What medicine can learn from the antiwork movement [PODCAST]

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“The classic thinking has always been that a career in medicine is more than just a job; it is a passion, a calling, an anchor of identity. There is a pervasive stigma in medicine against the self-advocacy of the worker. Bedside care providers who push back against their work/life imbalance are often made to feel guilty for putting themselves before their patients. Antiwork challenges those assumptions and inspires health care workers to reevaluate what role they want their jobs to play in their lives. The empathy and work ethic that inspired most of us to choose a career in medicine are not inexhaustible resources, and they should not be treated as such. Doctors and nurses can and should use their newfound bargaining power to demand better compensation, improved working conditions, and protected time to enjoy life outside of the hospital or clinic. The past year of working in medicine has been so enormously challenging that it has caused many to question how much we are willing to sacrifice for our jobs. This is a painful but necessary process. Learning from some of the lessons of antiwork can hopefully help us find a new balance that still allows us to care for our patients while taking better care of ourselves.”

Brendan James Flanagan is an emergency physician.

He shares his story and discusses his KevinMD article, “What medicine can learn from the antiwork movement.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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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 Brendan Flanagan. He is an emergency physician, and he wrote the KevinMD article “What medicine can learn from the antiwork movement.” Brendan, welcome to the show.

Brendan James Flanagan: Thank you for having me.

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

Brendan James Flanagan: Absolutely. I have what I would describe as a very traditional and boring path to where I am today. I was one of those kids who always knew I wanted to be a doctor. I very quickly found my calling in emergency medicine and went straight from college to medical school to residency, and I’m currently an attending at a large academic center now.

I think I should clarify, just because of the content of my article, that I do fundamentally love my job, and I’m not just saying that in case my boss may be listening. But as we’ll get into later, there are some things about medicine overall that I think could benefit from more of an antiwork standpoint.

Kevin Pho: Now, you mentioned you had a pretty traditional path to where you are today, and you knew pretty early on that you wanted to become a doctor. Has medicine been what you expected?

Brendan James Flanagan: You know, I don’t think medicine has quite been what anyone expected when they signed up for it. But I will say that I do still find a true sense of joy from the practice of medicine that I imagined feeling back when I signed up for it. There have obviously been some things that are more challenging that I did not anticipate, but I will say that that fundamental sense of satisfaction from helping people, I do think that remains in medicine today.

Kevin Pho: So you’re an emergency physician. Can you share some of these unexpected challenges that you may not have thought of, and share some of the rewards of emergency medicine today?

Brendan James Flanagan: Absolutely. Emergency medicine is always quite challenging, but it’s been especially so during the past two years of the pandemic. I think the challenges are quite obvious, in that we’re dealing with extremely high volumes right now. It can be anyone, anything, anytime. That’s kind of the standard logo for emergency medicine. I think the rewarding part is I get to use a wide breadth of my medical knowledge to take care of the patients in front of me. And of course, some of the frustrations in emergency medicine are always not having the resources that you would like to take care of the patients in front of you.

Kevin Pho: All right, let’s talk about your KevinMD article that you wrote. It’s titled “What medicine can learn from the antiwork movement.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Brendan James Flanagan: Absolutely. I first became aware of the antiwork movement sometime around the fall of last year, when it was receiving a lot of press coverage. For those of your audience who don’t spend the pathologic amount of time on the internet that I do, I’ll just summarize the antiwork movement quickly. It’s best encapsulated by the antiwork subreddit, which is an increasingly popular subreddit. In this forum, employees who are primarily from lower-wage, service-level jobs share stories of how frustrated they are with their employers. They share fantasies of quitting, they share actual stories of quitting, and the connecting theme is that they challenge the role that work ought to play in our lives, and whether it should dominate so much of our lives in such an extreme way.

I was very curious about the reaction that I was having to this forum, because I absolutely loved it. I couldn’t get enough of it, reading all the stories, and I found myself really commiserating with the people behind these stories. I was very curious about that reaction, because on a surface level, I don’t have a lot in common with the people who are writing these stories. I’m fortunate enough to be working at what is relatively a much higher-wage job, and a job that people respect for the most part.

I think there’s this stigma against lower-wage employees that the reason their jobs are miserable is because they are working in a lower-level job, and if they just worked harder, or went back to school, or achieved more in our meritocratic system, then they would get a job that they are happier with. But here I was with what I would literally describe as my dream job, and I was still empathizing with these people and their stories. That got me thinking that there was probably more of a common thread between the toxic work culture that they were describing in this forum and the work culture of medicine.

Kevin Pho: No, I completely agree with you. We talk a lot about clinician burnout on this podcast and on my site, and I think one of the reasons why a lot of physicians are burning out is really a lack of autonomy, or decreasing autonomy, and the fact that physicians feel like they don’t have an answer to just going to the clinic or going to the hospital and just working their shifts and coming home. So we have a lot of doctors talk about burnout, about empowering themselves where they can cut down a little bit and not be so consumed by the work hours that medicine demands of them. So what are your thoughts about this movement as it applies to medicine and health care? Are physicians able to embrace more of this antiwork movement?

Brendan James Flanagan: Yeah, I think I should clarify that I’m not necessarily advocating that any physicians go out and quit their jobs. I think that might be the correct path for some people; it’s going to vary individual by individual. But I think in just a very general sense, we will always need doctors, and there will always be people who are inspired to provide medical care, and that’s a good thing. I think what medicine can learn from the antiwork movement is challenging the assumptions about what role work in medicine should play in all of our lives.

I remember very distinctly when I was a medical student on my surgical rotation, I was given a textbook on surgery, and the preface for this textbook was advice to medical students on what differentiates a regular medical student from an honors medical student. The line that I’ll always remember was, “The honors medical student never wants to leave the hospital.” I think you could probably argue, “Oh, that textbook’s probably very dated, and we’ve evolved since then.” But I think that ethos of never wanting to leave the hospital, and that being the model for how a physician should approach their job, persists in many different specialties, not just surgery. I see it in my own specialty. I see it across the board in medicine.

The other thing about medicine is that it’s so inextricably tied to our identity. We are encouraged not to see what we do as just a job. It is a calling, it is a passion, it is something that you are meant to do, and it’s actually implied that you wouldn’t be happy doing anything else if you have this calling. I think antiwork can inspire us to challenge that assumption, to find things outside of the clinic, outside of the hospital, that inspire us, that give us a source of meaning and identity, and to know that that does not make you a deficient doctor or a deficient caregiver in that way.

Kevin Pho: So that conventional view of the doctor never wanting to leave the hospital and having medicine be a consuming part of their lives, do you think that contributes to the increasing level of physician burnout today?

Brendan James Flanagan: I think it absolutely does. You know, burnout is a particular area of interest of mine, and one common theme that I find about burnout is that despite it being so prevalent, it is also extremely isolating. Physicians who are experiencing burnout often feel marginalized by their practice community, even though so many doctors are going through the exact same thing. I think part of the reason for that is that medicine is a profession that thrives on enthusiasm and hard work, and if you are feeling, for whatever reason, like you cannot bring that sense of enthusiasm and hard work to your job, you are made to feel that you are doing something wrong, that you are letting your team down, that you are letting your patients down.

I think that sense, that incompatibility of various levels of passion for your work with medicine, the fact that medicine has to be all or nothing, is a huge contributor to burnout. I think that this leads to burnout in a number of ways, and one of them is that I think it makes burnout especially isolating as an experience, even though, paradoxically, it is so prevalent within the physician community. If you are experiencing burnout, I think it is very often perceived as a deficiency of enthusiasm or altruism on your part. You are seen as letting your team down, letting your patients down, and being, for lack of a better word, a bad doctor. One of the reasons that I wanted to write the article was that I think antiwork can help reframe that. Antiwork can make you feel OK with your desire to leave the hospital.

Kevin Pho: Now, how can we normalize that? Because I always encourage physicians not to define themselves 100 percent as a physician, unless, certainly, for some that’s their calling, and more power to them. But for the vast majority of physicians, like you said, you want them to have passions outside of clinical medicine, because that is one of the ways to combat burnout. But on the other hand, they’re seen as not as committed, like you said, a proverbial bad doctor, for not spending 100 percent of their time in the hospital. So there’s a little bit of a conflict in terms of the response. How do you advise physicians to navigate through those emotions?

Brendan James Flanagan: I think a large part of normalizing it comes from simply talking about it, so conversations like this one, and other conversations that you might have with colleagues who are experiencing burnout to some degree. The pandemic has accelerated so many of these trends in medicine and laid bare a lot of the problems that were there to begin with but are now so much worse. I think one of the upsides of that is that virtually everyone who has worked in the past two years has experienced some type of burnout to some degree, and so it has very much normalized the experience, and I think people are talking about it more. It also seems like this is a moment where there is more collective bargaining power for workers, not just in medicine but across the economy, and I’m optimistic that that might lead to better working conditions for workers of all types, including those in medicine.

Kevin Pho: We’re talking to Brendan Flanagan. He’s an emergency physician, and he wrote the KevinMD article “What medicine can learn from the antiwork movement.” Brendan, we’ve been talking about burnout in the medical profession for years now. Have you noticed that the needle is being moved from a health care leader standpoint or from an administrator standpoint? Are they taking physician burnout more seriously than they once did?

Brendan James Flanagan: You know, I certainly see more of an effort, at least compared to when I was in medical training, and at least burnout is recognized as a problem more on the scale of what I think it truly is now. So you will at least see efforts made by administration and health care leadership. Now, whether those efforts are adequate, I think you can break it down on an individual level. I think overall the answer is clearly still no, because you clearly still have all these physicians who are burning out.

What I am hopeful for is that, beyond the efforts that are being made by health care leadership and administration, powers that are outside of our control, this moment of pervasive burnout in medicine will inspire a lot of doctors to reevaluate the role that they think work should play in their lives. I think medicine is an amazing job, but it can still be just a job, and like any other job, it’s important to set healthy boundaries between your work and the rest of your life.

Kevin Pho: Now, can you give us a story or an example of doing that, of reevaluating medicine’s role in a physician’s life? Is there a success story that you can share with the audience?

Brendan James Flanagan: I mean, this is obviously still a work in progress for me, like it is for everyone, but I’d like to think that I have a healthier attitude toward my own job in the past two years. I still very much take pride in the work I do in the emergency department as a doctor, but I frequently try to redefine myself in ways that are not exclusive to me being a doctor. I try to put more effort into my family, more effort into my hobbies, and more effort into engaging with my community in ways that are not just medicine.

One thing that I have resolved to do more, which is part of the reason I wrote the article, is to talk about this more, because, as we were saying earlier, I think this type of change, in a culture that is as intransigent at times as medical culture is, is only possible when you start having these conversations.

Kevin Pho: And that journey to redefining yourself, how difficult was that for you?

Brendan James Flanagan: I think I went through a very difficult time at the beginning of the pandemic, as everyone working in health care probably did, and there are still days that I very much struggle with balancing my role as a caregiver with my role in everything else in my life. I do think that now I can honestly say that I have a better balance. I am more likely to advocate for my own personal time outside of the hospital. I am more comfortable saying no when I’m asked to do extra at work. And most importantly, I no longer feel like a bad doctor when I do have to say no and when I do have to advocate for myself.

Kevin Pho: And just to give expectations for those podcast listeners, how long did it take you before you felt a little bit more comfortable saying no and more comfortable with these new boundaries?

Brendan James Flanagan: It definitely was not immediate, and I cannot say with 100 percent truthfulness that I am even all there yet. I still sometimes feel like the regular medical student instead of the honors medical student. I’m fortunate to work at a place that has amazing colleagues who are at the top of their game, and I still oftentimes feel inadequate and like I should be contributing more to my job. Movements like antiwork have encouraged me to reevaluate that mindset more and to provide a cognitive stop, if you will, when I go down that path of feeling inadequate, of feeling like a bad doctor, and to remind myself that I can be more than one thing. And I think we do need to remember that both the regular and the honors medical students eventually will become doctors.

Kevin Pho: Absolutely. And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Brendan James Flanagan: Yeah, so again, I would reiterate that I think medicine can be an extremely rewarding job, but I would encourage us to see it more as a job. I think there’s nothing wrong with feeling like it is your calling and your passion, but oftentimes, when we define it that way, we allow our work to encroach on our personal lives in ways that end up being harmful for us down the road. So I would just reiterate that I love my job, but I do still see it as a job, and there is more to me than just the work that I do.

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

Brendan James Flanagan: Thank you for having me.

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