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Burnout: Choosing LESS admin/leadership duties

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  • #16




    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.
    Click to expand...


    This little vignette should be required reading for early career people. At this risk of sounding transactional you really want to aggressively ask yourself "how is this helping my career?"

    In academics doing stuff at the medical school absolutely is. Those small groups and PBL sessions actually count towards P+T and the Deans notice them.

    In community shops I would imagine it's even easier to get sucked into meaningless committee work. Not to say that community work is less important, far from it.

    Has anyone read the classic piece "understand academic medical centers?" Pretty great line about committee work: "Members of Most Institutional Committees Consist of About 30% Who Will Work at It, Despite Other Pressures, and 20% Who Are Idiots, Status Seekers, or Troublemakers. The remainder consists of those who don’t show up, attend because they have nothing better to do, or who can’t or won’t spend much energy on it."

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    • #17




      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.

       
      Click to expand...


      I believe this was a perfect example of how to reference/link your blog.

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      • #18







        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.
        Click to expand…


        This little vignette should be required reading for early career people. At this risk of sounding transactional you really want to aggressively ask yourself “how is this helping my career?”

        In academics doing stuff at the medical school absolutely is. Those small groups and PBL sessions actually count towards P+T and the Deans notice them.

        In community shops I would imagine it’s even easier to get sucked into meaningless committee work. Not to say that community work is less important, far from it.

        Has anyone read the classic piece “understand academic medical centers?” Pretty great line about committee work: “Members of Most Institutional Committees Consist of About 30% Who Will Work at It, Despite Other Pressures, and 20% Who Are Idiots, Status Seekers, or Troublemakers. The remainder consists of those who don’t show up, attend because they have nothing better to do, or who can’t or won’t spend much energy on it.”
        Click to expand...


        Good post.  I started going to committees so that my department had representation.  It is pretty amazing how the tone of the conversation changes when you are represented.  ie "the effing ER effed up yet again" vs "wow I can't believe how wonderfully the ER performed in that awful situation."  That comedy alone is worth the price of admission...although I would not do any admin work without reimbursement.  As I've posted in another thread, my partners end up subsidizing this.  Perhaps because I feel like I am working for my partners, worthless tasks and pointless discussions by salaried bureaucrats with corporate lingo can be hard to cope with; that's why 98% of my income is from taking care of patients and probably why we don't have any full time bureaucrats in my group!

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        • #19
          I guess I am learning
          An alt-brown look at medicine, money, faith, & family
          www.RogueDadMD.com

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          • #20





            Click to expand…


             

            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.
            Click to expand...


            I'm at that point myself. The administrative part of medicine is the one part that truly sucks my soul away. I'm transitioning out of all my leadership duties and hopefully, by the end of the year, I will be completely out.

            Every time I go to admin meetings I felt like 99% of it was worthless. It was that 1% that really could damage my practice and my colleagues' practices and the reason we need someone there.

            On the other hand, the paper pushers don't care what the doctors say the majority of the time so maybe it doesn't matter if we are there.

             

             

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            • #21
              I think it is vital to try and figure out what your ideal life is now, and strive to align your actual life with your ideal life. If the administrative work is stress and pain, why are you doing it? There needs to be a good reason for why you are doing what you are doing, and if it makes you less happy it's hard to rationalize doing.

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              • #22
                Thanks all.

                Two main reasons I've pushed and held on to these leadership positions is for the benefit of having more control over things such as schedule, etc.. and also because the organizations I've been associated with have been for-profit entities where income/lifestyle escalation has more potential down the line if things expand to other hospitals/markets.

                I actually find the clinical duties quite boring (haven't figured out if boring is something I should prefer) and I find the administrative duties quite frustrating with the explosion of nonclinical decision makers in big health systems.

                 

                In regards to my comment on not desiring to become financially independent, I guess I should clarify.  I'm a few months away from only having mortgage as debt (albeit a large mortgage...I live in a desirable area in one of the largest cities in the US) and my savings rate is close to 20%.  But I get the feeling that some on this site who are retiring at 40 are living WAY below means in undesirable areas.  I could do that if I was single, but not now.

                 

                As I think about it more, I could probably benefit from a coach/mentor who could help be master work/life balance...then the undesirable aspects of my career would not bleed over into my home life.  That would be a great start for me.

                 

                 

                 

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                • #23
                  I feel like we talk out of both sides of our mouth about admin duties.  I never want anyone to be over me but a physician, but mostly I myself don't want to do it and just want to practice medicine.  However, we hate when businesspeople or nurses end up as our boss.  Hell, the Army Surgeon General was a nurse for several years, and our hospital commander has rotated between a dentist and an MHA, and that built up a fair amount of resentment.

                  I, too, detest the futility and waste-of-time of those types of meetings, especially when there's a non-physician (or one who never went to residency) who thinks they know how to do my job better than I'm doing it, and that time spent isn't worth it financially or professionally (and certainly not emotionally).  I just have to hope there's a doctor within the organization that has the desire to step up and do it.

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                  • #24


                    I feel like we talk out of both sides of our mouth about admin duties.  I never want anyone to be over me but a physician, but mostly I myself don’t want to do it and just want to practice medicine
                    Click to expand...


                    This isn't directed at you specifically, but I don't truly feel there are many ways to just "practice medicine" anymore, regardless of who is doing the admin work.  The trend of those going into concierge medicine is probably the closest, as they have greater autonomy to do what they what with any individual patient.  However they are still at the whim of insurers when it comes to their patients obtaining certain medicines or paying for certain tests or providing care if they are hospitalized.

                    To me this is one of those things where people pine for a time that no longer exists and maybe never existed.  There may have been a brief period 50 years ago before costs exploded and we were beholden to insurance companies and when we had effective therapies for common conditions.  However I would also argue that back then physicians provided poor care in DIFFERENT ways and just didn't know it.  Overuse of antibiotics, overuse of diagnostic tests, prolonged or unnecessary hospitalizations.  Many things that were dogma 50 years ago have been shown to be demonstrably false and in many ways harmful to patients.

                    I'm fortunate in my environment that the "admin" in terms of providing clinical care is really directed entirely by physicians.  The hospital has non-physician/healthcare people at the top, but our department has many physicians in high level positions in the hospital that provide guidance on care.  Division and medical directors oversee QI along with any individual physician or nurse/NP that wants to champion a certain cause.  While we're given guidance on things like antibiotic stewardship and limiting the use of unnecessary tests, that generally happens with a physician (or similarly qualified person such as PharmD or PhD) expert leading or advising things.

                    On the other hand, we have our share of committees, and I do participate in some.  I've learned to say no -- someone wanted me to join a committee that met at 7am once/month.  It was a topic I am interested in and involved in already, but no way I'm making a standing commitment for 7am on a Friday morning when I have kids/family/a life.
                    An alt-brown look at medicine, money, faith, & family
                    www.RogueDadMD.com

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                    • #25
                      Different strokes for different docs--hence different reasons for burnout.  It's definitely better to have physicians in leadership positions regardless of specialty and background because at the very least, they've done their time in med school.

                      OP, you need to figure out which sandbox to play in since you state boredom in clinical yet frustrated in administrative work for your for-profit.  You will forever be fighting the current of corporate suits in the quest for the mighty dollar-- unless you become one of them.   If you see that in the tea leaves, it's imperative to have formal education like MBA or MHSA to ultimately reach your goals in that type of organization because you have to know their shoes and look at healthcare through that lens and speak their language.

                       

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