Covid-19 and Physician Burnout: How I Turned My Plank Into A Runway
[Editor’s Note: Today’s guest post is from Crispy Doc, a blogger who describes himself as “a mojo recovery specialist and financial literacy evangelist helping physicians who feel stuck change the axis their lives revolve around.” We have no financial relationship.]
The World Turned Upside Down by COVID-19
It was late March of this year, and I was intubating my first suspected COVID patient. Dressed like an astronaut in my powered, air-purifying respirator and supplemental PPE, the situation felt surreal.
Adding to the sense of the bizarre, our Emergency Department (ED) was a ghost town. What had been a steady 15% patient volume increase over the prior year seemed to evaporate overnight, as fear of contracting COVID in healthcare settings frightened away many who would otherwise seek help in the ED. A 60% drop in volume made us all nervous: In our group, we only generate revenue when we see patients, so our incomes were due for a hit. The longstanding belief in medicine as a recession-proof career was disproven quickly and brutally. It was hard to conceive of the economic suffering those without the benefit of a medical income would endure.
Intubations like this one made me apprehensive about bringing illness home to my family. I was less anxious than many, however, over the economic impact of COVID to me personally, thanks to a financial plan I’d implemented several years earlier. Although assuming control of my finances had resulted from a difficult brush with burnout, the payout was the peace of mind I felt at moments like this.
Burnout was Not Supposed to Happen to Me
I entered medical school over twenty years ago, fully expecting it would become my life’s calling. A perennial optimist, I sought a medical career as part of a spiritual fulfillment program to heal a broken world. The nice income would be an incidental perk, as I was pursuing medicine for the right reasons.
Somewhere along my career trajectory, however, medicine harmed me instead of nourishing me. It’s possible that the fissure began during my second year of medical school. Studying to keep up with the volume of material left me isolated, despite spending hours daily in class among my fellow medical students. I was in a friendly crowd but felt utterly alone. Accepting that this sacrifice was simply the cost of admission to medicine and assuming it would be offset by later rewards, I pressed on despite what I would later recognize as classic symptoms of depression. Eventually, the feelings dissipated.
Residency was an unexpected high point. I found my tribe and learned from a set of brilliant researcher-clinicians in my specialty of emergency medicine, where every day caring for society’s most vulnerable reinforced my sense of serving as an agent of social justice.
Burnout, as my mentors explained it, was unique to those who had entered emergency medicine before it was a formal specialty. My forebears did not know what they were signing up for, so it was predictable that they reported high rates of disillusionment. As part of the first cohort to undergo standardized training with realistic expectations for my career, faculty mentors assured me that burnout was not in my future. I mistakenly believed them.
Medicine was a Meaningful Career, but Never a Calling
Serendipitously, I worked with Dr. Rick Hodes, an internist who has spent his career in the horn of Africa caring for the sick and destitute. Rick is an observant Jew serving as medical director for a mission run by Catholic nuns treating patients whose spiritual beliefs range from Muslim to Ethiopian Orthodox Christian to animist. (There is a joke in there somewhere.)
Meeting Rick showed me what a true calling in medicine can look like, and I am proud to continue supporting his work. It also helped me realize that despite the meaning I found in medicine, I did not feel a calling in the same sense (or on the same order of magnitude) that Rick did.
Burnout Attacked From Every Direction, All at Once
Fast forward five years. Around the time our second child was on the way, I was mid-career in a position at a well-respected community hospital. It was a collegial environment, caring for an appreciative population alongside doctors I admired and considered friends, but our group was short-staffed due to illness, maternity leaves, and relocation. All of us worked more than we wanted to for a couple of years. Chronic exhaustion from work made it hard to be fully present at home.
My limited availability for our toddler and my worsening schedule became sources of resentment for my pregnant wife, a part-time physician. My chronic absence required her to pick up the slack at home, in addition to her clinical workload, while also nurturing a nascent business. My unsustainable schedule was being maintained at her expense. I also faced my first malpractice lawsuit at this time. (It would be dismissed years later.) The uncertainty of being named in a suit caused our bank lender to threaten to withdraw our loan after we’d entered escrow on our first home.
While trying to navigate this perfect storm from what felt like a balsa raft, I began to feel depleted, anhedonic and uncharacteristically cynical. The lawsuit transformed my patients from objects of my care and protection into land mines waiting to explode. Work changed from an adventure I enjoyed into a burden I dreaded. Medicine was consuming me entirely, and the most important people in my life were getting the dregs. Something had to change.
A small voice in my head started asking uncomfortable questions:
- If physicians are wealthy, why do I feel poor?
- Why don’t I control my time, and why does it feel scarce?
- What if I can’t slog it out for another 20+ years until retirement?
- What if this is as good as it gets?
Financial Literacy Became My Escape Hatch From Burnout
Escapist fantasies became a refuge, as I asked myself how much longer I needed to stay in medicine before I could leave it behind forever. But then, by inexplicable coincidence, I stumbled across the financial independence movement through Mr. Money Mustache, eventually discovering a budding physician finance blogosphere that inspired me to become financially literate.
I sat down with my wife, who never wavered as my ultimate support in my lowest moments. We agreed on what needed to change to place our family priorities back at the center of our decision-making universe. We also agreed that increasing the time I had available to dedicate to our family was more valuable at our stage of life than the income we’d lose to reclaim that time.
We used several levers to accelerate our journey to financial independence:
- We pared down recurring expenses we could not justify. The accumulation of marginal gains on a sustained basis worked in our favor.
- I assumed control of our finances, and we parted ways with our financial advisor, who was charging a 1% assets under management fee on top of expenses. This move saved us tens of thousands of dollars in the first year alone. This strategy succeeded because I invested both passion and time into becoming a do-it-yourself investor.
- We spent several years as super-savers, maximizing dual contributions to investments in a profit-sharing 401k, a corporate defined benefits plan, backdoor Roth IRAs, and our family HSA contribution.
- My wife started and grew a side-hustle that increasingly decoupled her income from her clinical work as a physician.
- We had the luxury of a dual-income household.
- We got lucky investing during the longest bull market in history.
We considered radical solutions such as relocation to a lower cost of living area and job change. Ultimately, we decided on a long-term plan to incrementally change my existing job into one that could accommodate our needs and priorities.
With an eye toward the long game, I initiated a series of proposals at work that were respectful of the needs and priorities of others in my group. After a couple of years of patience and persistence, the schedule I have today allows me to live the life I want. Equally important, the feedback I’ve received from my colleagues is that since adopting these proposals, the added flexibility our job incorporates has similarly improved their quality of life outside of the hospital.
Time Became More Valuable than Money
A critical aspect of what allowed us to successfully reprioritize was the ability to reassess the time value of money at different stages in life. When I was young and hungry in my medical career, I had ample time and very little wealth. It made sense to accept every shift I was offered because I needed the cash more than the Saturday night off.
When burnout hit me in middle age, part of the problem was that my mindset had remained static, whereas my life stage now encompassed a wife, two young kids, and a growing net worth. If I’d stopped to consider it, I’d have realized that controlling my time was far more precious to me than earning additional income. Taking control of my finances allowed me to redefine my relationship with medicine for the better by cutting back my clinical shifts. Now I’m more engaged with the science, more present for my patients, and the hassles bother me less than they used to.
Medicine is now a well-paid and fascinating hobby, one of many hats I wear – father, husband, outdoor enthusiast, reader, reluctant provider of free medical opinions, etc. Diversifying my identity means I no longer rely on my career in medicine to be the major determinant of my happiness – a strategy learned from managing our finances.
Start Stitching Your Financial Parachute Now
Physician finance blogs like the White Coat Investor began preaching to a tiny contingent of the converted – an online Trekkie convention of sorts. That geeky subculture is now leading the way for our fellow physicians as they cope with job insecurity and unexpected disruptions in cash flow during the current pandemic. Practicing medicine in the era of COVID has been devastating; I am loath to suggest there’s been a silver lining. It has, however, underscored the need for understanding and managing risk.
Cultivating financial literacy is analogous to mastering a power tool. A skilled user wields these instruments to build a shelter that protects loved ones and provides security in tumultuous times. As for the unskilled user of power tools, I see one of those every shift, usually missing a finger.
[Speaking of financial literacy, our Fire Your Financial Advisor and 2020 Continuing Financial Education courses are 10% off through July 13 and include CFE Park City course for FREE! It’s a perfect time to “cultivate financial literacy” and build your own path to financial independence! You can even hear a little more from Crispy Doc in the 2020 CFE course.– ed]
How is COVID-19 affecting you and your family? How are you coping? What advice do you have for others feeling insecurity, depression, anxiety, etc. during these unprecedented times? Please share your experiences below or join the conversation on our Facebook, Forum, or Reddit groups.