FROM ESSENTIAL TO EXPENDABLE: THE EMOTIONAL RESPONSE TO PHYSICIAN LAYOFF AND HOW TO COPE

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Following Content Also Features as a Guest Blog Post from MDObvious.

Worthless. If I had one word to sum up the sensation I have been left with after my layoff it would be this. I spent my youth in pursuit of skills I would use to help people and save lives. I sacrificed time with my family and in some cases my own wellbeing to meet the needs of those I thought were more deserving of that time and care. I believe that most individuals entering medicine are willing to give of themselves in such a way because it gives us purpose. When COVID first appeared, most physicians were unprepared for the scenarios we would soon find ourselves in. Some witnessed trauma first hand while others who were normally active in saving lives were placed on the sidelines. As weeks of shutdown passed into months, there was little guidance as to the next appropriate steps of action for carrying out safe and effective patient care. Feelings of worthlessness abounded, and for us physicians having this feeling is almost unimaginable. After all, being caring, useful and essential—that is who and what we are!

As a family physician I had to cast my preventive care abilities aside as my office was shutdown. However, feeling that familiar call to serve I volunteered to staff my organization’s COVID clinic. I spent a few months alternating seeing the sick one week and doing phone and video consultations with my own patients the following one. Visit numbers remained low as many patients struggled with technology and still others were afraid to come in at all. As summer commenced, we once again opened and visits slowly increased to near full capacity while I continued to serve occasional days in the COVID clinic. Though multiple staff members were furloughed during this time, by July everyone was back and the office seemed to be returning as close to pre-COVID protocol as possible. I thought the organization had passed the summit of the crisis, giving me hope that our worst days were behind us. How wrong I was.

WHEN YOU FIND YOURSELF ASKING: “WHY ME?”

As I mentioned in my previous blog post I was summoned to the administration office without warning to hear about my layoff. Up until that point our company warned of layoffs but had stated the goal would be focused on non-clinical employees. Though the fear had always been in the back of my mind as the pandemic changed my practice, I thought the chances of me losing my job were close to zero. After all, I was a full-time physician, female (which many of my patients were looking for), had previous experience and was not near retirement age. I wanted to be seen as a team player and I thought I had worked hard to be seen that way. I had volunteered to teach our new EHR system that I had used previously at another organization–for which I received no compensation. My Press-Ganey and colleague engagement scores were also quite good for a physician newer to the organization—patients and people enjoyed working with me. I thought my dedication had shown even more after I volunteered to work in our COVID clinic—a position that only a minority of our larger group had willingly done. I was also getting ready to move to production and in this post-pandemic practice environment this was also likely to make me cheaper to employ.

Though some of what I mention before made me what I thought was a benefit to the organization, some of it also made me low hanging fruit.  In an effort to prove cuts the bottom line from a cost standpoint, a single full-time position makes a bigger impact than lower paid, part-time workers. Those who don’t rely on benefits or healthcare from their employer—as I did—I’m certain also made them easier candidates to bypass. My newness also hampered my attractiveness as an employee—my practice was not yet full, and my lack of E-visits during the shutdown I’m certain showcased this deficit even further. My employer also still owed me a portion of my retention bonus, a cost they would not have to bear if my position was eliminated.

So now that you find yourself asking, “Why me?” you now have to start asking yourself, “What next?” Even if you have not already been laid off but find yourself working for an employer in a similar situation, I would recommend preparing. (See my previous blog post about things to do after you’ve been laid off, though some of those actions could be taken beforehand.) If you think you’re at risk, do your best to look as attractive as possible by bringing in as much revenue as you can. The sad part is that the revenue isn’t likely to show up for weeks or until the end of a financial quarter, but if you think you have time to turn things around now that COVID protocols are better established and preventive care is returning, put forth the effort. Sadly, we are not a benefit to employers as people, only as a way for them to make money.

CONTINUING TO WORK AFTER LAYOFF: THE GOOD, THE BAD AND THE CHANCE TO TAKE THE HIGH ROAD

Though I still have some shame admitting it, I mentioned in my previous blog post that I called off from work the day following my layoff. After lying awake at 3 am staring at the ceiling in my bedroom, I did not think I had enough sleep to drive safely to my office or think critically for the patients I had scheduled. My co-workers and support staff were told at an impromptu meeting the same afternoon of my layoff that my position was eliminated, so I was spared the embarrassment of having to tell them myself. Still, not being there made me feel cowardly.

Perhaps there was still some blessing in me not being there the day following my layoff. It gave me some time to process the news and call my close family to notify them. It also gave me time to get the tears out and build-up some resiliency for the next day when I would be returning full-time. The day of my return was definitely different. Very few of my co-workers spoke to me, and although I was certain it was not done out of discourtesy, it made the day long and isolating. The truth of the matter is that your co-workers are now former-co-workers, and they simply just don’t know what to say. They do not want to hurt your feelings or they may even feel scared about losing their job themselves. In general, avoiding uncomfortable situations and conversations is easier than facing them head on, so I think that’s how most colleagues–no matter how close you are–will respond. I found the best course of action was remaining as much my normal self as possible—saying hello, cracking the odd joke, and attempting to make light of the situation. It’s sad, but you have to be prepared for this change in your work relationships.

Continued interaction with patients after the loss of your job is another issue you’ll have to contend with. I would recommend taking time to practice what you will say to your patients. Sometimes this may be one of the first subjects you will bring up in an encounter, but with others it may be one of the last things you discuss. I found that for new patients (which I was still seeing despite my lay-off) informing them right away that they would be reassigned to one of my partners was best. It laid the groundwork that although I was still there for them, there was a limit to how much I could do in the time I had left. It also allowed us to discuss a transition plan right off the bat, which most patients appreciated. For my previously established patients—some of whom I promised I would be there for—I sometimes waited until the last part of the visit so I would not affect their agenda or cause them more worry. This experience telling patients about my job loss was sometimes quite humbling and their individual reactions varied quite a bit. Some were sad enough to cry, others incredulous that this could happen to a doctor and still others were very angry (though none of them directly at me). I was even able to commiserate with a few of my patients who had also recently lost their jobs due to COVID, and I think they appreciated my candor. With some of them it was even a bit cathartic—the expression that misery loves company certainly rings true here!

Overall, I truly do feel it was my duty to notify them if I was seeing them face to face. Although they would receive a generic letter in the mail stating I was no longer working in the office in a few weeks, I was happy that at least some of my patients would know that leaving them was not something I wanted to do. This interaction gave both my patients and me some peace. It will also allow you to steer your patients towards another physician that you think would be a good match for their personality or medical needs. Most of my patients appreciated a recommendation for a colleague directly from me, so be prepared to answer who will be available to take over once you leave.

I believe the most difficult thing to do during this work period was to maintain composure. At times I would find myself quite sad, often to the point of tears. It was surprisingly much easier than I thought to avoid crying at work—perhaps because I felt I had so much work to complete before I left. However, at home this was much more difficult. I had started divorcing myself from social obligations already due to the pandemic, and then found myself further isolated because I was no longer going out to get take-out food, run errands or pay for entertainment services in an effort to save money. This left me with little to do other than deliberate my own thoughts and try to occupy my young children. More difficult was trying to avoid the bitterness that was setting in. After all, I was still working extremely hard, but for no discernible benefit to my career. My moral compass and my desire to avoid risking the loss of my severance package kept negative behavior and words in check. Some of my colleagues remained a sounding board for me behind closed doors and I was grateful that they allowed me to vent my frustrations and remained a sympathetic ear. On my last day at the office they even threw me a going away party—properly distanced of course. It was one of the saddest parties I had ever been to, but I was grateful for the experience and the well wishes.

For those physicians working in a less collegial environment than I was, your transition out of your former practice may prove more difficult. Perhaps you had not grown close to colleagues due to differences in opinion, schedules or physical separation. In those situations, I would work hard to try to avoid cynicism while at your workplace. Remember that regardless of your feelings about your employment or worth, the organization has made its decision. The only thing you have control over now is you and the reputation you leave in your wake. I recommend thinking twice about any comments you make before they leave your lips and waiting at least 24 hours before sending e-mails to colleagues or management if you’re feeling frustrated when you write them.

COMBATING NEGATIVE SELF TALK: REBUILDING YOURSELF AFTER YOU’VE BEEN TORN DOWN

Asking myself why I lost my job was the first part of trying to move on. I already enumerated the reasons for my job loss above, but despite hearing from the administration that it was “without cause” and that it was financial reasons that led to my layoff, it was extremely difficult not to take the whole ordeal personally! I started to question my abilities as a physician—what was it about me that made me so expendable? Why was I not good enough to keep on the payroll? Had I done something wrong they weren’t telling me about? Had I said something off-putting to a patient or colleague? What was being said about me now behind my back? Would I ever be able to move past this? Not everyone falls into this rut of self-doubt, but I warn you that perpetuating negative emotions by thinking negative things about yourself will be far more ruinous to your career than the layoff will be.

First, you need to remind yourself that you are still an intelligent, educated and dedicated individual with useful skills. Even if you’re having a hard time believing good things about yourself at the moment, there are still people out there who believe this of you! Remind yourself that the reason patients, family and friends have confidence in you is because you are exactly the person you were before the layoff—a good person and a good physician! Surround yourself (as much as possible in this pandemic) with those who support you. Do things that remind you of the good you’ve done. I have kept a file of old thank you notes and accolades from previous jobs and patients dating from residency onward. I keep these next to all of my other career paperwork so that each time I’m moving on to a new position I’m reminded of the lives I’ve touched. If you don’t have something similar look at creating it now. It’s a morale boost and a reminder of why we’ve all entered this field in the first place.

The next best medicine for recovery from your job loss is healthy outlets. I’m not saying you can’t go home those first few days and have ice cream for dinner or watch some cathartic movie about the bad guy getting his comeuppance. A little self-leniency and a feeling of vindication can be healthy at a time like this. On the other hand, if you stick with this too long, you’ll just turn into a person who can’t fit into their interview suit or answer an interview question without sounding jaded. Remember, this is a time to take care of yourself. Eat right. Get back into a reliable sleep schedule. While we’re on the subject remember to keep a schedule. Set up times where you sleep, job search, study, relax and exercise. If you continue to keep your body and mind in the habits of those you had when you were working you are likely to find it easier to adjust when you do get back into the workplace. I mentioned before that I had canceled entertainment and social engagements to save money. This does leave me with more time to search for work and complete the CME I need to become a more attractive future employee. It also leaves me time to spend with my family and renew interest in those long-lost things called hobbies. I dusted off the old piano my mother gifted to me and started playing again. I’ve finally had time to use the bicycle I purchased three years ago that I never found the occasion to ride. Don’t take this unexpected time by yourself for granted. Do the things you wish you would have had the time to do when you were working.

TURNING A NEW LEAF: TAKING THE OPPORTUNITY TO GROW INTO SOMETHING NEW

It does sound cliché, but when one door closes another one opens. If you don’t start looking at your lay-off as an opportunity you’re going to miss out. Rarely do we find the time in our working lives to set aside to devote to something new. Was there something your old position lacked that you’d love to do in a new role? Have you wanted time to pursue something completely outside of medicine? Now you have the time to find this new passion in your next position. If you are fortunate to have at least some emergency funds or a spouse that can cover expenses for short while, then using this time off to find a job that is truly a good fit will be worthwhile. Try hard not to let fear or desperation get the better of you—remember, you are a doctor and somewhere there is a place for you where you are wanted and will be valued. If you do not have the benefit of financial support you may need to find work sooner rather than later. This is still okay! Even if you have a job doing locum tenens or per diem work look at it as an opportunity to network or see what other employers have to offer you.

Now is also the time to ask your own questions about job satisfaction. Were you really happy where you were before? What did you like about your job and what drove you crazy? Before you leap into your next position you should really delineate what your ideal job would entail. Perhaps now is the time you want to be your own boss or do contract work rather than being employed. Possibly you desire a change in practice environment or even the place where you live. Maybe work in an educational setting has always been an unfulfilled desire or work abroad has piqued your interests. Setting up lists of pros and cons about work may help you decide what to look for in your next position. Assigning numerical importance to these lists of pros and cons can further help in decision making. Remember that the qualities you desire in your workplace must also meet your needs for self-sufficiency and those of your family. Always consider that it’s difficult to have a dream job when you can’t live the life you want outside of work because of it.

Though it’s easy to fall prey to the feelings of worthlessness you have after a lay-off, try to treat yourself with grace and dignity. Give yourself the same patience you would give to a friend or patient that was going through what you are. It is not an easy time, but if you have the endurance to make it through the educational experiences and work experiences you’ve had before now, you must come to the realization that this is just a small bump in the road of a successful career. You may just find yourself a new person on a better path because of this experience.

Blog Post Excerpt from MDObvious.

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