The X-ray Beam: Crispy Doc
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Welcome to another installment of the X-ray Beam series.
There are some bloggers out there that are true wordsmiths and create posts that evoke a lot of emotion out of their readers.
Crispy Doc truly has a gift and his witty wordplay often causes me to chuckle as I read his prose.
If you have not yet discovered his website, I highly encourage you to read through just a few of his posts and I know you will be hooked as I was.
Although we have never met in person (I really hope to rectify that), there was an instantaneous online friendship formed through just a few interactions.
So I am very proud to present to you my friend, Crispy Doc who has donned the hospital gown (yes CD, the open part is supposed to be in the back, not worn inappropriately in the front as you have chosen to do so) and submits to the beams of the X-ray.
(If you can please give a brief introduction of yourself (age, medical specialty, years of medical practice).
I’m an emergency physician in my mid-40s, a graduate of a 4 year residency followed by a 2 year international EM fellowship during which I indulged academic aspirations and obtained my MPH.
In fellowship, I tried to find docs doing international humanitarian work whose lives I’d want to emulate.
I met several heroes (and rare zeroes), but none who balanced international work with family lives I would want.
My wife is a fellow emergency physician, with weekly per diem shifts and a busy consulting business.
We have two kids and live in the financial toxic wasteland known as southern California.
1. Crispy Doc is honestly my personal favorite website name as it perfectly conveys what happens when a doctor gets burnt out. What were some of the other names you considered before going with this one?
Thanks for the kind words!
The allusion is to both career burnout as well as what happens when you get exposed to the tenets of FIRE (financial independence, retire early).
Exposure to the latter FIRE tends to be a positive in the long run.
I’dlovenothingmorethantohelpyoucomedownoffyourmethbinge.com was a strong contender.
There was also a short-lived blog in response to my Press-Ganey scores, wouldyoulikefrieswiththat.com
2. Speaking of our profession in medicine, when did you know you wanted to become a doctor? Were there any influential people or events that made you embark on this career path?
I was a science nerd trifecta in childhood – Dinosaurs, Dungeons and Dragons, oh my!
I had the great fortune of wonderful biology teachers in high school that encouraged these proclivities.
Figuring my interest in science might naturally find a home in medicine, I became a hospital volunteer in high school.
One day a pulmonologist whose daughter I taught as a local Sunday school teacher recognized my face and waved me over as he was performing a bronchoscopy on a patient in the ICU.
From that day on, I thought medicine was the coolest applied form of science conceivable.
Add to this being a child of immigrant parents (who regarded medicine as one of three acceptable careers for their child), and there was ample support at home.
3. What were some of the deciding factors that led into choosing the medical specialty of Emergency Medicine? Were there any other specialties that you considered?
I’ve always wanted a career spent caring for underdogs.
The ED is where disenfranchised people find safe haven.
Folks regarded as “less than” or judged untouchable by society can come to be treated with dignity irrespective of status.
I loved the social justice aspect of the ED – no shoes, no shirt, no problem.
It gives me a small sense of helping repair a very broken world.
Primary Care was appealing as a med student thanks to a couple of Internal Medicine mentors I looked up to and admired deeply.
Another great experience came during a Family Medicine rotation, when a working class patient who spoke only Spanish gifted me a silver cross from her home country after I cared for her regularly.
I felt needed.
Truth be told, I liked a little bit of everything.
Pediatrics was great except for the parents and that bout of gastroenteritis.
Neurology was more exciting for the diagnostic than therapeutic prospects.
Critical Care was a chance to learn physiology by changing vent settings and pressors in real time.
OB/GYN was magical and scary, usually in the same moment.
Renal – not my bag, baby.
Endocrinology – fascinating.
Surgery – loved the initial evaluation and trauma, but didn’t fit in with the cast of characters.
I relished getting to lay hands on a patient when both the mystery and the potential stakes were greatest.
I also seemed drawn to the high sphincter tone moments of many specialties.
EM was the perfect umbrella drink for me: it united everything I liked about other specialties and threw them in the blender.
In retrospect, I received limited exposure to ortho, urology, ENT, GI, anesthesia, derm and radiology as a med student.
The classmates who went into these fields had largely decided on pursuing them in utero.
As someone who was waiting to experience what appealed to me, by the time I discovered they might be worth exploring, I could not easily make up for lost time.
So they were not on my radar early enough to have a reasonable chance of matching in them.
4. If you had to do it all over again, would you choose the same medical profession/specialty?
Yes. I always wanted to be the guy who raised his hand on the plane (not just because I’m hoping for the free flight coupons, although I don’t turn them down).
I’m grateful to feel I have something to offer any situation, and the intense focus followed by intense respite is a great fit for me.
5. If you were not a physician, what alternative career would you have gone into?
I was, at various points in my education, tempted to pursue writing, neuroscience research, and science teaching.
Journalism is dead; NIH funding has never been more competitive; and academic tenure is a shiny brass ring many grasp for but few reach.
Depending on how you look at it, I either have crap instinct, or choosing to pursue medicine over competing interests was my saving grace.
I’ve seen a close friend since high school, a chemical engineering Ph.D a far smarter and harder worker than I, end up extremely limited in his job prospects because his specialized expertise deeply restricts his geographic options.
Despite its warts, I thank my lucky stars for a career where I could show up in virtually any city in the U.S. and get a job that pays better than most.
Thanks to my flexible and in-demand career, I have choices where others feel constrained.
6. As your moniker suggests, you are a physician that has experienced burnout in medicine. What do you think were some of the underlying causes for your burnout? What are some precautionary measures you currently employ to prevent you from experiencing burnout again?
Like tracking your money, tracking your time can reveal uncomfortable truths.
At the time I experienced burnout, I was not allocating my time according to my values – far from it.
All of the things I’d spent my twenties wondering about – will I find the right woman, will we have kids, where will we live – had finally been answered in the best of ways by the time I’d hit forty.
I married an awesome woman, our son and daughter drive me crazy but I adore them, and I’m quite happy with the life and community we have near my family in southern California.
The problem was I allotted little time to enjoy this bounty.
My most important priorities got the dregs.
Loss of control over my time was a huge wake up call.
My burnout was precipitated by a two-year period of understaffing in our ED, and a perceived lack of autonomy and flexibility.
It reached an inflection point after a serendipitous encounter with the online FI community that led to a watershed financial literacy conversion experience.
First, I sat down with my wife and we had the, “I can’t keep doing this,” talk.
She works per diem as an emergency physician, and was completely supportive.
We also discussed my intention to take over our finances from our financial advisor of ten years.
Again, she completely believed in my abilities.
Finally, I looked at our numbers, and realized we’d inadvertently been front-loading our savings for the past decade.
We doubled down on our aggressive savings goals, while I started to explore how to reduce my clinical load over the next couple of years.
It was slow going, but by choosing charismatic allies and exerting the newfound moral authority burnout can imbue, my physician group gradually adopted new policies that permitted me to work fewer shifts.
A funny thing happened as I was trying to exit emergency medicine: doing less of it more humanely brought me a second honeymoon phase with my specialty.
Having more time to spend as a father and husband, making time to strengthen non-medical friendships, and volunteering on passion projects made me feel like a more complete human being, which in turn made me a happier and more effective doctor.
7. Have you personally fallen trap to any of the typical mistakes physicians make, and if so can you name some of your biggest ones?
I’m living in my biggest one.
We bought more house than we needed.
We’ve invested in sufficient upgrades both by design (my wife disdained the fans that recalled the Shakey’s Pizza look of her teen birthday party years) and due to misfortune (our downstairs flooded after a pipe ruptured, creating an excuse to remodel an entire floor with an insurance subsidy).
Our house now reflects our tastes so well that my wife is understandably reluctant to move into a fixer upper.
Our kids can also walk to school from now until they start college.
Our other big error was using a financial advisor for a decade when I could have managed our portfolio.
Our advisor was charismatic and ethical, not the dreaded commissioned salesman masquerading as an advisor you hear so much about.
It’s just that given the choice between paying fees that supported his kids’ college tuition and putting those amounts toward my own kids’ education, I’d have vastly preferred to fund the fruit of my loins.
8. If you had a time machine and could go back to any point in time and change just one thing, what would it be?
I’d buy a right-sized house.
We currently have a third more space than we need.
With the savings, we could easily have put up any visitors (our rationale for the extra space) in a nearby five star resort every time they visited and still have come out far ahead financially.
I wish we’d bought the home that would serve us well for 90% of the time, instead of one to accommodate the additional 10%.
At this point in the study, I noticed that Crispy Doc was indeed getting a bit crispier after being under the X-ray Beam for this extended amount of time.
I decided to use my medical judgement and turn off the X-ray beam so that Crispy Doc could recuperate and continue tomorrow.
Hopefully you will join us both tomorrow for the thrilling conclusion of Crispy Doc and his X-ray beam interview.
If you are interested in checking out previous individuals that were brave enough to expose themselves to the beams of the X-ray, please check them out here.
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