I’ve always marveled at the focus, concentration and unflappability of experienced surgeons. The amount of calm they exude even outside surgery is remarkable. Having watched them from the sidelines for close to 5 years, their sense of composure is something that I aspire to.
I have been shadowing surgeons for some time now. Five years ago, I was developing animal models of breast cancer in the In Vivo Pharma group at Astellas. Recently, I’ve been working with fresh human tumor samples, taken from bedside to bench by surgeons in my lab. While it is not exactly the same as operating on humans, you need to have steady hands and a clear head to do well.
Even today when I step into the operating room, I sometimes get a bit jittery watching surgeons operate on their patients. Every now and then a bit of self-doubt, fear and anxiety creep in. It’s easy to forget that despite all the years of study and practice that we are still human.
I remember the first day I had to watch surgeons in action, I was a nervous wreck. My heart was beating so fast that I thought everyone could hear it and I was sweating profusely. My brain was on edge from all the thoughts that were bouncing around in my head.
After the session was done, when I was in my room I thought to myself, “If I was going haywire in the room without being involved in the surgery, I wonder what the doctors would’ve gone through?!”
The scene inside the operating room is often stressful, chaotic and tempers sometimes boil over in the heat of the moment. The best surgeons, I’ve noticed, are the ones who are able to maintain a stoic demeanor while being responsive enough to handle any unpleasant situations that might arise.
I have seen things get really bad but they were almost always quelled before they go worse. I learnt that being a surgeon is to be a master of your scalpel as well as your emotions.
I always knew that the life of a doctor was tough. An experienced surgeon once told me, “Son, you might think it’s hard now, but it’s a completely different ballgame when you finally wear the disposable mask and the smell of antiseptic hangs in the air.”
Methods Used by Surgeons
While I’m far away from being a zen-master of surgery, there are a few tips given to me by masters of their craft that have helped maintain my composure during trying times. Hopefully they can help you as well.
Focus and Breathing
Meditating is an easy and effective way to get rid of stress from your wracked body. You can either go to classes to practice in a group or you can read books from famous authors about how to go on about it. If you’re just starting out career-wise, know that it’s normal to feel anxious before a surgery. And according to Peggy Huddleston, the author of “Prepare for Surgery, Heal Faster”, it happens to people on both sides of the scalpel.
There are several easy meditation techniques for people looking to get into it quickly. Lamaze breathing is one such technique where you focus on conscious or patterned breathing to achieve relaxation. Deep steady breaths and slow exhaling can do wonders for your nerves.
This is a routine that a lot of doctors have told me they follow to increase their mental-awareness.
Before you prepare for surgery, make sure you have a mental checklist of all the items that you would normally require for the procedure. Check them off one by one as your mind is able to register them. Pretty soon you’ll start doing this as part of your preparation process.
Still, many tune in to their favorite band for relaxation.
One of the best methods to relax, pre and post-surgery, your playlist should have everything that you’d normally need, from soothing sounds of nature, sea and surf, waterfalls, white noise and in case of extreme stress, The Beatles.
Find your right mix to help you get over stressful times and have it at your beck and call.
Some people I know turn to food in times of anxiety.
Berries, nuts, oranges, avocados are great for relieving stress and getting into a calm state of mind. You can also cheat a bit with chocolate as it has been found to have properties that work against anxiety. For best results, get dark chocolate with minimal or no sugar.
Nootropics are a branch of medication that helps you with cognitive performance. More than a few people suggested this as they seem to work for them.
There are different nootropics with pronounced anxiolytic properties which can help people during times of extreme stress or anxiety. Modafinil and Phenibut have been the most commonly used drugs for their calming effect on people.
The right nootropics can help most people get over their problems with anxiety. But you need to speak to your doctor before you start on them.
I hope this was able to give you some insight into the methods other surgeons use for beating anxiety before surgery. A lot of my colleagues use one or more of the above methods to get themselves into gear. All being well, they can help you too.
Surgeons have a huge responsibility on their hands. Saving lives is never easy and it puts considerable strain on us all. But if they are able to clear their mind and focus their thoughts, people get another shot at life. That to me is worth fighting for.
Dan Fries is an entrepreneur, businessman and author. He is the founder of Corpina Nootropics, and former oncology researcher at Harvard Medical School. Dan’s mission is to inform the world about nootropics and responsible cognitive enhancement.
Searching for a job in healthcare can be overwhelming. No matter where you are in your career, from just out of training to nearing retirement, it’s difficult to know where to start.
Searching for a job can be particularly frustrating if you are already working long days and don’t feel like you have a break—isn’t that the reason you are looking for a job in the first place? These apps and websites make it easy to search for a job, even when you’re pressed for time. Several of them will even alert you when a job comes up that meets your custom criteria.
PracticeLink – The only site on this list that is primarily dedicated to physician jobs. You can search hundreds of medical specialties, locations or general career types. It has more than 10,000 physician jobs available at nearly 5,000 healthcare facilities around the country. Find it at www.practicelink.com.
Health eCareers – The site has thousands of jobs covering all areas of healthcare. It has more than 8,000 physician jobs and more than 14,000 total healthcare jobs. In addition to job listings, it has helpful resources like an interactive salary calculator that can be changed based on your specialty and then compared to other healthcare careers. Find it at www.healthecareers.com.
CareerBuilder – Search by job title and then sort those responses by specific specialties, companies, cities and states. It features more than 25,000 jobs all over the country. Find it at www.careerbuilder.com or download its handy mobile app and search on your phone.
LinkedIn – You may already have a LinkedIn profile and seen the job suggestions LinkedIn automatically generates based on your experience. The site has an incredibly deep job board with more than 300,000 healthcare jobs. The site is found at www.linkedin.com. It also has an app for both your LinkedIn account and another, LinkedIn Job Search, specifically for job searches.
Indeed – Indeed touts itself as being the biggest job board in the world, which makes it great for your looking for opportunities inside or outside of the United States. It pulls jobs from thousands of websites into a very simple interface, including more than 350,000 healthcare jobs. The site is found at www.indeed.com and is also available as an app.
Kyle Power is director of interactive marketing at CompHealth, the nation’s largest provider of locum tenens physicians. CompHealth helps healthcare providers in more than 100 medical specialties find permanent or temporary jobs. For more tips for job seekers, visit www.comphealth.com/resources.
Why does having a sense of satisfaction and fulfillment as a modern doctor seem like such a struggle at times? There is an invisible battle going on, day-by-day between our search for a Fulfilling Career in Medicine and the hidden forces of Professional Burnout.
What is Burnout?
We each know what it feels like to be fried, toasted and spent after a long weekend of call or a tough night in the hospital. If you are able to recover your drive and energy before you return to work, great job. I hope your resilience continues.
Burnout begins when you are NOT able to recharge your batteries between call nights or days in the office. You begin a downward spiral with three distinct components.
- Emotional Exhaustion:
- You are emotionally drained, depleted and worn out and not able to recover in your time off
- You develop a negative, callous and cynical attitude toward patients and their concerns (“my patients are so #%*&!”)
- Reduced Sense of Personal Accomplishment:
- You see your work poor quality, without value or meaningless (“what’s the use?”) and see yourself as incompetent.
The standard scale for measuring burnout is called the Maslach Burnout Inventory (MBI). The originators of the MBI describe burnout as:
” … an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”
How Common is Burnout?
Numerous global studies involving nearly every medical and surgical specialty indicate that approximately 1 in 3 physicians is experiencing burnout at any given time. Recent studies show the burnout rate in American physicians is approaching 50%. Ouch!
(Mayo Clinic Proc, 2015 December 90:12, 1600–1613)
What is the Impact of Burnout?
Physician burnout is directly linked to
- Decreased patient satisfaction and quality of care
- Increased medical errors and malpractice rates
- Increased physician and staff turnover
- Increased rates of physician substance abuse and even suicide
The Burnout – Engagement Continuum
Burnout can be thought of as one extreme of a continuum with Engagement on its other end.
Burnout < ————————–> Engagement
Engagement leads to feelings of fulfillment and satisfaction. You feel your work makes a positive difference in people’s lives and your career has true meaning. Engagement is the emotional gold standard for career success.
It’s a Battle Out There – and it’s Not a Fair Fight
In the day-to-day practice of medicine, the forces of burnout and engagement are in constant conflict with each other. This is not a fair fight because much of the battle lies outside of our normal awareness.
While we focus on our patients and their issues, our practice environment is filled with invisible stresses that feed burnout and block us from engagement.
Here is a partial list of daily stresses working on burnout’s team. Note that they all exists above and beyond everything you do to keep up to date in your clinical skills!
Being a Doctor is Stressful … Period
The “most stressful” professions are characterized as having a high level of responsibility and little control over the outcome. We are not selling widgets here. This is a tough job that saps our energy every single day.
We work with sick people all day long (duh!)
Our days are filled with intense encounters with sick, scared or hurting people … with all the emotional needs that come with an illness. In the absence of training on creating boundaries, our energy can be severely tapped by these emotional needs alone.
Balance, What Balance?
Medicine has a powerful tendency to become the “career that ate my brain”, pushing all other life priorities to the side. As we get older, with more family responsibilities, the tension between work and our larger life is a major stressor for many. Training on healthy boundaries would help here too and is rarely available.
A Leadership Role You are Not Trained For
You graduate into the position as leader of a healthcare delivery team without receiving any formal leadership skills training. By default we learn a dysfunctional “Top Down” leadership style. Feeling like we must have all the answers and ordering our patients and staff around only ads additional stress.
The Doctor as the Bottleneck
The team can only go as fast as we can – and we are often behind schedule. Pressure mounts to perform at full steam all day long. We frequently end up being the person who slows everyone else down.
Who’s Paying for This?
The financial incentives are confusing at best. The patient is often not the one paying for our services and many of them receive their care with no personal investment on their part. You may have to deal with over a dozen health plans with different formularies and referral and authorization procedures … of which the patient is blissfully unaware.
A Lawsuit Waiting to Happen
The hostile legal environment causes many us to see each patient as a potential lawsuit. This fear factor adds to the stress of all the points above.
Politics and “Reform”
Political debate drives uncertainty about what your career will look and feel like in the future. All the pundits share the same complete lack of understanding about our day to day experience as providers in the trenches of patient care. There is no track record of common sense. We simply don’t know what to expect. (burnout LOVES that !)
Things Eventually Get Stale
The ten year threshold when your practice suddenly seems to become much more of a “mindless routine”, losing its ability to stimulate your creative juices each week. All of a sudden it seems as if medicine is “no fun any more”.
That’s an impressive list (and I am just getting started). Which begs the question …
Wait a Minute … Who’s on Your Team?
What skills and strengths are we bringing to this fight?
- We are extremely intelligent, quick learning, hard working with a drive to do our best. Once we know the tactics to defeat burnout, no one will work harder at putting them into action.
- Our connection to “WHY” we are a doctor – to our Purpose. The quality of this connection varies day-by-day, however it is a source of immense power and endurance when the connection is clear
- We have invested over a decade of our lives in our medical training and are not going to give up easily
- We get paid well enough to be in “the 1%”
- We are a respected member of the community
- Our families love and support us. We can draw strength from them
- It is possible for us to build and maintain a life outside medicine where we can recharge and recuperate. You might think of this as “resting between rounds”
Just like Rocky Balboa, we can take a huge amount of punishment – take a lickin’ and keep on tickin’. Our ability to simply “take it on the chin” and just keep comin’ is our tactic of last resort. (read on and I will show you some more skillful ways to put the hurt on burnout)
How can you tip the odds in your favor and Beat Burnout?
Recent research shows the efficacy of specific burnout prevention and treatment measures on both the personal and organizational level.
Personal Burnout Prevention Measures
- Self awareness and mindfulness training. Remaining connected to your emotions and energy moment by moment, actively staying present during the work day
- Appreciative Inquiry – doing more of what is working rather than focusing on what is not working
- Narrative Medicine – journaling or peer group processing of your work experience
- Work Life Balance: Creating and maintaining and healthy boundaries between work and non-work life areas
- Lowering stress by
- Learning effective leadership skills
- Exerting control where possible over your work hours (women physicians are leading the way here)
- Creating focus where possible on work activities that provide the most meaning
Organizational Prevention Measures
There is a natural place for burnout prevention at the organizational level. Any decrease in burnout should produce measurable increases in profits for the provider organization.
Recent research shows us a number of effective interventions.
- State an organizational intention to value, track and support Physician Wellbeing
- Institute regular monitoring for burnout amongst providers (MBI)
- Create CME programs teaching the Personal Burnout Measures above
- Provide time and funding for physician support meetings
- Provide practical leadership skills training
- Support job sharing and flexibility in work hours
- Create specific programs to support physicians suffering from symptomatic burnout
Burnout is waging a constant, invisible, soul eroding battle with our healthcare providers. Physicians engage this enemy every single day and research shows one third of us end up among the walking wounded. It is time to share the research proven tools to tip the odds in the favor of Engagement, Fulfillment and Career Satisfaction for our men and women “in the trenches” of modern medical practice.
Dike Drummond MD is a family physician, executive coach, trainer and consultant specializing burnout prevention and treatment services for physicians. Find over 117 separate ways to prevent burnout at his website, The Happy MD.
You’re in bed, tossing and turning. You can’t sleep. You feel like you are in a financial prison, constrained by the shackles of debt and trying to still have fun and enjoy life, but every month is hard and you feel like you are just getting by.
Perhaps, you feel like you are dragging a ball and chain every where you go. You’re wondering, how the heck am I going to break out of this joint and have financial freedom?
If you have a lot of student debt, you may be eligible for several types of debt-reduction/debt forgiveness programs. The difficulty lies in choosing among them all. Here are a few factors that you may want to consider when looking over the possibilities:
- Does it cover my field of practice?
- Do you need to specify a specific loan or can you get forgiveness on multiple loans?
- Is this an employer or a state-funded program?
- Are the benefits taxable or not?
- What is the length of the commitment?
- Does the employer or the state pay down the loan each year or do they wait until the end of the commitment?
Public Loan Forgiveness Program
If you work for a nonprofit or a government agency, consider the 10-Year Public Loan Forgiveness (PSLF) program, which offers many advantages. Sponsored by the federal government, it can cover virtually any field of practice.
Who? The major advantage of this plan is that ANY specialty could utilize the PSLF. It isn’t constrained to primary care physicians or specialties of particular need.
Requirements. Here’s how it works: While you are employed full-time for a public-service organization, you must make 120 on-time, full monthly payments. This includes residency and fellowship. Qualifying employment is any employment with a federal, state, or local government agency, or a nonprofit that has 501(c)3 status, as wells a certain nonprofits that are not 501(c)3s.
Think about this for a minute. This is just seven years out of residency or maybe only three, four, or five years out of fellowship—and you can be debt-free! So, make sure you enroll AS EARLY AS POSSIBLE when you are in residency.
The Nitty Gritty Payment Details. You don’t have to specify a particular loan because it can cover all of your federally backed loans, including Stafford, Perkins and other programs. The benefits are currently not taxable, but this could change in the future. The federal government forgives your balance at the end of the 10-year program.
Find out whether the organization you’re working for is a nonprofit or a for-profit. Some nonprofit hospitals can have a for-profit subsidiary for tax reasons.
Tax Consequences. Currently, the ENTIRE debts that are forgiven are exempt from state and federal income taxes. $200,000 is the taxable equivalent of $285,700 (assuming a 30% tax bracket). This is a huge potential benefit!
State Sponsored Debt Forgiveness Programs
Besides, PSLF, there are some really exciting opportunities offered in every state.
Make sure to check out state sponsored programs at: https://services.aamc.org/fed_loan_pub/.
As of the time of this writing (January 2015), there were over 71 different programs available across the country!
Here is an example of a current program in Minnesota…
Minnesota Urban Physician Loan Forgiveness Program
Who? Applicants are primary care medical residents, which include Family Practice, Obstetrics and Gynecology, Pediatrics, Internal Medicine and Psychiatry. You would apply July 1 to December 1 while completing medical residency training.
Requirements. Following completing of the residency, the participant must plan to practice for at least 30 hours per week, for at least 45 weeks per year, for a minimum of three years in an underserved urban community.
The Nitty Gritty Payment Details. The state will re-pay up to $25,000 per year of service, not to exceed $100,000 or the balance of the designated loan, whichever is less.
Tax Consequences. These payments are exempt from state and federal income taxes. $25,000 is the taxable equivalent of $35,700 (assuming a 30% tax bracket).
Time Commitment. You must serve at least three years or otherwise must repay plus interest what they paid towards your loan.
Here’s another example of another state forgiveness program…
Oregon Partnership State Loan Repayment (SLRP)
Who? Applicants are primary care medical physicians and psychologists (among other non-physician positions).
Requirements. Must be a US Citizen. The application period is normally open during October and November each year and awards are made in December.
The Nitty Gritty Payment Details. Qualifying providers can receive a maximum award of $35,000 per year of 25% of total debt, whichever is smaller.
Tax Consequences. These payments are exempt from state and federal income taxes. $35,000 is the taxable equivalent of $50,000 (assuming a 30% tax bracket).
Time Commitment. Commit to service obligation of at least two years. One year extension may be awarded for up to three additional years, for a maximum service obligation of five years.
Native American Forgiveness Programs
Besides working for a private non-profit practice or a larger public entity or HMO, some physicians may want to consider another alternative- working with Native American Tribes.
You can learn more by going to: www.ihs.gov/loanrepayment/
Who? Applicants are physicians specializing in obstetrics/gynecology, psychiatry, internal medicine, family medicine, and pediatrics.
Requirements. Must serve at a location on a reservation or other specified place by IHS. A few quirks to be aware of: IHS utilizes a ranking system to address the goal of filling staff vacancies in Indian health programs when granting LRP awards. This system assigns priority consideration to Indian health program sites with the greatest staffing needs in specific health profession disciplines. Also, IHS gives priority to applications of American Indians and Alaska Natives and to individuals recruited through the efforts of Indian Tribes and Tribal or Indian organizations.
The Nitty Gritty Payment Details. Physicians are eligible to receive up to $20,000 per year in health professions educational loan repayment when working for the IHS.
Tax Consequences. These payments are subject to state and federal income taxes. IHS will pay an additional 20% to the IRS to offset increased tax liability.
Time Commitment. A two-year service commitment is required.
National Health Service Corps Loan Repayment Program
In addition to the state programs, there are various other granting national programs and opportunities. For example, the NHSC Loan Repayment program provides loan repayment assistance to licensed medical providers who serve in communities with limited access to health care. There are both full-time and half-time options for service commitment. The dollar amount of assistance and length of service depend on participation in either the full- or half-time and on the need on the Health Professional Shortage Area (HPSA) score of the site.
Essentially, they are looking to fill physicians in “underserved” areas across the country. If you have one right in your area, this could be your ticket!
You can learn more about this program by going here: http://nhsc.hrsa.gov/loanrepayment/
Who? Selection is based on the staffing needs of the NHSC. For physicians, priority for selection will be given to those who have completed residencies in the following: family medicine, obstetrics/gynecology, pediatrics, psychiatry, geriatrics, or internal medicine.
Requirements. In exchange for loan repayment, participants are obligated to serve full-time upon completion of training at a designated NHSC-LRP site of their choice. US Citizenship required.
The Nitty Gritty Payment Details. Physicians may receive repayment of up to $50,000 in health professions educational loans (depending on site). Primary care providers working full-time at an NHSC-approved site with a HPSA score of 14 or above can receive up to $50,000 in loan repayment for committing to serve at site for at least two years.
Primary care providers working full-time at an NHSC-approved site with a HPSA score of 13 or below can receive up to $30,000 in loan repayment for committing to serve at the site for at least two years.
Tax Consequences. The loan repayments are exempt from gross income and employment taxes. These funds are not included as wages when determining benefits under the Social Security Act.
Time Commitment. It is a minimum of two years, but the physician could choose to stay longer. At the end of two years, Corps members can apply to continue their service and receive additional loan repayment. With continued service, providers may be able to pay off all their student loans!
As a physician, you’ve made a commitment to helping others and your community.
Now make a plan to pay-off your debt!
Consider for a moment… could you utilize one of the programs we have discussed?
Also, one other topic this isn’t discussed enough, what if you could COMBINE two of these programs simultaneously?
For example, you could enroll in PSLF, work for a non-profit in an under-served area, and then at the SAME TIME, do a state forgiveness program for 2 or 3 or 4 years (whatever the minimum commitment is).
This could hedge the bet of the federal government taking away the punch bowl from the party. This way you have substantially less debt no matter what happens.
If, as a young physician, you focus on paying off your debts, save for a rainy day, live within your means and put money away for retirement, you can then do the things you’ve long dreamed of doing and be well down the road to financial independence.
About the Author:
Dave Denniston, Chartered Financial Analyst (CFA), is an author and authority for physicians providing a voice and an advocate for all of the financial issues that doctors deal with. He is the author of 5 Steps to Get out of Debt for Physicians, The Insurance Guide for Doctors, The Tax Reduction Prescription, and his new book, The Freedom Formula for Physicians. For questions about slashing your debt, reducing your taxes, or anything else with a dollar sign in front of it, email Dave at email@example.com or check out his latest podcast at www.DoctorFreedomPodcast.com.
“Medical school is a great anti-mentorship program. You meet a lot of doctors you’d never want to become.” That’s what med students keep telling me.
Mentorless medical students?
I had no idea. Until students started shadowing me. Many also volunteer at hospice and free clinics. I asked one gal, “You must meet a lot of wonderful doctors there. Right?”
“Not really,” she said, “Doctors are on automatic pilot as they try to navigate through a staggeringly high volume of patients. It’s so disheartening. And what’s worse, everyone I speak with says, ‘That’s just the way it is. It is too expensive, difficult, and risky to go into private practice anymore. You can’t be a solo doctor in this day and age.’ After meeting you, I know there is another way.”
“You haven’t worked with solo docs?”
“No. I haven’t met anyone else who has escaped our broken system to practice medicine as it should be practiced—on a personal and human level. I was worried that I was having childish delusions of grandeur by thinking I could actually practice medicine in such a way in today’s climate. I worried I’d go through med school and residency only to find that in the end there was no refuge from our inhumane health care system. I’m here because there are no tools or mentors to help me be the doctor I’d like to be.”
Medicine is an apprenticeship profession. We learn by watching doctors around us. Sadly, many aren’t happy. Most docs I meet have been victimized for years. Many think they’ve got “burnout,” but physician burnout is really physician abuse. Hint: No amount of deep breathing, meditation, yoga, resilience training will make your crappy assembly-line job joyful. Cut your losses, get a real mentor, and move on.
So how do you find a mentor?
Look for doctors who are doing what you want to be doing and hang out with them—now! If you want to be a happy doctor treating real patients, your mentor should be a happy doctor who is treating real patients. If you take business advice from cynical doctors who are depressed—you’ll be getting career advice from depressed cynics, if that’s what you want. Warning: if they’re not happy successful doctors seeing real live patients, how can they help you become a happy REAL doctor?
How do you know if you’ve got the right mentor?
The right mentors are practicing medicine the way you want to practice medicine. Beware: there are many physician gurus, authors, speakers and burnout specialists out there who are no longer practicing medicine—because they “burned out.” Would you choose a divorced marriage therapist who has never had a successful marriage? Avoid advice from people who have never done what you plan to do.
Pamela Wible, M.D., founded the Ideal Medical Care Movement. She has been awarded the 2015 Women Leader in Medicine by the American Medical Student Association for her inspiring contributions to medicine. Need a mentor? Contact me. I can hook you up.