A Psychiatrist Burns Out

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COMMENTARY

Dedicated to Randy Levin, MD.

As I’ve written here before, I loved being a psychiatrist. Note the past tense. About 5 years ago, I no longer enjoyed it. I’ve also written about the epidemic rate of burnout in physicians. But I have never told my own story. As National Doctors’ Day comes to a close, it is only fitting to write about it in the hopes that my colleagues embrace self-care and work-life balance.

I am approaching the fifth year of my decision to retire from clinical and administrative work. The last straw, after EHRs had already reduced face-to-face time with patients in my setting, came a directive to begin 10-minute medication sessions with our public patients due to financial reasons. The email stated, in part, “We eat what we kill.” I didn’t know that we were patient game hunters until then! Before that policy change, I simply jotted down information as I continued to maintain eye contact with my patients. I was used to limited time with my severely ill public sector patients, but I never imagined it would come to this.

For the first time, after a career filled with clinical awards, I received patient complaints about my interaction with them. It was about the inadequate time I spent with them. That broke my heart. Though I had always hoped for an early retirement to be with my wife of nearly 50 years, travel the world, and be with our grandchildren, I moved that up by several years. I retired at the age of 66, the very day my wife became eligible for Medicare. We hoped our savings would hold up as long as we lived.

Outside forces decimated systems in which I worked.

I had been an administrator most of my career. This included a position at a large not-for-profit managed mental health care system. I tried to emphasize the well-being of all our staff. Beside monitoring patient satisfaction, we monitored staff satisfaction. Despite good feedback on both, I was called a “Nazi” at a state psychiatric presentation by one colleague, and another-a former American Psychiatric Association (APA) president-called me “evil” at a conference because he was vehemently anti-managed care.

It turned out that these experiences were great subject matter for the book I was asked to write: Challenges and Solutions for Managed Behavioral Healthcare (San Francisco, CA: Jossey-Bass; 1997). In retrospect, I must have done something right. Last year I received the APA’s Administrative Psychiatry Award. But even administrative work became harder with increasing business pressures.

I thought that I had always taken care of myself. I had tremendous support from my wife and we spent much time together. I always exercised, and I loved sporting and cultural events. I never had any troubling depression, even when outside forces decimated systems in which I worked. I never ever felt suicidal. I assumed I was building more resilience. In my residency, I had received some helpful psychotherapy.

After I retired, however, I realized that self-care was not enough. I felt emotionally lighter and slept better, even with sleep apnea. I was able to process, for the first time, the buried grief I had for my one and only patient suicide that occurred early in my first year of residency.

With new emotional reserves, I was fortunate to have unexpectedly made a new best friend, an already retired emergency physician. I learned from him about his retirement work on the high rate of burnout in his specialty. As soon as I learned about the core symptoms of burnout-cynicism, detachment, and lowered effectiveness-I realized I had been burning out without knowing it!

If you know the story of Moses, you may recall a burning bush drove his passion to help free his people. I believe most people who go into medicine see one type of burning bush or another when they receive the call to serve others in need. However, most of our bushes have been burning out. For our own sake, and that of patients, we need to find ways to keep them burning, or to rekindle them, do we not? Telling our own stories may help us understand and solve this challenge. We don’t want retirement to be the best solution.