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Burnout: Choosing LESS admin/leadership duties

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  • StarTrekDoc
    replied
    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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  • RogueDadMD
    replied


    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
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    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.

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  • DMFA
    replied
    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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  • ICUMD
    replied
    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.

     

     

     

    Leave a comment:


  • pulmdoc
    replied
    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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  • High Income Parent
    replied





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    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.
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    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.

     

     

    Leave a comment:


  • RogueDadMD
    replied
    I guess I am learning

    Leave a comment:


  • G
    replied







    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.
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    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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    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!

    Leave a comment:


  • G
    replied




    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.

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

    Leave a comment:


  • MPMD
    replied




    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."

    Leave a comment:


  • PhysicianOnFIRE
    replied


    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.

    Leave a comment:


  • artemis
    replied


    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.

    Leave a comment:


  • VagabondMD
    replied
    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.

    Leave a comment:


  • WealthyDoc
    replied




    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.
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    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!

    Leave a comment:


  • RogueDadMD
    replied
    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.

     

    Leave a comment:

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