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The Perfect Burnout Storm.
The year 2020 was truly a rollercoaster ride for me, especially at my workplace, courtesy of COVID-19.
So it should come as no surprise that the last few months of 2020 were probably some of the worst I have experienced ever at work.
I can honestly say that I have again felt the flames of burnout encompass me due to a perfect storm that occurred which exacerbated things even more.
Storm Factor 1: The Floodgates re-opened.
For my non-medical readers, in a routine year the end of the year is typically the busiest time for most medical specialties.
As the weather gets colder, flu season and other respiratory ailments become more frequent, keeping walk-in clinics and the medicine and pediatric departments humming.
This of course leads to increased imaging which keeps the radiology department on its toes.
Another phenomenon that is quite predictable occurs.
As patients have typically met their deductibles near year’s end, they now try to cram as many medical procedures and visits as possible before the insurance companies initiate a deductible reset at the beginning of the year.
There is therefore a mad rush to schedule larger procedures that patients have been putting off earlier in the year as the financial hit to their household is now minimal.
As we all have come to realize, 2020 was not a routine year.
COVID-19 had a large impact on the operations of my department, the timing of which magnified the normal end of the year run on imaging.
During the lockdown period in spring, imaging volume was so low that my partner and I employed a self-imposed furlough system to help maximize efficient use of our time.
There was a consequence however to having this extra time off earlier in the year.
The repercussion of this early break was that once the floodgates were open, all the studies that were put off now came pouring in, particular screening mammograms.
It was exactly the opposite of what you wanted to happen.
Rather than work hard early when you are fresh and slow down later to recuperate, the reverse happened with the break happening early and no reprieve once things started going full tilt for the rest of the year.
Storm Factor 2: The schedule from hell.
As I have mentioned before, mammograms are some of the most visually intensive studies I subject myself to.
Because of this fact, the week I am assigned to read mammograms (as well as ultrasound and xrays) is probably my least favorite just because of the sheer volume of studies coming across the screen.
A routine busy day for me is having to wade through around 50 mammograms before I get to go home.
Because of the post shelter-in-place mammogram rush, and coupled with the typical increase in volume of mammograms in the fall (which coincides with breast cancer awareness month in October), I soon found myself constantly breaking mammogram volume records each day (topping as high as 74 in one day).
By the end of the day it was not uncommon for me to have mild headaches from the eyestrain.
What made matters so much worse was a scheduling quirk that happened.
Normally the painful mammo week assigned alternates with a following week of reading CTs and MRIs.
Reading CTs and MRIs is far more enjoyable and does require the pixel by pixel scrutiny that a mammogram does.
Unfortunately the radiologist who covers for us (and only is scheduled to cover CT/MRI at his request) and then my partner both had personal issues pop up that had them missing a little over a week each.
To make matters worse, the specific timing of these consecutive absences resulted in me having to cover the mammo schedule for 3 weeks straight.
It also took a bit of getting used to going from a 4-day work week to a 5-day work week during this time as we didn’t have the extra body available to provide any relief.
Your mind and body tend to acclimate quickly when going from a harsh environment to a more pleasant one but it takes a lot longer doing it the opposite way.
All these factors certainly fanned the flames of my burnout which at the end of the year became an absolute inferno.
Storm Factor 3: The light at the end of the tunnel became more distant.
Because of the above factors as well as anticipated continued growth of the medical practice, my colleague and I decided that it was time to add a 3rd full time radiologist to the mix.
This decision dovetailed quite nicely with the fact that we were later told by the semi-retired radiologist (who had been providing coverage 2 days a week so each of us could have a day off) that he decided it was time he removed the semi from his designation and become fully retired before May 2021.
It just so happened that a previous radiologist who covered us years ago happened to express some interest in moving back into the area with his wife and considered our practice ideal for him.
It also turned out that his current work situation required him to stay on until the end of April.
It truly seemed like the stars were aligning and this would be a perfect transition for my partner and I.
I was mentally able to push through the painful schedule I endured in mid December because I knew that there was indeed light at the end of the tunnel.
However little did I know that this tunnel would get extended indefinitely and that light soon faded away.
Long story short, our much anticipated 3rd radiology partner, someone my colleague and I both got along great with, decided that he was going to stay with his current work situation and thus declined our offer.
It was quite the letdown and I felt defeated.
Whatever hope I had to fight off burnout faded in one fell swoop.
Of course we have restarted our search for a 3rd partner but it feels like we are already behind the 8 ball.
Graduating residents typically have jobs lined up by this time of year.
There also seems to be a nationwide hunt for radiologists as practices across the country are probably feeling the same situation.
Why has Financial Independence exacerbated the situation?
Go to any blog about Financial Independence and one of the things touted is that achieving FI can actually increase job satisfaction allowing you to work longer.
The main reasoning is that if you are no longer monetarily driven, you can tailor your job to eliminate the things you hate.
For example I know of many OBGyn docs that have removed the Obstetrics component of their practice which then improves the quality of life.
It is a bit more challenging for me as my partner and I do not have someone early in their career chomping at the bits to take on as much as possible to boost their finances.
Being financially independent for me has therefore made me question on more than one occasion why am I subjecting myself to this if there is no end in sight.
I arbitrarily chose age 53 as a potential target date to retire completely but it was not a money based decision (although I knew it would further pad my margin of safety, it was not the primary motive).
For me I knew I would be tied down geographically to this area because of my daughter and her schooling and figured I might as well work while she’s under my roof.
However if things do not calm down I just don’t see myself lasting that long.
An interesting development: When one door is closing another may open.
I have mentioned previously, that I have found my own personal Shangri La with my forever home.
But having a natural waterfall in your backyard does require some sacrifices to be made.
The biggest sacrifice to date was how I was at the mercy of satellite internet to connect me to the world because of my rural location.
Satellite internet is expensive, unreliable (highly weather dependent), and slow.
But obviously it was a sacrifice I was willing to make.
However this sacrifice limited one of the great potential lifestyle options for a radiologist, teleradiology.
In order to have relatively seamless viewing of radiology images, it has been demonstrated that bandwidth speed has to exceed 20 Mbps.
Not only does my current satellite internet fall woefully short of this number (I am lucky to get 12-15 Mbps on a good day), but I also get throttled down to single digit Mbps speeds once I exceed a whopping (sarcastically speaking) 50 Gb a month.
I could only imagine how painful it would be to read a mammogram (or any other study for that matter) from home with a setup like mine.
A light at the end of a shorter tunnel?
Because I was handcuffed to satellite internet, envisioning slowing down my medical career and transitioning to teleradiology was nothing more than a pipe dream.
So imagine my surprise when at the end of 2020 I was informed that an internet company would be laying down that very pipe which would carry the highly coveted fiber optic cable.
In fact at the time of this writing, the fiber optic cable has just been laid down all the way to the outer wall of my house from the street (which required quite a bit of trench work given the distance).
All that awaits is bringing this cable to the inside of my home (by a separate crew) and turning on the node.
My internet capabilities will jump exponentially, especially since I plan to go with the highest tier plan offered of 1 Gb/second with true unlimited (i.e. not throttled) data.
I will gladly pay the fee to break out of my current satellite internet contract (I signed a 2 year contract last year to get the unlimited data plan I currently “enjoy”).
The termination fee will likely be under $100 based on how many months remaining I have on the contract.
This is something I would gladly pay multiple times over to get out of as my current setup limits my ability to stream movies, play online games, or less importantly, stream educational content for my daughter (I jest).
Granted, even with this fiber optic setup I still won’t come anywhere close to the radiologist who is reported to have the fastest home internet setup in the United States, but I am okay with that.
So what’s next?
To be honest I am not sure.
I do not like the person I have become over the past few months as I have seen some personality changes, reminiscent from my old general surgery residency days, re-emerge (I plan on writing a follow up post detailing some of these changes).
I made the hard decision back then to switch residencies and go into radiology which truly was one of the best decisions I have made.
It would likewise be a hard decision to part ways with a place I have been associated with for almost 15 years.
I have already spoken with the board president about some of the issues I have been facing and how I find this current pace unsustainable.
Ideally a qualified candidate emerges from the darkness (only to re-enter that darkness in the reading room) and helps lessen the load on my colleague and I.
We are entering the time of year where volumes typically decrease as well due to the resetting of deductibles, so that may also help quench the burnout flames.
Just knowing that an alternate option has emerged, namely teleradiology, has also been quite comforting to me.
Note:
If you are in search of financial help, please consider enlisting the service of any of the sponsors of this blog who I feel are part of the “good guys and gals of finance.”
Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.
-Xrayvsn
NOTE: The website XRAYVSN contains affiliate links and thus receives compensation whenever a purchase through these links is made (at no further cost to you). As an Amazon Associate I earn from qualifying purchases. Although these proceeds help keep this site going they do not have any bearing on the reviews of any products I endorse which are from my own honest experiences. Thank you- XRAYVSN
Wow Doc, sounds like a confluence of bad things. Hang in there, the new internet might just be your savoir. Working from home is awesome but it does bring other challenges. At least you could drive less.
And I’m jealous, I live in an area with a total monopoly on internet, we have one choice and one choice only for high speed and they overcharge.
Thanks Dave for the encouragement.
Yeah it really has been a rough few weeks/months for me that has really tested my limits.
Definitely looking forward to fiber optic high speed internet. Hopefully not much longer. I agree working from home may pose other challenges but change of scenery may be what I need if I continue to feel this way with current situation.
I feel (some of) your pain, having had light duty this spring, and now dealing with delayed care and higher hospital volumes as COVID hits our area. But hang in there! Or, as wiser people have written: this too shall pass. Hopefully the end of year rush is over for you right now, and you will have time to interview some eager young radiology residents.
Appreciate the kind words. Yeah I am sure this is happening all across the world through the majority of medical specialties.
I am hoping these feelings pass as well. Probably has been the lowest of lows at work going all the way back to surgery residency.
Here’s hoping that reinforcements are not too far away. Thanks again and hope your situation improves as well.
So sorry to hear of your resurfacing feelings, my friend. COVID has brought the return of stress dreams and insomnia after over a year of good sleep, so please know you are not alone.
I understand your schedule to pad the nest egg further before you pull the rip cord, but it sounds like in crisis mode that could be accelerated if you really need to.
Hopefully that gives you an earlier exit if things remain untenable.
Hope your load lightens soon,
CD
CD thank you for the kind words. I wonder how many of our colleagues are going to have some form of PTSD after dealing with the issues of COVID. Never seen anything like it before so truly a black swan event in the financial and medical world. I’m hoping things return to normalcy now that the end of year rush is over. The key will be if additional warm bodies can be added to the fold in a reasonable time, especially since our cover guy is heading for sunnier waters this spring. I am extremely grateful that all the sacrifices… Read more »
There is light at the end of the tunnel. I expect things to get better physically and emotionally for a lot of us once the vaccine is more widely spread. It has been a very difficult and stressful year for everyone, but especially those in health care. I had a rough time in the Spring but things have stabilized for me. I’m glad to be able to continue working three days a week. I’m not sure what choice I would make if it had to be full time or nothing at all. It is hard to go back to the… Read more »
Thanks WD. Yeah, I hope there is indeed light at the end of the tunnel (and it’s not an oncoming train). This year has done a number to a lot of people physically, financially, and mentally/emotionally.
I would love to be able to drop down another clinical day and do a 3 day work week. Think I could handle that for many more years. I think radiologists are in demand right now in the job market (as evidenced by more and more recruiter emails I get in my inbox).
Stay safe and glad things have stabilized for you.
Sounds very familiar. Rads as well. A lot of turmoil in my young career. P/E take over caused me to jump into a great group, but was not a great fit. Found myself in the car all day and doing mammography (not my specialty) almost every day. Was burnt out and felt trapped because of my less than ideal job history. Concerned it would affect my ability to deliver the care I needed to. Covid was a blessing in disguise in some respects. Moved to reading more from home caused my stress level to decrease a lot from not having… Read more »
Thanks for sharing your experience as well. Yeah I actually was trained in interventional fellowship but gave that up when I moved to current place. I think my partner and I agree that mammography is the one modality that drains us the most. Add on top of that the majority of studies being done is now with tomosynthesis further makes each case that much more grueling. The guy that is currently covering us did one day covering in the beginning for the mammo day and said then and there he would not cover that modality any more (he now reads… Read more »
I’ve always been willing to do what was needed and had served me well before. But I had never done mammo 5 day a week, 3-4 weeks a month. I was a general rad put into a mammographers role… Had always been in a situation similar to yours where we switched off who covered it. Everyone shared the burden/pleasure equally. Among other issues I won’t get into. Tele — everyone is now open to it, but they want to give you the short end of the stick. Being on site gets you a premium in salary, benefits and partnership opportunity.… Read more »
Really appreciate you getting back to me and filling me in on some of the nuances of a potential teleradiology gig. I entertained one company and had a cursory call. Like you said they were looking to fill the graveyard shift (I believe 6p-4am). It is interesting about lower wRVU just because you are working from home rather than onsite. Although I guess if the company handles everything (like this one did, saying would send all necessary equipment and do all the credentialing in 70+ hospitals) I guess that would be the rationalization. Again appreciate you dropping by again and… Read more »
Hang in there mate. Slightly different in my world, but the changes are burning me out as well. Just hoping things shift again once vaccines get wider. Then I have to decide what I do next… I’ve kind of set that as my trip point with the realization I can do anything when there’s a defined change point.
Appreciate the encouragement FTF. I think the pandemic has a lot of people from all walks of life burnt out.
Part of it for me, and I bet a lot of people too, is the lack of a real vacation. That makes it feel like working nonstop with no real chance to recharge batteries.
Look forward to hearing how it turns out for you
This one really touched a nerve for me, Xrayvsn. The ebb and flow of the pandemic has been difficult. As a surgeon, we went from having most of our cases cancelled in the spring, to cramming them in on weekends and evenings to catch up in the fall. Now we’re back to apologizing to our patients again for their case cancellations. Instead of the sanctity of the OR, we’re rounding on Covid patients. It’s maddening and yes, it has drained my wellspring of resilience. All to say, I hear you. I feel your pain. I don’t have the luxury to… Read more »
Thanks for the encouragement TDD.
You hit the nail on the head with the ebb and flow comment. I prefer a steady pace throughout the year with a mild uptick at the end like in the past. Far more manageable than what occurred these past few months.
I do hope you are able to hang in there as well. The volume of imaging for me has trended down finally like normal but I still have a bit of shell shock and haven’t fully recovered my psyche. It’s hard to unburn toast.
Man, that is tough to lose the guy! But on the flipside, doesn’t that mean you and your partner are making a lot more money? And do you guys have the ability to just throttle back the demand and the mammograms and all that? Or is there some type of law against not seeing patients?
I’m so exhausted, and I don’t even have a day job! And I don’t know about the transition back to preschool again. My wife and I take care of our son so much better.
Sam
Financially yes my partner and I would make more money but the actually bottom line will not be as much as one would think (my work charges physicians overhead on a progressive pay scale much like the IRS so high earner physicians pay a greater percentage and dollar amount of overhead). Also with presumed tax law changes due to new party in white house I fully expect my marginal rate to be even higher). Both my partner and I are in a position where we are not prioritizing increasing active income any more. As for the mammogram situation it was… Read more »
Thanks for sharing your article. You mention that you have reached financial independence and that has made it more difficult to show up with the same desire and motivation to work. Yet at times in the article it seems like you would not be fully comfortable just walking away. In my opinion, once financial independence is truly reached, FI being a lifestyle supported by your accumulated wealth not a specific dollar amount, then you should simply just stop. Unless it is truly the love of the game, which it doesn’t sound like it is, it does not make a whole… Read more »
Thanks for the comment and great points. I guess my intent with the article title was that the feelings I was experiencing were magnified by the fact that I was indeed questioning why I am subjecting myself to this when I technically could walk away and in all likelihood be fine. Based on my annual burn rate over the past few years I should be able to maintain a similar level from my investments. I think covid got me a big gun shy because at one point I experienced a truly black swan financial event (real estate distributions were delayed/at… Read more »
I empathize with you regarding the difficulty bringing in new blood to your practice. Sometimes if you’re not located in a highly coveted part of the country, it’s hard to bring in anyone even if you can offer twice the amount of salary that a similar practice in the Bay Area.
The good news is the financially you are there. The silver lining is that your shackles aren’t as tight as what other physicians are bound to!
Great point Smart Money. The coastal areas seem to have the biggest draw of physicians so jobs are more coveted there.
Thanks for the words of encouragement. Yeah the shackles are definitely not as tight as they used to be. Have a great day
Yep, that sounds like a pretty rough end to 2020. At least you can subsist, to some degree, on the knowledge that you’re doing good work and genuinely, directly, helping people—during a terrible rough period of their own lives.
Still, that doesn’t fix your personal troubles. Sorry to hear. But to your last point, hopefully the internet situation and potential remote work increase could smooth things over a little and keep you going for some of 2021. No doubt it’s still a tough road ahead.
Really appreciate the comment a a encouragement. Yeah I am keeping my fingers crossed that the internet finally gets activated (hasn’t so far).
Right now still sludging along.
Thanks again and have a great day
Are we really supposed to feel sorry for you?
Your job is to go to a secluded room and read films??
Then go home to the view of the waterfall?
How awful! You mean no digging ditches all day or intubation covid patients?
You’re right, sounds terrible
Hopefully it gets better for you
Just because I don’t dig ditches does not mean I don’t get burnt out. Mental stuff (which may be beyond your comprehension) can also be a toll on the body too.
I would love to see you handle the amount of visual information I process and walk away without a headache and because it gets so dark by the time I get home I haven’t seen the waterfall in daylight except on weekends.
Beyond my comprehension- I like that
Try heart surgery for “mental stuff”
Try on call every other day, every other weekend. Try aortic dissection at 2 in the morning. Try ecmo for the 30 year old covid patient then try telling his family he didn’t make it
Heck in your case try working 5 days a week!
Now quit whining and be thankful you’re a radiologist
Well I hope you are more empathetic towards your patients than you are to your fellow colleagues. Unlike you I did not have the benefit of knowing what you did so when you brought up ditch digger I assumed you were a member of that society or tube intubator. And although heart surgery may impress some I hold you on equal footing to all medical colleagues (which by your tone obviously you don’t) We all have our own struggles and regardless what someone does if they are suffering I don’t try to add salt to the wound and try to… Read more »
Brutal comments here and on Doximity. I totally understand how FI can worsen burnout in that you think about quitting more because you can. I know POF for one enjoyed his job less after he was FI because the little things bugged him more because he knew he didn’t have to put up with them. But FI also provides the ultimate burnout treatment tool–you can cut back, quit, go do something else etc. In my case, FI allowed me to change all the things I didn’t like about my job. I now serve on no committees, work half as much,… Read more »
Really appreciate the kind words Jim. Yeah I knew that there would be some blowback from putting a post about how I’m going through burnout because the general perception everywhere is that radiologists have it easy (it may have been at one point early in my career, now I feel like I am in a post office and the mail never stops coming in). There may be a glimmer of light at the end of the tunnel which would be the best of both worlds for me (allowing me to go down to 3 days a week and get another… Read more »
Hang in there. Sometimes, you just have to push through it. Hopefully, you can find a new partner soon. The volume is down now, right? It should be easier for a while.
Thanks Joe. The volume still hasn’t dropped like it normally does this time of year but one thing that helped is I finally got a weekday off again (today actually) which is the first time since Christmas.
Keeping fingers on adding someone. There is a potential scenario that I hope goes through and will post about it if and when it does
Well, apologies, I guess I’m that guy. I work in the manufacturing industry, pretty distant from anything medical related. My family hit our deductible late in 2020. So I hurried up and decided to get my shoulder ache checked out. My doc got an xray first, then an MRI. Seems to be a minor situation so that’s good. But honestly, without hitting deductible, I would’ve just lived with the aches and pains. That’s the insurance world we live in, I guess. But the burnout scenario is hitting many in my company as well. I’ve been working from home since March.… Read more »
Appreciate you reaching out and by all means not blaming patient behavior at all in this. I would do the same thing. If I had to blame something it would be covid. The effects it has had on everyone in the Healthcare profession is unbelievable. Stress from dealing with the disease itself as well as how things get disrupted such as scheduling. The downtime in March through April really killed us because of the rush to make up for it an the end of the year. Been practicing for over 15 years and this is the first time I have… Read more »
Can’t you get teleradiology help? For the mammograms or whatever else is too much to handle? From your description, it could be difficult to find someone who wants to move to such a tiny practice in a remote area. You don’t seem to need another full time person. I would think one or more people who could give you telerad a day a week or several days a month might solve your problem. Or join up with another small group and cover each other. Perhaps then enough work for one more full time person The 10GB guy- Good for him.… Read more »
Thank you so much for the great insight. Yes we are currently looking into teleradiology opportunities as well to possibly offload some of the workload. There is also an interesting development that has happened that may actually be the best solution for me (hate to keep in suspense but I don’t want to jinx it yet until it possibly becomes official (and then I will write a follow up post). That is a great tip about having the telerad workflow setup like that. And I didn’t consider the potential snafu with the server being the bottleneck instead of my bandwidth.… Read more »