Three days after finishing my residency, I became the medical director of the community health center where I had taken my first job. It forever changed, and probably saved, my career.
The risk of burnout hit me early. While I loved patient care, I also found the stress, the lack of control of my time, and the inefficiencies of my clinic’s system hard to accept and to manage. I knew I was greatly privileged and well paid compared to most people in the world, and I did get joy from caring for my patients. Why was it so hard?
My serendipitous and early promotion to medical director gave me a new perspective and over time, new skills. I could actually do something about what made daily practice so stressful and inefficient. After a few years, I earned my public health degree, in part to better learn medical management, and found myself with an even broader set of perspectives and skills — ones that allowed me to understand that there was a lot more to my patients’ health than the care I could give them. That understanding helped me put the challenges of care in perspective, adding yet another level of burnout protection.
Now, I spend part of my time trying to address, or at least teach about, broader determinants of health. Many of the medical problems physicians see have social and environmental causes and remedies that lie beyond the tools we are taught in medical school. I think this mismatch between much of what we see, and what we feel ourselves called upon but unable to do, is one of the sources of burnout. Public health work is my serenity prayer. It gives me the understanding of what I cannot change, and also access to a larger toolbox so that I can change more things. When the rigors of daily practice exhaust me, I can lift up my head and see the bigger picture. When I get frustrated by the lack of immediacy that comes with teaching or policy work, I can ground myself with a day in clinic, doing good — one patient at a time.
Thirty plus years into my career, I still see patients, and I still love it. I practice part time, but what I have come to realize is that it is not that doing less patient care prevents burnout. Rather, it is my other work outside the clinic, that complements patient care, keeps it in perspective, and keeps it joyful.
Tony Schlaff is an internal medicine physician. This article originally appeared in What Works For Me.
