What early retirement taught me about burnout and purpose [PODCAST]



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Susan Landers shares her heartfelt journey as a neonatologist navigating the challenges of burnout, the rewards of practicing medicine, and the complex emotions surrounding early retirement. From her intimate experiences in the NICU to rediscovering purpose through hobbies, writing, and grandparenting, Susan’s story offers valuable insights for health care professionals and working parents alike. Join this reflective conversation about resilience, fulfillment, and finding meaning beyond the stethoscope.

Susan Landers is a neonatologist.

She discusses the KevinMD article, “Early retirement may not be the solution to your burnout.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Susan Landers. She’s a neonatologist. Today’s KevinMD article is “Early retirement may not be the solution to your burnout.” Susan, welcome back to the show.

Susan Landers: Kevin, thank you for having me. I think this is an important message for physicians today because so many of us are burnt out, have been struggling along for years, even before and certainly during the pandemic. My burnout happened later in my career when I was 62 years old. I was working full time in the NICU. My schedule was better—50 hours a week. It had been in the past 60 or more hours a week. But I was still taking night call, running to emergency deliveries, talking to parents, coding babies, the whole bit of ICU work.

It suddenly was more tiring than I had ever felt, and I thought, well, that’s just being 60. Then I became emotionally exhausted, and the cases that were difficult ethically really bothered me. There was a lot of disagreement between Neos about what to do about a 23- or 24-week gestation baby, and those didn’t used to bother me so much because it was always between the doctor and the parents. We had a baby who had a lethal birth defect, and she ended up going on dialysis, which was really ridiculous in my mind, because her birth defect could never be fixed, and she couldn’t be transplanted. She didn’t have an adequate pelvis and could not have a kidney put in her abdomen.

That case kind of tipped me over the edge, and I became emotionally overwhelmed. My husband was the pediatric nephrologist taking care of this baby, and we both felt very strongly that her care should be terminated, and we advised that to the parents. But her care persisted because some of my partners wanted to press on, thinking that she would have a good quality of life for some time. Anyway, then I began to get really cynical and really sarcastic. When I finally one day was rounding on a different set of babies, I wondered to myself, what was my purpose?

You know, that’s the real key to feeling burnout—when you feel like you’re no longer making a difference, when you’re just going through the motions of what you’ve done for months or years, what you trained to do, and all of a sudden it has no meaning. It’s not fulfilling. And you ask yourself, what in the world am I doing?

Luckily, I recognized burnout. I had read about it. I recognized it and knew I had to change. Because of my age, I asked my practice group to allow me to go to a different nursery and to work part time, which were great decisions. I immediately felt a weight lifted off—less rigorous work, less night call, a whole different location, a bunch of nurses and obstetricians who were nice to work with.

That change, that pivot—still in neonatology—allowed me to recover from my burnout. I did other things. I went into therapy. I met with friends and colleagues and had lunches and coffees and laughed and reminisced. I exercised like a banshee; it really improved my mood. I quit drinking for a time, and I did some journaling. I’m not very good at that, but I did some specific things to recover from burnout, and they worked. They worked within about a year. If you’ve got longstanding burnout, it doesn’t go away in a month off or a quick job change. It takes a while, and if you have ethical issues and moral issues, it takes even longer to go through all that with a therapist.

But I did recover from burnout, and I thought, well, this is a pretty nice life. I didn’t think it soon enough. I didn’t think working part time in a different nursery was any kind of life. I just thought of it as a precursor to retirement, as sort of an easing back, when what I had done was recover from burnout. What I thought I needed to do was go ahead and retire. So I was only 64 when I retired. Some people might consider that old, but a lot of people work well into their 70s, depending on how rigorous their specialty is.

After I retired, I was so bored, so adrift, so without a purpose, without meaning in my life. You know, retirement happens in a number of stages. There’s a great Ted talk by Dr. Riley Moines—M-O-Y-N-E-S—about the four stages of retirement. The first one is vacation—you do whatever you want, wake up when you want to, you have no schedule. The second one is loss, and the loss phase hit me really hard. I felt like I had lost my identity, and I had a hard time coming to terms with that. Again, what was my meaning? My children were all grown, out of the house, and if I wasn’t practicing medicine, what was I doing?

The third phase Dr. Moines talks about is trial and error, and I went through trial and error writing a memoir, being on podcasts, starting a newsletter, speaking to groups of physicians, and all of that was somewhat fulfilling—but not like practicing medicine. The final phase Dr. Moines describes is service to others, and I’m not there yet. The whole point of me telling you about these phases is that my loss phase in retirement was very significant. I felt like I’d lost my identity, my friends, my relationships at work, my reason for all the 30-plus years of training and experience. The trial and error phase was very problematic because I wasn’t very good at the things that I was trying, and I had been very good at practicing neonatology.

I want physicians to understand that when they retire, it is a major change in life. It’s hard to go back from retirement. I guess I could have bopped back into the nursery and asked to do something easy, but here I am now in my 70s, and I still miss practicing medicine. Maybe it is that some of us go into medicine to get the strokes and the kudos from patients and parents for all that we do for their loved ones, or maybe it’s just knowing how to do something really well that nobody else knows how to do. But I miss that so intensely. I think burnout makes us think that we’ve lost it, and then retirement, for sure, cuts it off.

So my argument is: If physicians are burned out, they should take the time to recover. They should pivot, change their workspace, change their lifestyle, move to a different practice—whatever they need to do—take six months off. But don’t quit medicine. Recover from burnout; stay in medicine, because there’s nothing on the planet as gratifying as practicing medicine. That’s the message of my piece.

Kevin Pho: Do you ever have thoughts about going back to medicine?

Susan Landers: I do, and because I let my Texas license lapse—like a silly person—I can’t do that easily. I could do consulting, but younger doctors, in general, don’t want to do that. I’m going to talk very much to an older doctor. I remember when I was in my 30s, listening to an older pediatric cardiologist tell me what she thought about a patient. I distinctly remember thinking, how could she know what she’s talking about? She’s so old.

I think that being a very old physician—my husband had the same feeling when he was 72 and retired—he felt like his patients needed somebody who had a more agile, brighter mind. So going back now is out of the question because I’m 73. Although writing about medicine is gratifying, and writing my memoir was gratifying. Yes, I do think about going back, but it’s going to be much harder for physicians to go back once they’re out. It’s almost like you have to reapply yourself and get privileges and get licenses and the whole bit—that takes one or two years sometimes. So the caution is: When you recover from burnout, don’t ditch medicine.

Kevin Pho: Now, as you reflect on this, and you went through decades of practice and you felt burnout, do you ever wish that you went on a part-time basis earlier on in your career rather than later on in your career?

Susan Landers: Yes, and I did. My older daughter, at age 16, developed an eating disorder. She stopped eating at the beginning of her junior year of high school, and I recognized it before her pediatrician did. I took time off; I pulled back to half time for a year to make sure that I could get her the care she needed—the therapy, the treatment—to be around, to talk, to be a mom, because I had been working too much. I was really lucky that my practice let me do that. So when I had a major emotional family crisis—a psychiatric crisis, an illness that needed my attention—I was able to pull back, go part time, and take care of my daughter. They let me jump right back in full time without missing a beat.

That’s the other message: If you’re overwhelmed in your medical practice, go part time. It’s only temporary. If you can’t find a practice that will let you work part time, find another practice. I have young pediatrician friends who set up a practice—all women, all mothers—to work three days a week from the get-go. I used to think, oh, they’re wasting their degrees, they’re wasting their time. Why’d they go to medical school and train to only work three days a week? They’re some of the happiest people I have known in my career, because they did not let medicine be everything in their lives. They were equally pediatricians and equally mothers. And I guess that message is: Pull back to do what you enjoy, but don’t let it overwhelm you.

Kevin Pho: Is there anything that hospitals and medical institutions can do? Because if we have all these physicians pulling back and going part time, that’s probably not going to help a lot of the hospitals. So are you saying that there is no way to practice medicine full time without getting burnt out? Is there anything hospitals and our administrators can do to keep physicians practicing medicine full time, or is that the nature of the job? Is that impossible?

Susan Landers: It’s not impossible. It’s not the nature of the job. We know that some specialties are higher risk for burnout than others, especially the hospital-based ones. Hospitals can do a better job of using the tools that groups like Cleveland Clinic and Stanford have developed to assess physicians’ degree of burnout. There are simple tools that doctors can use to rate themselves. They’re not talking to each other—they’re too scared of stigma, I guess—but they’ll write it down on a piece of paper. There are plenty of studies that show that physicians who fill out forms rating their own burnout, who then get help from a support group, a facilitator, a psychologist—University of Chapel Hill at North Carolina did gorgeous studies looking at physician burnout and support, teaching physicians how to handle stress the way they teach the military how to handle stress.

They took emergency department physicians and taught them all about the phases of stress and how humans handle stress and how humans should deal with it, and they measured doctors’ levels of burnout before and after that intervention. It made a huge difference. So yes, hospitals and big practices—HCA, Ascension Health—they can do something. There are tools out there for measuring how physicians are doing. There are programs for addressing physician burnout. We do not have to be on death’s door to get help from the people we work for or work with. I think it should be part of quality improvement. I think it should be part of JACO—that how physicians and nurses are doing is a measurable, finite thing that can be addressed. And staff wellness is just as important as patient satisfaction. We all know that hospitals love to ask patients how they’re doing and how they’re feeling, and what was their experience. They’ve got to start asking the doctors and nurses the same thing. When they do and use those tools that have been developed and tested, physicians won’t be on their last leg when they decide to quit.

Kevin Pho: We’re talking to Susan Landers. She’s a neonatologist, and today’s KevinMD article is “Early retirement may not be the solution to your burnout.” Susan, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Susan Landers: When physicians are on their last leg, feeling like they’re approaching burnout, or they’re sure they are burned out, please get help. Talk to a trusted colleague. Talk to a person in your institution that will not have stigma that you’re burned out or depressed.

Do not just go home and talk to your spouse. Do not go home and drink alcohol. It only dampens your feelings. It is no solution. There are plenty of studies that show that alcohol and marijuana use do not help burnout—they make it worse. But therapy is available, and support groups are available, and some hospital systems have developed physician support groups. Talk to your administrator. Find out what there is available for physicians. Many of the hospitals now have programs for nurses, and the better ones probably are heading toward programs for doctors. Burnout is not a hopeless endpoint. It is just overwork, overdone, lack of purpose, and it is something from which we can all recover.

Kevin Pho: Susan, thank you so much for sharing your story, time, and insight. And thanks again for coming back on the show.

Susan Landers: Oh, thank you, Kevin. I appreciate it.


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