I Quit Obstetrics at age 43: the “DABDA” Stages of a Major Practice Change
A few months ago, a physician who had discovered this website reached out to me with a flattering e-mail, letting me know that she was making some major changes in her career trajectory, and that what she had read here helped confirm her decision to take a step back from a demanding work schedule.
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.
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.
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.
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.
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.
And you’re sad that you’re missing yet another big family holiday dinner because you’re on call. And you’re sad thinking about the fact that your husband is 20 years older and will be sitting at home waiting for you to get home from work and who knows how much time you’ll have left together? (Stop! Don’t even go there. Way too sad!)
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 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!
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