Therapy for Physician Burnout: Time Off
In this blog, I'll be discussing the idea of taking time off as an employed physician.
Just the idea of taking time off is going to make you shudder. I know. You don't take time off from the job. You go above and beyond. You don't want to force someone to take over your shift. This idea may come from residency and jeopardy. It's not who I am. I've heard it all. I also have an earful for you too.
The first issue I want to discuss is the idea of you being an employee. If you haven't read this blog, I'll give you the TD;LR. You are a small cog in the healthcare machine. If you leave your company today, in two weeks, will your hospital or company care about you? I can tell you 100% that they will care that you left due to the lost revenue that you previously generated. But will they actually care about you as the person, not the golden goose? If you are lucky they will. I've found this to be far and few between though. The company will 100% scramble to find someone ASAP to fill the spot to continue to create revenue for their business. Plain and simple.
What about the idea of your patients? Here is the issue what that statement, "your' patients. If you are an employed physician, you do not have any patients. Zero. Zillich. Cero. Sero. None. Let me repeat that one more time for you. You treat patients but they are not your patients. The patients belong to the company that you are employed by. I'm not saying that you don't build a relationship with the patients you treat or you don’t care about them. What I am saying is that you need to take a step back and truly recognize your role in the organization. Traditionally, your role in the organization is to treat the organization’s patients. As long as it is in your scope of practice, it does not matter who the patient is. If your organization tells you to treat this patient, you better treat this patient or you might have problems. As blunt as this sounds, with healthcare heading the way it is with private equity and more and more physicians becoming employees vs business owners/ private practices, you have little say in your patient panel. The organization gives you directives that you follow. You treat patients but they are not "your" patients.
Therapy for Physician Burnout: The Badge of Honor
The next topic that I want to discuss is the idea that you don't take time off from your job. I've talked to many physicians and this seems to be a badge of honor. You rarely if ever take time off from your job. There are a few exceptions though. Death of a family member and birth of a child. I've heard too many stories of physicians not taking time off for their own health. I've heard about a physician who was dehydrated, had an IV, and was treating a patient who was dehydrated and had an IV. I`ve heard of a physician who had pyelonephritis who was in extreme pain, and had difficulty walking, but still went to work. I've heard this type of story for endless amounts of time. Is it really a badge of honor that you choose to take care of patients before taking care of yourself at every opportunity? An idea to challenge this thought is how can you pour from your vessel if you don't have anything left to give. Tell me that when you are ill, you can give the patient 100% of your skills and abilities. You aren't giving your patients 100%. You physically can't. To be honest, your clinical judgment may be at risk too.
I want to challenge the idea that you go above and beyond. I'm not saying going above and beyond is bad. What I am saying is to be aware of why you are going above and beyond, what this means to you, and if it is worth it. If you've been reading my blog, you know I am all about active decision-making. This is another place to use. Think about why you are going above and beyond your roles and responsibilities in this employed position. In this case, going above and beyond means putting your physical health and mental health on the back burner so you can fulfill your roles and responsibilities to a company. For many people, going above and beyond their role is something ingrained in them. It is a part of who they are. There is no other way for them. My challenge to that is if it is worth it. The first part is the idea of being compensated for your work. Do you get compensated for going above and beyond? Is what you are doing above your pay grade? Maybe you are doing it because you want to do the best for your patients. Maybe you are doing it because of your altruism. Side note, I know the healthcare system will take advantage of physicians’ and healthcare providers’ altruism. Don't think for a second they won't. The second part is the idea of if this is worth it. I know medicine takes time. Going above and beyond takes time. Good medicine takes lots of time. Time most physicians do not have, both professionally and personally. Is going above and beyond, uncompensated, worth your time and energy? To put it in a different perspective, would you rather be spending your time and energy working for free, spending time doing an activity that recharges you and brings you joy, or spending time with your loved ones? Go above and beyond if you know why you are doing it and if it is worth it to you.
Therapy for Physician Burnout: Company Protocol
Lastly, I'm going to talk about the "won't call in because I don't want to force my shift on someone else'' mindset. This mindset is ingrained in physicians during residency. You know about calling in, jeopardy, and payback. Someone has to cover and provide services to patients. If you call out during residency, there's the pressure of 'forcing' your colleague to come in. It's not a good look. This mindset 100% continues as you become an attending. I have news for you. When you become an employee of a company, it's management's job to make sure that the company continues when a person is not there. Unless it is written into your contract, it's not your worry about who will cover and care for the patients. Again, these are patients of the company and not yours. This is also connected to your being a cog. The company will find someone to cover for you, or they lose revenue. This is a company worry. Not an employee worry. That is one of the big differences between being an employee vs being in a private practice. When you are an employed attending, someone will cover for you one way or another. The company will make sure of it. Or they won't. And for the most part, most of the patients you would have worked with will be fine.
If you are in the ED, it's a slightly different story. I know most ED physicians do shift work, don't have paid time off, may have to find their own coverage if they call out, and their patients are more acute. In this case, you need to think about it a little differently. I understand that you show up or you don't get paid. Well, you’re a high income-earner and you may need to be putting away money for a rainy day, or considering putting money into an account as your 'paid time off' fund. In terms of finding your own coverage and having more acute patients, this isn't your issue to worry about because this isn't 'your' business and these aren't 'your' patients. The company will pick up the slack by either finding coverage or not. The company should 100% have a protocol in place for this common scenario and unless it is written in your contract, it isn't your problem. In terms of who's going to care for the patients, the ED will care for the patients. The ED machine will continue whether you are there or not.
This mindset shift should make you uncomfortable. The thought of taking time off for almost any issue shouldn't even be in your head, to be honest. I've had clients who had family emergencies or medical emergencies not even consider calling out of a shift. This is ingrained within you. This doesn't mean it has to be this way though. Things can change if you want them to. I know the older generation stays through and through with not calling out but the younger generation is moving to being more comfortable with calling out from a shift. Make sure you are using active decision-making when you have any type of event that will throw off your schedule. Take the time off when you need it. You are more than a physician. You are more than a person who helps others. You have a whole life outside of being a physician and your occupation. Stop sacrificing all the other aspects of your life for your occupational facet of life. You've already sacrificed your 20's. Are you willing to continue to sacrifice?
Reach out for Therapy for Physician Burnout
When you’re ready, reach out. Start your journey to overcome physician burnout with Chris Rabanera. Get started with a free 20-minute consultation. Offering online therapy in California, online therapy in Michigan, online therapy in Nebraska, and online therapy in Las Vegas, I specialize in addressing physician burnout, grief counseling, anxiety, depression, and providing tailored mental health treatment for men. Let’s get to work to make lasting positive change.
