Burnout, Opinion-Editorial

A Difficult Investment: Lessons from a Burned-Out You

Sometimes the best investment you can make in your career is also the hardest: it's an investment of time. 

When I was halfway through my (only) 3-year residency in emergency medicine (not neurosurgery), I took a 2-month break (what?!). It wasn't because I was admitted to the ICU, L&D, a psychiatric unit, or jail. In fact, I'm sure I could have continued to go on shifts, complete my assignments, and on paper been an adequately competent resident. So what was my deal?

My intern year had been typical. Challenging, exhilarating, frustrating — emergency medicine was still my dream job, even during my trauma rotation, the overnight shifts, and the inevitable interpersonal difficulties. I hated getting shouted at by attendings and watching kids die, but I was willing to come to terms with it for the privilege of serving our patients. Most rants became funny stories by the next shift. Things changed after I got engaged during intern year, when I moved into my fiance's "fixer-upper" and made plans to marry within the year. It was a time of ridiculous excitement, overcommitment, and stress. At first it was fun spending most of my time on residency and in my free time picking dress colors and demolishing decrepit cabinets -- but over time, these labors of love started to wear on me.

I started cutting back on my work outside residency, but by late fall, as my wedding loomed and our plumbing failed, I noticed myself not exactly looking forward to my scheduled shift. At first the hesitance was minimal, and I usually forgot about it by the time I finished my coffee, but it gradually worsened.

Soon I caught myself counting the hours to signout, and even resenting some of my difficult patients. I started each shift emotionally exhausted and left a little worse for wear. Though I was continuing to learn and develop as a clinician, I was becoming progressively neurochemically unfit for duty.

In my personal life I found myself losing patience to a surprising extent with my fiance and having difficulty re-grounding myself. It was around then, when I began worrying about my future marriage, that hopelessness began to rear its ugly head, and I knew I was burning, hard. Because that just wasn't me. I loved my family and my work, and something had to give.

I knew what burnout was, and I had followed the national conversation about wellness (which naturally grapples with the hidden curriculum of indefatigability). Programs are still unclear exactly how much "wellness" residents need, but it's somewhere between adequately controlling suicide rates and making residency a vacation, and no one knows how to balance our needs for both meaningful rest and rigorous training.

My program director was part of this "wellness" conversation, and I knew he would put his money where his mouth was. If I was honest about my state of being, he would probably agree that time off was a good idea and make it happen. Our department was wellstaffed, and amazingly, the program could afford my absence.

So why hesitate?

I didn't like the idea of quitting or backing down. I took pride knowing (from experience) that I could do 1,000+ pushups in a week or run a marathon without training, and I had just enough perfectionism in me to want to continually prove my grit. On a more sobering note, I had considered running for chief resident since intern year, and I knew time off would instantly call into question my ability to manage the additional responsibility.

Finally, there was the alternative of putting my head down and powering through. I could "grow up," "stop complaining," and delay gratification until graduation. In fact 65% of residents suffer burnout but choose not to take time off, and it's probably the best choice for most of them given the circumstances.

But for me, at that specific time in my life, the benefits of taking time off were greater than I think they will ever be in the future. I wanted to get the most out of residency, and return to it fully present and focused. I plan to be an EM physician for life — and not merely tolerate the field until I retire early.

It worked, I would say, and it was absolutely an investment in myself as a learner, a doctor, and a wife. I am fortunate to be in a progressive field with a permissive schedule and understanding PD. Time off doesn't make sense for every resident, but sometimes just knowing you have the choice helps put it in perspective.

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