I always thought of myself as born to be an EP. Throughout my career, I would routinely go home feeling energized at the end of the day. There was something almost invigorating about the chaos. Not that there weren't difficult days, but I loved what I did.
Then about five or six years ago, I suddenly realized that I somehow had gotten to be the old guy in my group, by at least eight to 10 years. I wasn't quite able to bounce back from the shift changes. I was getting physically and mentally tired. I had helped start our democratic independent group and happily held the banner for all that the American Academy of Emergency Medicine stands for. That meant doing my fair share of all the shifts and nights, and I didn't know how to say no comfortably.
I was very tired one morning as I was heading into a shift. For the first time in my career, I was a little apprehensive about drinking from the fire hose onslaught of patients that s the daily experience in the ED. My phone rang as I pulled into the parking lot. I let it go to message because I didn't recognize the number. Then I heard the voice of my dearest lifelong friend's son who said, “Call Mom, please. Something has happened to Dad.”
My friend and old college roommate Rick had died suddenly from complications of a surgery that I didn't even know he was having.
I am quite sure that I frightened my bright young superstar colleague a little while later when after picking up a chart, I turned toward her and broke down in tears saying, “I don't think I can do this today.” I finished my shift because that's what those born to emergency medicine do. But that day was a turning point.
Physical fatigue and depression began to take a toll. Burnout had unexpectedly become very real for me. I chose to embark on a journey of recovery. Here are the things that I did, and they have made all the difference for me.
Take Time Off
This seems like an obvious choice, but in talking with many of my colleagues during and since this time, I realized it is not a choice that can be easily made for many. I never thought I would experience burnout—ever! I never really thought about or planned for the possibility of needing to take a break.
How do you do that in EM? It does take a bit of planning, especially financial planning. I was lucky to be able to consider taking off for two, three, or even six months without significant financial stress. Fortunately, I was also a partner in an exceptional independent group and could have a legitimate discussion about taking a break or sabbatical. They were very understanding and supportive. The sabbatical concept should be incorporated into every business model of ED practice these days.
See a Doctor (Who Isn't You)
I had a routine physical exam coming up, so I looked forward to talking to my physician as a patient. At the end of our office visit, I asked him if there was someone I could talk to professionally in psychiatry or psychology to help me sort through my feelings, grief, depression, and burnout. This was perhaps the best decision I made. I would strongly encourage anyone experiencing burnout to take the advice you often give to others—seek professional help.
Talk to Loved Ones; Take It Easy
I spent more time with good friends and good people. I eased back into the ED when I felt like I wanted to test the waters. I opted to start picking up some shifts at a small critical access hospital rather than going back on the shifts at our big busy hospital. I found out three things quickly. First, I still love what I do. Second, decades of experience and training allowed me to provide great and needed care to a very underserved population, which gave me more meaning in my work. Third, I enjoyed being able to spend more time with my patients, the nurses, and everyone else who worked in the hospital. I also learned how to become more comfortable saying no to protect my time.
Change Your Perspective
I quickly realized that even though my income was notably less than what I was making when I worked at a big, busy community hospital ED, I was still making a good income and enjoyed life much more.
Go on an Adventure
Finally, my wife and I decided to take an adventure and experience more of this life while we still can. I chose to take a new job in a part of the world where I had never spent time. It had to be beautiful. It had to have a slower pace. And it had to bring inspiration daily through doing something meaningful with my skills. My wife and I decided to commit to a three-year adventure. We ended up in rural northern Idaho, where I now provide care in a small critical access hospital.
I definitely feel as if I have renewed my interest and found more meaning in what I do in medicine. I feel more appreciated than ever in my career in this small town. Life in general is much more fun than it was a few years ago. I recognize that not everyone experiencing fatigue or burnout is in a position to make the choices I did. I do believe, however, that you can choose a path to extend your career. I believe you can bring meaning and joy back to your practice of emergency medicine, but you might need the courage to embrace change.
What the caterpillar calls the end of the world, the master calls a butterfly.—Richard David Bach