My Burnout Journey ...

My path to becoming a physician started three generations ago with my great grandfather (my mother’s mother’s father) who was a GP during the depression in East Saint Louis, Illinois. I remember my grandmother telling stories of waking up as a child to find chickens tied to the back doorknob by patients who had been unable to pay cash the day before.

My grandmother went to college in the 30’s wanting to become a physician like her father. For reasons that are unclear, she ended up an educator. She taught 6th grade in Champaign, Illinois for over 40 years. My mother went to college in the 50’s wanting to be a physician and graduated as an educator as well. She had a long and successful career as a gifted and talented special ed teacher and even has a head start preschool named after her in Hastings, Michigan.

With these strong women in my family tree, each of their longings to be physicians frustrated by time and circumstance, I was born marked to be the next physician in the family. The first grandchild and a boy – both my mom and grandma were determined I would become the doctor in the family. They were never verbal about it. None of the haranguing you might see from a Jewish/Asian/Indian mother - just calm determination.

I grew up in Columbus Indiana. My dad worked for Cummins Engine Company. Through a job transfer, he took our family to England in 1973. I spend my high school years at Leamington College for Boys in Royal Leamington Spa, Warwickshire and learned how to play rugby, water polo, cricket and wear a school uniform every day.

Undergraduate at Indiana University, B.S. Biology. I was accepted at Mayo as one of five out of state students from a pool of 920 applicants. I remember saying, “I would be crazy to say no”. My mom and grandma were very happy.

4 years of frigid Minnesota winters – Rochester is in the middle of nowhere – and the incredible system that is Mayo. The doctors only had to think and give orders. Teams of bright eyed Iowa farm kids did all the work. I graduated and chose the second craziest Family Practice residency I could find, in Redding, California.

We ran a community hospital, did all the deliveries (235 deliveries and 35 C-sections skin to skin in my final two years of residency alone) and procedures ...  even all the intake physicals for the only locked psychiatric ward for 150 miles in any direction.

After I passed my Family Practice Boards, I worked for a year in the Redbud Community Hospital Emergency Room – a “reverse MASH Unit”. We had no general surgery on site, so my job was to keep the seriously ill alive until the chopper from San Francisco could pick them up and take them south. No one died in my year there who didn’t want to Several patients tried really, really hard.

My wife and I moved to Mount Vernon, Washington to raise our family. I joined the local 40 doctor multispecialty group as their 6th family doc. My practice was full spectrum. I admitted and rounded on my patients and delivered another 250 babies in my career.

Within a year of arriving, at the ripe age of 30, I was the chairman of the executive committee for the group. I always enjoyed both the clinical and business sides of medicine and was able to see both sides of these “silos” in healthcare. I went on to become the Managed Care Medical Director in the days of “capitation” – what is now called an ACO. This was the first time one of your colleagues ever had to sign off on a referral for specialty care outside the group.

I loved family practice; the relationships over time, the feeling of never knowing what was behind the next door, taking care of pregnant women, seeing them glow and helping through labor and delivery, stitching my teammates on the rugby field, raising our family. My mom and grandma were proud and happy.

In 1999, at the age of 40, all the color drained out of my career.  I lost all passion for medicine – both the clinical and business side – and took a one month sabbatical to see if all I needed was a break. It was as if I had hit a brick wall. The time off didn’t help. My mother and grandmother had died a couple years before. I had been in practice for 10 years and over 30,000 visits and the sense of mystery and adventure and always learning something new had faded.

We had two children under the age of ten.  I was the sole wage earner. I didn’t understand what was going on. I saw no resources and no one reached out to help. I felt like I was dying and that I had no other option but to quit. So I walked away from my full time practice. It took me several years to understand burnout was the cause. It was an agonizing time in my life, where I felt burned to the ground  yet, strangely, I never felt like quitting was a failure.

I supported our family for several years working part-time urgent care. I became certified in Interactive Guided Imagery and started a part time alternative medical practice using that technique with patients suffering from chronic pain, cancer, PTSD and depression.

I became a certified executive coach and started coaching entrepreneurs and physicians. Imagery and coaching opened my eyes to a whole new world of techniques to go beyond disease detection and help  people live a meaningful life.

My wife and I started a training company teaching leadership and facilitation skills to the US Navy’s LEAN Six Sigma Black Belt Certification Program. I started a residential real estate and a commercial real estate training companies and continued my coaching practice. I learned how to drive traffic on the internet, how to design and deliver high impact trainings both live and on video. I learned how to meditate, do yoga, recorded scores of Guided Imagery audios for my clients.

In my coaching I helped people make the jump from a job/career to a “calling” and grow their business as an expression of their purpose. Then my 24 year marriage came to an end.

In 2011 I started from the ground up all over again. I had held onto a dream to work with burned out doctors ever since I quit medicine 12 years previously. At that time, there were no doctors online and my skills as a coach were in their infancy. It was painful to let go of the dream then ... now I had a second chance to share what I learned in my years away from medicine with doctors at their own dead end. It was a calling I had denied for over a decade.

I realized for the first time, I had become the person my burned out 1999 self would have desperately wanted to meet. Just an hour of conversation over a latte would have changed my life. I am convinced that 60 minutes would have kept me from walking away from medicine. I realized the meaning of my 12 year journey - to help others in the same situation.

I looked to see whether doctors were on line now. They were ... by the hundreds of thousands. I reviewed the burnout literature. The tools that have gained research evidence of effectiveness were all things I had incorporated into my own life and taught to many of my coaching clients.

I asked myself, what would a person with career threatening burnout do in 2011? They would Google it. So I did just that and was shocked to find the results were simply a list of all the studies showing how prevalent burnout is  - 1 in 3 doctors on any given office day, worldwide, regardless of specialty.

What was NOT in the Google results was anything that could actually help you if you were one of the 1 in 3. It was as if the whole of healthcare was fascinated by this epidemic, but no one cared enough to do anything about it.

One thing I learned in my years as an entrepreneur is how to rank a web page on Google. I chose the website name TheHappyMD.com and determined that I would be on the first page for all the  physician burnout terms ASAP. I would build a website that offered, support, training, a helping hand, a connection and a conversation - I would offer any physician who asked the conversation that would have changed my life in 1999. I was determined to be a servant and a resource - to end the suffering, not just comment on it.

The last bit of motivation to build my professional life around this mission was a post on a physician-only website called Sermo. Sermo is a site where doctors post comments using anonymous usernames. The post was a fantasy one doc had of using a nail gun on a drug seeking patient The patient told the nurse their pain was a 10 out of 10, yet looked perfectly comfortable talking on their cell phone as the doctor entered the room.

His fantasy was to pull a 16 penny nail gun from his desk drawer, nail the patient’s hand to the exam table and then say, “Now THAT is a 10, would you care to re-evaluate your pain level”.

By the time I saw the post it had been up for only an hour and had over 100 supportive comments from other doctors. They posted their own fantasies that included lighting patients on fire and throwing them out windows, even kneecapping them.

I wrote a comment that this was inappropriate and a sign of burnout and was promptly and viciously “flamed” out of the conversation. The mob’s opinion was this was just venting and that it was actually healthy.

I started to post articles on burnout symptoms, causes, pathophysiology and simple ways to lower stress. These were all things I know work. They worked for me. They worked for my coaching clients.

My writing was picked up by  some of the largest blogs in healthcare. KevinMD.com, TheDoctorWeighsIn.com and even HuffingtonPost.com. Articles appeared in PhysiciansPractice and the AMANews, even physician sites in Australia.

My first coaching client told me the reason he called was he thought he was the most burned out doctor in his group until a partner committed suicide the week before our phone conversation. He took that as a sign to do something different.

Since then I have worked with hundreds of overstressed and burned out doctors, nurses, Nurse Practitioners, PA’s and healthcare executives to help them redefine their relationship with medicine. I have also worked to help healthcare organizations understand the simple steps to create a more physician friendly organization.

To be a doctor is a privilege, an honor, a calling requiring each of us to devote a minimum of 7 years and often hundreds of thousands of dollars just to step up to the starting line of our practice. Our health and happiness is the foundation of our ability to care, to heal and to alleviate suffering.

Our task is one of creative destruction ... not of healthcare ... the creative destruction of burnout and the clearing of obstacles to each of us becoming the  best physician we can be.

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