Recently, I took a few minutes to fill out a survey on physician burnout.   A slew of studies offer estimates of physician burnout of up to 50 percent.  In my field of primary care, the documentation and regulatory burdens may cause the number to soar even higher.

I am rounding out my fifth year in a busy suburban private practice and I am not burned out.  These questions moved me to reflect more on burnout and identify some steps in training that may have had a protective effect.  Many factors contribute to my lack of burnout: diet, exercise, family support, and sleep habits are huge players to be sure.

But my personal musings swung like a pendulum back to thing, one aspect of my life that I strongly feel has protected my brain the most from being fried. I deliberately started my family during training, a time in a developing physician’s life that necessitates an inordinate amount of time spent at work.  Learning to both mother and doctor at the same time offered some very important lessons which have gently nudged me down the path of career contentment.

Now, I am not suggesting that every resident and student immediately go out and conceive.  Although certainly go for it if this inspires you.  Having children forced me to sharply focus on my end goals during residency. I’d like to share those tips here in an effort to help those phsycians early in their training.

Use your time at work to study.

Doctor are students for life.  What a beautiful foundation of our career; this aspect certainly called many of us to medical school.  With two small children at home, the stakes became much higher in training.  I became determined to maximize the time I had at the hospital, soaking up every piece of knowledge to lessen time spent studying at home. I did rotations I knew would help me as a graduate in primary care.  I was constantly encouraging people to actively teach me.

For example, I knew going into primary care; I needed much more comfort with the initial diagnosis and management of diabetes.  As a resident, I printed out the new diabetes guidelines and spent a few minutes reviewing them with my wonderful endocrine attending. I brainstormed real-life presentations. We discussed medication to start in each scenario and timing for follow up visits.  Five years later, I sometimes joke that I could manage diabetes in my sleep.  I pass this on to my trainees, advising them “When you take care of a patient with a specific illness, suck every possible bit of information out of your residents and attendings on this topic.  Then go home and read more about it.”  Become an expert.  You will not forget this knowledge.  Actively strive to translate book knowledge into disease management skills you can apply later when in practice.

Get rest and learn to say no.

I was much less social in residency compared to medical school and college.  Having kids in training put exhaustion into perspective. It re-defined tired and trumped any fatigue I could ever feel in my life as an attending.  It gave me access to a very important lesson early in my career. I learned to say no.  I rarely commit to weeknight events unless necessary.  I value my sleep.  I don’t go to nighttime meetings if there is an option of having people come to my office on my lunch hour.  I have a few groups of girlfriends who get together regularly, and while I enjoy our outings, I am not at every girls’ dinner.  I value the weekend hours as a time to refresh from the exhaustion of the week.

Keep an eye out for unexpected mentors and reflect often on your ideal job.

You don’t need to spend a lot of time with someone in training to make a lasting impact. Having children during training made me look for unexpected mentors and identify people to emulate.  The most significant piece of advice I got in my four years of residency came late in my third year.  I was discussing job prospects with an attending I worked with for not more than a few half days over the course of a week.  She instructed me, “Write down a list of everything you want in your ideal job. You may not be able to get everything you want, but you can get close.”  I spent a significant amount of time in residency identifying what I was looking for in a job and which terms I was willing to accept.  This led me to personally identify starting later in the morning, so I can get my kids on the bus, ending a little earlier so I can be present at our family dinner and having at least one full day off every week.  It is also crucial to have your finger to the pulse of the salaries and various compensation packages offered locally in your field.  Talk to recent graduates.  Don’t go into the negotiation process blind. No one will willingly offers to pay you more money or offer you more flexibility.  You are in demand and especially in primary care, highly sought after.

As evidenced by the high percentage of burned out physicians, this field can eat you alive if you don’t set boundaries.  We sacrifice our 20s to prepare for this career, spending long and exhausting days away from our loved ones.  Many of us wait for our lives to start before considering what we would like those lives to be like. Having children in training allowed me to get a glimpse of what I wanted my life to be like and I purposely shaped my career around it in a way that has thus far been very satisfying.

Lauren Kuwik is an internal medicine physician.

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