My So-Called Life

I’m a partner in a medium-sized democratic group, big enough to generally be sheltered from huge swings in clinical load due to any individual's personal leave or hiring of a new partner.  I have EM doc friends who have mentioned that they’d have to miss out on previous commitments because of staffing changes such as those, and that always felt like a far-away problem, until recently our group was fortunate to pick up another contract, significantly increasing the clinical load faster than any group could hire.  Bottom line: I got steam rolled, drowning in work and losing contact with my “real” life.  It was all voluntary by the way; in our group’s typical uber-democratic fashion, I was able to choose how many shifts I could bear for a handful of months until more docs were hired on.  Just now I’m coming out on the other side as a great new group of docs recently joined our ranks, and I’m able to look back and reflect on lessons learned during my own ebb and flow of clinical work that is common for emergency physicians. 

Professional Lessons:

The Good - I typically work a lesser load of clinical shifts than most partners in my group due to also taking on administrative work, but had more of a typical load as of late.  I felt all warmed up every time I was heading into the hospital!  The usual stale cobwebs and inertia after a few days off of clinical work was never there, making the first patient encounter of a shift just as smooth as the last.  Clinically I felt like a well-oiled machine and it makes me appreciate that there truly is a critical mass of patients that I personally must see on a regular basis to keep sharp.  This will likely prove useful to remember as I near retirement or consider other non-clinical opportunities.  Perhaps even now, clustering my shifts might be the way to go as I try to balance clinical and non-clinical duties. 

The Bad - I am typically an everlasting gobstopper of empathy.  I would never question the logic of a patient’s choice of ED visit versus a PCP office, or why 3 a.m. seemed like the right time to stop on in.  People have their reasons.  But just jack up my clinical load a bit (ok, a lot) and my shoulders started to tense with each bell of the ambo door.  I knew it was taking a toll on me when I would read the triage nurse’s note and immediately internally start to question the motives of the patient I was about to see.  An alarm bell went off in my head.  Although I realized one could argue that this type of questioning is totally appropriate, I knew it wasn’t my typical outlook, and it was an outlook that certainly made it harder for me to love my profession everyday.  Keeping my previous empathy might even be more important that having a warmed-up clinical mind in my opinion.  It has quickly returned with my now decreased clinical load.

The Ugly - see below.

Personal Lessons:

Prioritize priorities - I had it all set.  My google calendar was loaded up, defending my personal life from my shifts.  Workouts? Check.  Sleeping? Check check.  My kids were even getting scheduled so I would be sure to set aside time for them.  But man, something was lost in translation.  My husband and I were interacting more as the changing of the guards than anything else.  Google calendar doesn’t do well providing downtime and spontaneity.  Everything but the bare essentials went to the wayside.  I hadn’t hung out with my sister for months.  I stopped turning down invitations to meet up with friends because the invitations stopped coming after being turned down so regularly.  A friend even asked me what it was like to live and breathe work.  Eek!  That’s not what I signed up for.  We made it to the other side just fine and I’m having a great time catching up with everybody, but when there are not enough slots to fit in all the priorities, something’s got to give.  I don’t think I’m alone among emergency physicians who aim to work to live, rather than live to work.  It’s easier than I thought to let it slip the other way. 

Guilt was gone - On the lighter side, the trouble I normally have with trying to balance work with everything else was suddenly easier when work ticked up, mostly because I got very skilled at saying no to protect my time.  Meeting mid-morning after a night shift?  No way, Jose.  PTA meeting on my night off?  Sorry, not sorry.  Cook dinner?  I’ve prepared some exquisite Subway for the family.  Outsourcing was in full force: yardwork, grocery shopping, scrubbing toilets? Buh-bye, buh-bye, buh-bye.  Even now that things have slowed down again, as long as I can swing it, I’ll attempt to keep the guilt away and the outsourcing full speed.  It’s amazing how the world continues to spin even though I haven’t personally balanced the school budget nor picked up a toilet brush.  Nothing like a little stress on my time management to help me flex those boundaries I should always set for myself. 

For those of you in smaller shops with even smaller staffs, I imagine this swing in lifestyle is your reality.  Hats off to you.  You likely have many more lessons to share with the rest of us.  Share them!  Hopefully, my lessons could better prepare or at least normalize this sort of transition for an EM doc who will experience something similar soon.  Most importantly, it was worth it.  The docs in my group are my family, and even though I might have a few more tricks up my sleeve next time, I know I’m ultimately in the right place because I’d do it all again in a heartbeat for my group and profession that I am so lucky to have. 

Dr. Lisa Maurer lives and works in the Milwaukee metro area, loving her role as a partner and Legislative Liaison in a community group called Emergency Medicine Specialists, as well as shareholder partner of ConsensioHealth.  She moved back home to the Milwaukee area after finishing school at the University of MN and residency at George Washington University, which included a Mini-Fellowship in Health Policy.  Within organized medicine, she focuses on the intersection of health care financing and health care delivery systems, especially at the state level.  She is the President of the Wisconsin Chapter of ACEP, member of the ACEP State Legislative and Regulatory Committee, the ACEP Reimbursement Committee, the EDPMA State Regulatory & Insurance Committee, and ACEP/EDPMA Joint Task Force.

Lisa Maurer, MD, FACEP