts have been a response to pressures associated with the old doctor’s life which was hard and unpredictable.
And I think most of your generation of doctors don’t like, and won’t like, and won’t tolerate as much the unpredictable lifestyle of medicine. Thus they will navigate towards jobs that provide predictable hours and predictable income. What do you think of that?
John: I think there’s just a bigger focus on having lives that separate your work life and family life and social life. It’s better to have balance and have things broken up rather than having your work-life steam roller over everything else.
Home Life and Burnout Prevention
Dr. Inc: There’s a bigger awareness now that doctors need balance in their lives or their well-being will be jeopardized. The high rates of burnout which are around 50% for all doctors are evidence that things have gotten out of whack. I think that is one thing that your generation has gotten right, the need for balance and time away from medicine is a critical part of preventing burnout.
Another secret to combating burnout is having a healthy and peaceful home life that provides you a haven and retreat from the pressures of our profession. I know you are married, and how long have you been married?
John: Two and a half years.
Dr. Inc: For me, my wife has very much been a significant factor in bringing stability to my life as she understands the sacrifices and time pressures that are associated with my doctor’s life. Empathy is all part of being a spouse of a physician. It’s not a great gig all the time. It can be pretty tough. Yet, I know she’s my rock. When I have had a tough day, she’s the one that smooths it all over. She is a stay-at-home wife and mom and truly makes our home a place of rest and peace. I can’t wait to get at home to her each day because of our deep love and connection. Tell me a little bit about how marriage has played out for you since you were married early in medical school?
John: I got married during my first year of medical school. We wedged it between two important exams in the fall. I took an exam early, got married, and then came back and took another exam. So it was pretty stressful. It was baptism by fire for my wife right from the beginning of medical school because we only did a short little two-day honeymoon. Right after that brief honeymoon, I needed to go stay in the library for the next four days straight to catch up on my studies. I told her you’re not going to see me, even though we just got married. I felt compelled to make up for the lost study time. She was conditioned from the start to understand that both of us would have to make sacrifices in order for me to pursue the doctor’s life. She is totally on board with this. It’s been really nice to have her be a part of the whole process together, as she’ll have a mutual appreciation of our sacrifices by the end of the residency. In that context, the doctor’s life won’t be just an individual journey for me, but a shared journey for both of us. Our goal is to allow the pressures of that journey to draw us closer and forge bonds of love that strengthen our bond of oneness.
Dr. Inc: Whether it be the first two years steeped in book studies or the latter two years filled with long clinical clerkship hours, your time with loved ones are often cheated. Even when you are home, you are often studying. So having someone who is understanding of that time commitment and who is supportive of it takes a lot of pressure off of you. Of course, that loved one also acts as a balance to force you out of your medical world and re-enter the flow of normal life. Whether it be to watch a movie, hang out with friends, or go out to eat. Your spouse-loved one provides you with an escape from medicine which is a powerful conditioning process that you want to learn to practice from the beginning. Allowing your vital relationships outside of medicine to fill your energy and love tank is a critical component of combating professional or personal burnout.
John: My wife often jests that she wished she had married a doctor instead of a medical student! But the truth is that our shared financial and social hardships connected to my training years will give us a greater appreciation for the doctor’s life.
Arrival Fallacy
Dr. Inc: That is a pretty smart observation on her part about marrying a doctor rather than a medical student! Of course, the pressures and complexities of relationships are the primary reason doctors often delay marriage till much later in their training. But that is inter-related to a concept that most doctors are familiar with, which is their expectation that their next professional phase with allow them to arrive in a space that no longer requires sacrifice, delayed gratification, and a loss of self-identity. Rather it will provide a long-awaited vista where autonomy and well-being flourish personally and professionally.
“It’s going to get better” becomes your creed. You and your loved ones will repeat these words over and over again. And truly it is important to remind yourself to stay focused and determined during your early years because the doctor’s life and all its allure will eventually come your way.
However, I would suggest that there are important habits, boundaries, and social architecture that is critical to building in the right way during your training, not after you arrive as attending. By conditioning yourself to these skills and behaviors during the hardest of times, you will form healthy tracks to walk on during your post-training days. Because, “spoiler alert”, your attending physician days will bring challenges and hardships to your personal and professional life that can be just as difficult as your training days. The biggest difference is that you are getting paid more as attending, therefore the hardships seem a little easier to endure….for a season. Regardless building robust well-being safeguards in your personal and professional life is critical at the beginning.
The truth is that you never really “arrive” at some magical professional phase, instead, you simply take on new challenges associated with each stage of your post-training personal and professional life. Life doesn’t get less complex, it tends to get more complex. What do you think of this fallacy idea?
John: I do think some things will get better as I progress through my training, but I don’t think you should take a passive approach and just think it’s going to happen on its own. You and your loved one-spouse should take steps to make it better. I’m very much a believer that you make your life what you want it to be now, not just in the future.
Life as You want it
John: I think that having the motivation and ability to create what you want for your life is critical. The doctor’s life is so much about opportunity and the options that are afforded to us personally and professionally. So if something is important to you, you need to make time for it regardless of your career phase. You need to make time for the things that you care about. For example, my marriage relationship is a priority in my life so I intentionally create time and space that allows us to be together. Growing our relationship helps me and her create a great life now, rather than waiting till I arrive as an attending physician to do that. You have to have a personal awareness of what creates well-being for yourself and the resolve to make decisions that feed that part of your soul.
Dr. Inc: Prioritizing things that are most important to you is a critical element to life in general, but especially important to young doctors who often allow their professional drive to crowd out other important pieces of their life. A psychologist once called this the “4 Burner Theory”. In essence, as this picture depicts, doctors are prone to place all their fuel energy into their professional burner and neglect the others. Although imbalance is often part of your early training journey, I would encourage you to recognize this four-burner theory and make sure to take steps to ensure a healthier well-being balance both during your training years and after.
John: To maintain any sense of balance in your life, really requires a radical commitment to balance. As you have taught me, medicine will consume all of your energy and all other priorities if you let it. Whether it be a relationship with your spouse, a relationship with a family member, or maybe even your faith life. They all require a radical commitment to maintaining them because your professional world will encroach upon them if you allow it.
And it’s really quite hard. The ramp-up of the entire training process is pretty radical. I feel like once you’re in, it feels like you can’t stop, or you’ll risk being left behind. It’s this fear of missing out that really feeds into the performance pressures associated with medical training. Competing for grades, the letters of recommendation, residency slots, fellowships, etc.. all just seem to keep ratcheting up the necessarily focused commitment. It’s a push that seems to culminate in your arrival as an attending physician in your chosen specialty.
During medical school, you are actually paying $20,000-$50,000 annually intuition for this process and therefore you feel like you need to have an “all in” mentality. So you wisely dedicate most of your time to succeed in becoming a doctor knowing that you have a large debt to pay off in the end. It hangs on you and can affect a number of things that range from how you use your free time to what specialty you choose (and its expected compensation that will pay off your debt).
Don’t BE consumed by medicine
Dr. Inc: You really have to whittle down the handful of things that you consider the absolute most important things in your life that you’re going to prioritize and make happen on either a daily or weekly or monthly basis. If you don’t do this, medicine will control you and your life.
The risk you will run is that your brain’s pleasure center will be filled with dopamine hits from only medicine. As a learner, it happens when you read, see, and experience new medical discoveries. It happens when you take a test and perform well. It happens when you compete with others in training and beat them. It happens when you get good reviews from your superiors. It happens when you are able to help heal your patients. All of this begins to create a feedback loop within medicine that risks usurping all other sources of dopamine that feed your brain’s pleasure center. Once that conditioning process is set in motion, it is hard to decode.
So right from the beginning, I encourage you to pro-actively make sure you source your pleasure and well-being from things outside of medicine. If you work at constructing this architecture early in your career you will benefit from it long term. This will prove to be an important piece of burnout prevention for your life, and it is totally under your control.
John: Because everything seems so high stakes all the time that in your training, you feel like you can’t help but put the majority of your energy towards your school. If you don’t pass this test if you don’t get honors in this clerkship if you don’t get this letter of recommendation if you don’t excel at your USLME tests. It just seems to go on and on, month after month. The harsh reality is that you’re not making the importance of those things up in your head. They are critically connected to getting to the next stage. The truth is if you do terrible and step one, say if you get a 200, you’re not going into dermatology, no matter how much you want to do it.
So the pressure to excessively focusing on your professional burner is not something you can easily ignore.
Be Proactive and Intentional
John: But you can find some pleasure in other things if you are intentional, and for me, that involves scheduling things as I try to maximize my time with each burner. For example, during each clerkship, I will literally schedule everything out for the whole month in order to figure out how to get all of the studying done in order to get the grade that I want. This not only helps me get the grade I want, but it allows me to free up more time to do things that I care about such as trying to work out four or five days a week or making sure that I’m spending time with my wife every day.
Without being intentional and proactive, your sources of well-being outside of medicine are not just going to happen. You have to commit to them. I’m not gonna turn on the TV when I get home, for example, instead, I’m going to keep studying so that I can be done by 7:30 pm. Then I can hang out with my wife for a few hours and relax and chill out. Then I start over at 5:00 AM the next day and repeat the process. It requires some discipline to accomplish this, a lot of it. But I think most successful people can manage their inner drive and holistically reach their goals.
Dr. Inc: I agree, and learning to do this during your training years will help you to continue with similar patterns after you become an attending. It does require some inner discipline, which is naturally one of the qualities that are found in most doctors. But if you don’t tap into it, it will lead to the under-development of the skills needed to bring full balance to your life.
During your training, you do have a limited capacity for managing all of this. And in some regards, you might feel like you are in a bubble that isolates you from the rest of the world. I certainly felt that way during my training. But I was still able to maintain the core priorities of self-care, loved ones, family, and faith during my training. Those elements have continued to carry me as deep sources of pleasure and well-being throughout my career.
I encourage you to not let yourself be consumed by medicine, and early in your life build out sources of well-being that will be life-sustaining for you.
If you do this, you will be able to fully enjoy the doctor’s life and all of its pleasures. And you’ll be able more likely to avoid burnout.
Share with me your thoughts about how you have succeeded, failed, or are challenged to find balance in young physician life.
