Episode 119: Women in Medicine are Burning Out

Show transcript: 

Welcome to The Broad Experience, the show about women, the workplace and success. I’m Ashley Milne-Tyte.

This time…a lot of us have at least one female doctor. In some ways, their working lives sound quite familiar.

“I think we look at other women and we judge ourselves on how they’re doing. So we see this little iceberg of their lives and we say, are we doing as good a job as they are?”

But the job has challenges most of us won’t have to face at work…

“You don't necessarily show that emotion. And so that's how I carried on most of the time. And most of the time that worked, you know 90 percent of the time that worked, and then every so often terrible things happen and you react to it.”

At the end of 2016 I did an episode on burnout – and the reaction seemed to show this is a problem a lot of you have experienced.

And over the last year or so I’ve heard from a few doctors saying look, burnout is a HUGE problem for women physicians. Depending on which study you look at, women doctors are burning out at twice the rate of men, and that can’t be good for any of us. A Harvard study has also shown elderly hospital patients do better under the care of women doctors – but is that because women are throwing so much of themselves into that care it’s leaving them spent?

In this show we’re going to talk about burnout and lack of empathy in a profession that on the surface seems to be all about it. We’re going to talk about how women judge one another’s success, and how they can help eachother.

Robin Devine is my first guest. She lives in Columbus, Ohio. She’s in her mid-forties with two teenage sons and a husband. (We had a few technical difficulties during the interview so ended up speaking on Skype.) 

After her medical residency Robin did a fellowship in sports medicine. She was athletic herself and thought, maybe this’ll be my career.

“But I got about halfway through it and thought, I don't want to see people for ankle sprains for the rest of my life. I want to experience kind of the continuity and that whole patient experience where you treat people from cradle to grave. The whole shebang.”

She wanted to develop relationships with her patients over years. And she thought being a family doctor, with somewhat regular hours – would allow a bit more time for other things…

“Medicine often is, not just a job, it's not just a career, it's a life. And you have to be happy and I knew that I would not be happy if I couldn't do the other parts of living, which was having a family and having interests outside of work.”

AM-T: “Well yeah, tell me about that. I was going to ask you when you met your husband and how much you thought about the intersection of work and life before you had kids.”

“Hmmm. So I met my husband, I used to be a runner in high school and college and I met him playing ultimate Frisbee. And we dated for about five years and we ended up getting married the last year my residency. And you know, I had friends who during residency had babies and I remember I was very driven then and I couldn't imagine, I couldn't understand in my brain, in my mindset at the time, why someone would want to take a break from this thing they’d work so hard for to start their family then. It was a very ignorant mental model that I had. But that's kind of the frame of mind I was in at the time.”

But once she got married, she felt quite differently. She didn’t want to wait to have kids. And

her first job in a family practice looked pretty good to a 30-year-old on the cusp of her career. She joined a practice with another female doctor who worked with her husband – he was a lawyer, and he ran the office.

“One of the reasons I took the job was they had a lot of kids and they were very much encouraging. They thought in order to be a family doctor you have to have perspective, and we really encourage you to have a family. We provide maternity leave.”

Which was great. Because she got pregnant quite quickly. Things were going well.

“And I was pregnant, about 25 weeks pregnant, and I started having pre-term contractions, and I went to the doctor and he said, ‘you know this happens a lot with physicians because you're on your feet all day long. You need to you need to cut back because your cervix is shortening.’ And at that time many years ago there wasn't the treatments that they have now to stop that. And so he said, you need to go to a part time, that either means half the patients or half a day.”

So she called her bosses on her way home…explained the situation, told them she needed to go part time. And as she remembers it they seemed supportive, the wife maybe more so.

So that was on a Friday – she’d had about 18 patients scheduled for the following Monday. So she goes into the office on Monday morning, expecting to see maybe nine patients on her new schedule.

“And when I went into the office they had moved every single patient into the morning, so I had 18 patients in half the time.”

AM-T: “Whoa.” 

“[Laughs] And I I'm like, there must be a mistake. And so I went up to the office manager, which was her husband, and said what is going on? You know, I'm supposed to be part time. And he looked at me and he said, ‘We all know you're going to end up on bed rest. So we're trying to get these patients seen before you go.’ And I didn't really feel like there was anything I could do. It was a little bit surreal, I couldn't believe he was saying this to me. And so I went and saw the patients. And by the time I got done at one in the afternoon, because I was running around, I was contracting every four or five minutes and I was just a wreck because I thought I'm going to have a baby at 26 weeks. So I called my doctor and he said, ‘get in here.’ And he took one look at me, because I was sobbing and crying by the time I got there, and he said, ‘you're done.’ He said this didn't work. You're on bed rest. So I spent ten and a half weeks on bed rest and had him just around 37 weeks.”

And though she did return to the practice after having her son, she quickly realized the relationship with that couple wasn’t going to work long-term.

Her next job lasted almost 12 years. She became a partner in another family practice with two male doctors, both older than her. She learned a lot, got on well with her partners, and thoroughly enjoyed her patients. She says the financial arrangement wasn’t ideal, though. She took a big financial hit because she had another child during this time. And at one point her partners made clear to Robin that they thought it was only fair the practice should pay them more, since they had stay at home wives to support, and her husband had a job. She says there were definitely double standards, but this was largely a positive period in her career.

But when she got in touch with me in 2016, she was feeling overwhelmed. She had left that practice and gone into academia, joining the faculty at a big hospital, also in Columbus – she still saw patients, but she taught as well.

AM-T: “When you moved into that job you said, ‘I thought I’d hit the jackpot. A salary that was set across the system and a female boss.’ But it wasn’t quite that simple, right?”

“No. I sat in the first interview, my first interview is with three female faculty and they sold me 30 seconds in, and I wasn't even convinced that I wanted the job. I went into the interview thinking I don't need this, I don't need to be here. And so I wasn't even nervous, but I thought, wow, I want to work with other women who have families and juggle this and do this, because they're going to understand, and I’m not gonna have to live up to…you know in my practice that I was in, both of my partners had children and stay at home wives. And so you know I'm not sure they ever really put any of their expectations on me. But my inner expectation was that I had to work as hard as they did. And if a kid was sick or something happened, my first thought would always be, well what would they do in this situation? And I could do no less than that because I was a physician and I needed…you know that was that is kind of the measure I think that I was holding myself up to. And so I thought it would be a lot different in joining this practice with a lot of women in it.”

AM-T: “And?”

“It wasn't. I worked with a bunch of fantastic human beings and physicians there, some of the most brilliant people I know, and caring and selfless. But the work life balance was insane. For me. It didn't work in my lifestyle. And I think when you work, especially women, I think you look at other women and we judge ourselves based on how they're doing. And so we see this little iceberg of their lives and we say, oh, are we doing as good a job as they are?

And so I really struggled in that job because number one I'm kind of an introvert. Even though I am chatty. Teaching is a lot of you being in front of people all day long and being in groups, and that was not necessarily filling my cup per se. And I was just overworked – and then I felt bad about myself because I thought, all these other women are doing this. They're doing this and they're thriving, and they were here before I was. So why can't I do this?

And it wasn't until, we were at a graduation dinner and I was with some of my colleagues and I was with this woman I really respect, and she's a fantastic physician and she has kids and a husband, and she is very athletic. And I thought, oh, she does this all the way I should be doing it. And we were having this discussion about the food and she mentioned that, ‘oh, we don't cook except on the weekends. We have carry out and frozen food all week long because we can't fit that into our lives.’

And I realized that, hey, not everybody's doing this as well as I think they are.”

But for a long time that feeling – that she just wasn’t doing things as well as she could be – it dominated her thinking.

“I mean I was working on average 60, 70 hours a week. And really putting myself out there. And I think if I had felt that I was doing this fantastic job and I was succeeding, I might have been OK with that. But I got to the point where I felt like I was doing nothing well. I wasn't a good wife. I wasn't a good mom. I wasn’t a good physician. I wasn't a good teacher. And I felt like I had 20 balls in the air and at any moment they were all going to come crashing down.”

Then that started to happen.

A few years ago her husband started bleeding from a place none of us want to see blood – a gastrointestinal bleed, they call it. At first, he was diagnosed with ulcers. But then further tests came back and they showed that he had lymphoma. It was a slow growing form of the cancer, but still…stage 4. He was 48.

“I was completely caught off guard by it. I just, in retrospect the signs were there but I had no idea. And I was, I was probably in the throes of burnout at the time, and really had no reserve. And so it really shook my world I would say.”

So she has two young boys to care for and keep cheerful for. A husband she wants to be an advocate for. And a job that is sapping her. At first she only told her boss what was going on at home…

“And I wasn't real comfortable with anybody else. We were in a huge program with lots of residents and faculty and staff and I wasn't in a place where I could really deal with those questions on a daily basis: How is he? What's going on? So initially I was very, very closed off about it and still very much struggling as far as motivation and work.”

But despite that, asking for time off just didn’t feel right.

“We were all spread very thin and very kind of stressed out. And so I felt like asking for time off when my husband had treatment was a big burden on everybody else and some of that may have been my internal, again, measurement of what I should be living up to. But you know initially my husband had to have weekly chemotherapy treatments, and luckily they were very benign and he didn't have severe adverse reactions from them. But they had to give him some medicine that made him sedated and so he couldn't drive himself. And so initially I said to my work, I'm going to go to the first two or three and see how he does. And so I went back afterwards and I said, he can't even stay awake out of the parking lot. And I really felt like that was my role, that I had to be the one to be there, and it wasn't a responsibility. It was this was what I was called to do. You know I do this every day for people who I don't even know. And I felt like I need to use my skills to help my husband, and to be there for him and to advocate for him. And so I went back and said, I need all this time off. And it was it was not denied. They rearranged my schedule, but I never really had any conversation after that about my needs or you know, ‘how is he?,’ any of that. And you know I think a lot of that is because everybody was struggling or working very hard. And I think it's hard for you to have empathy for somebody else when you are not looking forward to having to cover their shift or take on their responsibilities when you don't have any extra room.”

AM-T: It's so interesting because you know from the outside we see medicine as, well, an empathy job. And it seems like there isn't necessarily always empathy for each other for those who are called to do that job.”

“I think that's often very true, and that's a culture that we as physicians propagate. We are conditioned to put the patient first. If I could give you a penny for every time I heard, ‘the patient comes first’ I would be much richer than I that I am as a physician. And I think that one of the ways that we also cope with some of the really horrible things that we see is to compartmentalize. And so with those two things, that institutional culture of the patient comes first and the high stress that goes along with it…I think that is something that we could do a lot better in medicine.”

AM-T: “What’s happened since then with your husband’s health and everything?”

“So he is doing quite well now. He had a recurrence last year. So he has a form that is incurable, but it is slow growing. So we're hoping that it will be a couple, many years maybe before he has another issue with this. He just had some scans and everything was normal. So that's good. And I think that was really a turning point for me. And it was also about the time when I read the article that Anne-Marie Slaughter wrote about women having it all. And it was very, it was just an aha moment for me. And so I really at that point made a vow to change and to really think about what is important in my life.”

As she said when she wrote to me, and she was still in the middle of all this, “I’ve finally realized this career I have forged for myself means nothing if I can't be there for my family--especially in the area of health and illness.”

 “And you know I go back to that time when I told you that my colleagues were having babies and I couldn't understand why they were doing that at that point in their lives. Because I never realized at that point in my life how important my family would be to me. And so you know I had to really re-evaluate what I wanted out of life and what I wanted out of medicine. And so I'm in a much better place now. I think that medicine as an institution has a lot more work to do because I think we lose out on a lot of very talented people who take really good care of patients but can't do it all.”

She says during her husband’s illness and her worst period of burnout, she realized she was distancing herself too much from patients and their illnesses, compartmentalizing too much… so she could cope with everything.  

She decided it was time to change gears.

“I am still teaching in the residency. And so I see patients with residents but I don't carry my own what we call patient panel. And so that was really hard to give up some of my patients I had been seeing for 17, 18 years, and I had to say goodbye to them and that was really tough. But I didn't feel like I was necessarily the best person to take care of them at that point. And so I am working there, and then also working part time at the same health care system overseeing academic research. And so for me that’s a way for me to affect change at a much higher level, more of a bird’s eye view than a street level view.”

AM-T: “And it's funny because although you said part time, it doesn't seem that part time to me because you're pretty much… you're working except for, was it Friday afternoon and Monday mornings?”

“Yes. And it's Friday afternoon, right? And I've been working. It is much less than it was before and when I choose to work extra it's usually for something I'm very passionate about. And so you know, I normally don't work Friday afternoons but I had a couple conference calls because they were projects I was really passionate about. And so I ask myself every day now, is what you're spending time on moving you towards your goals? And that's really a reminder for me. Is this important? Should you be doing this? And what I did this afternoon certainly was and so that fills my cup and I think that's what keeps you from being burned out is, you have to get that positive energy back in. And I think that's what's hard for a lot of women is we give, give, give, and we judge ourselves, but we don't always fill ourselves back up.”

In a minute…there are some unique stressors in a medical career.

“You have to look at patients and say, ‘are you going to be the next one to sue me?’ Even though that's not a realistic way to look at things. But you feel just so betrayed in a way.” 

That’s coming up next. Don’t go anywhere.

My next guest is also based in the Midwest. Heather Anaya grew up in Indiana, the oldest of five kids. Today she lives and works in Iowa, another rural state. Her ambition started early.

“I wanted to be a doctor when I was four years old on my first day of preschool.”

For years she assumed she’d be a pediatrician – she’d always loved kids. But during her training she found herself drawn to the world of obstetrics and gynecology.

“It's interesting because the body is so different during pregnancy, it has to respond to support this pregnancy and it changes in so many ways that the physiology and all the things you learn about the human body in medical school kind of go out the window in some ways because everything is so new to adapt to pregnancy. And I just found that fascinating, just what the human body can do. And when women are pregnant it's just a great time in their life to really make a difference in their health care.”

Heather ended up specializing in high-risk pregnancies – she’s known as a maternal fetal medicine specialist. So she witnesses a lot of joy, but there’s heartbreak too.

“Right off the bat I just want to say I didn’t go into the specialty thinking it would be all rainbows and puppy dogs. And I knew there would be heavy issues and very sad things. But I was drawn to that because I feel my personality and my training, I’m a great doctor to assume that role. So I went in eyes wide open. But at a certain time it does wear on you; my days generally involve taking care of women who are very sick. So maybe that have issues with high blood pressure or diabetes or heart problems, very severe heart problems, or babies who are very ill, so have trouble growing or have birth defects that’ll be impactful life long…there’s lots of situations that come up on a daily basis and you can only compartmentalize so much until it starts affecting you and wearing on you.”

Recently a mother died after giving birth – she had complications from a liver disease. Heather says she was an older mom; she had several children already. She says it’s horrific when a mother dies. But she sees it as her job to stay strong for the patient’s family and also the team she’s working with, many of whom are younger. When that mother died Heather says it took her a week to really process what had happened; she broke down one day when she was at home with her family.

She says she was raised to be tough.

“I played men's soccer in high school. I mean I was tough. Yeah you do, you go on. Bad things happen but you fix them or you know, you power through. You don't necessarily show that emotion. And so that's how I carried on most of the time. And most of that time that worked, you know 90 percent of the time that worked, and then every so often terrible things happen and you react to it.”

She’s been reacting a bit more lately. She had kids in her late 30s. She and her husband have a girl and a boy, they’re four and two now.

“I'll have to say when I had my children…I become way more emotional about patient situations, about things in general, and I think that's a good thing. I've seen that change in myself. I've had a few patients, one in particular that I still keep in contact with. She's just amazing but she had to make a very difficult decision for her baby. Her baby had a very, very severe heart defect and she decided, her and her family decided that they weren't going to have all these extensive heart surgeries, they were going to have comfort care and be with the baby until she passed away. And this is a little bit on the fringe because most people say, just do all the surgeries and just make that happen. And she honestly made the decision, just such a selfless decision. I just was in awe of her. But anyway I could not see her without crying. I cried with her so much. I still get a Christmas card from her every year and I cry when I see the card.”

She says the female physicians she knows – a lot of them are struggling. Not only do they pour themselves into patient care and identify with their women patients. She says it’s often a woman doctor who’ll get asked to take on that extra patient, and usually she says yes. Or maybe a colleague is having a problem at work and they need to talk – they come to her. Or there’s a committee that needs chairing - yup, again, it’s often a female doctor who’s asked to do it. The difficulty so many of us have setting boundaries, she says it’s huge with women in medicine. And home situations can play in too. She says studies show…

“…women, working women physicians often have working male or working partners or husbands or wives, and men physicians often are the sole breadwinner of the family, which has its own stresses of course. But we have a lot of work and home responsibilities that come into play, and so I think those are the issues that are starting to come up for women physicians in all of this comes together to seeing more patients and the way insurance works now, more production. And yet we still want to relate to these patients and so there's a lot of psychological attachment and empathy and anyway, it drains our resources.”

It can even bring on despair. She says the burnout rate is bad enough. But there’s more disturbing news.

“Unfortunately the suicide rate in physicians is increasing. And for women physicians that proportion is higher which is a very, very sad statistic.”

She says it’s hard for over-burdened doctors to take a career break, to step away from the workforce for whatever reason…

“If you even leave for less than a year, or you leave for a year, it’s actually very difficult to get back both financially and academically because you have to go through these re-training processes…”

It’s quite an impediment. Something else that stops doctors from leaning out – at least American ones – debt.

“I have paid quite an exorbitant amount of money to go for med school tuition and I and for undergrad, for all of my schooling. And so I have a huge student loan debt that I need to repay over many years because it's quite a huge amount of money and that that keeps me, well number one in a in a job where I can have a salary that can repay that. I mean it's more than our mortgage every month to pay back my student loan payment so that…I couldn't just decide you know what, I'm not going to do medicine, I'm going to do something else, because I would really not be able to pay back those loans. Even now it's definitely a stretch to pay those back.”

AM-T: “Do you mind telling people how much it is and what you have to pay back every month?

“No, it's over three hundred thousand dollars. I think $350,000 when I came out of training and then every month that's about 4000 dollars a month to repay the student loan debt.”

She says she has about another ten years of payments before she’s free of that debt.

Another stress factor is litigation. Obviously when something goes wrong in a medical situation it can be devastating to the patient and their family. Heather says her field of obstetrics and fetal medicine…it has the highest rate of litigation of any medical field. She and her colleagues treat high-risk patients and things don’t always turn out well. But getting sued was a shock.

“It was awful. I mean I can't even explain the feeling because you've spent your whole life, I feel like I've spent my whole life preparing for this career and being the best physician that I can be. And yet someone is…you read this, whatever they bring you, the paperwork they bring you when they're serving you with your papers, and about all these awful things in lawyer speak. But it's horrible and it's demoralizing. And you have to go back to work and you have to look at patients and say, ‘are you going to be the next one to sue me?’ Even though that's not a realistic way to look at things. But you feel just so betrayed in a way.”

That said, Heather says she’d tell her kids to be doctors. She says you can do so much good for someone else. But she would like to spend more time with them. A typical week for her could be 65 hours – it involves everything from ultrasounds and C-sections, to teaching, administration, and travel to rural parts of the state where her expertise is needed. She says she tries to maintain some balance by working out – every single morning. She runs or does yoga.

“So regardless of what time I have to be at the hospital I wake up earlier to do that before  my kids wake up, and I really make sure that I spend quality time with my kids and my husband, especially at night. Or today for instance I'm going to be in the hospital for about 30 hours, and so my I went with my nanny to pick up my kid from preschool just to see her for about 30 minutes, and then we picked her up, she dropped me back off at the hospital. And it was just even a few minutes to be with the kids. But that was that was really special. So I really try to maximize that time especially because my husband, his current role he travels a lot during the week so he may be gone in another state Monday through Thursday.”

AM-T: “I mean you mentioned your nanny when we first spoke, and you said you definitely couldn’t do this without her.”

“No. She's amazing. She is practically my other daughter at this point and she is amazing. So I was very fortunate to have her in our lives.” 

AM-T: “What’s her name?”

“Her name is Kayla.”

But Heather’s hours will drop by close to half later this year.  Just like Robin Devine, she has found her way to what looks like a saner existence. Her husband’s job asked him to move to Chicago this summer. They’re doing it. Heather has secured a new position there with better hours, but still good pay.

"Because I still love medicine. Despite all these challenges that keep popping up it's still an amazing specialty, an amazing career. But I'm able to have more time with my family and have...you know, I don't want to look back and realize that my kids grew up at night and I missed a lot of that."

AM-T: “But Heather, is this the only answer for other physicians like you? Is the only answer for people on the cusp of burnout to scale back? Is there no other way to make it an easier life?”

“I think there are other ways. And going part time or going, I'm calling it semi part-time, has been cited as a looming issue for medicine in general and access to care, so it's going to get some recognition at some point if even that's to say, we don't have enough physicians to take care of patients.”

She says talking to other women is at least part of the solution. She’s part of a Facebook group for physician moms, and that may seem small, but it’s been really helpful – conferring with some of those women helped her land her new job, on her terms.

“It’s an outlet for physicians to give ideas and be like, hey, this is what my schedule looks like, even like how to negotiate. So I've had mentors and friends talk about, you know what do we do to negotiate this particular job and hours. And it's not even about the about money so much as it's about time. And that was my sticking point too, is I want the time.”

And speaking of time, while I was putting this show together I heard from a young doctor-in-training in Australia. She also brought up burnout, and she said, ‘I feel medicine lends itself quite well to job sharing but the attitude is, ‘it’s never worked before.’ But she told me, “I feel it hasn’t worked before because it hasn’t been tried before.”

And here’s a final word from Robin Devine. She says stick up for your colleagues, because you never know when you’ll need them to stick up for you…

“You know if somebody says I can't come to that meeting any more, and my kids are sick, we aren't always our best selves in those moments. And so I think really advocating for our colleagues and for change in the system. You know, why is the job that we do still based on a 1950s physician whose wife stays home?”

Thanks to Doctors Robin Devine and Heather Anaya for being my guests on this longer than usual episode.

And if there’s ever something you hear in a show and you want to re-visit it, I post transcripts of every episode on the website. Just find the show you want at TheBroadExperience.com, look in the show notes and click on the link to the transcript.

This show is produced, edited and hosted by me. If you can afford to kick in to support The Broad Experience I would be really grateful and you would essentially be part of the team. And one of the things I love about doing the show is building a community around it. Just click the support tab on the website – a $50 donation will get you the official Broad Experience T-shirt – ladies cut. You can also become a sustaining contributor with a monthly donation of whatever you like.

And go ahead and subscribe so you never miss an episode – you can get the show on iTunes, and if you’re an Android user like me…try the RadioPublic app.

I’m Ashley Milne-Tyte. Thanks for listening. See you next time.