Uh Oh, I Want to Fix Things Again…

feeling the burn, again.

Over the last 2 months, I have been feeling the dread slip back into my work.  I spend the day before heading out of town thinking about the all the crap waiting for me.  This used to be normal, but I haven’t felt this way since I left my first job.

I was starting to worry.  I needed to take a look around and figure out what had changed.

problem 1 – working too damn much

I decided to take some time off in January and February – about 6 weeks.  This is  really easy to do as a locums, you just don’t accept any work for that time.  On the other hand, I won’t get paid if I don’t work.  So, I have been working more than usual to bank some money

In September, I was worried about having enough income to make it through those six weeks (I am still trying to aggressively pay down on my student loans). So, I signed up for any and all work that came a long for Nov-Dec.  For instance, I was on call for 264 hours in November.

problem 2 – location monotony

One hospital gets its schedule of need out about 1-2 months before other locations.  In my anxiety about having enough work, I signed up for a lot of work at this location – 192 hours in November.

Every location has its problems and dysfunctions.  This location’s downsides are: it is near an interstate and serves a more transient, mental health burdened population(more drugs, alcohol, suicide attempts, etc.).  It is also near a prison – so that is always fun.

Summary:  an emotionally draining patient population.

Moreover, because of the its demographics, the hospital gets less funding from the local community and yet the ED and hospital are busier than many of the places I work (and doesn’t pay that much more).   For instance, they don’t have auto-injector epinephrine – too expensive.

Despite these downsides, I didn’t used to mind working there that much.  What changed?  Why am I getting frustrated and crispy again?

in the nomadic world – freedom is all

Nomadic societies adopted their ways of life because the resources in one location were too finite and ephemeral to support a permanent population.

In places with limited resources but permanent populations – i.e. the desert, societies drastically alter the landscape to create more reliable sources of water and food – i.e. irrigation works and aqueducts.

The same is true in my work life.  In order to subsist, I must either be a transient nomad or alter an organization to increase its efficiency and ameliorate its affects on my life.

The continued ossification of medical bureaucracy leaves me little hope for the latter.  So, I live light on the land and move frequently.

For instance, when I work at a hospital once a month or so,  I leave, hand off the remaining clinical work, and move on with my life.  That becomes harder when you are back at the same location repeatedly.

Seeing you on the schedule in 2 days, nurses won’t address a concern as soon as possible.  Instead, they hold onto it, letting it fester, until you have returned and drop it in your lap as soon as you walk in the door.

While understandable, it is frustrating.  Especially because the questions are usually the same ones over and over.  Standing orders, protocols, etc can solve a lot of this busy work.  However, I don’t have the power to enact any such thing at the hospitals where I work.  I don’t fix things, I just see patients.

This arrangement works fine as long as the boundaries are respected.  However, human beings don’t like boundaries.  2 year olds and 92 year olds try and test them all the same.  We just don’t like them.  Moreover, we love feeling like we are getting special treatment.

here’s the rub, i like fixing things

I like finding creative solutions to complex problems.  This is actually why I got into family medicine.  When done creatively and intentionally, the longitudinal relationship in family medicine is exceedingly powerful at preventing disease and improving people’s lives.

The human psyche is exceedingly complex and most illnesses in our society are rooted in behavior.  Finding creative solutions to disease processes rooted in behavior is really challenging, interesting, and satisfying work.  Unfortunately, our system does not value this work.

Moreover, making systems and organizations run well is also primarily a psychological task.   You have to understand the values and motivations of groups and individuals, thereby harnessing them to accomplish the tasks at hand.

Again, as the MD in the room, no one wants to let you do this work because in the short term, they can use you to generate more income.  This is doubly true as a locums.

Normally that doesn’t bother me much because I don’t have to deal with inefficiencies and dysfunctions of a given system on a regular basis. Yet, in my anxiety to make sure I had some financial wiggle room to get through the time off, I started playing with fire again.

getting singed

So, I am a little singed right now.  It shouldn’t surprise me given my workload.  Nonetheless, I have had the benefit of learning another lesson about locums work – better not to wear out your welcome.

But here is the beauty – I don’t have to quit, find a new job, or start attending hours of likely useless meetings to try and make things better.  I just change my schedule, move around a bit.

I employ the millennia-old nomadic solution – follow the rain to somewhere else.

Sisyphys (1548–49) by Titian, Prado Museum, Madrid, Spain

The downside is I don’t get to employ my desire to make things better and the system does not benefit from those skills (assuming I have any).  Yet, my personal experience is systems do not want to improve, only perpetuate, themselves.

So, I ask, Why be Sisyphus when greener pastures are just over the horizon?


6 thoughts on “Uh Oh, I Want to Fix Things Again…”

  1. I can see how some of the unpleasantries with a normal practice can creep into a locum job if you are essentially a very frequent visitor.

    Is there much competition for locum spots that you feel the need to jump at the one place that releases the schedule early? (i.e. do you feel if you wait till everyone released the schedule you could still get the hours needed but also the variety desired?)

    1. It is very month to month how much pressure I feel to jump at specific assignments. Normally, I do not feel the need. I did back in September because I was trying to make sure I had enough cash flow to tide me over (it is made a little funny by how I am paid – once monthly on the 15th for the prior month’s work). If I had waited, I probably would have been fine, but the potential downside seemed to outweigh the benefit at the time. I still ended up turning down work in Nov-Dec because of schedule conflicts or not wanting to go directly from one assignment to the next.

      Also, other non-work related commitments – vacation, visiting family, etc all make it so you have be a little less choosy. So, months where I don’t plan on doing anything other than working and living my normal life – I can be much more discerning. It is an interesting arrangement – but I still have way more control over my schedule than I used to.

  2. The nomadic life of a locums….

    It’s what I love…and what I hate.

    I love knowing that I don’t have to face the same problem, at the same place, over and over.

    I hate knowing I’m not a part…

    1. Wouldn’t it be so much better to be part of a mission driven, functional, humane organization that is moving the needle on healthcare? I don’t suppose you know any….

  3. LOL….”functional, humane”????

    You gotta be kidding me. After 30 plus years as a doc, I long ago figured out that it was up to me to both be humane to myself, and humane to my patients and co-workers.

    (I’m trying hard to be functional….)

    When I started, one hospital I’m aware of had one administrator, one assistant administrator, and one secretary as it’s administrative staff. Now has an administrator, 5 assistants, 6 secretaries, one COO, one CFO, and no telling how many “clipboard nurses”…who formerly did patient care, and now critique doctors….

    Oh, and the formerly functional, decent offices are now opulent.

    I’m happy…but I control much of my life (schedule), and pretty much refuse to work with people that can’t behave decently. (such are the perks of being older, and financially stable).

    I believe having a life outside medicine (mine is flying…both professionally, and for fun), and I strongly believe in not letting yourself become sleep-deprived.

    (I enjoy your blog….I spend a fair amount of time on the high plains…and your descriptors are accurate…)

    1. Yeah, I thought it was a tall ask. I am glad you enjoying the blog. Sleep definitely makes my life better. I increasingly think this might be as good as one can reasonably hope for. And you know, life isn’t that bad for me right now, all things considered – and I should know.

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