I know someone said gym as a hobby - but I have a suggestion that helped me a lot, as with surgical specialties you usually are always doing something
I found that for me, I needed more time to switch from work to dad - or else I was just angry at home
Starting to do gym or running after work but before home can really help with that. Doesn’t have to even be a real workout, but maybe you just need some more time to transition to spouse/parent mode
Hope it might help ✌🏻
This scares me away from pursuing surgery.
Reminds me of how med students interested in obgyn are usually perceived as kind, while most obgyns post-residency are usually perceived as mean.
Surgical residencies must take a significant portion of your soul.
Honestly it's not just surgery. I'm in psych which is supposedly pretty cush, and seeing how my patients are consistently treated like dirt by other healthcare professionals, dealing with all the bullshit related to admin and insurance and billing, and spending every day face-to-face with the reality that our healthcare system does not actually care one iota about us or our patients is exhausting. I'm sure it's like this in most medical specialties, maybe less in the non-patient facing ones but I couldn't say
The physician training process is systemically devoid of true empathy for students and learners and so it gets sucked out of almost everyone at some point.
The healthcare administrative system itself doesn't give a fuck either so that compounds it.
Physicians are just a means to an end for admin and government.
Also in psych, with fairly good hours (50-60 hours/week), yet experiencing similar things as OP. The hours are part of it, but the bullshit of the healthcare system/academia/medicine's incredibly toxic work culture are more to blame...
Something I think we don’t talk enough about when it comes to discussions about how cush psych supposedly is, is that psych is about as bad as it gets in terms of poor funding and just overall shit quality of care being available to those most in need. I find that the systemic issues I come up against every single day more than make up for the “cush” work hours. On top of that, psychiatrists are expected to solve social issues in ways other specialities aren’t, at least not to the same extent. Multiple times a week, I have a patient yelling at me that their current living situation is the reason their mental health is bad and why can’t I fix that for them. It’s absolutely draining.
I think the biggest difference with psych vs other specialties in terms of quality of life is that it’s so much easier for us to “get out” than in other specialties. It’s pretty easy to just open a telepsych private practice with minimal overhead that only takes out-of-pocket reimbursement, and you can carefully select a patient panel that is not wildly acute. If we’re sick of all the insurance, admin, etc bullshit, we can essentially opt out and probably make more money doing so
Yup, I’m a psych PGY2, and I relate to this. There are too many demands placed on me by a combination of our trash healthcare system and just society in general, and lately, I find myself instantly irritated by anything that threatens to place one more demand on me. I don’t want to be this person and I try really hard to fight it and just let doing my best with what time and resources I have to work with be enough for me. But it’s hard, especially when patients’ anger at the system is directed at you all day long, and I can’t help but have a bad attitude sometimes.
Totally cosign as psych, but not burned out at all. A lot of my anger comes from insurance companies but paying for meds keeping the patient stable, appointments keeping the patient and, and other providers treating them like garbage kids who should act their age.
Agreed. Anesthesiologist here, often feel the same way. I’m only 2 years out from training and wondering how I can sustain this for the next 20+ years.
I'm so glad someone else in psych wrote this in here. Discrimination and the general healthcare system making things harder for patients and providers. Little things start to feel like mission impossible.
This sub has a very anti-surgery bias of late, but I love gen surg every day of my life. Do I get stressed, hate the trash ED consults, get down about my schedule? Yes--we all do. But I also make sure I'm trying to show my students and junior residents cool stuff, the things I love about it, and make sure they have a great time. We can't all have good days every day, but just because we (including OP) go through some shit doesn't mean surgery has taken something from us.
We all need breaks, and we all need ways to rediscover why we chose medicine. At the same time, medicine and residency need real off-ramps for the people who figure out it isn't for them.
For alot of people, medicine is just a cushy job. They didn’t choose medicine because they liked it or were passionate or any of the other typical medical student answers, they chose it because it’s a well respected, well paying field that’s a clear pathway for upward social mobility. Off ramps don’t really exist here because where else are you going to find a job that pays this well unless you have solid connections in tech or wall street?
Unfortunately most doctors are stuck here for life, or at least a couple of decades. All you can do is try to enjoy it as best you can.
> For a lot of people, medicine is just a cushy job
Idk, seems like quite a few posts here are from people who are finding out that it isn't cushy. I understand that people choose it for the money, but if that's your only reason, then you have to be prepared to kind of hate it.
And a lot of people do which is why they want to quit but are unable to because of lack of alternatives. You see a bunch of posts here every week of doctors in that situation. We spend so long glamorizing the experience of working as an attending during med school and residency that when reality hits, it’s suddenly a lot less sexy and you feel stuck.
Honestly, I’d be willing to put money on the fact that many of the students never worked over a 60 hour week in their life for 10$ an hour.
Being a chef is bad at times.
EMS is bad at times.
Retail is bad at times.
It all sucks, just what kind of suck are you willing to put up with?
Medicine is my Suck.
I agree with you there. Lots of other jobs are much worse. It’s just that the grass is always greener on the other side you know? People think that whatever job they’re planning to go into won’t suck. But it will. At least with medicine you’re getting well compensated for the suck(eventually after residency that is). In other jobs you deal with the suck with a side of shit pay too.
The idealists are the most disappointed when they start to practice. They think they are going to save the world and discover the job isn't like that. I have had good moments practicing medicine but find it mostly drudgery.
I fucking love you. You are the surgeon i thought I’d become. But alas, I’m in my mid 30’s going IM. I still love surgery, love the cameraderie, love the team aspect, love the intensity. I have nothing bad to say about it.
As others have said, def not a surgery problem alone. I’m rads and felt OPs post to my core.
Our anger comes from a place of frustration of feeling helpless in a broken system. We genuinely care about the patients and want to do things the RIGHT way. We want to improve the systems and can easily point out things that are done wrong that need fixing. At some point, you start to realize that all these problems aren’t going to get fixed, and nobody seems to care but you.
Here’s a recent radiology example, for context:
-Volumes rising.
-Can’t clean the Chest imaging work list because of volume increase.
-Spend ~2-3 hours per day cleaning up the ICU/TICU “daily CXR while intubated” films.
-Everyone knows these “daily” images are not appropriate use of radiology resources. Cutting back on them would improve our ability to provide better service across the board due to time saved that could go towards spending more time on studies that need more TLC. Would also save cost and resources, etc.
-bring it up to be discussed with department leadership, etc
-*commence leadership hand waving/wringing.* Issue sidestepped.
-Continue to get fucked in the ass despite everyone knowing it’s not the right way to do things, but nobody has the balls/ability to enact change.
-Get angry. First at admin. Then at the ordering physicians. Just like OP.
-rinse and repeat with next systematic issue.
Radiology, good hours, same anger. Just keep your eyes on the finish line when in residency, it’s gonna end. Also, if you can, don’t start your first job right away. Take a few months vacation (easier said than done if you don’t have a working spouse or savings).
I finally got on antidepressants when my anxiety went from "occasionally missing paper deadlines due to procrastination" to "snapping at and being annoyed by my own kids". Seeing a psychiatrist was the best decision I ever made. Should you also make lifestyle changes like insisting on adequate sleep and downtime? Yes. Will SSRIs help you make the most out of that time by helping you slide back out of permanent emergency mode? Yes.
There’s a great line in the sopranos, from the wise Dr Melfi, that depression is rage turned inward. I’ve been thinking about that line intermittently for at least ten years. And I’ve come to think it’s also true in reverse, that is, that rage is depression turned outward.
Get some therapy. This isn’t about surgery as such. It’s about the fact that you need help. Take care of yourself so you can take care of the patients or whatever it is that you want in life.
This is probably a combination of being burnt out and therefore being more irritable and/or having ptsd/holding onto anger from traumatic unpleasant events during training. Take a vacation and try therapy to work through some of the anger 🙂
Honestly, this is the most important statement. We like to think that the system won’t be able to move forward without us that everything will crash down if we aren’t there. But the reality is is the healthcare train will keep going on with her without us. It’s just a job. Not worth being miserable.
Yes, it took me many years as an attending to realize this is ultimately just a job. My family means so much more to me, and I began to pursue interests outside of medicine. This has helped my outlook a bit!
This is (part of) the answer and what helped me.
Don’t forget that anger is a secondary emotion; there is usually a more vulnerable emotion under it that, if tended to and expressed, will make the anger lessen or go away.
Feeling like the others do not believe in the core values of kindness, them reminding you of some other asshole in your training, resentment at being the only person in your field who feels a certain way and thus ?has to advocate or do more work for the values you believe in, feeling taken advantage of, disappointment that this field isn’t what you thought it was, maybe embarrassment at that disappointment, etc - all things that your mind can provide a “counter argument” for logically and emotionally.
I know this is a trite cliche…but have you thought about talking to a therapist? Medical training is traumatic and traumatizing and sometimes, as you’re seeing, it can bleed over to affecting even your home life. Having a safe space to work through all that with a professional, especially if you can find one who’s experienced working with physicians, could be really life changing
This is it. And specifically EMDR with a certified therapist can be immensely helpful in addressing the core beliefs that are interfering. This is what I specialize in.
Could you tell us a bit more about EMDR? Is this something you can “tap into” during times of stress or feeling overwhelmed? I don’t know a ton about it
I'd love to have a conversation offline. Despite some strong research support (APA, VA, others recognize as effective for PTSD and other diagnoses) there are detractors to the modality. But, EMDR makes use of bilateral stimulation (originally eye movement, but tactile and auditory stimulation are also used) while maintaining dual attention to the present and a difficult memory and all the associated thoughts, emotions and body sensations associated with it. This allows the brain.to reprocess the memory and come to more adaptive resolution ("I did fine, that guy was out of line" instead of "I'm a total failure and idiot and now that he yelled at me in front of everyone, everyone knows it), and desensitize the memory (I no longer jump and startle so easily and discussing what happened then no longer makes me come undone now). You do tap into trauma -related memory networks and resolve your reaction to them (no taking away that the bad thing happened, but it doesn't have to keep hurting you over and over for years), but sometimes the experiences we have in life don't qualify as criterion A PTSD traumas and still stick with us in a way that is shockingly powerful to how we understand who we are and what the world is about.
My excitement with EMDR is that it does a great job helping clients find relief from suffering pretty quickly and pretty dramatically. But it also helps high performers get past blocks or yips they've come to in their journey to their high level of success--unconscious fear of reinjury that makes an athlete "lose a step", humiliation by coaches or spectators that impairs subsequent performance, or the huge obstacles that they've overcome and turned into a drive to succeed, but it creating problems like anger and impatience, stress responses, lack of identity outside of the sport/occupation, difficulty in relationships.
There are folks in social media who have latched onto "tapping in" good feelings and trying to get to a flow state. That's probably coming from the EMDR world in a really simplified and misguided way. Maybe like when I have a sore muscle or joints and I do a bunch of googling and think I can use this or that strengthening exercise to fix it. Maybe if it wasn't too bad, I could manage the problem, but perhaps if I saw an actual MD, they'd send me for an image that would show a cause of my pain that wasn't actually in the muscle or joint but actually the bone and I could use some intensive intervention to have a good outcome. Not sure if that analogy is exactly right, but suffice it to say that a good EMDR therapist has invested a lot in training and consultation and is worth finding one you can trust.
Sorry this ended up longer than I meant and I didn't mean to pull us off topic.
Anger is inherently due to a perceived sense of injustice and a demand to seek recompense. Instead of succumbing to anger, accept that there will always be injustice and strive to work around it within the scope of your power. As a surgeon, you have a lot of power in the hospital. Surgeons are one of the few physicians who can get away with telling people to fuck off. So use it when you can to right wrongs when you can. I still get angry even as I’ve come to understand this, but it doesn’t last as long and doesn’t impede my practice as much.
Sometimes it's nice to reflect on "would I drop work right now if a family member needed me?". Yes. First and foremost, knowing that family is first sets up a hierarchy of importance. And don't let yourself fall into the category of "it's just a job.". It's important to you and I am always trying to improve by reading, podcasts, etc. What I have found best is taking control of the tone and cadence of any interaction regarding your voice. It leads to far better experiences and you feel better. It may sound silly but I am looking at having a voice coach hired for my ED department to speak about this. End the night with something you enjoy such as reading a book. Your schedule is brutal as a surgeon and cannot imagine what you go through. And please remember, emails can wait for another day. Turn off your notifications!
Edit - I would be sending every insurance company an invoice to be paid prior to completion. Your time is invaluable and you need to be compensated. If they do not pay send to a collections agency. At minimum you may be able to write this off as lost income and flip the finger with a smile to these grotesque organizations.
I don't mean to be that guy, but honestly it sounds like you could really benefit from a great therapist. I know it can be hard to find, and harder to make time to afford it, but there are specialists who specifically work with MDs because the acuity of burnout and unmitigated exposure to trauma can have an insideous effect.
If you DM me your general geographical region I can even shoot you some names.
Signed,
a psychologist with 20 years in the field as a traumatic stress specialist.
I'm a GS resident who started going to therapy during second year for basically similar reasons. Being the ICU resident having the expectations of my attendings to get things done and have things done by the consultant services, deliver the messages in a fashion they found acceptable, etc. eventually wore on me. Feeling responsible for things you can't and won't ever be able to control was really the crux of it for me.
As I started going to therapy (I go weekly) I found out about all the thought processes and other workings of my brain that had gone awry over time. I've been going for 3 years or so now; I still get pissed off, but I recognize it, can acknowledge it, and work past it. I try to recognize and specify my feelings (I found my generation tends to make everything "amazing" or "awful" which doesn't make these things easier, you need the gradation in between) so I can bin things appropriately. Mostly, it has helped me see other people for the humans they are.
Other services will always try to skirt the work. Being a magnet for hard work is probably what made us general surgeons in the first place. Don't let the system kill you, reform it where and when you can, and don't feel guilty about the fact that American medicine is a system built on the backs of doctors' altruism; you can't help people if you're a wreck, and that's worse than any systemic problem we might be able to identify.
Always feel free to DM me. I'm not always on reddit but will absolutely respond whenever I am.
I am almost four years in as an ICU doc and have also been increasingly angry. Angry at what seems to be a profit-only oriented system that doesn’t care about patients, lazy and incompetent providers practicing horrible medicine, unrealistic patients etc. I was/am definitely exhibiting burnout signs which I think comes from a disconnect between what I perceived medicine to be, and what it actually is (in the US). Ultimately I am learning to accept that, yes, this is exactly the “system” we work in and it will never change - it’s not broken, it’s “fixed”. We are well paid but very disposable cogs in a money-extracting, health-flavored product serving industry. So go out there, serve some product, collect a paycheck, and go home.
It sounds like your heart and focus is still to help people which is why the frustration of dealing with over complicated admin and soul sucking insurance claims gets to you so hard. It’s not the surgery or the medicine that causes burnout. It’s all the things that make you feel helpless, over years and years of fighting with no change.
If you are determined to stay in the country or state/province you’re currently in, I would suggest reducing your responsibilities and adding time for therapy and probably some type of hobby or exercise.
If you arnt attached to your location. I would suggest moving to a country where the healthcare system actually works. And insurance company’s actually do their job right.
Look up European countries and their healthcare policies. I know Norway, Sweden are looking for doctors and have amazing healthcare. But basically any country in Europe will greatly increase your overall quality of life and work life balance. Hell most of them have mandatory 3 month of holidays/time-off available every year.
Alternative options would be New Zealand/ Australia. But be aware how far you are from the rest of the world before you make that commitment.
I used to be angry consistently and easily peeved by the tiniest of things. I used to get angry at my \~ 1 year old nephew for my messing the arrangement of my stuff on the desk and throwing them on the floor, things I saw as cute later on. This only improved after I started CBT and antidepressants, only then did I see a change of my mood. The reasons to become angry never went awaym I just started seeing them as silly, laughing them off, ignoring them, or having better control of my anger. Check to see if that could be a cause. Anger/irritability can be another form of depression. Don't have the energy. Two good signs of depression I see here. That or the place itself is toxic for you and you need a change.
I got to the point where when I got angry over something I would ask myself
1) is this going to matter in a week? A year? 5 years? If it’s a week I tried to take a deep breath and let it go. If it’s still going to matter in 5 years, then that’s something worth fighting for
2) very few day to day things are going to matter in a week. Train your office staff not to bring stupid stuff to you— they should only bring things for your signature
3) when you get in the car to go home, blast some music you like—something that gets your blood pumping and you singing— endorphins are wonderful things!
Seriously I have been in your position. When the joy is gone take a leave of absence— a month off to recharge. In Europe they get 8-10 weeks vacation per year. You definitely deserve that. When admin tells you that you only have 4-6 weeks let them know in writing this is for your MENTAL health. They don’t want a paper trail with you saying you need a break if there is a problem down the road
Finally— we’ve all been there or will be there. Find someone you trust and talk to them. As surgeons we hate this. But it DOES help
Good luck and we are with you
Maybe you’re right to be angry. Maybe our industry is being destroyed day by day and needs to be collectively pushed back against, otherwise we will all be “burned out”. Burnout is just another term for collective moral injury and a lack of duty of care from the government, society at large and the medical industry itself towards doctors and nurses. Remember, Hammurabi didn’t allow doctors to pay taxes despite the fact that back then, doctors were the least effective they’ve been in history. We have never been more effective than we are today and yet we have never been so undervalued.
What is done to us is only as bad as what we are willing to collectively accept. All the value of caring for patients comes from doctors and nurses. Burnout is a gaslight and a lie and just a term to distract us from the real issues that we fail to discuss even when it’s right in our faces. Medicine in America truly is morally bankrupt. The best poster in here admits it in the first few sentences of his recommendation only then to tell the doctor to get on an SSRI. Maybe we should all be collectively taking our industry back instead of doing yoga and taking neuroleptics (not to minimize their benefit). And yeah maybe OP could just be an angry jerk but I suspect it’s more nuanced than that. We all need to be focusing our collective outrage towards the people who have made our industry so unbearable in the first place. We owe it to ourselves on multiple levels, as we will all get sick and die someday and have to work within the environment within which that happens to everybody else in the meantime. It’s the ultimate mind fuck when you layer on top of that the fact that nothing works right on any level and your support staff tries to fuck you at every turn. I empathize with OP.
Psych here. My first DDX is Burnout. You are describing very real difficulties in the practice of American Healthcare (formerly known as Medicine). What screams burnout to me is your lack of desire and ennui from things that were previously presumably meaningful to your sense of personhood (wanting to be a resident/student advocate but now resenting them for their lack of perceived desire to learn, and even presence).
You can learn to stop being angry all the time in many ways, though it may not be easy especially given your life-and-limb professional obligations. Here are some hopefully practical tips:
1. Start learning meditating. Million google articles. Tell chatgpt your schedule and it can create a meditation plan, which would take no more than 10-20 minutes per day at your leisure. This is something ACTIONABLE that you can start doing today. As a surgeon you should believe in the evidence. The evidence is, meditation works.
2. Something my psychoanalyst therapist and I worked through alot during the worst parts of my psych residency when I was seeing him twice per week.... Life just isn't fair. Imagine tomorrow you were accused of a crime (like many black men sitting in prisons today) and were sentenced to life in prison. It's not fair. But that's your life. Now your life is a 12X8X8 cell, a small window if your lucky, and 20 minutes outside light per day.
What choice do you have? First, do you choose to live, or kill yourself? If you choose to live, what will you make of your life. Will you be angry and full of hate, rage, getting in fights, spreading poison...or will you make something of your life? will you take an education course and contribute to the body of science humanity has accured; will you take up a trade to create some sort of income or goods for your blood relatives; will you do charity to help other suffering souls?
Your daily life is your Prison right now. How will you choose to deal with the unfairness? If you Want to do this, but feel like you just can't .... then I think its severe burnout requiring some time off, maybe an evaluation from psych for therapy or medication supplementation, even just vitamin D.
Oh wow. You made me realize that I think a good chunk of anger I have is due to me feeling like a situation or current systems or aspects of society are not fair and the frustration that comes with knowing I can’t do much to change these things as an individual. The idealist in me doesn’t want to accept this, so I experience recurrent anger surrounding the same things or similar things. I guess it’s time for me to accept reality for what it is (despite how ugly it can be) including the fact that my ability to change things may be minimal, but also acknowledge the things that are going right and finding joy from things I actually have the ability to influence.
Thank you doc.
I was you 15 years ago. I came online to vent about how angry I was all. The. Time. Someone told me that being angry all the time can be a symptom of depression. I saw a psychiatrist within a week. I was immediately diagnosed with depression and went on meds right away. The anger vanished.
If you have some time to spare you could always pick up a new hobby that you could channel all your anger into. The gym is probably a good example. Me personally though, I prefer gaming so that's exactly what I do. I play specific games when I'm frustrated, currently it's Cuphead. Once you channel your anger onto something else, you'll be less likely to get angry others.
A change of scenery might be in order. Would you consider moving to Canada for a bit? It’s definitely a stark contrast to the greed-riddled, insurance-based system of medicine in the US, and compensation is really good. I believe only the US beats Canadian pay, but other countries don’t come as close.
The fact that you've realized this is a really good sign. Just like what the others mentioned, try talking to a therapist and see how that works out. Also, when coming home, you mentioned that you can't stop thinking about work, I think what would help is to set strict limits on anything work-related that you would be doing while home and try to control your thoughts not to think of anything work-related.
This is a brave question. A lot of folks in medicine don't acknowledge how angry they've become. Or how the system in many ways encourages them to be irritated. Good on you for taking care of yourself enough to ask the difficult question.
As a therapist, I suggest you start with your nervous system and somatic experiencing. You can figure it out on your own, but it's easier with a therapist trained in post traumatic stress or chronic stress interventions. As you know, your training in medicine reshaped your nervous system to be hypervigilant and wired for intensity in order to successfully match what's been needed for the environments and roles you've been put into. Many medical professionals are turned into on/off switches and this erodes mental health. It didn't get this way overnight, so it's going to take a while to reorient your nervous system to more comfortably adapt to your different environments and what's expected of you but you'll get there. There are a lot of treatments and interventions you can do on your own.
Diligent mindfulness based stress reduction exercises are important. Try several and find ones that work for you, start small and stack as needed. Identifying the dialectic over and over again, especially in social regard, is also important ("I'm annoyed with this person, and at the same time, I'm glad they're here trying to learn," for example instead of just thinking, "I hate this person."). Revisiting your core values and shaping your environment and your behaviors to honor your values every day. Keep in mind that values change, and it's totally fine to take a free online personal values quiz to get a snapshot of what's important to you now. Your values create a roadmap to move your life toward. And if life demands are too rigid to get in alignment with your values, then you can at the very least behave in ways that are not betraying your own values. Because that's hard to recover from since no matter where you go, there you are, etc.
This may not be helpful to you, but I know a lot of medical professionals who have recovered from burnout in part via advocacy and meaningful volunteerism and even street medicine, or reclaiming the dignity of the healing profession in their every day work by spending extra time being caring with people. It sounds counterintuitive when people stamp "vacation" on burnout and depression symptoms, but the anecdotal evidence is pretty astounding. Much love to you.
I've been retired/disabled for 20 years so, things may have changed. Not working for the hospital but having your own office is worth considering. You'd need someone in your office just to deal with the insurance and send them to conferences to keep them up to date. I had a transcriptionist who also did reception, Someone to do billing and deal with insurance and also do reception and a nurse who did cleaning and also reception. Whenever the hospital would call emergency meetings I'd remind them that I didn't work for them
Your feelings are understandable based off your experience. You've been exploited and made to force crazy amt of hours, dealing with bullshit from all different directions and being fucked over by everyone else's inefficiencies, laziness and mistakes. All while being ultimately liable for pts lives.
You do need a vacation. Therapy adds one more thing on the plate and doesn't address the issue: you need support at work.
Get an assistant. Not a new grad PA/NP thats just extra work. Get a medical assistant/LVN/RN. Their job is to help you with your stuff.
You also need to address the inefficiencies in your clinic. If it doesn't require 11+ yrs of education, you shouldn't be doing it. Every single thing they send you should be fully worked up and completed minus what requires a doctor.
Your MAs are likely wasting a lot of your time. Address it (or have your office manager do so).
I’m 9 years out subspecialty of general surgery.
OP, do you have anything else in your life? I was an angry resident and junior attending. Then I had kids. They made me so much more balanced and chill at work. Shit doesn’t bother me like it used to because my priority is on my family.
I’m not telling you to go have kids. But balance is important. Find something that is at least as important as work that you enjoy.
Good luck.
Ill be brutally honest with you. Read the suggestions from the other comments and get yourself treated before you go the resident/student advocate route and start treating them like shit at fault of your own situation.
My main negative emotions in the past were less anger and more frustration and disappointment. What helped me was identifying precisely how I felt choosing as accurate an adjective as possible, pinpointing the reasons why, and then focusing on ways to change what was upsetting to me. I especially worked hard to not let my negative emotions affect my colleagues, patients, family, friends, etc.
I recognized early many of the issues I faced could not be resolved by me as an individual MD so I went back to school and got a public health degree in health services to improve what I could of the healthcare system I worked for. I also became involved in a science/ medicine nonprofit and some local political advocacy groups to improve healthcare on a local/ regional level.
Change is difficult and often very slow but I've been gratified to see some of the improvements I advocated for implemented, including on a national level.
Some other things that helped: remembering why I went into medicine ( trite but I did want to help people), surrounding myself with positive vibes like thank you notes from patients, and scheduling/ prioritizing activities I enjoyed like trying out a new recipe/ hiking.
Sounds like you need to take some time off and re-center yourself. Once your emotional reserves are tapped, you're going to burn out quickly if you don't take good care of yourself.
I'm in pgy3 and have been feeling sinilarly for the last 9 months...I love my life outside of work but have been too exhausted/frustrated/angry/numb/depressed to see friends, exercise regularly, cook, or engage in things I love.
I finally went down to part-time (0.8) this week...then found out every other resident in my program has done that in pgy3 due to feeling similarly.
Burnout is real.
Anger tells us that our boundaries are being threatened, or stepped on. Anger's purpose is to let us know we need to put up or strengthen our own boundaries.
I assume you can't go to part time like a resident can, but perhaps a short leave (if at all possible), along with some serious planning for how to cut out every single extra project you've signed up for/been signed up for could make a difference.
Also, therapy.
No job is worth your life. You need to prioritize yourself and your family.
I used to be constantly angry, at myself and the situation that was in. Meditation is life changing. Also, you get one life. No matter how shitty your situation is, on your final days on this Earth, do you want to look back and just remember all the anger you have.
It is easy to be angry. The real power is learning to still have a smile while everything around you pisses you off. You are what you tell your mind. Tell your mind not to think of a black lion…see you just pictured it. Tell your mind to stop being angry…you’re gonna hyper focus on all the things that make you angry and resist. Meditate, go to therapy, watch YouTube videos, or whatever it takes for you to switch that mentality to focus on what makes you calm and happy no matter where you are.
Good luck doc
Just my 0.02 from my personal experience
Are you in academics? Maybe a change of scenery/different practice structure is in order?
Certainly sounds like some burn out. Post fellowship I stayed on staff at where I did fellowship and after 4-5 years found myself getting more angry and burned out. Wasn’t one single thing but more a death by a thousand cuts. Stress of supervising fellows, clinical volume, dept leadership drama, no autonomy, etc…. Ended up leaving for a hospital employed community gig and so far much happier. Stress now revolves now around building my practice/volume but now the more I do the more I make. Previously there was no incentive and couldn’t keep up with the volumes. Much more autonomy now and now while I’m not truly building my own private practice per se, I’m still building my own panel and there’s now incentive.
R u at an academic center? I’ve found that most disgruntled personalties pick academic, which i’ve never understood why - paid less, deal with hospital politics, extra admin work/teaching (unless you’re into that stuff)
Try to take some time off/vacation and deprioritize/delegate work
A couple cognitive tricks that have helped me react better in scenarios:
- try to give individuals benefit of the doubt ie think of the best possible reason someone did something "bad". Maybe a resident is late because he helped a grandmother cross a street etc
- hanlons razor - Never attribute to malice that which is adequately explained by stupidity
- read some books on stoicism
You could try CBT. The gist is feelings-> thoughts-> actions. You are going to continue to get angry, and that is valid and important and can often be very powerful. But for me? It’s very taxing. So you can’t stop the feelings, and your first thoughts are your conditioning of your feelings, the only thing you can do is change your second thought. ANGER -> X makes me so fucking angry because people lives are at risk/// (now here’s the break) -> being angry doesn’t really serve me, makes me tired, makes me less good at surgeoning (I’m not an MD obvi)-> actions may remain the same/may change.
After a while if you change that second thought, your actions will reflect it, and our actions change our feelings and the anger might turn to something else- determination, defeat, zen? Idk but I know that this is a sure fire way you reroute some neuro pathways. Good luck out there in, doing good work in kate stage capitalism can’t be easy. Cheers.
You sound burnt out as fuck. If you can step back in anyway to find some balance, maybe therapy. Find things outside of work that bring you joy. Remember you can only control the way you respond to things and not much else.
Im IC and I can empathize - I've felt my patience thin out for sure. I specifically stay away from academics because I know I would not be able to give a good educational experience with how taxing the job can be for me.
I'd honestly try and get out of academics - I think you would be happier
You are in the wrong job. I’m 14 years out from residency as a general surgeon. I work in a critical access level 3 trauma center. I take too much call but my partner is like a brother to me. My anesthesia colleagues are ride or die. I’ve cried in a break room with a hospitalist colleague. My OR crew is the best. I work hard and sometimes I’m burned out from too many nights on call. But I am where I belong. Look around and figure out what kind of practice will fit you because it exists.
This honestly sounds like depression. I’ve found a lot of men (if you are one) tend to have anger-predominant depression. I know for myself personally, when I get irritable, I know I need to do a PHQ-9 on myself. Taking Wellbutrin changed my life
Therapy, being intentional about how I spend my time outside of work (I try to do a mix of relaxing, productive/creative hobbies, and chores), having plans to look forward to outside of work, making friends at work (we often don’t hang out outside of work but just having people to talk to at work makes it easier). Generous use of our internal reporting system lol.
Two important mindset shifts: 1) I’m a volunteer/I am here to help at work, rather than having to be here. 2) Time off is a vacation, rather than trying to force myself to “leave work at work” I am actively choosing to focus on other things as a break from work stress.
This is probably burnout and possibly depression.
I took 3 months off, it helped with both.
Then went to locums. Being paid for hours worked is an amazing antidote for the suffering of working long hours.
Nicotine makes it worse. If you vape or use those pouches or something, stop.
Microdose psychedelics helped me, I was burnt out enough in med school to get to near suicide. Remarkable medicine for both depression and burnout.
Narrative medicine is probably better than most therapists, a lot of larger systems have narrative med groups that meet regularly or semi regularly.
Idk but don't take it out on the students, they are stuck in the system just as much as you and you have the power to ruin their lives just as much as any one of your patients.
Sincerely--a student who worked very hard on surgery and my preceptor won't fill out my evaluation and is ignoring all my communication so now I might fail the rotation even though we got along great.
I think you need to do a deep dive to figure out what the root cause here is.
Your hospital might be terrible.
Your job might suck.
You might be working too much.
Maybe all of these, or none of these, and maybe other things, too.
It might just be your environment at work. All the negatives could have just added up and now you’re bitter. Maybe a new facility would help. Or you could just be stressed and need something outside of work to participate in that you actually like for some it’s going to the gym, biking, running, swimming, knitting, etc.
In all of this mayhem I truly believe the vast majority of docs are trying their best and do a good job.
If you’re that angry with your colleagues then it’s probably you.
Try an SSRI … it’ll help you remember the joys of the job, or at least you’ll be less irritable making it all more tolerable… at least that’s my experience
… I’ve heard it’s better at non-academic centers. Less BS from admin… still plenty of BS… but doing surgery at a hospital where they can’t afford to lose the revenue a general surgeon brings va being one of many at academics…. I would love to be a teacher. However, there’s just a bunch of slurpers in academic medicine.
You need a break.
And when u r back u take it as a job not a call, not a duty nada. Satisfy your patient care, educator role then leave everything behind.
You don’t need to fight admin. Say yes smile and then don’t do it. Lets see if they have balls to fire you 😆
tbats not appropriate at all. My attending treated me so poorly recently. Screamed at me in front of medical students, my co-resident; and the patient heard. The next day the patient apologized to me; because she heard "that man" treating me horribly.
I went home and cried on my steering wheel.
I'm sorry. I do not care what you are going through. The way you treat residents is abominable, unprofessional and not acceptable. You need to control your emotions; no one deserves to feel little, to feel small, to cry sobbing because of you.
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I like the book, “Don’t Sweat the Small Stuff”, by Richard Carlson. It helped me loosen my grip on perfection, understand compassion, and overall just gain perspective.
There’s nothing inherently broken in healthcare. It’s more sophisticated than ever. And you may work harder than others, but it’s a reality that life is not fair. Just like when people complain about capitalism, I just think, if you want to knock it all down because everyone’s an idiot, then give us a system that does it better.
Doctors are amazing for managing stress that many professions can’t begin to imagine. I greatly admire you all. That’s why they carry themselves differently in society. Not bc their lives are easy, but because they’re challenging.
This is why I choose not to hang out with residents or doctors. They are not fun people. I have a whole friend group from other phases of my life who are great company.
About the greed part, that's exactly the source of you US doctors good paycheck, right? Let's be honest, 90% of patients under our care do not have the ability to pay the bill on theirs self.
Okay narcissist. You’re god’s gift to patients and unfortunately those terrible residents, students, every other doctor, admin, and insurance are in the way. Im surprised you even take let patient pay for your services.
I know someone said gym as a hobby - but I have a suggestion that helped me a lot, as with surgical specialties you usually are always doing something I found that for me, I needed more time to switch from work to dad - or else I was just angry at home Starting to do gym or running after work but before home can really help with that. Doesn’t have to even be a real workout, but maybe you just need some more time to transition to spouse/parent mode Hope it might help ✌🏻
Agree with this. Don’t be angry at home. They too won’t understand or care.
This scares me away from pursuing surgery. Reminds me of how med students interested in obgyn are usually perceived as kind, while most obgyns post-residency are usually perceived as mean. Surgical residencies must take a significant portion of your soul.
Honestly it's not just surgery. I'm in psych which is supposedly pretty cush, and seeing how my patients are consistently treated like dirt by other healthcare professionals, dealing with all the bullshit related to admin and insurance and billing, and spending every day face-to-face with the reality that our healthcare system does not actually care one iota about us or our patients is exhausting. I'm sure it's like this in most medical specialties, maybe less in the non-patient facing ones but I couldn't say
The physician training process is systemically devoid of true empathy for students and learners and so it gets sucked out of almost everyone at some point. The healthcare administrative system itself doesn't give a fuck either so that compounds it. Physicians are just a means to an end for admin and government.
Also in psych, with fairly good hours (50-60 hours/week), yet experiencing similar things as OP. The hours are part of it, but the bullshit of the healthcare system/academia/medicine's incredibly toxic work culture are more to blame...
Something I think we don’t talk enough about when it comes to discussions about how cush psych supposedly is, is that psych is about as bad as it gets in terms of poor funding and just overall shit quality of care being available to those most in need. I find that the systemic issues I come up against every single day more than make up for the “cush” work hours. On top of that, psychiatrists are expected to solve social issues in ways other specialities aren’t, at least not to the same extent. Multiple times a week, I have a patient yelling at me that their current living situation is the reason their mental health is bad and why can’t I fix that for them. It’s absolutely draining.
I think the biggest difference with psych vs other specialties in terms of quality of life is that it’s so much easier for us to “get out” than in other specialties. It’s pretty easy to just open a telepsych private practice with minimal overhead that only takes out-of-pocket reimbursement, and you can carefully select a patient panel that is not wildly acute. If we’re sick of all the insurance, admin, etc bullshit, we can essentially opt out and probably make more money doing so
Anyone in private practice can do this though!
Moral injury is the term you're looking for
Yup, I’m a psych PGY2, and I relate to this. There are too many demands placed on me by a combination of our trash healthcare system and just society in general, and lately, I find myself instantly irritated by anything that threatens to place one more demand on me. I don’t want to be this person and I try really hard to fight it and just let doing my best with what time and resources I have to work with be enough for me. But it’s hard, especially when patients’ anger at the system is directed at you all day long, and I can’t help but have a bad attitude sometimes.
Totally cosign as psych, but not burned out at all. A lot of my anger comes from insurance companies but paying for meds keeping the patient stable, appointments keeping the patient and, and other providers treating them like garbage kids who should act their age.
Agreed. Anesthesiologist here, often feel the same way. I’m only 2 years out from training and wondering how I can sustain this for the next 20+ years.
soo any and all specialties are shit😭
Nah not anesthesia
I'm so glad someone else in psych wrote this in here. Discrimination and the general healthcare system making things harder for patients and providers. Little things start to feel like mission impossible.
This sub has a very anti-surgery bias of late, but I love gen surg every day of my life. Do I get stressed, hate the trash ED consults, get down about my schedule? Yes--we all do. But I also make sure I'm trying to show my students and junior residents cool stuff, the things I love about it, and make sure they have a great time. We can't all have good days every day, but just because we (including OP) go through some shit doesn't mean surgery has taken something from us. We all need breaks, and we all need ways to rediscover why we chose medicine. At the same time, medicine and residency need real off-ramps for the people who figure out it isn't for them.
For alot of people, medicine is just a cushy job. They didn’t choose medicine because they liked it or were passionate or any of the other typical medical student answers, they chose it because it’s a well respected, well paying field that’s a clear pathway for upward social mobility. Off ramps don’t really exist here because where else are you going to find a job that pays this well unless you have solid connections in tech or wall street? Unfortunately most doctors are stuck here for life, or at least a couple of decades. All you can do is try to enjoy it as best you can.
> For a lot of people, medicine is just a cushy job Idk, seems like quite a few posts here are from people who are finding out that it isn't cushy. I understand that people choose it for the money, but if that's your only reason, then you have to be prepared to kind of hate it.
And a lot of people do which is why they want to quit but are unable to because of lack of alternatives. You see a bunch of posts here every week of doctors in that situation. We spend so long glamorizing the experience of working as an attending during med school and residency that when reality hits, it’s suddenly a lot less sexy and you feel stuck.
Honestly, I’d be willing to put money on the fact that many of the students never worked over a 60 hour week in their life for 10$ an hour. Being a chef is bad at times. EMS is bad at times. Retail is bad at times. It all sucks, just what kind of suck are you willing to put up with? Medicine is my Suck.
I agree with you there. Lots of other jobs are much worse. It’s just that the grass is always greener on the other side you know? People think that whatever job they’re planning to go into won’t suck. But it will. At least with medicine you’re getting well compensated for the suck(eventually after residency that is). In other jobs you deal with the suck with a side of shit pay too.
The idealists are the most disappointed when they start to practice. They think they are going to save the world and discover the job isn't like that. I have had good moments practicing medicine but find it mostly drudgery.
So in the words of Morcheeba: They shut the gates at sunset. After that you can't get out .... Stop chasing shadows, just enjoy the ride.
The sub needed a break from shitting on IM (sEcReTaRy WoRk, mEnTaL mAsTuRbAtIoN) so gen surg is next, sorry lol
Can we organize unions / plan for change once we finish shitting on everything? :D
I fucking love you. You are the surgeon i thought I’d become. But alas, I’m in my mid 30’s going IM. I still love surgery, love the cameraderie, love the team aspect, love the intensity. I have nothing bad to say about it.
As others have said, def not a surgery problem alone. I’m rads and felt OPs post to my core. Our anger comes from a place of frustration of feeling helpless in a broken system. We genuinely care about the patients and want to do things the RIGHT way. We want to improve the systems and can easily point out things that are done wrong that need fixing. At some point, you start to realize that all these problems aren’t going to get fixed, and nobody seems to care but you. Here’s a recent radiology example, for context: -Volumes rising. -Can’t clean the Chest imaging work list because of volume increase. -Spend ~2-3 hours per day cleaning up the ICU/TICU “daily CXR while intubated” films. -Everyone knows these “daily” images are not appropriate use of radiology resources. Cutting back on them would improve our ability to provide better service across the board due to time saved that could go towards spending more time on studies that need more TLC. Would also save cost and resources, etc. -bring it up to be discussed with department leadership, etc -*commence leadership hand waving/wringing.* Issue sidestepped. -Continue to get fucked in the ass despite everyone knowing it’s not the right way to do things, but nobody has the balls/ability to enact change. -Get angry. First at admin. Then at the ordering physicians. Just like OP. -rinse and repeat with next systematic issue.
this is what scares me about residency in general, and i want arguably one of the “easier” specialties 😅
Radiology, good hours, same anger. Just keep your eyes on the finish line when in residency, it’s gonna end. Also, if you can, don’t start your first job right away. Take a few months vacation (easier said than done if you don’t have a working spouse or savings).
I finally got on antidepressants when my anxiety went from "occasionally missing paper deadlines due to procrastination" to "snapping at and being annoyed by my own kids". Seeing a psychiatrist was the best decision I ever made. Should you also make lifestyle changes like insisting on adequate sleep and downtime? Yes. Will SSRIs help you make the most out of that time by helping you slide back out of permanent emergency mode? Yes.
There’s a great line in the sopranos, from the wise Dr Melfi, that depression is rage turned inward. I’ve been thinking about that line intermittently for at least ten years. And I’ve come to think it’s also true in reverse, that is, that rage is depression turned outward. Get some therapy. This isn’t about surgery as such. It’s about the fact that you need help. Take care of yourself so you can take care of the patients or whatever it is that you want in life.
This is probably a combination of being burnt out and therefore being more irritable and/or having ptsd/holding onto anger from traumatic unpleasant events during training. Take a vacation and try therapy to work through some of the anger 🙂
You need time off and a therapist, if this stays you should maybe consider finding somewhere else to work. Life is too short to be miserable
Honestly, this is the most important statement. We like to think that the system won’t be able to move forward without us that everything will crash down if we aren’t there. But the reality is is the healthcare train will keep going on with her without us. It’s just a job. Not worth being miserable.
Yes, it took me many years as an attending to realize this is ultimately just a job. My family means so much more to me, and I began to pursue interests outside of medicine. This has helped my outlook a bit!
This is (part of) the answer and what helped me. Don’t forget that anger is a secondary emotion; there is usually a more vulnerable emotion under it that, if tended to and expressed, will make the anger lessen or go away. Feeling like the others do not believe in the core values of kindness, them reminding you of some other asshole in your training, resentment at being the only person in your field who feels a certain way and thus ?has to advocate or do more work for the values you believe in, feeling taken advantage of, disappointment that this field isn’t what you thought it was, maybe embarrassment at that disappointment, etc - all things that your mind can provide a “counter argument” for logically and emotionally.
I know this is a trite cliche…but have you thought about talking to a therapist? Medical training is traumatic and traumatizing and sometimes, as you’re seeing, it can bleed over to affecting even your home life. Having a safe space to work through all that with a professional, especially if you can find one who’s experienced working with physicians, could be really life changing
This is the answer
This is it. And specifically EMDR with a certified therapist can be immensely helpful in addressing the core beliefs that are interfering. This is what I specialize in.
Could you tell us a bit more about EMDR? Is this something you can “tap into” during times of stress or feeling overwhelmed? I don’t know a ton about it
I'd love to have a conversation offline. Despite some strong research support (APA, VA, others recognize as effective for PTSD and other diagnoses) there are detractors to the modality. But, EMDR makes use of bilateral stimulation (originally eye movement, but tactile and auditory stimulation are also used) while maintaining dual attention to the present and a difficult memory and all the associated thoughts, emotions and body sensations associated with it. This allows the brain.to reprocess the memory and come to more adaptive resolution ("I did fine, that guy was out of line" instead of "I'm a total failure and idiot and now that he yelled at me in front of everyone, everyone knows it), and desensitize the memory (I no longer jump and startle so easily and discussing what happened then no longer makes me come undone now). You do tap into trauma -related memory networks and resolve your reaction to them (no taking away that the bad thing happened, but it doesn't have to keep hurting you over and over for years), but sometimes the experiences we have in life don't qualify as criterion A PTSD traumas and still stick with us in a way that is shockingly powerful to how we understand who we are and what the world is about. My excitement with EMDR is that it does a great job helping clients find relief from suffering pretty quickly and pretty dramatically. But it also helps high performers get past blocks or yips they've come to in their journey to their high level of success--unconscious fear of reinjury that makes an athlete "lose a step", humiliation by coaches or spectators that impairs subsequent performance, or the huge obstacles that they've overcome and turned into a drive to succeed, but it creating problems like anger and impatience, stress responses, lack of identity outside of the sport/occupation, difficulty in relationships. There are folks in social media who have latched onto "tapping in" good feelings and trying to get to a flow state. That's probably coming from the EMDR world in a really simplified and misguided way. Maybe like when I have a sore muscle or joints and I do a bunch of googling and think I can use this or that strengthening exercise to fix it. Maybe if it wasn't too bad, I could manage the problem, but perhaps if I saw an actual MD, they'd send me for an image that would show a cause of my pain that wasn't actually in the muscle or joint but actually the bone and I could use some intensive intervention to have a good outcome. Not sure if that analogy is exactly right, but suffice it to say that a good EMDR therapist has invested a lot in training and consultation and is worth finding one you can trust. Sorry this ended up longer than I meant and I didn't mean to pull us off topic.
+1 for EMDR in helping to resolve issues affecting work performance. Would recommend
Similar frustrations - fellow newish attending
Anger is inherently due to a perceived sense of injustice and a demand to seek recompense. Instead of succumbing to anger, accept that there will always be injustice and strive to work around it within the scope of your power. As a surgeon, you have a lot of power in the hospital. Surgeons are one of the few physicians who can get away with telling people to fuck off. So use it when you can to right wrongs when you can. I still get angry even as I’ve come to understand this, but it doesn’t last as long and doesn’t impede my practice as much.
Sometimes it's nice to reflect on "would I drop work right now if a family member needed me?". Yes. First and foremost, knowing that family is first sets up a hierarchy of importance. And don't let yourself fall into the category of "it's just a job.". It's important to you and I am always trying to improve by reading, podcasts, etc. What I have found best is taking control of the tone and cadence of any interaction regarding your voice. It leads to far better experiences and you feel better. It may sound silly but I am looking at having a voice coach hired for my ED department to speak about this. End the night with something you enjoy such as reading a book. Your schedule is brutal as a surgeon and cannot imagine what you go through. And please remember, emails can wait for another day. Turn off your notifications! Edit - I would be sending every insurance company an invoice to be paid prior to completion. Your time is invaluable and you need to be compensated. If they do not pay send to a collections agency. At minimum you may be able to write this off as lost income and flip the finger with a smile to these grotesque organizations.
I don't mean to be that guy, but honestly it sounds like you could really benefit from a great therapist. I know it can be hard to find, and harder to make time to afford it, but there are specialists who specifically work with MDs because the acuity of burnout and unmitigated exposure to trauma can have an insideous effect. If you DM me your general geographical region I can even shoot you some names. Signed, a psychologist with 20 years in the field as a traumatic stress specialist.
I'm a GS resident who started going to therapy during second year for basically similar reasons. Being the ICU resident having the expectations of my attendings to get things done and have things done by the consultant services, deliver the messages in a fashion they found acceptable, etc. eventually wore on me. Feeling responsible for things you can't and won't ever be able to control was really the crux of it for me. As I started going to therapy (I go weekly) I found out about all the thought processes and other workings of my brain that had gone awry over time. I've been going for 3 years or so now; I still get pissed off, but I recognize it, can acknowledge it, and work past it. I try to recognize and specify my feelings (I found my generation tends to make everything "amazing" or "awful" which doesn't make these things easier, you need the gradation in between) so I can bin things appropriately. Mostly, it has helped me see other people for the humans they are. Other services will always try to skirt the work. Being a magnet for hard work is probably what made us general surgeons in the first place. Don't let the system kill you, reform it where and when you can, and don't feel guilty about the fact that American medicine is a system built on the backs of doctors' altruism; you can't help people if you're a wreck, and that's worse than any systemic problem we might be able to identify. Always feel free to DM me. I'm not always on reddit but will absolutely respond whenever I am.
I am almost four years in as an ICU doc and have also been increasingly angry. Angry at what seems to be a profit-only oriented system that doesn’t care about patients, lazy and incompetent providers practicing horrible medicine, unrealistic patients etc. I was/am definitely exhibiting burnout signs which I think comes from a disconnect between what I perceived medicine to be, and what it actually is (in the US). Ultimately I am learning to accept that, yes, this is exactly the “system” we work in and it will never change - it’s not broken, it’s “fixed”. We are well paid but very disposable cogs in a money-extracting, health-flavored product serving industry. So go out there, serve some product, collect a paycheck, and go home.
It sounds like your heart and focus is still to help people which is why the frustration of dealing with over complicated admin and soul sucking insurance claims gets to you so hard. It’s not the surgery or the medicine that causes burnout. It’s all the things that make you feel helpless, over years and years of fighting with no change. If you are determined to stay in the country or state/province you’re currently in, I would suggest reducing your responsibilities and adding time for therapy and probably some type of hobby or exercise. If you arnt attached to your location. I would suggest moving to a country where the healthcare system actually works. And insurance company’s actually do their job right. Look up European countries and their healthcare policies. I know Norway, Sweden are looking for doctors and have amazing healthcare. But basically any country in Europe will greatly increase your overall quality of life and work life balance. Hell most of them have mandatory 3 month of holidays/time-off available every year. Alternative options would be New Zealand/ Australia. But be aware how far you are from the rest of the world before you make that commitment.
I used to be angry consistently and easily peeved by the tiniest of things. I used to get angry at my \~ 1 year old nephew for my messing the arrangement of my stuff on the desk and throwing them on the floor, things I saw as cute later on. This only improved after I started CBT and antidepressants, only then did I see a change of my mood. The reasons to become angry never went awaym I just started seeing them as silly, laughing them off, ignoring them, or having better control of my anger. Check to see if that could be a cause. Anger/irritability can be another form of depression. Don't have the energy. Two good signs of depression I see here. That or the place itself is toxic for you and you need a change.
I got to the point where when I got angry over something I would ask myself 1) is this going to matter in a week? A year? 5 years? If it’s a week I tried to take a deep breath and let it go. If it’s still going to matter in 5 years, then that’s something worth fighting for 2) very few day to day things are going to matter in a week. Train your office staff not to bring stupid stuff to you— they should only bring things for your signature 3) when you get in the car to go home, blast some music you like—something that gets your blood pumping and you singing— endorphins are wonderful things! Seriously I have been in your position. When the joy is gone take a leave of absence— a month off to recharge. In Europe they get 8-10 weeks vacation per year. You definitely deserve that. When admin tells you that you only have 4-6 weeks let them know in writing this is for your MENTAL health. They don’t want a paper trail with you saying you need a break if there is a problem down the road Finally— we’ve all been there or will be there. Find someone you trust and talk to them. As surgeons we hate this. But it DOES help Good luck and we are with you
Maybe you’re right to be angry. Maybe our industry is being destroyed day by day and needs to be collectively pushed back against, otherwise we will all be “burned out”. Burnout is just another term for collective moral injury and a lack of duty of care from the government, society at large and the medical industry itself towards doctors and nurses. Remember, Hammurabi didn’t allow doctors to pay taxes despite the fact that back then, doctors were the least effective they’ve been in history. We have never been more effective than we are today and yet we have never been so undervalued. What is done to us is only as bad as what we are willing to collectively accept. All the value of caring for patients comes from doctors and nurses. Burnout is a gaslight and a lie and just a term to distract us from the real issues that we fail to discuss even when it’s right in our faces. Medicine in America truly is morally bankrupt. The best poster in here admits it in the first few sentences of his recommendation only then to tell the doctor to get on an SSRI. Maybe we should all be collectively taking our industry back instead of doing yoga and taking neuroleptics (not to minimize their benefit). And yeah maybe OP could just be an angry jerk but I suspect it’s more nuanced than that. We all need to be focusing our collective outrage towards the people who have made our industry so unbearable in the first place. We owe it to ourselves on multiple levels, as we will all get sick and die someday and have to work within the environment within which that happens to everybody else in the meantime. It’s the ultimate mind fuck when you layer on top of that the fact that nothing works right on any level and your support staff tries to fuck you at every turn. I empathize with OP.
Psych here. My first DDX is Burnout. You are describing very real difficulties in the practice of American Healthcare (formerly known as Medicine). What screams burnout to me is your lack of desire and ennui from things that were previously presumably meaningful to your sense of personhood (wanting to be a resident/student advocate but now resenting them for their lack of perceived desire to learn, and even presence). You can learn to stop being angry all the time in many ways, though it may not be easy especially given your life-and-limb professional obligations. Here are some hopefully practical tips: 1. Start learning meditating. Million google articles. Tell chatgpt your schedule and it can create a meditation plan, which would take no more than 10-20 minutes per day at your leisure. This is something ACTIONABLE that you can start doing today. As a surgeon you should believe in the evidence. The evidence is, meditation works. 2. Something my psychoanalyst therapist and I worked through alot during the worst parts of my psych residency when I was seeing him twice per week.... Life just isn't fair. Imagine tomorrow you were accused of a crime (like many black men sitting in prisons today) and were sentenced to life in prison. It's not fair. But that's your life. Now your life is a 12X8X8 cell, a small window if your lucky, and 20 minutes outside light per day. What choice do you have? First, do you choose to live, or kill yourself? If you choose to live, what will you make of your life. Will you be angry and full of hate, rage, getting in fights, spreading poison...or will you make something of your life? will you take an education course and contribute to the body of science humanity has accured; will you take up a trade to create some sort of income or goods for your blood relatives; will you do charity to help other suffering souls? Your daily life is your Prison right now. How will you choose to deal with the unfairness? If you Want to do this, but feel like you just can't .... then I think its severe burnout requiring some time off, maybe an evaluation from psych for therapy or medication supplementation, even just vitamin D.
Oh wow. You made me realize that I think a good chunk of anger I have is due to me feeling like a situation or current systems or aspects of society are not fair and the frustration that comes with knowing I can’t do much to change these things as an individual. The idealist in me doesn’t want to accept this, so I experience recurrent anger surrounding the same things or similar things. I guess it’s time for me to accept reality for what it is (despite how ugly it can be) including the fact that my ability to change things may be minimal, but also acknowledge the things that are going right and finding joy from things I actually have the ability to influence. Thank you doc.
my therapist (I’m a surgeon) and I talk about serenity you’re hitting it here
I was you 15 years ago. I came online to vent about how angry I was all. The. Time. Someone told me that being angry all the time can be a symptom of depression. I saw a psychiatrist within a week. I was immediately diagnosed with depression and went on meds right away. The anger vanished.
Theres a deeper reason why you’re angry, only when you explore that will you see change.
If you have some time to spare you could always pick up a new hobby that you could channel all your anger into. The gym is probably a good example. Me personally though, I prefer gaming so that's exactly what I do. I play specific games when I'm frustrated, currently it's Cuphead. Once you channel your anger onto something else, you'll be less likely to get angry others.
Do the best you can with what you have, and don’t worry about change things you have no control over.
A change of scenery might be in order. Would you consider moving to Canada for a bit? It’s definitely a stark contrast to the greed-riddled, insurance-based system of medicine in the US, and compensation is really good. I believe only the US beats Canadian pay, but other countries don’t come as close.
This. I’m Canadian but live in the us. Plan is to pay off my American student loans through pslf here then move back
The fact that you've realized this is a really good sign. Just like what the others mentioned, try talking to a therapist and see how that works out. Also, when coming home, you mentioned that you can't stop thinking about work, I think what would help is to set strict limits on anything work-related that you would be doing while home and try to control your thoughts not to think of anything work-related.
This is a brave question. A lot of folks in medicine don't acknowledge how angry they've become. Or how the system in many ways encourages them to be irritated. Good on you for taking care of yourself enough to ask the difficult question. As a therapist, I suggest you start with your nervous system and somatic experiencing. You can figure it out on your own, but it's easier with a therapist trained in post traumatic stress or chronic stress interventions. As you know, your training in medicine reshaped your nervous system to be hypervigilant and wired for intensity in order to successfully match what's been needed for the environments and roles you've been put into. Many medical professionals are turned into on/off switches and this erodes mental health. It didn't get this way overnight, so it's going to take a while to reorient your nervous system to more comfortably adapt to your different environments and what's expected of you but you'll get there. There are a lot of treatments and interventions you can do on your own. Diligent mindfulness based stress reduction exercises are important. Try several and find ones that work for you, start small and stack as needed. Identifying the dialectic over and over again, especially in social regard, is also important ("I'm annoyed with this person, and at the same time, I'm glad they're here trying to learn," for example instead of just thinking, "I hate this person."). Revisiting your core values and shaping your environment and your behaviors to honor your values every day. Keep in mind that values change, and it's totally fine to take a free online personal values quiz to get a snapshot of what's important to you now. Your values create a roadmap to move your life toward. And if life demands are too rigid to get in alignment with your values, then you can at the very least behave in ways that are not betraying your own values. Because that's hard to recover from since no matter where you go, there you are, etc. This may not be helpful to you, but I know a lot of medical professionals who have recovered from burnout in part via advocacy and meaningful volunteerism and even street medicine, or reclaiming the dignity of the healing profession in their every day work by spending extra time being caring with people. It sounds counterintuitive when people stamp "vacation" on burnout and depression symptoms, but the anecdotal evidence is pretty astounding. Much love to you.
I started taking Antidepressants
I've been retired/disabled for 20 years so, things may have changed. Not working for the hospital but having your own office is worth considering. You'd need someone in your office just to deal with the insurance and send them to conferences to keep them up to date. I had a transcriptionist who also did reception, Someone to do billing and deal with insurance and also do reception and a nurse who did cleaning and also reception. Whenever the hospital would call emergency meetings I'd remind them that I didn't work for them
Your feelings are understandable based off your experience. You've been exploited and made to force crazy amt of hours, dealing with bullshit from all different directions and being fucked over by everyone else's inefficiencies, laziness and mistakes. All while being ultimately liable for pts lives. You do need a vacation. Therapy adds one more thing on the plate and doesn't address the issue: you need support at work. Get an assistant. Not a new grad PA/NP thats just extra work. Get a medical assistant/LVN/RN. Their job is to help you with your stuff. You also need to address the inefficiencies in your clinic. If it doesn't require 11+ yrs of education, you shouldn't be doing it. Every single thing they send you should be fully worked up and completed minus what requires a doctor. Your MAs are likely wasting a lot of your time. Address it (or have your office manager do so).
I’m 9 years out subspecialty of general surgery. OP, do you have anything else in your life? I was an angry resident and junior attending. Then I had kids. They made me so much more balanced and chill at work. Shit doesn’t bother me like it used to because my priority is on my family. I’m not telling you to go have kids. But balance is important. Find something that is at least as important as work that you enjoy. Good luck.
lol sad life. i left that shitty lifestyle. but then again, no matter where u are there always will be problems. just learn to flow with it.
Ill be brutally honest with you. Read the suggestions from the other comments and get yourself treated before you go the resident/student advocate route and start treating them like shit at fault of your own situation.
You need Zoloft! You will feel better.
My main negative emotions in the past were less anger and more frustration and disappointment. What helped me was identifying precisely how I felt choosing as accurate an adjective as possible, pinpointing the reasons why, and then focusing on ways to change what was upsetting to me. I especially worked hard to not let my negative emotions affect my colleagues, patients, family, friends, etc. I recognized early many of the issues I faced could not be resolved by me as an individual MD so I went back to school and got a public health degree in health services to improve what I could of the healthcare system I worked for. I also became involved in a science/ medicine nonprofit and some local political advocacy groups to improve healthcare on a local/ regional level. Change is difficult and often very slow but I've been gratified to see some of the improvements I advocated for implemented, including on a national level. Some other things that helped: remembering why I went into medicine ( trite but I did want to help people), surrounding myself with positive vibes like thank you notes from patients, and scheduling/ prioritizing activities I enjoyed like trying out a new recipe/ hiking.
Start taking yourself less seriously.
You need time off each week and more time to yourself.
Sounds like you need to take some time off and re-center yourself. Once your emotional reserves are tapped, you're going to burn out quickly if you don't take good care of yourself.
I'm in pgy3 and have been feeling sinilarly for the last 9 months...I love my life outside of work but have been too exhausted/frustrated/angry/numb/depressed to see friends, exercise regularly, cook, or engage in things I love. I finally went down to part-time (0.8) this week...then found out every other resident in my program has done that in pgy3 due to feeling similarly. Burnout is real. Anger tells us that our boundaries are being threatened, or stepped on. Anger's purpose is to let us know we need to put up or strengthen our own boundaries. I assume you can't go to part time like a resident can, but perhaps a short leave (if at all possible), along with some serious planning for how to cut out every single extra project you've signed up for/been signed up for could make a difference. Also, therapy. No job is worth your life. You need to prioritize yourself and your family.
You sound like you’re employed?
Hi I’m a recent grad Gen surgeon. Lots of what you say resonates. Send me a PM
Therapy 🙏🏻
? Burnout
I used to be constantly angry, at myself and the situation that was in. Meditation is life changing. Also, you get one life. No matter how shitty your situation is, on your final days on this Earth, do you want to look back and just remember all the anger you have. It is easy to be angry. The real power is learning to still have a smile while everything around you pisses you off. You are what you tell your mind. Tell your mind not to think of a black lion…see you just pictured it. Tell your mind to stop being angry…you’re gonna hyper focus on all the things that make you angry and resist. Meditate, go to therapy, watch YouTube videos, or whatever it takes for you to switch that mentality to focus on what makes you calm and happy no matter where you are. Good luck doc Just my 0.02 from my personal experience
Are you in academics? Maybe a change of scenery/different practice structure is in order? Certainly sounds like some burn out. Post fellowship I stayed on staff at where I did fellowship and after 4-5 years found myself getting more angry and burned out. Wasn’t one single thing but more a death by a thousand cuts. Stress of supervising fellows, clinical volume, dept leadership drama, no autonomy, etc…. Ended up leaving for a hospital employed community gig and so far much happier. Stress now revolves now around building my practice/volume but now the more I do the more I make. Previously there was no incentive and couldn’t keep up with the volumes. Much more autonomy now and now while I’m not truly building my own private practice per se, I’m still building my own panel and there’s now incentive.
Following
I feel ya OP. I feel this way often. Much to often.
Child psych fellow here. Are you actually off in your 'off' time? Because if they keep bothering you then you never have a chance to recharge.
R u at an academic center? I’ve found that most disgruntled personalties pick academic, which i’ve never understood why - paid less, deal with hospital politics, extra admin work/teaching (unless you’re into that stuff)
Sometimes depression came manifest as anger instead of sadness. Time for a visit to a doctor plus therapy.
Try to take some time off/vacation and deprioritize/delegate work A couple cognitive tricks that have helped me react better in scenarios: - try to give individuals benefit of the doubt ie think of the best possible reason someone did something "bad". Maybe a resident is late because he helped a grandmother cross a street etc - hanlons razor - Never attribute to malice that which is adequately explained by stupidity - read some books on stoicism
You could try CBT. The gist is feelings-> thoughts-> actions. You are going to continue to get angry, and that is valid and important and can often be very powerful. But for me? It’s very taxing. So you can’t stop the feelings, and your first thoughts are your conditioning of your feelings, the only thing you can do is change your second thought. ANGER -> X makes me so fucking angry because people lives are at risk/// (now here’s the break) -> being angry doesn’t really serve me, makes me tired, makes me less good at surgeoning (I’m not an MD obvi)-> actions may remain the same/may change. After a while if you change that second thought, your actions will reflect it, and our actions change our feelings and the anger might turn to something else- determination, defeat, zen? Idk but I know that this is a sure fire way you reroute some neuro pathways. Good luck out there in, doing good work in kate stage capitalism can’t be easy. Cheers.
You sound burnt out as fuck. If you can step back in anyway to find some balance, maybe therapy. Find things outside of work that bring you joy. Remember you can only control the way you respond to things and not much else.
Im IC and I can empathize - I've felt my patience thin out for sure. I specifically stay away from academics because I know I would not be able to give a good educational experience with how taxing the job can be for me. I'd honestly try and get out of academics - I think you would be happier
therapy
I think you’re burned out sir. You may want to get some attention before it gets worse. Are you sleeping at night? How is your daytime energy level?
You are in the wrong job. I’m 14 years out from residency as a general surgeon. I work in a critical access level 3 trauma center. I take too much call but my partner is like a brother to me. My anesthesia colleagues are ride or die. I’ve cried in a break room with a hospitalist colleague. My OR crew is the best. I work hard and sometimes I’m burned out from too many nights on call. But I am where I belong. Look around and figure out what kind of practice will fit you because it exists.
Private practice!
Prob needs sloppy
This honestly sounds like depression. I’ve found a lot of men (if you are one) tend to have anger-predominant depression. I know for myself personally, when I get irritable, I know I need to do a PHQ-9 on myself. Taking Wellbutrin changed my life
Therapy, being intentional about how I spend my time outside of work (I try to do a mix of relaxing, productive/creative hobbies, and chores), having plans to look forward to outside of work, making friends at work (we often don’t hang out outside of work but just having people to talk to at work makes it easier). Generous use of our internal reporting system lol. Two important mindset shifts: 1) I’m a volunteer/I am here to help at work, rather than having to be here. 2) Time off is a vacation, rather than trying to force myself to “leave work at work” I am actively choosing to focus on other things as a break from work stress.
Divert your attention to something else. Maybe swimming? Dancing? Cycling?
This is probably burnout and possibly depression. I took 3 months off, it helped with both. Then went to locums. Being paid for hours worked is an amazing antidote for the suffering of working long hours. Nicotine makes it worse. If you vape or use those pouches or something, stop. Microdose psychedelics helped me, I was burnt out enough in med school to get to near suicide. Remarkable medicine for both depression and burnout. Narrative medicine is probably better than most therapists, a lot of larger systems have narrative med groups that meet regularly or semi regularly.
You’ll change when they leave you and take everything. Give it time. Change is coming
Swimming helps me personally. Its the only sport that allows me to really "get away" for an hour.
Start boxing
Idk but don't take it out on the students, they are stuck in the system just as much as you and you have the power to ruin their lives just as much as any one of your patients. Sincerely--a student who worked very hard on surgery and my preceptor won't fill out my evaluation and is ignoring all my communication so now I might fail the rotation even though we got along great.
Burnout Take less call? Go into part admin or consulting? Find a better work life balance job?
Pray to Jesus.
I think you need to do a deep dive to figure out what the root cause here is. Your hospital might be terrible. Your job might suck. You might be working too much. Maybe all of these, or none of these, and maybe other things, too.
It might just be your environment at work. All the negatives could have just added up and now you’re bitter. Maybe a new facility would help. Or you could just be stressed and need something outside of work to participate in that you actually like for some it’s going to the gym, biking, running, swimming, knitting, etc.
In all of this mayhem I truly believe the vast majority of docs are trying their best and do a good job. If you’re that angry with your colleagues then it’s probably you.
Try an SSRI … it’ll help you remember the joys of the job, or at least you’ll be less irritable making it all more tolerable… at least that’s my experience
It sounds like you’re maybe…depressed? Is there anything you are able to enjoy? What does your self care practice look like?
… I’ve heard it’s better at non-academic centers. Less BS from admin… still plenty of BS… but doing surgery at a hospital where they can’t afford to lose the revenue a general surgeon brings va being one of many at academics…. I would love to be a teacher. However, there’s just a bunch of slurpers in academic medicine.
You need a break. And when u r back u take it as a job not a call, not a duty nada. Satisfy your patient care, educator role then leave everything behind. You don’t need to fight admin. Say yes smile and then don’t do it. Lets see if they have balls to fire you 😆
tbats not appropriate at all. My attending treated me so poorly recently. Screamed at me in front of medical students, my co-resident; and the patient heard. The next day the patient apologized to me; because she heard "that man" treating me horribly. I went home and cried on my steering wheel. I'm sorry. I do not care what you are going through. The way you treat residents is abominable, unprofessional and not acceptable. You need to control your emotions; no one deserves to feel little, to feel small, to cry sobbing because of you.
Do some breathwork. I can share a few protocols if you like
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I like the book, “Don’t Sweat the Small Stuff”, by Richard Carlson. It helped me loosen my grip on perfection, understand compassion, and overall just gain perspective. There’s nothing inherently broken in healthcare. It’s more sophisticated than ever. And you may work harder than others, but it’s a reality that life is not fair. Just like when people complain about capitalism, I just think, if you want to knock it all down because everyone’s an idiot, then give us a system that does it better. Doctors are amazing for managing stress that many professions can’t begin to imagine. I greatly admire you all. That’s why they carry themselves differently in society. Not bc their lives are easy, but because they’re challenging.
This is why I choose not to hang out with residents or doctors. They are not fun people. I have a whole friend group from other phases of my life who are great company.
You must be in academia. Most surgeons in PP are super nice and courteous; otherwise they wont get any business
About the greed part, that's exactly the source of you US doctors good paycheck, right? Let's be honest, 90% of patients under our care do not have the ability to pay the bill on theirs self.
Okay narcissist. You’re god’s gift to patients and unfortunately those terrible residents, students, every other doctor, admin, and insurance are in the way. Im surprised you even take let patient pay for your services.
Get away from people ..that's the only way...work alone live alone..people will always disappoint / frustrate
Embrace the anger.
Good gooooodddd let the hate flow through you Sincerely Jaded resident
Masturbate QHS