We were just about to our knees
“Part-time” was only a tease
We’re doing outpatient care
And we’ve time to spare
And full-time seems like a breeze
Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time position with a Community Health Center.
On December 1, our clinic relinquished adult inpatients at both hospitals to the two hospitalist services. We continue to take care of hospitalized children and newborns.
When I first signed on, my contract specified I would see hospital patients in the mornings and take care of outpatients in the afternoon. Within six months our hospital practice had grown past the point where one doc could take care of the whole census, and we hired a fulltime hospitalist.
Rarely do situations stay stable, and our inpatient load expanded to the point that our full-time hospitalist needed a “hospital helper,” to see patients under the age of 18 along with one hospital. The hospital helper would finish morning rounds, and do afternoon clinic.
We handled the daytime work without problem. I enjoyed the physical, mental, social, intellectual, and spiritual challenge of hospital work. The nighttime call burden became unsustainable. Most evenings after clinic, “call” meant admitting patients at both hospitals till 11:00PM, and a minimum of 6 phone calls between midnight and 7:00 AM. The vast majority of the phone communications involved making life-and-death decisions, and each one demanded awakening fully. As time progressed, our patient numbers increased, and the patients we cared for grew sicker. And my part-time position came to eat 54 hours a week, not counting time required to recover the day after call.
As our staffers drifted towards burnout, our devotion and caring for each other never faltered. Each of us tried to make adjustments to cope with the unreasonable. One used vacation days to not work Tuesdays, one went to part-time. I took a cut in pay so I wouldn’t see patients the afternoon after call. And I formulated an exit strategy.
I had tap danced on the brink of burnout before, I could sense the symptoms coming back, and I didn’t like it. The more my fatigue, the less my empathy. One evening I recounted a conversation with a particularly difficult patient to my wife. “You’re angry with him,” she said, “He deserves a different doctor,” and I couldn’t deny the truth.
It took a new CEO with incredible negotiating skills to recognize the problem, devise a solution, and implement it.
You can see the relief in the faces of the physicians now. With clearer complexions reflecting better sleep, we tend to chuckle, giggle and laugh when we talk. Most night call involves more mistake beeps than real ones.
One can easily see the toll the vigilance takes during call hours; the doc stays on edge waiting for the next interruption. We did not anticipate the relief that would come from general stress lowering, but that relief has come to us, very real and very strong.
Our patients have lost little continuity of care, the theoretic advantage of a practice holding on to inpatient duties, because the burden demanded rotation.
For the first time since I finished undergrad, my work week comes close to 40 hours and most weeks finish on Wednesday. I have time for both recreational reading and for writing.
I’m back from the brink of burnout. Again.