A Word About the Grass-is-Greener Fallacy

In this week’s blog, I’d love to discuss the grass-is-greener fallacy. I don’t pretend to know all the answers, but hope to spark some healthy reflection for you, especially if you find yourself in that boat.

First, I want to validate that if you are practicing clinical family medicine or academic family medicine, no matter what form it takes – you have a challenging job. The challenges are deep and broad. Most of us are partially or fully employed as opposed to owning our practices. The autonomy that was once granted even to employed physicians has eroded. There are some organizations that only focus on the bottom line and forget about the service part. Money and organizations aside – there are more patients than we can care for in the way we prefer. EHRs and insurers complicate matters. Our patients are more complex than ever. Access to care compounds the complexity. The explosion of medical knowledge is challenging even for the most specialized. I am not here to gaslight you. This work is not for the faint of heart.

It has always bewildered me that there was a perception that doctors who aren’t “smart enough” for a subspecialty should choose family medicine. I honestly believe it’s one of the most challenging roles in the physician world. Now, I don’t want to get us off track by specialty comparisons – because it is a complete waste of time. We – and our patients – need all the specialties! I also don’t want to go down the wormhole of justifying our existence to those who don’t understand. I grant them the grace to be wrong about me – you – our profession. I need to focus my bandwidth on more worthy causes.

Secondly, let’s just put it out there that some of you are in toxic work environments that are not healthy for you or your patients. I’ve coached some in impossible situations with demanding bosses and a severe lack of resources and support involving psychological torture. Not the majority of family docs, but a small minority – and truly, the answer for you is to get out ASAP.  Your situations have me always coach residents about accepting jobs in which they set themselves up not to be stuck.

Thirdly, I want to acknowledge that changing circumstances can be helpful even if you’re not in a toxic situation. One of the physicians I’ve coached explained how she didn’t need any coaching around burnout because she had addressed that by hiring a scribe and two additional partners to help with the workload. I personally recovered from my burnout in a clinical setting that provided me time with patients and amazing support for the clinical work, and one in which I didn’t have more work than I could do during business hours. Unfortunately, I didn’t learn any of the tools to prevent burnout in more “normal” clinical settings.

What do I mean by more normal settings? Well, that office is somewhat of a dying breed. Only 30% of family physicians work in independently owned practices, according to the latest in the recently published Family Medicine Factbook. (That’ll get Dr. Una fired up!) 

By more normal, I mean seeing patients in an area that doesn’t have enough primary care physicians, where pressures exist to double book, work people in, and have shorter visit slots than can address all of their needs. That is the current reality for most.

So with all of that covered, the main thing I want to focus on is avoiding the grass-is-greener phenomenon.  And I’m not even talking about a job hopping. I’m talking about being at the fence and constantly feeling like your pasture isn’t as good as 2 plots down. That’s a terrible state for you mentally and emotionally. I’ll demonstrate.

Even in that “ideal” practice, I recovered in – prior to having a coach and learning some of these tools, I found myself venting to one of my colleagues on more than one occasion. Old patterns lived on. It turns out there’s truth in the saying, “Wherever you go, there you are.” Fortunately for me, my friend took the opportunity to share her mindset. She explained putting up with these issues in her mind trumped other issues in other practices, and that always kept her grounded. There are trade-offs with any job. 

So, I began to retrain my brain. I came across a video from Brian Sexton from Duke in which he discussed a gratefulness study on internal medicine residents. The residents who instituted the practice had decreased depression, decreased burnout, increased work-life balance, and better interactions at work. 

I shared that video with the residents during a lecture on about a clinical topic a few weeks later. Many found it hopeful. But one resident, historically one of the most upbeat and caring physicians I’d known, was uncharacteristically grumpy about it.  The following week, I was precepting him in procedure clinic. We chatted about it, and he had so many residency criticisms (all true), and I asked if I could tell him a couple of things from my work in the private office. He remarked, “I know, I know, Dr Caylor – you have the “perfect clinic” and life is great!” I explained that’s not what I wanted to discuss. I told him how 1. The x-rays in our clinic are taken by MAs, who get only a couple of hours of training. Often, we have to have them retake the films. I'd had specialists remark on the quality.  2. I explained that our MAs go off to nursing, PA, or medical school right about the time they are excelling in their roles, and we have to start from scratch again. 3. Our EMR doesn’t have a way to identify who the PCP is, and so often, I’m seeing my colleagues' patients and vice-versa.

He paused considerately and said, “That stinks!” And I explained that when I allowed myself to focus on those things, I could get myself worked up and frustrated. And how “what we focus on expands.” However, due to my grounded colleague’s modeling, I slowly learned to switch to looking at the things that were working well and those that I’m grateful for. We talked about overcoming negativity bias. I think the conversation was helpful for both of us, as it reinspired me to keep up the mental work. He was able to come up with things that he enjoyed about being a doctor, even as a somewhat crispy resident.

I reflected on that memory at a recent physician conference where the speaker, Cy Wakeman, asked for a show of hands if they had a difficult person they had to work with on a regular basis. Here’s the picture I snapped:

I thought, what if everyone who has to work with difficult people, thought they would be better off somewhere else? Unless it’s in a solo hut off the grid – chances are good they’ll replace one for another.

Cy then asked for someone to take the mic and explain their situation. A woman took the mic and told about her boss and others in administration, who expected more than she could give, they didn’t listen to her or anyone… the list of offenses went on with angry passion in her voice as we all nodded in sympathy for her. Some shouted – “Leave!” And others nodded as Cy was writing furiously. Then Cy, in her unique way, said I’ve written down on the left side of this paper “This” and on the other side “That.” Let me read you the “This” – she read all the things off. Then said, “This is story – this is your narrative.” She then read the items under “This,” which had about 3 things. She has a boss. The boss sent an email saying “xyz”. And something else.

And then she tore the paper in half, crumpled up the right side- the “That” side and tossed it on the ground. She said, now that we’ve dropped the drama, I’m going to read you the “That” again. And after reading the facts, she said, now, what’s the next thing you want to do with just the facts of the situation? She, and all of us, became grounded and calm. It was true. She gets to decide what she will do with the facts. And she can do it in a way she’s proud of.

So, I invite you to remember and accept (without endorsement) our current healthcare reality in the US, focus on the things that are working well in your sphere, and then perform your own “This” and “That” exercise. What’s left? With the drama dropped, what’s the next best step for you? You get to decide. Choose your hard.

And whether that’s crossing the fence, working on your mindset to see if you want to stay first, changing how you engage and influence your own system for good, just shifting your perspective and finding joy where you can – deciding system change doesn’t belong in your lane, I support you. This work matters! What you do matters!

There's not a person I work alongside clinically or academically that I'm not appreciative of. The only thing I hope for all of you is that you lessen the unnecessary pain caused by yearning for pastures that have their own sets of weeds.

Next week, we will move on to a blog series of procrastination and decisions.

Until then, Have a joy-filled week!  Tonya