This is right on time.

In the news, media and professional organizations, work-life balance and burnout is all the rage. I’m proud to introduce the 2nd volume of our work to you, released by my publishing company (Swiner Publishing Co.) which became a #1 Amazon best-seller this month: Thinking About Quitting Medicine, vol. 2!

It highlights the struggles that medical and dental providers go through in figuring out what they really want to be when they “grow up.” Don’t be turned away, though, because it’s not just for the medical field. It speaks to a broader issue of burnout that all of us can experience in life and work. Here’s an excerpt from our book, including our Intro and my Chapter about my personal life.

Get your full copy, on ebook here: www.bit.ly/taqmvol2 or printed version here: printed book

INTRODUCTION

It feels so good to be back here!

Your response to Volume 1 was out of this world. From showing up to support our visionary physician authors across platforms to showing up at the book launches in Atlanta and Durham, you have let us know that we are tuning in to your frequency.  You are Thinking About Quitting Medicine and you are ready to do more than bellyache about it. You yearn to feel alive and passionate and in love with each new day again. You long to feel that sense of pride after each task completed as it feels connected to your higher purpose.

You want that feeling of fulfillment that is spreading through the internet world, but you can’t seem to figure out how to manifest that in this life, this hospital, this clinic, this call room, this phone call, this procedure.  Maybe you’re bogged down from the new EMR with each hospital administration change. Maybe you’re over the 18-year-old-sounding snarky insurance guy that you get to talk to before you work your way up the chain of command. It shouldn’t bother you as much as it does. It’s a little thing added on to so many other little things and it feels like death by a thousand cuts.

In numbing the stress of the day grind out you may have shut out your emotions and somewhere along the journey forgotten how to turn them back on.

This is the place where the culture and media will throw around phrases like imposter syndrome, emotional exhaustion, burnout, stress-induced executive dysfunction and roll out charts and checklists.

This is not that book.  Our physicians dug deep and found the courage to tell their stories and serve as their contribution to the world.  Sure, they may pepper the above phrases into their lives here and there, these phenomena are real and there is no denying the physician suicide crisis.

In this book we bring you a reminder that there are other ways to interpret your current situation with an eye on the possibilities. Each physician-author’s deeply moving vignette takes you through what they felt that led them to think about quitting medicine. In each journey, you’ll discover that despite fears similar to yours, setbacks, trials, and tribulations, they chose to continue to believe. They chose to continue to imagine and to walk in their purpose.

We welcome you to volume two. We invite you to join our authors on the Thinking About Quitting Medicine page where you can continue to build a deeper relationship with each of them.  Come share your story with our docs so they can help you see what’s possible for you.

Thank you once again for your continued support.

Nicole and Mani

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Voted 1 of 10 Best Doctors in NC in 2017, DocSwiner is a family physician, two-time best-selling author, blogger, speaker, wife and mother in Durham. She is also affectionately known as the Superwoman Complex expert and has written two best-selling books on the topic. She loves taking care of the family as a whole—from the cradle to the grave. Her interests include minority health, women’s health, self-care and entrepreneurship. She attended Duke University and went to medical school at the Medical University of South Carolina in Charleston, SC. She’s lived in the Triangle (Durham, NC) since finishing residency at UNC-Chapel Hill and continues teaching as an Adjunct Associate Professor with the Family Medicine department. When she’s not treating patients at Durham Family Medicine, she’s speaking locally and nationally, blogging, teaching others to self-publish and spending time with her family. Her passion is making medicine “plain” to her patients, so that all people, from all walks of life, can understand how to take better care of themselves and their families. She often blogs, guest blogs and speaks locally and nationally on these and other topics. She is also available as an influencer and brand ambassador, as she’s previously represented SheBuysCars, Hyundai, prAna clothing, DurhamKnows HIV awareness and Scarlet Myth Cosmetics. Contact her at cnswiner@gmail.com for further information.

S: 40-year-old (still) full-time doc, publisher, speaker & consultant, continuing to seek joy and balance in work, family and love.

O: Happy, yet not settling for contentment. Still working on “baby” weight five years later, but unashamedly enjoying good food and wine. All faculties secure and intact.

A: Superwoman (#nosuperwoman) in full effect

P: Has given up on the myth of work-life balance, and now will work on more work-life integration. Here’s how:

DocSwiner’s Story

I turned 40 this year, thank God. Leading up to this milestone birthday, I wondered what kind of emotional and mental changes I’d experience. Nothing much changed, except for my tolerance and patience, a bit. I now know what I want out of life and work, and I’ll fight my hardest to achieve.

Today, as I write, on 7/23/18 at 4pm, two (a mother and daughter pair) of my most challenging patients “let me have it.” They’ve noticed that I’m no longer in clinic on Mondays and Fridays, and on days that I am here, I’ve included some telemedicine slots with my clinic appointments. The elderly mother is none-too-pleased, as she mentions that I should have “thought about that before I went to medical school, if you wanted to work less and take more time off.” Two or three years ago, this would have upset me at the thought that she felt I should let my career and patients control me and my happiness in this way. Today, I laughed to myself and to her middle –aged daughter, who looked at me apologetically and was horrified that her mother would talk to me in such a way. I patted the daughter’s knee and reassured her that I was ok with it, and just said I was “unbothered.” The truth is, I understand and understood where the mother is coming from—she’s used to the old fashioned doctor (and, the old fashioned me) that was at her every beckoning call, would freely work her into the schedule whenever she needed and drop all things to make her happy, even while she was being belligerent to me and the staff at times. The new practicing physician in me now knows that I’m worth more than that.

I’m not going to explain to every one of my patients (I will to some if asked in the right fashion) why I’m making the decision to cut back to three days a week in clinic and work from the home the other two; but I will explain to you. As I finish this chapter, sitting next to my co-founder, Mani, on a Friday morning, in DC at Busboys and Poets (a restaurant and bar I’ve always wanted to come to), I feel blessed. I’m trying to create a lifestyle and career in which I can work remotely. My kids are now in Kindergarten and second grade, and I’d love to be home more for them and go on some field trips. I’m loving the career consulting and publishing work I’ve been doing for the past three years, and I want to be more free to travel to speak and meet clients. The next step may be to become licensed in other states, so I’m able to do telemedicine visits even when I’m on the road. I think the options are endless.

So, my friends, don’t feel stuck. The road of out your rut or funk may be filled with obstacles, but it’s not impossible to traverse. If you need help—emotional, mental, financial, strategic—then don’t be afraid to reach out to mentors and experts. Create the work-life balance and integration that you desire.

Thinking About Quitting Medicine, vol. 2

Swiner Publishing Co., 2018

The doctor is out? Why physicians are leaving their practices to pursue other careers

“After 20 years, I quit medicine and none of my colleagues were surprised. In fact, they all said they wish they could do the same,” said one doctor.

by Nicole Spector / Aug.18.2018 / 3:54 PM ET

The Association of American Medical Colleges projects a shortage of 42,600 to 121,300 physicians by 2030.Getty Images

The news that New York University will offer free tuition to all its medical school students, in the hope of encouraging more doctors to choose lower-paying specialties, offered hope to those wishing to pursue a career in the field.

However, becoming a doctor remains one of the most challenging career paths you can embark upon. It requires extensive (and expensive) schooling followed by intensive residencies before you’re fully on your feet. The idea, generally, is that all the hard work will pay off not only financially, but also in terms of job satisfaction and work-life balance; then there’s the immeasurable personal benefits of helping people, and possibly even saving lives. In terms of both nobility and prestige, few occupations rank as high.

So why is there waning interest in being a physician? A recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.

There appear to be two main factors driving this anticipated doctor drought: First, young people are becoming less interested in pursuing medical careers with the rise of STEM jobs, a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed.

“There are definitely fewer people going to [med school] and more going into careers like engineering,” Fowler told NBC News.

Fowler also speaks to the desire among millennials to be in hip, urban locations — a luxury you likely won’t get when you’re fresh out of medical school and in need of a residency.

“This is why places in middle America hire firms like ours,” Fowler said. “They’re having a harder time attracting people.”

But perhaps the more interesting story lies not with those deciding to eschew medical degrees; it’s with the people who went through all that training, who became doctors — and then decided to opt for another path.

This drastic career change can be a result of new med school grads being unable to find a residency within a reasonable period of time.

“Graduating med school doesn’t mean you’ll get into a residency,” said Fowler. “There aren’t enough residency slots for medical grads. So you have that population of people who have an MD but didn’t practice for that reason. There is this bottleneck effect.”

The mounting bureaucracy

This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”

And then there are those doctors who left medicine because the cons of the job started to far outweigh the pros.

“After 20 years, I quit medicine and none of my colleagues were surprised. In fact, they all said they wish they could do the same,” Dr. Amy Baxter told NBC News.

“I began to feel like an easily replaceable cog in the health care machine. With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.”

Baxter left pediatric emergency medicine to head a company that develops physiological products for personal pain management.

Dr. Ha-Neul Seo, director of global recruitment at EF Education First in London, was a general practitioner in the U.K. for several years before heading to the U.S. to study health care management and policy. She wound up leaving medicine to focus on education because she felt, to some extent, she’d defaulted into a career that turned out to be more tedious than expected.

“As a patient you want your doctor to love and be passionate about their work — and I realized that wasn’t me,” Seo said. “Some parts were incredible, but the moments when I felt I was making a true difference were too few and far between. And then there was the issue of work-life balance. I had my first child and was barely seeing him. The schedule was relentless.”

Dr. Nicole Swiner, a physician and author, has stuck with being a doctor because she loves it so much, but she deeply empathizes with those who decide to leave.

“It has gotten worse for all of us, unfortunately — whether you work in the hospital or in the outpatient setting,” she told NBC News. “We are burdened more by nonmedical business or insurance professionals without any medical training. It’s disheartening. ​I have transitioned to more part-time clinical work [so as to focus more on] speaking, writing and consulting.”

“Become a full-time consultant, author, speaker, entrepreneur, baker, cheerleader — whatever. Just be happy. Life’s too short,” Swiner said.

Hey, good people!!! So, if you didn’t know I recently joined the 40 & over club this past April. Since joining I have now gained a new characteristic of not caring much about anything but the things I love. I have also re-created my work schedule where I will be in the clinic for only three days, with doing more tele-work from home. It inspired me to post some ideas and questions on Instragram in my Instastories and received some great feedback.

…and what perfect timing it was when I came across an article titled “People Over 40 Should Only Work 3 Days A Week, Expert Claim“….

Click here to read the article.

But while reading the article, it made me think…

Life is expensive! So working 3 days a week is taking a financial back step, or a financial cha-cha, depending on how you look at life. Me? I say let’s dance baby…let’s dance.

But okay, I understand. Working 3 days may not be financially feasible. So that leads me to remember some tips that helped me.

Planning takes time, organization, and dedication. Set some time aside to prioritize your goals, and write them down.

Work less and live more! Life is more than work. You have to enjoy your free time; wait…you have to have free time to enjoy! If you feel that you are working too much, then cut back some on some work. Also, just learn how to say no.

So these next two tips are personal boundaries we have to set for ourselves. And although it will be tough, and take some time to master…I know we can do it!

In addition to the article, I wanted to add a quote from two debt burden and financial experts Drs. Nii-Danko and Renee Darko.

“The debt burden for many physicians and other professionals can be a major factor in determining if cutting back hours is financially possible. For us, significantly decreasing our debt burden allowed us to not only cut back on the number hours that we worked, but actually allowed us to live on Nii’s salary so that Renée could primarily stay at home once our baby was born. Without so much debt, your income can really go a long way.”

If the article and above quote aren’t enough encouragement to cut back, then I don’t know what it! Also, find encouragement and inspiration from your tribe; your community. A good friend of mine tweeted this recently:

–right on time as I was writing this blog. Cutting back is required at times to practice healthy self-care.

Now, I don’t want you all to think that I don’t understand how hard it is to step back from our income. It’s easier said than done. However, I have confidence that we (the 40 & Older Boss Group) can cut back some days to enjoy our life! Let’s take control of our time & finances so we can live our BEST LIVES!

As Lil’ Duval says…….

My comments were featured in a recent article in Healthline Newsletter!

If you are “addicted” to eating ice, take a look here or read below to find out one reason why you might be.

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Why Do You Crave Ice?

I’ve had 2 wonderful opportunities this month to be in Essence Magazine! One on their #snapchat format, and the other online. Of course, I am beyond excited and would love for you all to check out the articles here or below!

You can also find the snapchat posts through my IG posts.

Enjoy!

Written by: Michelle Darrisaw, Essence Mag

May, 30, 2018

The Many Different Types Of Anxiety And Depression

Here’s an article I penned in 2010 around this time of year. Still very relevant…..

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This month makes a year that I’ve been writing articles for medical education. My first article centered on the issue of depression and being self-aware of the warning signs.

Here are some of the most common stress-related disorders that I see on a daily basis.

1. Depression and anxiety/panic disorders. This is pretty easy to understand. The more stress a person has, the worse underlying mental health disorders can become. The stress of loss of a loved one, loss of a job or threat of losing your job, or a strained relationship can lead to overwhelming sadness or symptoms of panic. Insomnia and sleep disturbances can occur as racing thoughts and worry increase at night. Alcohol and tobacco abuse can also occur concurrently as ways to self-medicate in the absence of correct ways of treatment such as prayer, counseling, therapy or prescribed medication.
2. Hypertension and heart disease. Otherwise known as high blood pressure, stress can cause an increase in constriction of blood vessels. Stress has not been proven as a direct cause of high blood pressure, but it can have an overall effect on the release of hormones from the nervous system and circulatory systems, which makes it harder for the heart to pump blood to our vital organs. If blood pressure is chronically high and blood vessels have enough damage or cholesterol buildup, heart disease can be the result. Some chest pain can even be linked to stress.
3. GERD (acid reflux) and stomach ulcers. Emotional stress can lead to an increased production of acid from proton pumps and H2 receptors in our stomachs. If acidity is prominent, a burning sensation can be felt and pain can extend from the stomach (in the center and to the left of the middle of the stomach) all the way up to the esophagus and throat. Foods that we eat, including caffeinated beverages, spicy ingredients and citrus can make this worse. If left for too long, ulcers, or an eating away of the lining of the stomach, can develop and even worsen to the point of bleeding.
4. Obesity. Stress can cause an increase of the hormone cortisol to be released from the adrenal glands. Cortisol is linked to increased glucose (blood sugar) and weight gain. Also, while some of us eat less with stress, many of us eat more “comfort foods,” which are generally more sweet and fatty, and have more calories.
5. Headaches. Migraines are thought to be the most common type of headache, but tension is probably higher on the list of causes of headache. Both types can increase with stress. With tension headaches, a tense pressure or squeeze can be felt in any part of the head, usually with muscle tension and soreness of the neck and even shoulders. Migraines are thought to be associated with signals from the nervous system that relax blood vessels. When vessels relax, blood rushes to them and cause dilation. If too dilated, this can cause pain.
6. Abnormal menstrual cycles. Skipping a period can be very distressing for a woman, especially if unexplained. Although we don’t know what the certain cause is, it is thought that emotional stress affects release of certain pituitary hormones that can cause irregular periods. If weight is lost or gained due to stress, estrogen or a lack thereof, it can also cause irregular periods.
7. Viral infections. When we’re stressed or fatigued, our immune system doesn’t work as well to prevent us from infection. We all have antibodies from vaccines or from previous infections that have built up in memory cells and are programmed to increase when we are exposed to infections. Stress reduces this response. Colds can occur more frequently and, even worse, viruses such as herpes and HPV (human papilloma virus can show themselves during these “down” times.
8. Cancers. This one is controversial, as some studies say one thing and some say another. The conflicting data questions whether stress can be a direct cause of some cancers. In 2002, a study was done on patients who had breast cancer that was treated. The question was asked if stress could be linked to the cancer coming back. The study could not prove it to be true. However, in animal studies, an increase of stress hormones was linked directly to growth of some tumors. Long story short, the evidence is inconsistent, but there may be truth to the claim that stress can lead to certain cancers.

All in all, be self-aware of the signs. If you’re feeling overwhelmed, as we all at some point do, be pro-active by exercising, drinking plenty of water, getting good restful sleep and doing those things that you enjoy doing with those you love. If it still feels like life is crashing down on you or your body is breaking down, please see your doctor.

I contributed to an article featured on WeHaveKids.com. I shared my opinions on stomach issues in children. I share my support for using probiotics for an aching tummy. See here or read below!

Thanks,

DocSwiner

I think I might have a little S.A.D (Seasonal Affective Disorder) during the winter season, or I’m truly a Spring baby, having been birthed in April. One good winter snow and Christmas celebration, and I’m good on the cold weather. I’m almost immediately ready for the longer days, warmth and sunshine of the Spring, and our recent time at Unscripted Hotel here in Durham gave us a quick taste of what’s to come once the warm weather hits. My birthday trip to Cabo in Mexico definitely has me ‘feening’ for warm days, sitting by the pool and cocktails. I’m sure Unscripted can scratch that itch at home 🙂 Here are 3 reasons why:

1. The folks: Tabitha Rodriguez-manager extraordinaire of Unscripted- personally invited me and my husband to their chef tasting and “aphrodisiac” cocktail night, featuring Bedlam Vodka, on Valentine’s Day. It was a short-and-sweet preview of the food and cocktails that I’m looking forward to having more of on the rooftop near Unscripted’s pool and pool-side bar, once the sunshine hits.
2. The food: For the VDay meal, we feasted on the first course of oyster pearls. Then, we were then given a variety of delectable cocktails, including ones with coffee and chocolate. My favorite that night was the bacon-wrapped asparagus. Although these aren’t offered on a daily basis (only on special occasions), the food there, in general, is great. Give the Impossible Burger a try, with some fries, next time you’re there.
3. My bday: Most weekends, you can find your fave local DJs in the lobby and enjoy drinks on the comfy couches. It’s where I’ll be this Friday celebrating my 40th birthday. Come on out and celebrate with us as DJ Mic Check blesses us on the 1s and 2s.

Soooooo excited for the Spring and Summer!

Doc