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Welcome to another installment of the X-ray Beam series.
I am very excited to have a physician blogger that truly is gifted with the way of the written word and runs the website, Reflections Of A Millennial Doctor.
If you can please give a brief introduction of yourself (age, medical specialty, years of medical practice).
I am technically a millennial at 33 years of age, but I think there’s talk about relabeling the 1975-1985 generation to Xennials so maybe some rebranding is in order!
Currently I work as a hospitalist, but was previously a Med-Peds primary care doc who just quit private practice after 3.5 years.
Your website is called, “Reflections of a Millennial Doctor.” What were some of the other names you considered before going with this one?
I must admit… I didn’t really spend a lot of time thinking about the name.
I definitely expend way more effort now trying to think of catchy titles for my blog posts!
I knew I wanted Millennial Doctor in there, quite honestly more for branding purposes and also to reclaim the term from all the bad mouthing I’ve seen about my generation on other social media forums.
It was my hope I’d be able to show we are much more thoughtful and intentional than how we are portrayed.
Not sure how successful I’ve actually been at that, but I’m kinda stuck with the name at this point!
Then came the issue of “Reflections”.
I briefly considered “Musings of a Millennial Doctor” for a hot second, but it didn’t quite have the ring I wanted, plus the alliteration was a little tacky when I said it out loud.
As I was editing pictures from my Pacific Northwest adventures, I realized I was a sucker for reflections and it hit me: Reflections of a Millennial Doctor.
If you’ll allow me to get pseudo-deep here, one cannot move with intention without reflection.
My writing has ended up serving as a mirror to see myself more clearly in an effort to get unstuck from my burnout struggle.
Now it’s time to channel that into intentional living.
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 set on my path into medicine when I was born – there really wasn’t any other option for me.
My parents had a lot of say in that: I was always going to be a doctor.
I did veer off for a year and pretended to be a pharmaceutical sales rep, but the physicians I met during that year encouraged me to return to medicine.
They were part of a Filipino good ol’ boys golfing club who took me in as an “orphan”, and I couldn’t help but be sucked back into medicine.
Alas, that is another story for another day. 🙂
What were some of the deciding factors that led into choosing the medical specialty of Med-Peds? Were there any other specialties that you considered?
I actually went into med school to become a neonatologist but quickly discovered that I loved everything.
Med-Peds is the ultimate non-choice.
It opened up all of the sub-specialties if I so chose, but unfortunately took away the surgical options.
However, I apparently turned into a miserable person to be around when I was on my surgery rotation which was quickly pointed out to me by my then-fiance, now-husband, so I decided to learn how to cook and hack meat instead.
It still involves a blade but less risk, right?
If you had to do it all over again, would you choose the same medical profession/specialty?
I still enjoy the puzzle of internal medicine and the resilience and simple joy of children.
There is a little regret for me not pursuing a Peds Heme/Onc fellowship, but that ship has sailed.
There’s no way I’m ever going back into training.
If you were not a physician, what alternative career would you have gone into?
I apparently get people to divulge all their secrets almost immediately.
Have you personally fallen trap to any of the typical mistakes physicians make, and if so can you name some of your biggest ones?
You mean other than falling into a savior complex?
I think you mean financial, and fortunately no, I haven’t.
We live on less than a third of our income and haven’t made any terrible financial missteps.
We probably spend way too much money on food carts and craft beer but it’s worth it.
If you had a time machine and could go back to any point in time and change just one thing, what would it be?
My writing goes through so many of my regrets, so it may be surprising for me to come out and say I wouldn’t change anything about my life.
My struggles have defined who I am, and I’m stronger and more resilient for them.
With that being said, if I had to choose one thing, I would 100% have eloped rather than spent so much time, effort and money on a single day.
Granted, we spent less than $10,000 on the wedding almost 9 years ago but I could’ve done without all the pomp and circumstance.
What inspired you to start a blog? Were there any surprises along the way? Do you have any advice to individuals who may be contemplating starting a blog of their own?
I’ve journaled off and on since I was a child.
It’s therapeutic for me to write in stream of thought, then edit the crap out of it about 100 times before I release my thoughts into the world.
It satisfies those perfectionist tendencies in me. 🙂
That aside, reading The Happy Philosopher and Vagabond MD’s stories of burnout really made me want to put my story out there.
I also remembered making my own website in high school and found it to be fun back then, so I figured it would be something to distract me from all my burnout woes when I got home.
And what an effort-intense distraction it was!
Blogging takes up an inordinate amount of time.
I tinkered around on the website for a full month and wrote 5 posts before I had it go live… I will say writing has become a much faster process for me now, but those first 5 posts were painful.
I had no idea where I was going, what points I wanted to make.
Don’t delve too deep into the blog – it wasn’t my best stuff since I was meandering around aimlessly.
I keep those posts up though to remind myself how far I’ve come.
Other than the time suck that blogging is, the other big surprise is that people actually started reading!
Every time I get a message or a comment it just blows my mind.
First off, I’m really bad at commenting myself (sorry Xrayvsn!) even though I read a ton of stuff, so the fact that people will reach out and message me amazes me every single time.
And they just share the most heart-wrenching and vulnerable things – I am so humbled by it.
I never expected that to happen – I thought I would be that tree falling in the forest.
Does it make a sound?
All of that to say, I expected mostly silence and some intermittent, “Keep your chin up” and “You can do it!”, so this was a pleasant surprise.
For those who want to start a blog, my advice is:
- Be realistic about how much time and effort you’re willing to put into it.
- Write for yourself – don’t try to copy what’s already out there.
We all have our own stories to tell, and you are the only one who can tell yours.
In your blog you specifically describe yourself as a storyteller who happens to be a physician in primary practice (and not the other way around).
You have a very appealing writing style and every article you author has an uncanny ability to transport me into the exam room right along with you.
It truly is a gift and you are indeed a wordsmith.
Where did you develop your passion for writing?
Do you see yourself pursuing any professional writing endeavors?
Thank you so much for your kind words!
You know, other than writing mandatory essays for school I hadn’t really written anything meant for consumption since university until the blog.
I have old poems I used to turn into songs back in the day, and perhaps that’s where my writing style originated from since poetry naturally evokes emotion.
Otherwise, I’m just wingin’ it!
I have considered maybe doing something more with the writing, but I’m not sure what that would look like.
If I do though, you’ll be the first to know!
What is the biggest non-medical accomplishment you have achieved to date?
Surviving high school, med school, residency and early attending life with my relationship/marriage intact!
A lot of life has happened over the last 15 years, and it takes a lot of effort and communication to continue to grow in the same direction, especially since we’re two very different and highly opinionated people.
When did you develop an interest in personal finance and was there an event that brought personal finance to the forefront of your consciousness?
As a child of immigrant parents from a third world country, I was always reminded of how privileged I was to grow up in North America and to be grateful for what we did have.
It didn’t set in until I went back to the Philippines as a teen and realized I still had family members who lived without running water and electricity.
Money literally is power.
Power to move beyond scrounging for your basic necessities.
Power to propel yourself forward into a life of your choosing.
Power to help others move their stations in life.
Since then, I’ve had a very strong sense of what is enough.
Everything else is icing on the cake.
Everything else is learnable including the 401k/403b/taxable investments, etc.
Complete the following sentence: I would consider the Reflections of a Millennial Doctor website to be a success when I achieve….
I’ve actually been pretty adamant about not setting goals for the blog.
I’m not in it for the views or the likes, though I’m not going to lie – they are a nice pick me up on crummy days.
For me, I achieved success the first time someone messaged to tell me my post resonated with them.
I just needed to reach one person to make this worth it.
Otherwise I’m writing for me.
There’s a certain sense of relief when I get the words out on the screen, and it holds back the rumination until next week.
If I’m happy with the post, then I consider it a win.
For a reader unfamiliar to your website, what are three posts you are most proud of that they can gain an insight about you and your philosophies?
- Death of a Primary Care Physician’s Career: A Cautionary Tale, Act One
- If You Could See Medicine Through My Eyes – inspired by Xrayvsn himself!
- You Know Your Job is Killing You, Right?
Is there a book or books that has made a major impact in your financial well-being?
The Millionaire Next Door, hands down.
The Gone Fishin’ Portfolio my father gave to me when I graduated college – it taught me the set it and forget it (then re-balance yearly) mindset very early on.
Otherwise, everything else has been from blogs or random things my dad has sent me.
Can you name 5 things that had the greatest financial impact?
- Working minimum wage jobs: Retail and boba tea barista were my first places of employment. When you realize that $50 shirt is worth a full day of your time at your minimum wage job, you start to think long and hard about your purchases and that has carried over for me even now.
- Student loans: I have no undergrad loans as I had plenty of scholarships, I stayed home for pre-med and my father paid the remainder. However, the med school student loans have been a significant source of stress as they compel me to keep working at this frantic pace. I plan on cutting back as soon as the loans are paid off.
- Marrying the right partner: My husband is just about as frugal as I am! At this point, we just assume the other person is going to make smart purchasing decisions but we still run purchases in excess of $50 past each other (other than regular living expenses like groceries or gas). When there’s a mismatch of spending habits and standard of living expectations between partners, there will always be friction. No thanks.
- Immigrant parents: The imprinting of their guilt for living in a first world country is real.
- Doctor money: I would be remiss if I didn’t include my salary as a physician. I make more than I’ll ever need, and once the student loans are paid off, it will allow me the flexibility to cut down significantly while still living a comfortable lifestyle.
Can you share with us a hidden talent that most people would be shocked to find out about you?
Believe it or not, my writing is something I’ve kept secret from most people.
Not only am I anonymous on the blog, I also shy away from talking about it in real life.
If you were to meet and get to know me in real life, there’s a 99.99% chance you would never become aware of the existence of my writing.
Then again, I never tell people I’m a doctor, instead saying I’m in customer service so that’s just the kinda person I am.
You get to pick one person who is dead and one person who is currently alive to answer any questions you may have. Who would you choose and why?
Joan of Arc.
I’d want to know what compelled her to act so out of turn from gender roles for her time, and how was she able to gain support?
How far off from reality is her legend?
Was she really powered by God, was she crazy or did she use religion as a way to galvanize her supporters?
It would be a fascinating delve into that woman’s psyche.
I have adored him since TNG (The Next Generation for all the non-Trekkies out there), which still is the ultimate Star Trek series for me.
His body of work is so prolific and I’d love to ask questions about it all.
Plus he just seems like a standup guy who you could have a nice chat over a spot of tea with.
Most people associate physician burnout as happening to those old grizzled veterans of medicine (I feel like I am going to be a card carrying member soon), yet you have eloquently publicized your own bouts with physician burnout despite being relatively early in your career.
Can you describe the factors of medicine that accelerated your path to burnout?
I could go on about this forever, but I really think what it boils down to is the emergence of new technology/EMR and its poor utilization that has accelerated burnout in my generation.
A lot of us go into medicine thinking we’re going to help people via face to face interactions, but instead we come out on the other side realizing medicine has turned into tending to an electronic medical record and clicking meaningless checkboxes.
Even in specialties that aren’t patient facing, a lot of our days are spent managing non-medicine-y aspects and administrative expectations that undermine our ability to provide good patient care.
Moreover, in a world where we highlight patient choice and encourage them to talk to their doctors about xyz, we then limit doctors’ appointment times and put them on a schedule built for productivity PLUS we penalize doctors for not reaching the 95th percentile for patient outcomes and satisfaction as if we’re 100% responsible for other people’s behavior.
Perhaps if we were given time to think during our days, we would then realize all the money from OUR increased productivity is just paying off healthcare administration’s bloating costs which add zero value to patient outcomes but pad the salaries of executives.
How do you not burn out when you’re operating on this system that is clearly doomed to fail?
Of course, this is speaking from the primary care perspective.
I’m sure there are other unique factors that go along with other specialties that I am not privy to.
What are some of the steps you are taking to reduce this feeling of burnout and prevent it from rearing its ugly head again?
When I was in primary care, I attempted to cut back on my schedule but it still was not enough.
I came to realize unless something changes significantly to primary care in the future (such as direct primary care), continuing to work in that environment is not sustainable.
So, I decided to move into hospitalist medicine and see if the shift work would be better.
I’m not going to lie – it has been a struggle to transition to the new work schedule and re-acquaint myself with hospital medicine.
After just a month, it feels like I’m back in the thick of burnout once again, so I’ve cut back a lot on the blog and other things that take away from time with my husband, family and friends.
I try to exercise when I can (running and yoga with my Down Dog App), take landscape photos when I hike, and play piano which is therapeutic for me.
These are just temporizing band-aid measures, however.
I think the thing that is most helpful with burnout is realizing you have other options – there is always a plan B.
We tend to feel stuck, but often times we’re in a trap of our own making.
Seeing the trap for what it is can be one of the most liberating things you’ll ever experience.
With that being said, I’ve given myself a 3-6 month trial on this new job to allow for the expected pain of growth to subside, and if I still feel burned out, I’ll move on to plan B (which is now actually plan C).
Any advice to the younger generations of physicians coming after you that might prevent them from feeling burnout in the first place?
Know what you’re getting yourself into.
Know what you want your life to look like outside of medicine.
Know that your priorities in your 20s when you started this path may vary greatly from what you’ll want in your 30s/40s/50s – maybe you won’t want medicine to play as big of a role in your life when you’re older.
Ask the questions I didn’t think or know to ask of the attendings who practice in your desired field:
- What does your life look like when you get home? Do you even have a home life?
- What are the non-medicine things you’ve done to set yourself up for success?
- How do you maintain the things that are important in your life – hobbies, relationships, etc?
If they can’t come up with any answers, those are red flags.
As for pre-med/med students, I would challenge them to stay and watch their residents and attendings churn through paperwork, even after they’ve been told they can go home.
This is the stuff they’re shielded from.
They should see the hours of clicking and phone calls and filtering through angry patient messages.
This is the reality of the work we do, and perhaps they should be given the opportunity to see this and decide if they still want a part of it.
I don’t mean to dissuade everyone from going into medicine, but I do think part of the disillusionment that fuels burnout is the fact that we keep presenting this idealized view of medicine, enticing people to join the calling and then hand them this shit storm for them to wade through on their own with minimal help.
If they’re willing to go through the process still, then at least they’ll be prepared and slightly more armed with the knowledge to change the system.
Let us say you have hit your target number for financial independence.
Would you a) continue to practice medicine the way you do now, b) continue to work but reduce clinical workload/eliminate certain components, or c) exit medicine completely regardless of age?
I go back and forth with this all the time.
Some days I completely want to quit, sell my house and live in a van, traveling across the world.
But the glimpses of the meaningful work I can have while practicing medicine keeps me from ruling out this profession altogether.
I’m still on the search for what that looks like for me and if I can find it, I would probably continue to work on a part time basis.
If not, there are plenty of other ways to meaningfully impact and connect with others – blogging has surprisingly filled part of that need for me, and I’m so grateful for everyone who’s reached out to me to vent, ask advice or to collaborate!
Thanks for the opportunity (and your patience) to undergo the X-ray beam!
Again thank you so much for your time answering these questions and being placed under the “X-ray beam.” I look forward to your continued posts and wish you much success.
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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Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.
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I am a big fan of Millennial Doctor’s work and I really enjoyed this interview. Thanks for sharing your journey and reflections on your blog. All of your posts are extremely well written and totally relatable. Your voice is needed to show that physicians are not alone in their struggles with burnout and bureaucracy. I particularly enjoyed the one titled ‘What are you going to do about this?’ I hope your hospitalist job works out but I have a feeling that you might have to make some more adjustments before you find your “dream” job. Best of luck and I… Read more »
Thanks MD for stopping by and leaving a great comment. I agree that M is an incredible writer and really has shed lights on the plight of the millennial doctor (as well as other doctors for that matter) these days.
I too feel that she still has not found happiness in her new hospitalist role and that highlights the sad state of medicine we are trending towards if we lose great doctors like her.
You are too kind! You know, on one hand I want to say that we are losing great doctors whether or not they choose to decide to stay in medicine or leave. These great doctors eventually stop being empathetic and start punching the clock if they decide to stay, so patients will still lose out on that experience. So what is worse? Stay or leave? On the other though, doctors choosing to leave who still feel a calling to serve will likely find another way to care for others It just won’t be through the confines of a clinic, hospital… Read more »
Thank you so much for your kind words and reading about my journey! I don’t pop onto twitter that often anymore, but I always appreciate seeing that you’ve shared my posts.
I was hopeful the hospitalist gig was going to work, but 3 months in I’m realizing perhaps I’m trying to jam a square peg into a round hole. Either I sand down the square or change the hole.. haha. We’ll see how this goes.. I’m sure there’ll be a post about it when I finally decide!
Enjoyed the interview. Unfortunately, I’m a little older than a Millenial but will still check out the blog. Thanks.
I’m much older than a Millennial but I really do enjoy her writing and blog. I don’t think you will come away disappointed (if you do, I offer a full refund 🙂 )
M! What a great interview/inside look. I always enjoy your thoughtful, introspective writing even though I’m not anywhere near medicine professionally. You still make me think, which is why I keep reading. 🙂 Claps all around.
Don’t forget the interviewer with the incredibly poignant questions if I do say so myself. 🙂 Thanks for dropping by MFM!
Thanks for your kind words!! I’m always surprised when non medical people read my stuff. I’ve enjoyed all your coast pics on instagram! Definitely inspiring some wanderlust.
Definitely need to give kudos to xrayvsn – these were great questions which is why it took me so long to answer!
I too am shocked and the scope of readers I have visiting my blog (and those are just the percentage that comment). With every blog there are readers that do not comment as well and I’m sure expand the demographics even more.
I’m the old grizzled bastard of the bunch and have experienced first hand the demise of medicine. It happened under the run-up to Obama care under the guidance of Johnaton Gruber and Ezekiel Emmanuel, and when CMS shifted to an “evidence based” reimbursement as a cost containment action. If the outcomes are the same and you have 5 years living on NTG or 5 years getting a bypass. we’ll force the NTG since it costs pennies compared to bypass. This led to the monetization of the Dr’s time by the MBA , creation of the EMR to further allow met-analysis… Read more »
Sad but brilliant assessment of the current medical climate Gasem. I hope this doesn’t get buried in the comments and people don’t get a chance to read it, almost deserves a post of its own. Physicians are one of the easiest groups to take advantage of. You don’t find unionization by medical doctors because they really do put patient care first over their own needs. Can you imagine if physicians went on strike? Lives would certainly be lost and that is just not something any of us would put at risk. And thus we are taken advantage of by corporate… Read more »
As another old gray guy….Gasem is absolutely correct.
The only vote that matters is the “vote with the feet”. Get financially independent, so you can say “NO”.
It is amazing how your perspective changes when you can simply tell the bureaucrats “sorry, I’m not doing that”.
I agree planedoc that financial independence is the key to giving you the option to dictate life on your terms.
The main problem is with increasing student loans and decreasing reimbursement it is harder and harder for young docs to do so and they are stuck in the rat race that much longer
Fortunately I won’t have much longer til I am free from my student loans – I plan on being done within the next year. It irks me when people tell me you can’t pay off your loans within the first 5 years of completing residency on “just” a primary care doc’s salary because I am proof that you can. You just have to decide what your priorities are, and for me, it’s freedom. Because once I’m done with these loans, I’ll be able to move in and out of medicine as I please without having to be shackled to a… Read more »
That’s awesome to hear M. Congrats on being so close to paying off your loans. You will feel a huge weight off your shoulders once it’s removed
That means your freedom is a countable number of days Congrats!
So glad to see your interview of M, Xrayvsn. She’s a treasure. I’ve got salt and pepper in the stubble, so probably straddle the geezer divide in medicine. No matter how much we are forced to be mechanics at the body shop, human machines with souls will never be happy treated as widgets. The problem: each time I do stupid finger magic to distract a crying child or flirt shamelessly with an eighty year old grandmother, I glimpse how this can be the best job in the world and it sucks me back in. I sincerely hope that eventually cutting… Read more »
I hope that M finds her way back too. There are parts of medicine that are incredibly rewarding. Sadly the % of time that occurs is getting smaller and smaller as the non-rewarding stuff is put more and more on our plate.
I, too, get sucked back in for these little moments of connections. It’s just how I’m wired, which makes it all the more difficult to envision myself doing anything other than this. We’ll see. I have a meeting with my medical director next week to discuss how the transition has been going, and I’m leaning toward cutting back now, even without being entirely FI.
Some goals just aren’t worth breaking yourself over.
I’m late into the game of commenting (I go on random digital minimalism blogging/commenting hiatuses every now and then). But I definitely wanted to give props to M and XrayVsn. I enjoyed this interview a lot. Since I was born in the early 80s too, that qualifies me as either a millennial or a xennial too. Looks like it makes me one of the youngest commenters here :). I wish there were better solutions to the problem of burnout. While I’m part of a wellness committee in our hospital, there’s only so much we can do. I know a lot… Read more »
Welcome back old (or should I say young?) friend. 🙂
Glad to always receive insightful comments from you. I hear you about sometimes taking a break from it all (every now and then I try to but get sucked back in 🙂 ).
That is outstanding you haven’t experienced burn out and I hope you never will. I can say that I have definitely experienced it and it is not fun.
I hear you on taking breaks – I’ve been doing that a lot myself here recently, which is why I’m late to your comment! I’ve been doing a lot of thinking about what makes someone prone to burnout vs being protected from it, and I will be honest – I think I’m just wired for it. I’ve always been the type of person that if I think something’s wrong, I won’t stop trying to fix it until it’s right, whether that’s putting the dishes in the dishwasher the RIGHT way or getting insurance companies to admit they never read my… Read more »
I probably oscillate between banging head on wall and shrugging it off. There are somethings I do take a stand on but it is very frustrating to deal with people/companies that are bottom line oriented rather than wanting to do the right thing.