This was not an easy decision for her. I don’t think anyone, including me, chooses to give up valuable skills that were not easy to come by without some serious contemplation and reflection.
This OB/Gyn grappled with her decision to drop the OB part, and she relates the process she went through to the stages of grief most often discussed when dealing with death.
When I leave medicine, a part of who I am will perish, but I believe that will allow other parts to flourish. I believe today’s author feels the same about leaving obstetrics behind.
I Quit Obstetrics at age 43: the “DABDA” Stages of a Major Practice Change
I was just about to turn 43. I was Chief of the Department of Obstetrics and Gynecology, and on the verge of sending out a major announcement to hospital administration and our group. I knew that there would be no turning back after hitting send.
I announced that I would no longer be participating in the OB/Gyn on call group. I waited in agony for our meeting the next day, wondering how this bombshell would be received, whether I would be allowed to continue my office OB practice, whether the hospital would keep me on as Chief.
In the years and months leading up to this pivotal moment, I was a hardcore, workaholic OB — passionate, energetic and fully devoted to my career. This drive, a modest lifestyle (without children) and an aversion to debt meant that I would achieve financial independence in my early 40’s.
Married to an OB/Gyn 20 years my senior, I had long been contemplating what my career life would look like when he retired. Two years away from that milestone, and having just paid off our 7-figure mortgage in 8 years, we celebrated by giving away all of our on call shifts. All of them.
After 13 years of not parting with a single shift (barring emergencies and funerals), we took advantage of our on call group’s flexibility (no mandatory minimum shifts, no restrictions re: on call shift giveaways). I thought it would be hard to do, but after struggling with (and getting over) the initial guilt, it was easy. And awesome. It was heaven.
After 6 months of successfully re-distributing six 24-hour shifts per month, it became clear that some group members were feeling bitter — they felt it wasn’t “collegial” that we weren’t covering any nights or weekend shifts. I found this more than a little bit ironic, given my current tireless work as Chief, our previous track record of covering almost 100% of our assigned shifts (every Christmas, every long weekend…), and that there were several other group members fighting for extra call.
It was also ironic that the loudest complainers were the ones that had given away more than half of their call shifts for decades. Although I had been planning to continue with the new status quo of simply giving the shifts away, in the interest of transparency and collegiality, I bit the bullet and decided to leave the on call group.
I’ve been reflecting a lot on this journey, (“a lot” is an understatement, more like constantly….) I realized that the events leading up to this point could be categorized under the “DABDA” framework — remember that med school psych lecture where they talked about this acronym for the phases of grieving?
It’s not that I want to compare my decision with death and dying (because I see it as such a positive and life-affirming change). But I have to be honest with myself; there is a part of my life that I’m letting go of that may never come back. I have to be sure that I can accept that decision- now and years from now.
DENIAL
No one wants to admit that they are starting to hate their job, especially a doctor. Remember all of those people at the MCATs? There are thousands of students desperate to be where you are today.
You’re “living the dream”! How could you be so ungrateful? I’m not sure exactly when it happened. There was no particular bad case (touch wood, no major bad outcomes or lawsuits), no turning point. More like a slow growing and silent malignancy.
Vacations had always been written on my calendar (still addicted to the paper kind…) in big block letters. One day I started crossing off each day with a thick, red magic marker. I couldn’t wait until the end of the day for that moment, and started allowing myself to cross it off at the half way point in my day.
When I first confronted myself on this new habit, I just thought I loved vacation- couldn’t wait to get to Mexico, or Italy, or our vacation condo in Banff. But then I saw that I was doing it even for the months where there was no vacation in bold letters. Hmmm.
ANGER
There has been a lot of anger. Anger at the Ontario government’s devaluation of doctors (a 20-30% pay cut when you consider zero raises on top of fee cuts). Anger at hospital administration for solving their bed shortages by giving away ours to internal medicine (now always under pressure to find space for each new unanticipated delivery or emergency, on top of the day’s inductions and C-sections, pressure to push patients out the door). Anger at seeing good nurses leave because they’re burnt out too.
Anger at the unappreciated, under-compensated stresses of administrative work. Anger at watching colleagues who aren’t following guidelines, managing patients to maximize their own financial gain. Anger at the patient who refuses an indicated postdates induction (after you’ve just gone through an unexplained stillbirth with a patient who would have done anything to prevent it if she could have).
Anger at ruthless, anonymous internet criticism — disgruntled patients representing such a tiny fraction of your patient population but such a large proportion of online commentary. Ok, you get the idea. A lot of anger. Thank goodness for all of the joyous moments and team victories that mostly balance out against the anger.
BARGAINING
If you just get through this next 12-day marathon of call and office without a break, then you can allow yourself an extra day off next weekend. Only 3 more marathons to get to the next vacation. If you survive this 10-delivery, 24-hour shift, just think of how you can justify buying that new guitar you don’t really need (and never have time to play…)
You can’t decrease your mortgage payments now. You’re so close to the end. Just book a few extra hours of patients! I’m sure each of us has made these sorts of bargains with ourselves to push ourselves just a little bit further, just a little bit closer to the burnout flame.
DEPRESSION
Thankfully, I have never suffered symptoms of clinical depression (and this practice shift is about making sure that I never do). But I definitely have been sad. And I know that every subspecialty has its sad moments. And they wear you down over time. And then work starts to be less fun. And then you’re sad that work isn’t fun anymore.
But that last sad thought is a big part of what’s driving me now. At the end of my life, I don’t want to be sitting on a big pile of cash with no one to spend it with, sad that I was at the hospital when I could have been spending time with my husband.
ACCEPTANCE
Acceptance is the last leg of my journey and there’s still quite a bit of road ahead. I don’t think I could have made it this far on my path to acceptance if it weren’t for the online community and websites like this one.
I discovered the concept of FIRE only a few weeks before making my decision firm. I devoured old posts for hours. And when I found this site, with candid and heartfelt posts from other doctors (doctors!! Actual doctors like me contemplating practice changes and “RE”!)- I knew that I wasn’t alone.
I wasn’t lazy. I wasn’t a “loser” for feeling a bit burnt out. I was allowed to be proud of my hard work and enjoy the fruits of my labor. After my big announcement, when the waves of doubt came crashing, and the mini panic attacks began, I read passages from Dr. Cory Fawcett’s book “The Physicians Guide to Smart Career Alternatives and Early Retirement.”
Each page reaffirmed my decision, and let me know that my decision was strategic, not reckless, that my new career path would have value. That I was not being selfish, I had earned this.
I have accepted and acknowledged that the work that I do in my office has its own value. Although there’s less “life saving” compared to my hospital shifts, it is certainly still “life impacting”. In 2016, I made a commitment to my referral base that I would expedite all IUD insertion consults.
In no time, these consults had taken over my office, and I was loving it. Young, mostly healthy girls and women, requiring minimal time and paperwork. Yet I was able to have a huge impact on their lives, giving them 5 years of protection from unwanted pregnancy in just a ten minute consultation.
What Comes Next
And so my plan moving forward looks like this: 3 days per week of office (IUD’s, non- surgical gynecology, and I will initially still see office OB). I’ll also spend 1 day per week assisting my husband in the OR. I gave up my own elective OR’s in 2017 since my surgical gyne volume was so low, and I never looked back.
I wouldn’t have been able to leave the on call group if I still needed OR time from the hospital). When he retires in 2 years, I will phase out office OB completely and go down to 2-2.5 days per week (depending on travel- it will be nice to be able to leave for more than 5 or 6 days at a time without having to find someone to cover 80 OB follow up patients!)
Oh — and I almost forgot to tell you the best part — hospital administration said that if I’m not doing call that I’m not “allowed” to be Chief (Hooray!!! A thankless, miserable job that I never wanted. I had agreed to it only because it was my “turn”.)
I will miss attending deliveries, the easy ones and challenging ones, will miss hearing the nurses marvel at my 20 minute c-sections (I’m allowed to brag about just one thing, OK?) will miss using those finely crafted technical skills. But I will not miss doing those things at 4 am on a too-early Tuesday morning or at 2 pm on a sunny Saturday. And I definitely will not miss meetings!!!
Everyone is shocked and confused. They keep asking “are you OK?” (I think the baseline presumption is nervous breakdown…) Of course, it’s hard to tell the “whole truth”- nothing invites dagger eyes quicker than a 43-year old talking about financial independence when so many colleagues are nowhere near it.
I mostly tell them that the decision was “multifaceted”. And that I’m really OK. So OK, in fact, that I caught myself actually whistling at the office! (my secretaries are loving me these days, they have already noticed a dramatic improvement in my stress level). When I talk about my new plans, I have to watch myself, I make sure to turn my grin down a notch. I don’t want to gloat!
Many, many thanks to PoF for this site that has been life changing, and this opportunity to share my story.
[PoF: Thank you for taking the time to document this difficult decision-making process. I know from my limited role as the labor-epidural-placer and S-Section companion that Labor & Delivery can be a stressful world. It doesn’t take off nights, weekends, or holidays.
Best wishes for happiness and fulfillment as you move on to this next chapter in your life. Happy Holidays to you, yours, and readers everywhere!]
Have you made or contemplated a significant career change? What were the most difficult parts of that decision or transition for you? Comment below!
Congratulations on FI! I hope you are enjoying every second of your time (I’m new to the site and your post). As an obgyn who is also stepping away in 2021 from full time practice in my 40s, it’s hard to explain to everyone ‘why’ without giving away how happy I am! I encourage every resident I train to achieve FI as soon as they can. life is short and we have all worked too hard not to enjoy the fruits of our labors ( no pun intended!)
So excited for you! Now almost two years since I made my decision and wrote this post, I can say I have never been happier, and cannot believe that I ever worked at my previous pace . I am currently two days a week, mostly contraception and a sprinkling of general gyne. Surprisingly, my take home income has only dropped a third while my workload is down so dramatically and stress is down a million, trillion percent (the wonders of a new tax bracket and less overhead). Not missing OB or the OR a bit (not a single bit, not for a second! What ever possessed me to choose such a stressful job to begin with?!!)
Congratulations on your decision, I hope that your FIRE experience is as positive as mine has been !
There will always be naysayers if you go off the beaten track. I quit OB at 56. It is a tough life. I work 3 days per week but still do some surgery. You have to do what is right for you and your situation.
Oh, congratulations! This was a wonderful post and so encouraging to read. I’m a young ER doc working on finding balance early to maximize my longevity in the field, so my journey will obviously look different, but ultimately I think we all hope for this to be our path – to work hard, enjoy our careers, but still be able to enjoy our lives as well. Thanks for sharing!
Kudos! I enjoy reading about how other docs strip off the undesirable parts of their jobs to create a more enjoyable and sustainable practice. I think that working hard and taking some lumps for the first 5-10 years of practice helps to build skills, reputation, and confidence, but beyond that, mostly you are grinding yourself to the ground.
Good luck with the next phase of your career and life.
Thank you for sharing your story! Love reading about women reaching FI!
Congratulations on moving to the next phase of your life. It is hard to take that first step. It was hard for me to take the first step each time I decided to make a change in my practice to make it better for me. I was always happier after I finally did it though. I’m proud to have played a small part in your career changing move. Your story will help others to gain the courage to make a bold move.
Happy New Year,
Dr. Cory S. Fawcett
Prescription for Financial Success
I hear your story and it’s great you realized what you need and how to get there.
My wife gave birth November 21, 2018, to our first child after 30 hours of labor followed by a C-section. Her OB checked on her numerous times during the day and spent 3 hours at the bedside helping her push before realizing that the baby was stuck (sunny-side up) and wasn’t coming out. Then it was off to an emergency C-section. Her entire afternoon of patients was canceled, and she had to postpone an urgent surgery at another hospital. Not to be melodramatic, but our baby’s life was in her hands, and we were terrified at the way things were going. My experience as a neurologist was not an asset, I can tell you! Our doctor gave us her full attention at all times, which was an enormous help in keeping my pulse under 100 bpm.
I relate this story because our OB is in her mid-forties with children and a husband. When we see her in the office she is always in scrubs and looks tired. I hope she figures out a way to avoid getting burned out because we would like to have more children!
It’s a shame our system doesn’t reward hard-working OBs the way it should, and I’m not talking about salary, but somehow offering a reasonable lifestyle. Both you and your husband are valuable assets to your community, and it’s a shame you both have to retire. But you have to do what’s right for you, that’s for sure.
My own anti-burnout approach has been to work locum tenens or full-time 7 on/7 off and pursue my other interests actively. It works, but it’s always a struggle. Best wishes in this new phase of your career.
PS: I would never mention the word “retirement.” There’s been discussion here before on this. When I make a change, I say that my career is “evolving in a different direction,” which leaves plenty of room to explain if anyone wants to listen and avoids the loaded word “retirement.”
Andrew, I’m so happy your baby arrived safely! Congratulations!
I well remember the agony and stress of those long labours, then long 2nd stage/ pushing stages… So many of them in my last 18years. I will continue to be grateful to my colleagues who are there now at 4 am saving lives, and have come to accept that it was “enough” for me to have been there for the years that I was. I will continue to “be there” for my office patients now, but in a different (hopefully happier, less burned out) way. Congratulations again!
It’s amazing how your elation comes through loud and clear in your writing- congratulations!
Martyrdom in medicine is a bizarre phenomenon that holds many of us back.
I recall a surgical attending when I was a med student who (rumor had it) trained under DeBakey. Residents would whisper as he passed, with reverence, about how when he was a resident his program was so rigorous they had to assign a nurse to take each resident for a mandatory 15 minute break to the helicopter pad on the roof to avoid vitamin D deficiency from lack of sunlight. This was said with admiration!
Do other professions feel similar guilt at achieving financial freedom or earning happiness?
Warm wishes as you enter your glide path out of medicine!
CD
Thanks CD!
Love the vitamin D story. The “grandfather” of our residency program worked until his mid 80’s (when the hospital kicked him out of his office space at 80 he moved to a private office!) There were stories of him performing surgery while ill, with an IV running (in his own arm as he cut…) told with the same “admiration”. To call these “role models” is insanity, IMO.
So happy for you and proud of where you stand in your journey! There will always be outstretched arms waiting to pull you back, so many reasons for you to discard what you know in your heart to be your way.
Each step and decision will get easier as you already know. Don’t worry about being “too happy” and gloating! The naysayers are going to be annoyed with you anyway… no reason to cover up the joy in your life!
Hi M-
Your words mean so much. As per my previous messages via Instagram (Dec 12, under a different name…) your blog has been a HUGE help and comfort to me during this career transition.
I am in the middle of the office right now, 44 OB’s scheduled with waiting room packed. Trying to stay positive and friendly despite news that one of my patients had a massive abruption and stillbirth this morning at 39 weeks (a predisposing placental anomaly discovered only at birth, normal ultrasound 3 days ago…) THIS is where burnout lives and grows. I have SO much gratitude for the online support group that has been created for us all.
All the best!
Congratulations!! Thank you for sharing your experiences and emotions! I am also 43 and transitioning in my work this spring. The concept of financial independence and support/knowledge from sites by PoF and WCI have been instrumental in helping me to determine I was able to cut back my clinical work!
Enjoy your newly found freedoms!
GXA,
If you have interest in sharing the story of how you cut back, I’d love to hear more about it.
crispydocblog (at) gmail (dot) com.
Thanks for considering!
CD
So happy for you and your decision. Your post definitely spoke to me as well as no matter what specialty you are in (and I am supposedly in one of the lifestyle “ROAD to success” specialties of radiology) you can get burned out and work becomes less and less fun.
I have pared down my clinical workload by taking a day off each week and paying someone to cover me.
I also made the very smart decision when I was in my early 30s to choose a job that offered a pretty sweet lifestyle (M-F 8:30a-5pm, no call, no weekends) over those that paid more but required call.
There will always be haters out there. Physician on FIRE had an article that was lambasted by a lot of physicians and the comments I read demonstrate the ignorance of the majority of us in our field. Rather than be happy for someone who was frugal and put his high income to good use, they compared where they stood in life, got bitter, and vented.
No one will live your life but you. So it should only be you that should play a part in the major life decisions. If it makes you happy, go for it. We are only on this small blue marble traveling around the sun for a short time.
It takes courage to go against the grain and do what is best for you. It takes even more to think about it, write about it, and share it. Thanks for all that. Your story will help others just as Cory Fawcett and FIRE bloggers helped you.
I love this post.
Thank you for walking us through your thought process and journey towards taking this step. There are many physicians who are contemplating similar moves, and your post is going to provide some encouragement for these physicians to take hold of their live and to do what is best for them.
This is such a hard double-edged sword. I am curious to know how early in your career you started having these feelings? Financial independence can provide strength when nearing it, but I wonder how much it helps when you are still in the middle of your career marking off those calendar days with your red marker. Did that make you resentful when you realized the solution was still a ways away, or did you only come to this realization recently when stepping back was possible?
Thanks again for being open and honest about your journey!
TPP
Thanks for your support TPP!
It’s hard for me to pinpoint when exactly I started feeling burned out. Over the last few years of our mega mortgage payments, we were excitedly counting down until that milestone (I think maybe that’s when the red marker thing started). Once we reached it this March, and decided to give away all on call shifts, it brought such a tremendous relief, and I dreaded the the thought of even just one shift…. That’s when I first realized I had been feeling burnout all this time. This realization coincided nicely with my discovery of the physician FIRE online community, and then my new realization that the mortgage payout had left me FI. The red markering has continued until my official hospital end date (Jan 1) but 3 months after my announcement, I continue to be dramatically happier with my work life (since my announcement I have slowed down significantly and have had less contact with the colleagues and administrators that were such a huge contributor to my workplace dissatisfaction).
Update: my husband has moved up his own FULL retirement date to June 2019, and found another OR assist until then, so now I have been doing office just 3 days a week. Even started an educational YouTube channel for my IUC clinic patients (and the internet at large…) and am working with the major IUC manufacturer in Canada on a video series that will help other practitioners learn to counsel about IUC. Never have been more sure that my decision was the right one, and I am actually loving my job again!
Thanks again for your support!