When I started this blog, it was meant to be a catch all of my thoughts; a creative outlet. The Pivoting Physician. At the time I was transitioning from my primary care job to being full-time obesity medicine physician. My pivot started in 2020. At the time, I was a mid-career primary care physician in the US for 13 years. It was of course, the middle of Covid, a lot of other doctors facing uncertainty - were paid less, furloughed or just simply lost their jobs. Some continued to work, a lot because of their passion for medicine and humankind, some out of duty to their organization. I am not heroic by any means. I loved my patients and cared for them a lot but the passion for medicine at the time was just gone. In other words I was a burned out physician, possibly has been for a long time, but the uncertainty of the Covid pandemic brought it very front and center that begged the question:
Is this all there is?
Suddenly the commute to work was filled with dread, sometimes tears. In burnout mode, I could not imagine 15, maybe 20 more years of this, let alone last the day. There were a few times I had excused myself from a patient visit to give myself a good cry. I know I did not necessarily meet the criteria for depression. The American Medical Association describes it as a long-term stress reaction that can include emotional exhaustion, depersonalization and feeling of decreased personal achievement. Long term stress reaction. If you are a physician you know what I'm talking about.
Exhaustion: Long clinic hours, and then charting at night long after everyone has gone to bed.
Depersonalization: where your patient care is translated into numbers or productivity. I do get that it's what the business of medicine has become anymore.
Decreased personal achievement: can come in variety of forms. Press-Ganey reviews for one. A lot of your self-worth can be eroded by one negative review. Another way of decreased personal achievement is being dictated how you practice by insurance companies. Where your medical opinion and expertise do not matter, and your medical decision making is undermined by individuals with little medical background, following insurance protocol of denial after denial. So then, endless paper work, prior authorizations and appeals take up a lot of your day instead of patient care.
Our training as physicians ingrained in us to "first do no harm", to put patients' well-being first. Moral injury is when your training, values and beliefs are challenged, set aside and ignored - or all of the above, in order to meet the demand of medical insurance companies, EHR, the hospital system. Add to this the constant navigating of what the patients want vs what they actually need. Every instance that you are forced into a decision that is not in the patient's best interest, you feel a sting of injustice. Angry in the beginning, but with how often it happens you eventually feel deflated, defeated. What do they call it?
In the 1960's scientists did an experiment on dogs where they were given series of shocks. in the beginning of the experiment they tried to find a way to avoid the shocks. But when they realized there was nothing they could do, they stopped trying. In the second part of the experiment, they were given an option to get out of it, but because of what they learned in the beginning, they no longer tried.
By 2020, while my family life was great - supportive husband, a smart and loving son - Work was nowhere near perfect much less approaching any kind of job satisfaction. We were a 2-physician household and financially "well-off" as long as we kept working anyway. Both of us had the so-called "golden handcuffs." During Covid, there were a lot that was compromised in terms of patient care. We also sacrificed a lot, especially my hospitalist husband, who still has traumatic moral injury, post-traumatic stress triggers to this day. He cared so much and took every death personally. As for me, after years of primary care, I already was burned out leading up to Covid. Don't get me wrong, the people in my work community were great, supportive of one another. The work is just a beast. A lot of my evenings and weekends were spent finishing charting, or worrying about unfinished charts. The work just never ends at 5pm for a primary care physician. Covid added yet another layer of uncertainty and difficulty. I have gotten into a difficult rut that I could not see the end of. One end was to get out of medicine all together. But at the time, I did not know anything else but be a doctor.
At the height of Covid is when I found personal life coaching. It was introduced to me by way of Passive Income MD (passiveincommd.com). To this day, I'm very thankful to Mike's cousin, Joel Napenas for introducing me to this community. There, I was introduced to the concept of
Living life on your own terms.
Peter Kim, the founder of PIMD, passiveincomemd.com held an annual conference called Leverage and Growth, where he featured physicians doing things outside of medicine. One person that stood out to me was Dr. Katrina Ubell, a pediatrician and a life coach. She helps physicians lose weight with coaching. This piqued my interest for coaching. I have been treating obesity for a while and the things I heard from her were a different perspective. There were a lot of physician speakers doing interesting entrepreneurial endeavor. Another physician that I particularly was watching out for was Dr. Letitia Alto. A family medicine physician like me who found success in investing in real estate with her husband Dr. Kenji Asakura. That led me to check out semiretiredmd.com,
and this led to a beautiful cascade of events that changed my life, though I didn't know it yet at the time.