Burnout: Choosing LESS admin/leadership duties

[ICUMD]

Briefly

I'm 6 years out of fellowship.  Have had several jobs in various practice settings.  Have always pushed hard for leadership duties and have reaped those rewards with higher compensation and respect within the physician communities that I have worked across the country.

I'm not in the same boat as some of you....I'm not looking to get out, nor am I going to arrange myself and my family financially to retire early, etc..

I always thought my natural progression (in academics or private practice) would be to work very hard to gain leadership duties early and then "slow down" later with more nonclinical duties so that I could look ahead into by 60's or even 70's and still have my hand in medicine.

Now, I just don't know....

 

Any recommendations FOR EXITING physician leadership and returning to laborer?

My current setup offers a healthy ICU Director stipend that would require me to be away from home a bit more replacing that income with clinical shifts.

 

Again, I'm playing the long game here...starting a family, etc..  NEED a long term solution.

 

Thanks all...Have been active reader of these forums since they were established.

 

[q-school]

Respecfully, you don't have to map out your entire career right now.

The administrative duties frequently demand more and more time as you progress up the chain and for most specialists cost them money.

If you need to step back from nonclinical duties for a few/several years, just tell them that. Someone else will be forced/asked/volunteer to do it. Very few young people stay in the early admin positions for long. Either they burn out because they are too nice and most of those positions require compromise of relationships with fellow practicing physicians (pushing unrealistic administrative demands) or they are ambitious and move up.

Especially only six years out. Too early in my opinion to give up hard earned clinical skills. And if you don't spend enough time clinically you will lose skills or fail to acquire new ones.

Having said all that, I feel for you but I'm not sure what your question was.

I guess my advice is to really take some time and craft long term goals and see if admin is a necessary part of those goals or something that would make the goals more difficult to achieve. Lots of other ways to contribute to the local medical community other than admin if you feel you want to be a good citizen.

Good luck.

[SValleyMD]

I'm in a similar situation. Only two years out of fellowship. I initially expressed a lot of interest in getting "involved" and wanted to be "at the table and not on the menu." This allowed me to starting getting more and more admin responsibilities.

Just last week I said screw it. I dropped all roles and committees and probably burnt some serious bridges.

Meetings were painful. Nothing ever gets done or accomplished. Admin lingo was driving me crazy. I was having to get involved with physician witch hunts or "behavior" issues. Most meetings were at 7 am or 5 pm to accommodate docs schedules. Most admin were PCPs who are mostly in it to protect themselves so it's a constant pcp vs specialist fight. And although I thought 175 hr was "easy money" as a new attd I quickly realize the % at the end of the month was trivial in comparison to the mental pain.

I also expect to practice till my 60s and thought initially that transitioning to admin would be easier. I don't think that's the case anymore. I'll just do 3 clinic days that I can sleep walk through, get some cash flow and call it good.

[ICUMD]

Thanks.

My question stems from the fact that the natural progression of a career is one where the early years are heavy clinical and the latter years are heavy admin...just a generalization, I'm aware.  What I am contemplating is the reverse...and the question is....am I just trading one set of problems for another?

There are potential long term ramifications of dropping admin responsibilities.

[ENT Doc]

ICUMD wrote:

Thanks.

My question stems from the fact that the natural progression of a career is one where the early years are heavy clinical and the latter years are heavy admin…just a generalization, I’m aware.  What I am contemplating is the reverse…and the question is….am I just trading one set of problems for another?

There are potential long term ramifications of dropping admin responsibilities.

Click to expand...

Perhaps you are, but I think the more important question to ask yourself is about your purpose - what is it you want to accomplish in life, with your family, in your career, and what long-term role will best fulfill that purpose.  Burnout comes from many different sources.  You could get hit with it because of too much admin or going to heavy clinical.  I would suggest not forcing yourself to achieve a certain income per se - replacing clinical to cover ICU admin income.  Go back to the basics - what were you looking for in those admin duties, what do you want to achieve in life, and how to do so while maintaining happiness.

[q-school]

Yup there are for sure potential ramifications. There's a reason normally there is a progression.

Having said that, the stampede to hospital employed physicians has upended a lot of things. The admins generally try to empower yes men/women physicians who appear affable and friendly and don't complain.

However it is difficult to be an outstanding clinician right out of the gate. It is especially difficult to be a good researcher, educator, community citizen, parent, and spouse all at the same time.

For myself, I found myself missing more and more of kid stuff and putting my wife in the position of having to be the bad guy. I didn't spend as much time with my parents, trying to invest time in external accolades and sadly my dad passed way too soon. Having said that I followed the more traditional progression and still serve as division head. I'm just not also head of research and Education and serving on compensation committee, Emr committe, p and t committee, anymore. I'm sure there were some I forgot. Once they find someone good, they will overload that person. The same attributes that make you valuable for one will make you valuable for most. I am able to spend more time with my kids, but obviously wish I had made some different choices regarding time spent with parents. I had no problem giving up admin responsibilities andbhad none for several years, but they came back and asked me to serve and here I am.

I wouldn't worry too much about long term consequences however. If you want out, use the same skills you used to get in, and just leave the door open for coming back in few years. Admins change, times change, you may even change jobs. You will always be in demand and there is a bottomless pit of thankless admin positions for physicians.

[StarTrekDoc]

There's always a push/pull between admin/frontline and specialists/primary care.  I climbed the leadership ladder over the years with the goal of making the system better; shifted focus leadership after 10 years; but eventually pulled back after 14 years after hitting that burnout mark.  50% clinical 50 admin = 150% time involvement.

We hit the reset button.  Moved to our desired ultimate retirement location in SoCal.  Had to decide another leadership position or not.  Decided to go back to 100% clinical and did that for two years.  I reentered admin work again last year at the health system's behest.

Take home point -- you're young.  Find the balance.  If you find yourself arguing needlessly with folk and dreading work or impacting family---pull back.  Take a breather with good two week vacation and put EVERYTHING down.  No emails.  No work.  Vacation.   Clear the head.

Come back and see if the system blew up or not and if you're willing to tackle the issues and likewise, the system work with you.   If you find yourself shaking your head over the next weeks, inform administration that you're pulling back.

Give a 14 day notice for admin to ID a replacement and 60 day for you to exit.  That will give you time to ramp up the clinical schedule too.

Remember this -- it's YOUR decision but do it right and don't burn the bridges for no good reason.  There is plenty of time for reentry if you want it that way.

[TheHappyPhilosopher]

The long-game is avoiding burnout and being happy. If you are in it for the long haul then the money doesn't matter. You will make plenty no matter the job. If you don't like the administrative stuff then don't do it. Say no to all responsibilities that don't bring you joy. Create a job that will make you happy - not like in 15-20 years but right now.

[Sneezy]

I am later in my career (early 50s) and do roughly 1/2 admin and 1/2 clinical

For me this is a good balance as I found near 100% clinical time earlier in my career emotionally exhausting.  I also enjoy to have some quieter time to sit in my office an work.  I don't love meetings

My plan is to cut back the administrative part when I get close to 60 and just do clinic

YMMY

[G]

I would echo what others have said that nothing is set in stone.  If money is an issue, I'd be surprised if you couldn't make more doing clinical than admin.  (Actually, I would suspect that nobody would want to be a worker bee and it would be hard to get stuff done if all the docs were queen bees.)  I personally have had a little bit of leadership duties right out of residency.  For me this was a good way to meet a lot of people and makes my "job" (either in the clinical or admin setting) more enjoyable with a nuanced view of the entire hospital.

[RogueDadMD]

A lot of physicians doing full time clinical early in their career or burning themselves out right now, because many (not all) clinical jobs no longer lend themselves well to being enjoyed when you are a full time clinician.

I am 4.5 years out of fellowship.  I've made a conscious decision NOT to be hard core clinical at the beginning to avoid burning myself out, and because there are job related things I want to do that are not purely seeing patients.

I have not reaped money, but I've been rewarded with more flexibility and time to do things with family.  I'm doing clinical research and while I work as many total hours as my full clinical colleagues (probably more many times when writing a grant), I'm not even close to worrying about burning out on the clinical work.  Going stretches with fewer ER shifts makes me love getting back to the ER, no matter how bad the shifts.  When I have a few terrible shifts or a terrible couple weeks in the ER, having a break to do other things means I have *never* felt burned out clinically.  I enjoy having a good impact on patients without having to slog through 40 patients on an overnight shift.  I still feel stressed because frankly writing grants and meeting expectations at my university for such things is often *higher* stress than clinical work, but having a mix of both makes me appreciate my job more and I think will make me less anxious to exit early solely for not enjoying my job.

At the risk of ticking off ENT Doc, this recent introspection on the state of my own career seems apropos here:

http://www.roguedadmd.com/2017/05/ruminations/

If I go back full time clinical I'll be fine for awhile if it means not having a grant deadline or 5th manuscript revision/submission or a project falling apart while I am on vacation.  That's a different type of stress, but it's re: work I enjoy so I *want* it.  However I also know my personality and know that full time clinical is also going to burn me out faster even if the day to day stress is less.

In your case it almost seems like the lifestyle is worse because of your other duties.  If that's the case, maybe it is the right move to slow down the admin time.  Some things (like research) are hard to just pick back up, but committees and things are always going to be there, waiting for someone.

When it comes to family/kids, the thing that will be most valuable is time.  If changing your role gives you more ability to BE with your family, and the income drop (if any) isn't going to impact lifestyle, then it seems reasonable to explore the change.  However if your personality is similar to mine (and it sounds like it may be), your job satisfaction could go down also.

 

[WealthyDoc]

SValleyMD wrote:

I’m in a similar situation. Only two years out of fellowship. I initially expressed a lot of interest in getting “involved” and wanted to be “at the table and not on the menu.” This allowed me to starting getting more and more admin responsibilities.

Just last week I said screw it. I dropped all roles and committees and probably burnt some serious bridges.

Meetings were painful. Nothing ever gets done or accomplished. Admin lingo was driving me crazy. I was having to get involved with physician witch hunts or “behavior” issues. Most meetings were at 7 am or 5 pm to accommodate docs schedules. Most admin were PCPs who are mostly in it to protect themselves so it’s a constant pcp vs specialist fight. And although I thought 175 hr was “easy money” as a new attd I quickly realize the % at the end of the month was trivial in comparison to the mental pain.

I also expect to practice till my 60s and thought initially that transitioning to admin would be easier. I don’t think that’s the case anymore. I’ll just do 3 clinic days that I can sleep walk through, get some cash flow and call it good.

Click to expand...

I pretty much agree with SValleyMD although I still do admin work.  I'm 70% clinical and 30% admin currently.  You can change it over time.  It is up to you.  And it is variable overtime.  Change the mix and see how you feel.  Everybody is different.  I do like the connections and variety.  I like meeting different people, thinking differently and influencing areas outside of one patient at a time.  On the other hand, there is a price.  Mostly the price of 7 AM meetings, or conflicts over things you can't control.  Admin work isn't necessarily easier.  It doesn't necessarily pay more or less either.  Situations vary.  Listen to your body, energy level, and effect it has on your family.  Take you best guess at a proper mix and adjust later if needed.  Best wishes on this adventure!

[VagabondMD]

Thirteen years into my career, I took on department chairman and group president responsibilities, in addition to my full clinical load, and did this for seven years. There is no question that this contributed to my burnout and shortened my career. The chairman functions were not paid by the hospital, but my group did pay me a modest stipend for the overall administrative chores and allowed me some extra time to get the admin work done.

At some point, around year five or six, I was sitting in a hospital meeting, painfully poring over the details of some clusterfk or another, and I looked around the room at the others. Two-thirds were hospital employed administrators and nurses, and the other third were employed physicians who were specifically compensated for their administrative role. I was the only schmuck in the room not paid to be there, while my real work was piling up immediately underneath the conference room.

It was at this moment that I said "enough" and set upon the path to give up these administrative roles. I also make a conscious effort to not volunteer or be volunteered for committees and meetings unless I think that I will benefit from being there. It sounds selfish, but hospitals have a way of getting docs to volunteer for stuff out of duty, and I no longer play that game.

[artemis]

ICUMD wrote:

I’m not in the same boat as some of you….I’m not looking to get out, nor am I going to arrange myself and my family financially to retire early, etc..

Click to expand...

I would strongly encourage you to rethink this.  The primary advantage of financial independence is not that it allows you to retire early; it's that it allows you to say something other than "Sir, yes sir!" to hospital administration when they keep telling you "Jump higher!"  It gives you much more control over your life.

You're only 6 years into practice, and you're already sensing that your original plans to "ease up" as you get older by cutting back on clinical practice in favor of administrative duties may not be as feasible as you originally thought.  You have no idea how you will feel about your job a decade from now, or what your personal health (both physical and mental) and family obligations (to your elderly parents as well as to your spouse and kids) might be.  A serious accident, a parent with Alzheimer's, or a kid with severe autism could change EVERYTHING when it comes to your career plans.  Needing (as opposed to wanting) a big paycheck can easily become a trap that's very difficult to escape from.

You can still live a nice lifestyle while working toward financial independence.  Do yourself and your future family a favor, and make financial independence a goal.

[PhysicianOnFIRE]

ICUMD wrote:

I’m not in the same boat as some of you….I’m not looking to get out, nor am I going to arrange myself and my family financially to retire early, etc..

Click to expand...

I copied this line to quote and saw that @artemis did the exact same thing. Kudos.

If you are already questioning your decision to pursue increased admin duties, who's to say you won't want to work less clinical time in 5 or 10 years? How you feel today has little bearing on how you might feel ten years from now when you might have three kids, an overburdened spouse, and you're missing dinners, games, recitals, and are too tired to play. Or maybe you'll have a dream job and be able to do all of it and then some. But you can't predict which it will be, so why not start saving enough to make FI possible? Plan for the worst, expect the best.

I volunteered way too much of my time on committees and administrative duties in the first 8 years of my career. I never received a dime, but it cost me dearly in terms of time, stress, and aggravation. After I started my current job a few years ago, I made it clear I was not interested in committee work. I've paid my dues.