Physicians and the midlife dip [PODCAST]

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“We all go through our early lives in the S-curve of our medical education–college, medical school, residency, early practice. As you reach the mastery phase, I would posit that there is a downward dip as we realize that we are no longer in that exciting hypergrowth phase. The search for a new curve happens, the desire to ascend the second mountain, to find a more meaningful purpose.

How do you begin to find that purpose? Some people take a sabbatical or quit their job entirely. Some physicians look for leadership positions or transition to a non-clinical role. But while this may fix some of the career discontentment, you will stay in the dip, the valley, the bottom of the U-curve without a true search within yourself. It is through a reassessment of your true values that you will find your why.”

Beverly Joyce is an obstetrician-gynecologist and physician coach.

She shares her story and discusses the KevinMD article, “Physicians and the midlife dip.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Beverly Joyce. She is an obstetrician-gynecologist and a physician coach. She wrote the KevinMD article “Physicians and the midlife dip.” Beverly, welcome to the show.

Beverly Joyce: Thank you, Kevin. It’s a pleasure to be here talking about my article with you.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Beverly Joyce: Absolutely. I am an OB/GYN by training. I wanted to be an OB/GYN since I was a little girl, and I loved that job for about 20 years. After about 15 years in private practice, where I was delivering all my own babies 24/7/365, as you can imagine, it got to be a little onerous. And I had kids and a family, and I just got to a point where I was burning out, and I didn’t even recognize that I was burning out. But once I was sort of made aware that that was going on, I made a shift, and it took about three years for me to transition out of doing OB.

During that process, I learned a lot about physician burnout and the flip side of that, physician wellness. I started up our physician wellness committee at my community hospital. I learned a technique in stress management called HeartMath, which I then brought to teach some of our physicians at the hospital. And then, as if that wasn’t enough, I decided I needed to reach out to people of my own kind, which were midlife women physicians in particular. And so I took a physician coaching course, and now that is my new path, although I’m still practicing gynecology.

Kevin Pho: Now, when you made that transition to coaching, or when you realized that you were burnt out from what you were doing clinically, was it a singular event, or was it something that just built up over time? And if it was the latter, what actually pushed you to realize that, in fact, it was burnout?

Beverly Joyce: Yeah, it definitely was the latter. I mean, there’s no one single straw that breaks the camel’s back. It was just the accumulation of the stress and sort of that anxiety that I put on myself, because I had this perfectionistic expectation that I would be there for all my patients all the time, and then all my, my two kids, you know, they had soccer and all this stuff, and I just couldn’t do it all. And, you know, that feeling built up in me, where it was PTSD every time my pager would buzz.

But the one thing that actually happened, which was very uncomfortable for me, was that one of my practice partners, I was in a group of four, came to my house and basically did an intervention on me. She said, “You are being this horrible person,” which I was. I was angry, I was irritable, I yelled at people, but I was also anxious, depressed, and just, you know, feeling really bad. Not suicidal to that point, but who knows where it would have gone. So after that intervention, which is what I call it, that was when I really decided that something’s got to change.

Kevin Pho: All right, so let’s talk about your KevinMD article, where you talk about more of your story. It’s titled “Physicians and the midlife dip.” Now, for those who didn’t get a chance to read the article, can you just walk my audience through it and share the story of why you decided to write it?

Beverly Joyce: So I realized, in part in my own life and then in a lot of different readings that I had been doing, that it seemed like there was this point in a physician’s career in particular, but more generalizable to people, where you get to a certain point, whether it’s in your 40s or your 50s, where you’re pretty accomplished in your job. You do it well, but there’s a sense of, like, there’s something more, or there’s something that’s missing, there’s something additional that you want to do or a change you want to make. And so I really started delving into that, and particularly as it pertains to women physicians in this sort of phase of life. It actually also coincides with menopause, probably not coincidentally. So I really wanted to learn more about that.

And so the midlife dip is sort of describing that period in somebody’s life where they’re at a decision-making point about potentially doing something different. And so that’s kind of where I’m focusing my coaching, to help women physicians in particular figure out, you know, do they need to make a change, or do they just need to find some joy and fulfillment in where they currently are?

Kevin Pho: Now, for those women physicians in their 40s and 50s, what kind of signs and symptoms can they show that may suggest that they would want to change?

Beverly Joyce: Well, certainly any of the signs that point to burnout. And I think as we learn more and more about that, especially during COVID, we see that it’s, you know, the three burnout things. It’s, you know, now you’re going to make me name them, but basically just feeling like you need something different in your life and being dissatisfied with where you are.

And for women, you know, if they’re experiencing perimenopausal symptoms, oftentimes there are some mental and emotional things that go along with that that are really not very well understood, but anxiety and depression in particular. And then if they’re having sleep deprivation due to hot flashes or night sweats, obviously that can accumulate and create this sense of just dissatisfaction with life.

Kevin Pho: Now, what kind of advice do you share with these physicians who come to you in this scenario? Just walk me through a typical path they would take next.

Beverly Joyce: Yeah, so, I mean, with coaching, it’s not really advice giving so much as it is kind of delving into what’s going on with that person, and really asking the questions of them, of her, you know: What does it mean for you to be a physician? What is something that you, if you’re on your deathbed, want your legacy to have been? What do you want your life to have meant?

And many times, once women have a family and they have kids, these goals and things that they may have started out with in the beginning of their career, you know, tend to change. So, you know, it’s looking at life in terms of multiple transitions along the way, and not thinking of it necessarily as just the linear progression from training to residency to career and, you know, thinking about the destination of where you’re going to get to. You have to think about it sort of in the idea that your life is nonlinear, essentially.

Kevin Pho: Now, what does that look like from a practical standpoint? So if you have a mid-career physician who does realize that he or she has other commitments, whether it’s a family or children or whatnot, what are some practical ways that they can implement to really change the course of their career?

Beverly Joyce: Well, the first thing would be just starting out with a self-care perspective and realizing, especially for these physician moms, that, you know, they spent a good portion of their lives taking care of other people, their patients, their kids, their husband, and really kind of turning the table and starting to think about some self-care things first. As you start to do that, then your relationships with others do start to improve, and you may even find that you are happier in your current situation.

Now, obviously, we talk about, you know, do you really want to change to a different situation? And some people do, and some people find that just through managing their self-care more with boundaries, you know, that might help them sort of stay where they are and be happy.

Kevin Pho: Now, how much of the resolution to burnout is the physician himself or herself versus the system that that clinician works in? You know, whenever I talk about burnout on this podcast, and I read articles on my own site, there’s always a sense of whether the physician is resilient enough versus whether the system is breaking that physician. And a lot of doctors I talk to, they’re the most resilient people that I’ve met, right? They’ve been through organic chemistry, they’ve been through residency and fellowship training, and trust me, there’s nothing, as you know, there’s nothing more that can build up their resilience than medical training. So the question is, I guess, when it comes to resolving burnout, how much is it the physician, and how much is it the system that physician works in?

Beverly Joyce: Yeah, I think that’s the 64-million-dollar question, because I agree with you, physicians are some of the most resilient people, just having gone through what they go through for training. That being said, there is a place for some personal resilience training that people can go through, because I think physicians tend to have this sort of linear sense of “This is my job, this is what I do, this is who I am.” So I do think there’s a place for that. And the HeartMath that I alluded to before has helped me to kind of manage my own emotional state, my cortisol, my, you know, sympathetic-parasympathetic balance.

But there is, for sure, a systems issue that needs to be addressed. I think both in training our young physicians, I think we really do need to emphasize the self-care piece during training. We need to be a little more flexible in how we allow physicians, not just women, but women and men, to have families during training. And that’s going to require a huge shift in how things are done, and I don’t begin to have the answers to that, but I have faith that there are a lot of people now that are working on this. And certainly, for burnout, systems and physician resilience are going to have to be combined.

Kevin Pho: We’re talking to Beverly Joyce. She’s an obstetrician-gynecologist and a physician coach. She wrote the KevinMD article “Physicians and the midlife dip.” Beverly, I want to get back to your story, where you said that your partners had to come to you for an intervention. Now, is that something that you had expected? And I was curious, what was your response at that time when your partners had to intervene?

Beverly Joyce: Yeah. Oh, my gosh. Well, my mental state at the time was, I chose this career, I loved it, I should still be loving it, and I just need to keep going, because eventually I’ll get to a point where it’ll be easier, like when my kids are older. So no, I didn’t expect that at all from my partners. And looking back on it, it was that kind of massive lifequake that happens to you that makes things change.

And so, as awful as it was for me at the time, and I really wish that my partner had come to me with some empathy and said, “You know, based on your behavior and the way you’re acting, something’s going on. Do you want to talk about it? What can we do?” So that would have been, you know, the ideal scenario. It wasn’t. But looking back on it, I have to say that that was the one thing that really made me change.

Kevin Pho: And now that you have time to reflect over your career, is there anything that you would have done differently back then, knowing what you know now?

Beverly Joyce: It’s so hard to say. You know, we come to our life where we are with so much experience and knowledge that we’ve gained over the time. But I guess I would say to my younger self, or people in training, you know, don’t expect your life just to be this linear path. I think physicians expect that because it’s high school, it’s college, it’s med school, it’s residency, it’s profession, and then, you know, you get to your profession and all of a sudden it’s like, “OK, well, what now? Is this the end?” And I would say, don’t think of it as the end. I mean, you’re learning, you’re taking care of your patients, yourself. And when you get to a point where you want to make a transition, don’t fight it. You know, be open to it.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Beverly Joyce: I would say, you know, have an open mind. As physicians, we all have talents, we all have skills, we all take problems and solve them, and we’re very good at that. But when it comes to our own life and self-care, it’s really, really crucial that we pay attention to that piece too, because you’re not living your life to get to a destination. You’re living your life, and you should try and enjoy it along the way.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Beverly Joyce: Thank you so much, Kevin. I appreciate it.

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