Here’s a physician who’s living what many doctors daydream about. He didn’t just get out of medicine.
Read Matt’s post below to inspire your own dreams.
Enjoy!
Getting out of Medicine
I have a friend who, like me, is an emergency physician. He’s also a racecar driver – and a damn good one. He’s good not just because he’s got talent on the track but because he spends hundreds of hours working on and understanding his car.
For my friend, racing has been an antidote to the strain of medicine. But it’s not enough. He’s been burning out.
At some point it occured to me that my friend and his car are not so different. They function in high-pressure, high-stakes situations, asked to perform optimally. Mistakes are not tolerated. Performance is the priority.
Medicine and racing have a lot in common.
The difference is in the maintenance. For example, my friend knows how important it is to change the oil in his car. He knows that if he doesn’t there is a very predictable series of events that will ensue.
First, as the oil degrades, its ability to cool the engine decreases and the risk of overheating increases. Second, as more debris accumulates in the oil, it thickens, decreasing the efficiency of the engine. Finally, as metal on metal friction increases, engine damage occurs. Ultimately, the heat generated can essentially weld the pistons and cylinders together.
Catastrophic failure.
As I worried about my friend, it struck me that many physicians I know are like vehicles in various stages of neglect. They are not functioning as well as they could. Grinding on. Damaged.
Physicians commit suicide three times more often than the population at large. Something about modern medicine is toxic to our own well-being. There is an epidemic of catastrophic failure.
Why do so many of us take better care of our cars than ourselves? I think our system is inherently designed this way.
On a race track the pit crew’s sole job is to ensure the vehicle is optimized. Even our consumer vehicles have onboard computers that remind us to get oil changes and maintenance at the appropriate times. The system is designed to promote the health of the machine.
The same cannot be said of physicians. Doctors are, ostensibly, more valuable to society than cars yet physician health and well-being is being undermined more and more every day. Imagine a pit crew pushing off essential maintenance and upkeep for the sake of a few bucks or a few more laps. It’s irresponsible. Unthinkable. The risks are too high.
But they’re even higher with doctors.
About two years ago I realized the signs of burnout I was seeing in my friend and colleague were appearing in me. I was told I was valued but I felt expendable. I would secretly loathe going in to work. I felt like the system was squeezing me for every last bit of productivity at the expense of sustainability. I was grinding through shifts rather than navigating them smoothly.
As a relatively young MD, I looked ahead ten or twenty years and didn’t like what I saw. My constant internal monologue was “I’m not sure how long I can do this.” I had thought medicine would be a thirty year career but only ten years in I was becoming more pessimistic by the day.
What I started to realize is that the way we practice medicine was designed for the 1970’s. It doesn’t work now. Everything is different: the patients, the diseases, the administration, the finances, the metrics, the standards. Medicine is a new beast and many of those who practice medicine are getting eaten alive.
You’ve probably read all this before. Physician burnout is being talked about more and more – and that’s good. We need to have serious conversations about physician health that don’t just centre on the individuals. We can’t put the onus on struggling physicians to “get help”. There are too many.
At the same time we have to insist on a system redesign that incorporates real measures that support physician health – radical ideas like paid CME, paid vacation, sick days and protection from deeply traumatic processes like college investigations and lawsuits.
But there is one option that is often left off the table when discussing physician burnout . . . and that is simply leaving medicine.
We think medicine is supposed to be a lifelong career, but that’s an anomaly – most people will have half a dozen jobs or more.
We feel like we’d be abandoning the patients, but in reality we’re all replaceable. Besides, what patients need are healthy, functional doctors not burnt out shells.
We assume we can’t afford to leave. But can you afford to stay?
If a physician leaves medicine prematurely, most of us figure they were forced out. Perhaps they got in some trouble with the College or they burned out so thoroughly that practicing medicine would be an impossibility.
But what if leaving medicine is simply the best decision among a handful of options?
I had choices. I could have have transitioned from emergency medicine to family medicine. I could have changed departments. I could have accepted an offer for an administrative position. I could have even continued to slog it out in the ER for another five or ten years.
Instead, I took a long hard look at my life and came to a few important realizations:
- It’s more important to me to be a good dad and husband than a physician.
- The system is broken and I don’t want to martyr myself trying to fix it.
- I’m more than happy to forego a “physician lifestyle” to regain control of my time.
Continuing to practice medicine was simply incongruent with my values. Having lost its appeal, I was doing it for the money. I just didn’t want to live that way.
My engine was overheating and starting to show signs of damage. Continuing to drive on the track of medicine would only lead to further deterioration.
There are other tracks to race on. Other pit crews who care about you. Your identity does not have to be wrapped up entirely in that “MD” behind your name. Just because you have a medical degree doesn’t mean you have to martyr yourself for medicine.
It’s okay to get out before you’re thoroughly gutted. It takes a little faith, but you can find a way.
As for me, my wife and I decided that the best thing for our family was to do something radical. We have taken our four boys out of school to travel around the world for year. After selling our house, our cars and most of our stuff we are now living out of our backpacks as budget family travelers. Every day we learn about the world and ourselves.
Here’s one of the things I learned: I thought medicine was the most important job I could do. Turns out, this is.
As for my friend, after years of searching for a way to make medicine sustainable, he’s slowly decreasing his shifts and racing more. Leaving medicine may or may not be right for him but I can’t wait to see what he is capable of once his engine is repaired.
Matt Poyner (formerly MD, CCFP-EM, now actively extricating himself from the habit of placing those letters behind his name) practiced emergency medicine in Ontario for thirteen years and is now in a far away land with his family relearning how to be a husband, dad, and normal human being.
Matt blogs at Big Family Small World.
Please check out Matt’s blog above. I think you’ll like it!
Good for Matt, sincerely. It takes a lot of courage, a lot of confidence, and a lot of faith in yourself and your family to make that work.
The flipside, of course, is that his newfound joy will be parlayed by the politicians and the bureaucrats into more “proof” that doctors are too privileged and too spoiled. So those feeling the same symptoms of frustration and burnout but *can’t* afford the same upheaval in their lives (thinking of single parent MDs especially) will get dumped on.
We now have ample evidence that the countless Bright Ideas of the past last 20 years – LEAN, Primary Care Reform, EMRs – burn through piles of money without fixing the problem, setting aside that we can’t really agree what the problem is.
In my own family, my children have learned pretty quickly that the perception of life as a doctor doesn’t reflect the reality. I’m relieved that my son has expressed zero interest in following his parents’ footsteps. But if I think about it from society’s point of view, we should be alarmed that bright children of accomplished professionals are deciding on their own to stay away.
Thanks Frank! I’m going to let Matt respond. He might be in a different time zone, but I’m sure he will respond.
When Shawn invited me to write a guest post I was both excited and intimidated. I think we are all here because we respect Shawn’s thoughts and insights. I’m honoured that he considers my perspective worthy of this forum. At the same time, as a silent voyeur for years, I am well aware of the high level of intellectual discussion that takes place here in the comments. I have a slight case of imposter syndrome, but I will do my best to respond.
Franklin – Thanks for starting the conversation. There’s always a flip-side. Do we stop seeing patients because we know 0.1% might complain? Do good bloggers stop blogging because they are exposed to the trolls? At some point we just have to make our decisions on principle and practicality, haters be damned.
For all the money that is wasted in the system – and I totally agree with you there – I won’t complain about the income I was able to generate as a physician. Combined with the sale of our home, our savings have afforded us financial freedom, at least for the time being. But even the financial benefit of being a physician is being eroded.
If any of my kids want to become doctors, there will be several long hard conversations for sure!
I can relate. Have thought of “retiring” for years and wondered what I could do since my entire adult life has been medicine, even sacrificing so much time with my children and husband. I have worried so long about leaving my patients, abandoning them, while knowing in my heart we are all replaceable. It reached the fever point where I had daily thoughts that I would be better off dead and started taking antidepressants to get through the days and quiet the thoughts. I did not seek help through OMA because I do not trust their confidentiality. Accessing resources locally is just about impossible. I accepted that I was done, don’t care about patients’ concerns in the same way I used to, and I have an exit plan now. I am reluctant to advise my patients any earlier than necessary because I don’t want to tell them that I am sick emotionally from the work, I don’t want them to feel bad for me, I just want to be done. I have stopped the meds after two weeks realizing that I have a future ahead free of the demands, constraints, rules that are growing exponentially. My mood is better as I expect to transition into “retirement” in the next three months. My professional life felt out of control but now I have taken charge again and I feel hopeful. Every day, I have new ideas of things I want to do over the next 20 years or so. I feel healthy again.
Wow. Thanks for posting this, Anonymous. You story was painful to read, but I’m so happy to hear that you have hope again. Matt will respond shortly I expect. Thanks again! Shawn
Thank you for posting this! I would bet that everyone here can either sympathize or empathize with your story.
We get so much pressure from all directions (most of all from within ourselves) to stick it out in medicine. I know it is all well-intentioned, but when so many are considering suicide as an escape we MUST find a way to validate leaving medicine as a viable option instead.
If I had a mission, that would be it. Thank you for furthering the conversation with your story. That is exactly how the validation will happen.
I accessed help through OMA when they were affiliated with OPA for this service. I can’t say enough good things about their professionalism and confidentiality. I have never felt that they betrayed me. I am a better person, better professional and more content as a result. Please trust them because if you need help and know it it is only a matter of time before you wont be able to hide.
I have a colleague who had her access of psychiatric help held against her at a CPSO hearing. I have a nurse colleague who is going through the same with CNO.
Sounds like their services genuinely worked for you. I’m really happy to hear that.
I wonder how bad things have to get before the average doc seeks professional help. Then there are others who, rationally or not, will consider suicide before such programs.
I just think the more options we can put on the table, the less trapped we will feel. Thanks for bringing up this option.
So I am NOT old (he says…) – less than 55… but in 2 weeks I will be done with clinical practice and will be turning over my roster/practice/patients to someone else. Call that retirement if you wish, but its time for me to take a break.
Those that know me, know I’ve been involved with OMA politics at the grass roots for 20 years. (Until the rules changed and I had to call it quits due to time served). I enjoyed advocating for my colleagues and felt as a physician, even though the work was changing and challenging, I was still in control.
Fast forward to the last bunch of years and we get vilified, disrespected, clawed back and blindsided – both provincially and federally, and the burnout feelings start. The last few years have been at times frustrating, provoking both anger and anxiety, and unfortunately sometimes with a small dose of condescension.
Many of my patients who have mental health issues present because they feel they have no control or choice in what’s going on with their lives. The parallel is obvious. Todays physician’s have no way to fight back – they either persevere or they can walk. I have the luxury that I can walk.
A colleague recently was in a similar situation approaching his retirement date and had an unfortunate situation with a bad medical outcome that is now before the college. Another “young” colleague was one month from taking down his shingle when he felt a new mass.
We can work until we drop. We are doing great work until something unfortunate happens. Then we are the worst physician in the world. Yes, nothing bad will ever happen to us….
If you dread going into work, I agree it is time for a change. Once has to regain control to feel empowered and worthwhile. For today, I say congrats if one can walk away. I worry for those that can’t.
Hi Rob, I have to say I’ve enjoyed reading your comments here over the last few years. Administration (and less so, politics) is something I have seriously considered on several occasions as a means of contributing outside of the perceived woes of clinical medicine. At this point I am glad I didn’t go down that path.
Your comments remind me of Seligman’s experiments illustrating the phenomenon of learned helplessness (Psych 101). It is not stress and hardship that are the problem. It is stress and hardship that we can neither control nor escape that is so destructive. Frustration and anger are one thing, but when these emotions give way to depression, hopelessness and a lack of will it is more than our patients who will suffer.
It’s cliche but we HAVE to take care of ourselves first.
“At the same time we have to insist on a system redesign that incorporates real measures that support physician health – radical ideas like paid CME, paid vacation, sick days and protection from deeply traumatic processes like college investigations and lawsuits.“
Matt, this is a great observation, but I fear that these “radical ideas,” that are just routine matters for others in our society, are not even on the radar as we hope and wait for a new contract. And I fear that if our leadership came back to the members with a contract that had more modest fee raises but benefits like those described, they would be vilified. The problem is that most doctors don’t value these preventive measures against burnout and mental health issues for themselves. Not until it is often too late.
Hopefully our next contract can focus on these sorts of issues, which is absolutely essential if our healthcare system is to remain viable.
Hi Paul – I agree. The paradox is that even I would have spoken out against the administrative cost of such measures! I only changed my mind after I started looking for ways to get out.
One of the things that changed my mind was investigating locum opportunities in New Zealand. Less clinical hours (75%), paid non-clinical hours (25%), less pressure to see more patients, paid vacation, paid sick days, paid CME, RRSP matching . . . it is like they wanted their docs to have a sustainable career – what a concept!
But they do earn less. Unfortunately, when you’re burning out it’s easy to think more money will help.
For those who are interested in creating their own financial escape plan, there is a great Facebook group run for and by Canadian physicians (Paul and Jane Healey) called “Physician Financial Independence” – a great source of information.
The system has fallen apart and the foot soldiers are dropping too. I hope things turn around quickly.
The very fact that we refer to ourselves as foot soldiers kind of says it all.
Unfortunately, bureaucracies are incapable of turning around quickly. So, to follow through with the metaphor, if this is not a war you want to fight for the duration (or the hill you want to die on), have a look at your strategic options.
Wonderful piece.
In regard to “The system is broken and I don’t want to martyr myself trying to fix it” I have chosen at this time, I’m 50 years old, to not practice clinically due to ‘broken system’ but I am finding Advocating for constructive change quite rewarding.
As part of the Advocacy, I am being more open with the public about some of the challenges I’ve faced practising psychiatry today in Edmonton, AB. May people are way more than shocked.
Given the ‘broken system’ I no longer feel comfortable committing to an ongoing relationship with a patient that may require resources of the larger medical system.
And, having to restrict my psychiatric practice only to patients who are stable and well enough to be very unlikely to require resources from the larger system is pretty uninspiring. Not why I became a doctor to cherry pick most stable patients 🙁
Nor to do one-time psycho-pharmacology consults on people where is clear indication they need skilled psychotherapy.
If anyone wants information on the current Advocacy effort please contact me at tammy_hugie@yahoo.ca
I find your story fascinating. Most people I have known who went into admin find it just as frustrating as clinical medicine which is why I didn’t take that route. I think a lot of us would be interested in a way to use our experience in a truly beneficial way that was also tenable on a personal level. Could you comment, in broad strokes, on the kind of work you do and who you do it with?
Matt,
Not sure I can say I work in Admin as the work I am currently doing is volunteer, i.e.) not paid!
I am the Director of Advocacy of the Alberta Mental Health Advocacy Coalition (AMHAC), a Coalition that includes former and current frontline healthcare providers and others interested in public Addictions and Mental Health care in Alberta, the Alberta Mental Health Advocacy Coalition (AMHAC).
We are concerned that the current problematic relations between health management/leadership and frontline care providers undermines quality of care, patient safety, and responsible stewardship of public resources.
We currently have an Advocacy project underway where we have shared information with the public about some challenges frontline care providers have faced with dysfunctional healthcare management/leadership and the lack of accountable responses from current system. We have also shared a moving testimonial from a patient (anonymously of course) of impact on her due to dysfunctional healthcare management.
Generally receiving very positive response.
Many members of the public are truly shocked that physicians (most especially those working FFS in public health organizations) have no proper means with clout to redress dysfunctional management or conflicts between front-line clinicians and healthcare management/leadership. At least not a physician who is not one of many physicians in quite a large organization or is not oneself a physician in a politically strong position in the larger system.
This is some of the information in our current Advocacy effort.
“It matters little if patients find frontline healthcare provider(s) whose integrity and judgement they trust, if those healthcare provider(s) work within organization(s) where leaders undermine frontline healthcare provider(s).”
“Without the support and resources of a larger healthcare organization/healthcare system, individual care providers are not able to provide adequate care to particularly sick, high-risk, and or complex patients.”
“The intent of the Alberta Health Professions Act (HPA) is undermined if critical decision-making regarding quality of care and patient safety is subject to unilateral decision-making by healthcare managers/leaders who are not held to same level of accountability as the regulated Health Professionals.”
Some of our main proposed solutions are:
Proposed Solutions
• Healthcare managers held accountable for health outcomes, not solely cost outcomes.
• Effective conflict resolution process between frontline healthcare providers, healthcare management, Union representative (if Union members involved) with Patient Advocate(s) present, and binding arbitration.
• Consequences for healthcare managers/leaders involved in ‘ambush management’- lack of any or adequate notice to front-line workers of critical changes affecting ability to meet their care responsibilities. Frontline care providers need to be included in decisions and determinations of timelines.
• Additional measures to safeguard health professionals who speak about concerns and or advocate.
Although we are based in Alberta, we suspect other provinces may face similar challenges. Thus, we have shared our Advocacy information more widely and there is an upcoming phone call October 2, 2018 with Don Davies, NDP MP, Vice-Chair and Member of federal Standing Committee on Health to discuss concerns.
There also is a meeting regarding Advocacy concerns with the Alberta Health Services (AHS)-Executive Director (ED)-Addictions and Mental Health (AMH)-Edmonton zone Mark Snaterse scheduled for Oct 12, 2018. So far, we have representation from interested public, Addictions and Mental Health front-line care providers, College of Alberta Psychologists, Psychologists Association of Alberta, Alberta College of Social Workers, Office of Public Guardian & Trustee, and Edmonton Police Services. We would like to have diverse representation present, and so far, do not have a confirmed primary care provider to attend.
So, any FP’s interested in attending, please let me know!
Or any other interested parties, for that matter.
If needed, there may be availability of a call-in option.
If anyone interested in supporting this Advocacy effort, or just like more information, email me at tammy_hugie@yahoo.ca.
Thank you for laying that out for the rest of us. I would have been shocked if you had said you were doing similar meaningful work within the usual administrative structure.
Given the value of what you are doing, it is a shame that it is pro bono, but perhaps that is the best way. Being beholden to a paycheque carries significant limitations.
Your story is inspiring in a significant, concrete kind of way that I hadn’t considered. It’s awesome and I hope it gains traction and influence.
Thank you so much for your kind words!
Hope you and your family enjoy the travelling.
I have done quite a bit of budget travelling myself, and I often really enjoyed staying at hostels. You meet really great and interesting people. And most have private rooms.
I admit, I’ve not yet done the airbnb option. I’ve heard mostly good to great experiences there as well, with of course a few not so good 🙂
I LOVE my BMW M4 !!!
Went to Munich to drive it through the alps down to Florence before it was shipped over a month later.One of the best holidays my wife and I have had.Four yrs paid maintenance,and I look after it ….. my baby.
My wife and children LOVE me,’maintain’ me…..
The health care system,hospital,and society no longer value me …… only the services I provide in their vision.
Luckily,when I started my orthopedic practise 28 yrs ago,I began to do insurance assessments outside of OHIP,which,over time,has become 60% of my practisewhen things continued to deteriorate in the ‘system’.I was fortunate to be able to stop taking call and have continued to operate about half as much as previous …. still able to feel the ‘joy of medicine’.
I know I am the exception … not the rule.
I truly believe that docs are where they are now in Ontario/Canada because they have lost control,choice,and autonomy …. if we had a parallel private system that would act as a pressure release valve for both patients and docs(like the UK),society would be much better off.
Clearly, the OMA negotiations team should be made aware that any agreement should include an M4 and a trip to Europe for every physician 😉
Always happy to hear when a physician has made the right moves to remain professionally satisfied.
Given the new realities of modern medicine, I tend to agree re: a parallel private system. But the public system must also be cared for.
Hi Matt
I want you to know how grateful I am to hear your story. As I have journeyed through a tumultuous five years divorcing myself from medicine (all the while grieving the loss of caring for patients) I have felt very lost…no longer a part of the medical community but not knowing how to integrate into another life all the while dodging old patients at the supermarket to avoid feeling overwhelmed with guilt . I have been very lucky to have a tremendous support system of family, friends and medical colleagues. As the multitude of replies to your post suggest, hearing from someone who has “been there done “ helps provide a path to self acceptance. I applaud you.
Hi Heather – thank you for commenting. We actually have a personal connection as I practiced in the Collingwood ER for eight years. You were a great doc to your patients. It pains me that you still struggle with your decision to exit practice. I can see how it would be even more difficult in a small town.
It has occurred to me more than once that leaving medicine is like leaving a dysfunctional relationship. You can know it is the right thing to do while at the same time part of you might still love that person, feel a sense of obligation, guilt, etc . . . so many feelings that just don’t jive with the rationality of the decision. There are some things that just bypass our frontal lobes.
I’m not really a touchy-feely kind of person, but I really appreciate everyone who is sharing their struggles here. Thanks. If anyone wants to email me directly for any reason, please feel free: bfsw2018@gmail.com
What an inspiring blog!
Maybe a visit to New Zealand should be the compulsory 13th step in our rehab?
I’m willing to participate in the pilot project!
Me too!
Hi Matt
I’m totally aware of our connection. You always impressed me with your patient care and respectful interactions with me. Amazing how persons within a very small(medical) community in a small community can be struggling along similar paths without awareness of the others struggles. It does emphasize how closely we guard our (perceived) vulnerabilities.
Well done you for speaking out
I agree. The danger becomes exponentially worse if you have no one to decompress/commiserate with. We should all have a “burnout buddy”.