Selfies

What does it mean to be happy while at work?

What does it mean to be happy after a full day of work?

I've spoken numerous times before about how taxing it was to practice medicine in the US. In residency, I worked 13-26 hr days. I expected to be constantly busy and constantly challenged, mentally and physically. In private practice, I came to accept days of seeing way too many patients, and being pulled between office obligations and the hospital and OR. Even after I joined a larger practice where there was better coverage, as employed physicians, we were all still working too many hours, and giving up too much of our "free time", without appropriate compensation. As a collective, we physicians would all commiserate with each other but we shrugged our shoulders and accepted the belief that this was part of the package. This is what we signed up for.

It doesn't occur to most of us that it is not only possible to leave work not feeling completely drained, but that it was something we should expect. Over time, I have noticed that more and more physicians have rejected this antiquated and often paternalistic view of what it means to practice medicine, and we have been moving more toward the desire and demand for better balance, a career that gives more satisfaction. Unfortunately, many of us only find this by leaving clinical medicine.

Burnout does not come solely because of physical exhaustion. If that were the case then days off and vacations would be enough to counteract that. Per Mayo Clinic, it is more complex than that:

---

Job burnout can result from various factors, including:

• Lack of control. An inability to influence decisions that affect your job — such as your schedule, assignments or workload — could lead to job burnout. So could a lack of the resources you need to do your work.

• Unclear job expectations. If you're unclear about the degree of authority you have or what your supervisor or others expect from you, you're not likely to feel comfortable at work.

• Dysfunctional workplace dynamics. Perhaps you work with an office bully, or you feel undermined by colleagues or your boss micromanages your work. This can contribute to job stress.

• Extremes of activity. When a job is monotonous or chaotic, you need constant energy to remain focused — which can lead to fatigue and job burnout.

• Lack of social support. If you feel isolated at work and in your personal life, you might feel more stressed.

• Work-life imbalance. If your work takes up so much of your time and effort that you don't have the energy to spend time with your family and friends, you might burn out quickly.

The following factors may contribute to job burnout:

• You have a heavy workload and work long hours

• You struggle with work-life balance

• You work in a helping profession, such as health care

• You feel you have little or no control over your work

---

One of the reasons why I left private practice to become a hospitalist was due to the fact that my lack of control over my clinic list, surgical load, call schedule became unbearable. I didn't even have control over which patients I saw. There were times when I would express to management that I had a rude/disrespectful patient. I would insist that they see one of my partners moving forward, but then they would show up on my schedule again and again. Late patients on an already packed clinic day were allowed to still be roomed, causing us to miss part of lunch or leave for home way later than we are supposed to. If I was delayed at the hospital because the OR was running behind, or a case ran longer than expected, I had to push hard and insist that I be given enough time to not only get back to the clinic, but to factor in for the much deserved stop for lunch that I'd missed. I came to understand that we were just a cog in a wheel. Our needs were not important. Even though it is our work that pays the salaries of all of the office managers, medical assistants and staff, they had been taught that the bottom line, not our work satisfaction, was what needs to be prioritized and protected. I know that one thing that appealed to me about becoming a hospitalist, was that I had more control over my day to day life, even though it meant that I would actually be more challenged while at work. For that control, for the extra days of being home and knowing that I could say yes to speaking and advocating or doing interviews about issues I was passionate about, I was willing to give up whole aspects of my repertoire. It was the right move, but it was not enough.

I say all of this to say that I did the best I could to work within the systems of medicine that were available to me. Just as I decided to leave the US in order to leave political systems that were designed to work against my well being, I also realized that I needed to leave the US in order to leave healthcare systems that were doing the same professionally. I needed to move to a system in which the expectations about the role and experiences of the specialist were different.

Instead of being squeezed for every ounce of your energy that can be gotten out of you for the same salary, here, I am compensated for any after hours work or additional duties. My responsibility to my family is paramount, and my health is prioritized, not jeopardized.

I am back to doing pretty much everything that I was trained to do as an obstetrician gynaecologist and now I also get to teach again, which I enjoy. My job is filled with stress and challenge, problem solving and crisis management, but when I think of the list of causes of burnout I feel so blessed to see how many of those things no longer apply to me.

While I love caring for people and I am humbled by the impact I can have in people's lives, I don't remember regularly feeling inspired or energized enough to take selfies after a full day's work back in the States. I see it as no small feat that I have taken so many since arriving to NZ. It is the little things that speak the loudest about where you are and how far you've come.

What a difference a year can make