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The Perfect Burnout Storm.

The year 2020 was truly a rollercoaster ride for me, especially at my workplace, courtesy of COVID-19.

So it should come as no surprise that the last few months of 2020 were probably some of the worst I have experienced ever at work.

I can honestly say that I have again felt the flames of burnout encompass me due to a perfect storm that occurred which exacerbated things even more.

Storm Factor 1: The Floodgates re-opened.

For my non-medical readers, in a routine year the end of the year is typically the busiest time for most medical specialties.

As the weather gets colder, flu season and other respiratory ailments become more frequent, keeping walk-in clinics and the medicine and pediatric departments humming.

This of course leads to increased imaging which keeps the radiology department on its toes.

Another phenomenon that is quite predictable occurs.

As patients have typically met their deductibles near year’s end, they now try to cram as many medical procedures and visits as possible before the insurance companies initiate a deductible reset at the beginning of the year.

There is therefore a mad rush to schedule larger procedures that patients have been putting off earlier in the year as the financial hit to their household is now minimal.

As we all have come to realize, 2020 was not a routine year.

COVID-19 had a large impact on the operations of my department, the timing of which magnified the normal end of the year run on imaging.

During the lockdown period in spring, imaging volume was so low that my partner and I employed a self-imposed furlough system to help maximize efficient use of our time.

There was a consequence however to having this extra time off earlier in the year.

The repercussion of this early break was that once the floodgates were open, all the studies that were put off now came pouring in, particular screening mammograms.

It was exactly the opposite of what you wanted to happen.

Rather than work hard early when you are fresh and slow down later to recuperate, the reverse happened with the break happening early and no reprieve once things started going full tilt for the rest of the year.

Storm Factor 2:  The schedule from hell.

As I have mentioned before, mammograms are some of the most visually intensive studies I subject myself to.

Because of this fact, the week I am assigned to read mammograms (as well as ultrasound and xrays) is probably my least favorite just because of the sheer volume of studies coming across the screen.

A routine busy day for me is having to wade through around 50 mammograms before I get to go home.

Because of the post shelter-in-place mammogram rush, and coupled with the typical increase in volume of mammograms in the fall (which coincides with breast cancer awareness month in October), I soon found myself constantly breaking mammogram volume records each day (topping as high as 74 in one day).

By the end of the day it was not uncommon for me to have mild headaches from the eyestrain.

What made matters so much worse was a scheduling quirk that happened.

Normally the painful mammo week assigned alternates with a following week of reading CTs and MRIs.

Reading CTs and MRIs is far more enjoyable and does require the pixel by pixel scrutiny that a mammogram does.

Unfortunately the radiologist who covers for us (and only is scheduled to cover CT/MRI at his request) and then my partner both had personal issues pop up that had them missing a little over a week each.

To make matters worse, the specific timing of these consecutive absences resulted in me having to cover the mammo schedule for 3 weeks straight.

It also took a bit of getting used to going from a 4-day work week to a 5-day work week during this time as we didn’t have the extra body available to provide any relief.

Your mind and body tend to acclimate quickly when going from a harsh environment to a more pleasant one but it takes a lot longer doing it the opposite way.

All these factors certainly fanned the flames of my burnout which at the end of the year became an absolute inferno.

Storm Factor 3: The light at the end of the tunnel became more distant.

Because of the above factors as well as anticipated continued growth of the medical practice, my colleague and I decided that it was time to add a 3rd full time radiologist to the mix.

This decision dovetailed quite nicely with the fact that we were later told by the semi-retired radiologist (who had been providing coverage 2 days a week so each of us could have a day off) that he decided it was time he removed the semi from his designation and become fully retired before May 2021.

It just so happened that a previous radiologist who covered us years ago happened to express some interest in moving back into the area with his wife and considered our practice ideal for him.

It also turned out that his current work situation required him to stay on until the end of April.

It truly seemed like the stars were aligning and this would be a perfect transition for my partner and I.

I was mentally able to push through the painful schedule I endured in mid December because I knew that there was indeed light at the end of the tunnel.

However little did I know that this tunnel would get extended indefinitely and that light soon faded away.

Long story short, our much anticipated 3rd radiology partner, someone my colleague and I both got along great with, decided that he was going to stay with his current work situation and thus declined our offer.

It was quite the letdown and I felt defeated.

Whatever hope I had to fight off burnout faded in one fell swoop.

Of course we have restarted our search for a 3rd partner but it feels like we are already behind the 8 ball.

Graduating residents typically have jobs lined up by this time of year.

There also seems to be a nationwide hunt for radiologists as practices across the country are probably feeling the same situation.

Why has Financial Independence exacerbated the situation?

Go to any blog about Financial Independence and one of the things touted is that achieving FI can actually increase job satisfaction allowing you to work longer.

The main reasoning is that if you are no longer monetarily driven, you can tailor your job to eliminate the things you hate.

For example I know of many OBGyn docs that have removed the Obstetrics component of their practice which then improves the quality of life.

It is a bit more challenging for me as my partner and I do not have someone early in their career chomping at the bits to take on as much as possible to boost their finances.

Being financially independent for me has therefore made me question on more than one occasion why am I subjecting myself to this if there is no end in sight.

I arbitrarily chose age 53 as a potential target date to retire completely but it was not a money based decision (although I knew it would further pad my margin of safety, it was not the primary motive).

For me I knew I would be tied down geographically to this area because of my daughter and her schooling and figured I might as well work while she’s under my roof.

However if things do not calm down I just don’t see myself lasting that long.

An interesting development: When one door is closing another may open.

I have mentioned previously, that I have found my own personal Shangri La with my forever home.

But having a natural waterfall in your backyard does require some sacrifices to be made.

The biggest sacrifice to date was how I was at the mercy of satellite internet to connect me to the world because of my rural location.

Satellite internet is expensive, unreliable (highly weather dependent), and slow.

But obviously it was a sacrifice I was willing to make.

However this sacrifice limited one of the great potential lifestyle options for a radiologist,  teleradiology.

In order to have relatively seamless viewing of radiology images, it has been demonstrated that bandwidth speed has to exceed 20 Mbps.

Not only does my current satellite internet fall woefully short of this number (I am lucky to get 12-15 Mbps on a good day), but I also get throttled down to single digit Mbps speeds once I exceed a whopping (sarcastically speaking) 50 Gb a month.

I could only imagine how painful it would be to read a mammogram (or any other study for that matter) from home with a setup like mine.

A light at the end of a shorter tunnel?

Because I was handcuffed to satellite internet, envisioning slowing down my medical career and transitioning to teleradiology was nothing more than a pipe dream.

So imagine my surprise when at the end of 2020 I was informed that an internet company would be laying down that very pipe which would carry the highly coveted fiber optic cable.

In fact at the time of this writing, the fiber optic cable has just been laid down all the way to the outer wall of my house from the street (which required quite a bit of trench work given the distance).

All that awaits is bringing this cable to the inside of my home (by a separate crew) and turning on the node.

My internet capabilities will jump exponentially, especially since I plan to go with the highest tier plan offered of 1 Gb/second with true unlimited (i.e. not throttled) data.

I will gladly pay the fee to break out of my current satellite internet contract (I signed a 2 year contract last year to get the unlimited data plan I currently “enjoy”).

The termination fee will likely be under $100 based on how many months remaining I have on the contract.

This is something I would gladly pay multiple times over to get out of as my current setup limits my ability to stream movies, play online games, or less importantly, stream educational content for my daughter (I jest).

Granted, even with this fiber optic setup I still won’t come anywhere close to the radiologist who is reported to have the fastest home internet setup in the United States, but I am okay with that.

So what’s next?

To be honest I am not sure.

I do not like the person I have become over the past few months as I have seen some personality changes, reminiscent from my old general surgery residency days, re-emerge (I plan on writing a follow up post detailing some of these changes).

I made the hard decision back then to switch residencies and go into radiology which truly was one of the best decisions I have made.

It would likewise be a hard decision to part ways with a place I have been associated with for almost 15 years.

I have already spoken with the board president about some of the issues I have been facing and how I find this current pace unsustainable.

Ideally a qualified candidate emerges from the darkness (only to re-enter that darkness in the reading room) and helps lessen the load on my colleague and I.

We are entering the time of year where volumes typically decrease as well due to the resetting of deductibles, so that may also help quench the burnout flames.

Just knowing that an alternate option has emerged, namely teleradiology, has also been quite comforting to me.

 

 

Note:

If you are in search of financial help, please consider enlisting the service of any of the sponsors of this blog who I feel are part of the “good guys and gals of finance.”

Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.

 

 

-Xrayvsn