The Worthy Physician

Seeing and Being a Light in a Time of Darkness with Dr. Amna Shabbir, MD

• Sapna A Shah-Haque

Share episode

Send us a text

Picture this: after years of grueling education and rigorous residency, you’re finally an early career physician. Exciting, isn’t it? But what happens when the glitter fades, the pressure builds, and you find yourself grappling with burnout and moral injury? In our eye-opening conversation with the empathetic Dr. Amna Shabbir, we journey into the heart of these challenges. Dr. Shabbir, a geriatrician internist and a coach for early career physicians, candidly shares her personal encounters with burnout, moral injury, and even postpartum depression, reminding us that doctors, too, are human.

There’s a lot to unpack in our chat, but one insight emerges clear as a bell: setting boundaries is crucial. It’s not just about preventing burnout and cultivating your own mental wellbeing, important as that may be. As Dr. Shabbir illuminates, boundaries also lead to better relationships with patients and higher patient satisfaction. She also underlines the critical role of communication in navigating this balancing act. If you’re an early career physician, or if you simply want to understand the pressures they face, you won’t want to miss these insights.

But what happens when it all becomes too much? When the stress doesn’t fade, when you can't seem to find your footing? Dr. Shabbir makes a compelling case for seeking help – a notion that, sadly, is still stigmatized in the medical field. She emphasizes the need for a shift in the system, driven by active choices from physicians. Tune in for an immersive, enlightening conversation that not only tackles the harsh realities of physician burnout but also offers a beacon of hope for preserving the art of medicine and supporting physician wellness.

What you’ll learn:
Dr. Shabbir’s Journey through heartbreak.
The importance of asking for help.
Strategies to identify what you need in life.
How to create white space.
Resources for early career physicians.
The power of choice.
The importance of asking for help.

Connect with Dr. Shabbir:
Website: https://dramnashabbir.com/
Blog: https://dramnashabbir.com/blog-4-1
Ebook:https://www.earlycareerphysician.com/e-book

LinkedIn: https://www.linkedin.com/in/amna-shabbir-md/
Instagram: https://www.instagram.com/dr.amnashabbir/   
Twitter: https://twitter.com/ashabbirmd?lang=en

Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.


Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books

Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker

Check out the free resources from The Worthy Physician:
https://www.theworthyphysician.com/freebie-downloads

Battle of the Boxes

21 Day Self Focus Journal

Dr. Shah-Haque:

Welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shah Haque, reigniting the human spirit and your passion for medicine. Today I have Amna Shabbir I'm really a fan of the positive messages that you leave and I'm really happy that you're here to share your experience.

Dr. Shabbir:

Thank you so much, sapna. I am a podcast fan and I'm excited to be here. I've been listening to the Worthy Physician's podcast since 2022, and many of the episodes, and I am really grateful for the work that you've been putting out.

Dr. Shah-Haque:

Thank you. It actually started out as a way to try to figure out why is there so much burnout, moral injury, physician suicide I lost my best friend to suicide in 2019, but the question is, why isn't this being talked about? And so hoping to normalize that conversation. So I'm thank you Absolutely. Tell us about yourself. What gets you up in the morning?

Dr. Shabbir:

I am a geriatrician internist. I love taking care of older adults. I'm also a coach for early career physicians. What gets me up in the morning these days is really on the days that I go to the nursing homes. I love seeing my patients that are in the SNFs and the rehab facilities. There's something very spiritual almost about caring for older adults for me, so I love that experience. And the rest of the days and the rest of the time I'm all consumed about all things physician wellness. These days I really want to do as much as I can. I'm writing, I'm sharing, I'm coaching, I'm here. Those are all the things.

Dr. Shah-Haque:

And why? What got you into that part of maybe? I kind of like to frame it as preserving the art of medicine, I think that's a really good way to look at it.

Dr. Shabbir:

I think this stemmed from just a long-standing desire to help as many individuals that I could, not just as a physician, but also as a colleague. And then there was my own experience of burnout and moral injury and postpartum depression and everything all lumped up into one, whatever diagnosis we want to give it. That has brought me to where I am. When I started my job, right out of residency, I worked as a primary care physician for almost four years and after that I went back to medical training and trained as a geriatrician and currently working in post-acute long-term care part-time, so right out of residency. I was as passionate as can be humanly possible to practice primary care. I'm always the primary care physician at heart. I don't think that my entire soul and being can divorce that existence ever. So I was extremely passionate and I was ready to take over the world. We were going to do this chronic care management.

Dr. Shabbir:

And then I started and slowly, over the course of the first six months, I started feeling the effects of burnout, and I didn't know what to call it at that, because that's not what I was looking for. I was looking for how can I make my own and how can I make my life great? Of course, I mean, I had a one-year-old at that time and then also, how can I practice the best medicine possible? So really, I was trying to show up the best way that I could and, having been, you know, having worked as a really celebrated resident, had good experiences from residency, I was looking forward to this chapter of my life to be maybe the best chapter, like I have arrived and I'm here.

Dr. Shabbir:

But unfortunately it was the other way. And you know, there was that dream that I had of being that primary care physician who did everything and I was doing that and that's maybe that was part of the problem. But I started to feel very overwhelmed, overall exhausted. There was never enough time to rest, to sleep, to actually exercise, to eat good food, to have any time with my daughter and I was wondering, okay, I worked so hard to get here, is this it Like? Is this what I have worked all my life to get to?

Dr. Shah-Haque:

So I'm here nodding my head because I Primary care is difficult. I don't think that admin or other specialties I think everybody's gonna say this about their specialty and enravely. So what was it? There was an article that came out a few months ago Takes 27 hours to do what a primary care physician does 27, 26, something like that. So essentially day, but we know that clinically we have, we're roughly in there for about eight hours and most of that, same patients. That's not even including the administrative part and the arrival fallacy is exactly that, and I'm looking at the sign that you have behind you. Life isn't about finding yourself, it's about creating yourself, and so I think that it's very common. And how did that change your perspective, or how did you pivot? What happened next?

Dr. Shabbir:

I will say this, that when burnout happened and all the bad things were happening, I was reflecting on what do I want to call it? Do I want to call it burnout and oral injury? And yes, absolutely Like those are. If I was to use the clinical terms, they fit the Maslatt burnout inventory and all the three common core definitions and I absolutely feel Dr Wendy Dean's work surrounding moral injury. So, yes, all of that was happening. But what did I? As a human experience, and that's what's up now? I was thinking yesterday. You know what I had?

Dr. Shabbir:

Heartbreak, that's what I would call it when you work so hard to get to your dream life and you think that's, this is what it's going to be. It was heartbreak. And then there was this loss of dream like this, the sensation that I really cannot do what I want to for my patients and I really cannot take care of myself the way I want to, and so there was that loss of dream and then I grieve that loss. So there was heartbreak and then there was grief and then slowly, as all of this kind of melted into each other, I think there was extent, existential distress Like this is what's happening period, and then we can call it clinically, surgically, we can call it whatever. So, as I acknowledge all of this, like the human and me was really heartbroken. That's what was happening and how did I pivot and what was I going to be doing? So initially, when all of this was happening, my solution to every problem, all my life, has been to work hard. So I said I am going to work hard and work myself out of burnout, like that's what's going to happen. I'm going to see how much I can advocate for myself, how much differences I can create in my workflow. And, yes, I did try to do some changes that were helpful, but taking on more tasks and that's really never the answer. So I thought that you know what I'm lacking? Personal fulfillment. Maybe I need to do more teaching, so I took on more teaching roles, and maybe I need to do more QI, so maybe that will help me. So I was doing peer teaching and QI and teaching students, but that wasn't the answer.

Dr. Shabbir:

So, like three years in, I had a moment where I just sat down, and this was after I had already received some pharmacotherapy for postpartum depression. That happened after I had my second child. During this process, I also had counseling and I had coaching, which is coaching, is still ongoing. So in that moment, when I was able to have some relief after asking for help, I sat down and I realized you know, what is the one thing that gives me the most joy out of what I do in primary care? And that was really taking care of older adults. Like I love older adults and everything about them and the older they are I just love that and I love helping families and that's what really gives me joy. So I realized that part in the second, how I really thought that I needed more training, which is true we don't get enough exposure to geriatrics just in our residency. So that's where I made that decision to actually go back to medical training to treat my burnout. That's also not something we frequently hear like more training to treat burnout, okay, but I thought that that really aligned with my purpose and fulfillment goals and actually helped me in that regard.

Dr. Shabbir:

And the second thing really was the process of asking for help, which was so difficult. I am a South Asian female, I'm also an international medical graduate, went to medical school in Pakistan and all of those things really shaped my identity culturally as well. There was an element of not asking for help Really like the more you work, the more you work. It's almost like morally better and I think that transcends culture. I feel that my culture was there, but also the medical culture perpetuates the same beliefs. All of that really was a hindrance in terms of asking for help.

Dr. Shabbir:

But once I realized I had to move past that because I was given choice. We all have choice, no matter how small we think it is. It's non-existent, but we do. You all have choice and I know that a lot of times I'll have my friends. They'll argue with me this is just. I'm in a toxic workplace. I can't do anything about it. But I will always say that the moment I recognize that I have a choice to either stay, a choice to leave, a choice to advocate for myself, even if I was able to make small changes around my environment. I had all those choices and I chose at this time to further pursue medical education, to really hone in what gave me sense of joy and sense of purpose.

Dr. Shah-Haque:

Even though more training wouldn't necessarily be the answer. The key here is that you change to do something that aligns with your values and purpose, really realigned what you were doing with who you are. You do have a choice, and you chose to try something that's a little unconventional, yes, and so when did you realize that you had that power of choice?

Dr. Shabbir:

The moment I had some white space is when I started to recognize that, because when you're just surviving, barely surviving, you wake up. You're waking up in reactionary mode. Oh my goodness, like I already know, my in-basket is exploding, kids are having tantrums, I have to drop them off to school, I have to go, and that also. That would only happen if my husband was out of town, otherwise the patients are scheduled so early in the morning. Maybe you're dropping one kid. It's a mess, it's all over. So there was a lot of reactionary moments. It was cruise control, whatever I could do. But then I actively started recognizing I need time off. Where can I create that time for myself where I actively block out time for reflection? And that was also after I was able to get help. So in the moments when you are completely busy and absolutely overworked, I felt like there was no moment to actually have a breather and think. So when I created those time windows, even if there were just 30 minutes, one hour, I was able to sit down and ask myself what are you doing and do you want to keep doing this? And then it was like how are you living? Do you want to keep living like this? And the answers slowly started coming to me, and during this time I also I think that another moment that provided me a lot of opportunity for self-reflection was, just as I started to get better from my postpartum depression, the pandemic started, and then, a couple of months into the pandemic, I actually fell and fractured my right foot, and that was an entirely long process of healing, which I was in a cast, I couldn't drive for about six months.

Dr. Shabbir:

It was like the perfect time to do telemedicine, let's just say that. So I continued to see my patients from home, but it was also disability inducing in a way, because I had a one-year-old who was running around and I couldn't care for her. I couldn't drive All the time. I was really in lockdown at that time. So the cast was on for about two and a half three months and that was the time I practiced completely telemedicine from home. Those were the moments that allowed me some perspective. Really, where do I want to go from here? Because I didn't have my commute, otherwise I was still seeing the four plus patients, something somewhere close to that. I felt like the commute went away and I was able to sit with a piece of paper and just sit and think and really get the help that I needed. And then when I returned I was in a brace. But putting on PPE with a brace and a scooter, that was a whole different experience because I was helping in the respiratory care centers. So it was just one thing after the other.

Dr. Shah-Haque:

You were thinking and yeah, Wow, Some of the things that you're talking about really. I mean so for internal medicine patients, 24 is a lot, that's a lot. And then to add that onto the pandemic and PPE with that injury, that kind of knocks it up to a whole another level. And so where are you now? How have you transitioned to where you are?

Dr. Shabbir:

now, I think, subnaut, the transition happened more so. It was like this mental journey, because pretty much everything that's going to manifest in your life starts with a thought and it starts in your brain. It starts as a dream, as an idea, and the moment I made that choice that I was not going to live like a sick human being which it was like I was ill at work and at home I was juggling too many balls. Some of them were falling all over the place. Usually they were the wrong ones, because at work I was 100% Like you couldn't tell what was happening internally, so everything was all messed up. So the moment I made the choice that I couldn't proceed with life like this, I think that was really the tipping point for me. And from that decision of choice, everything else manifested from there on and I realized that often we're just there a lot. There's a lot that goes on internally that prevents us from asking for help. Of course, social conditioning, everything that we have is there for a reason. Even the moment that it took me forever to ask for pharmacotherapy for my postpartum depression was the fact that I didn't want to write on my license. I didn't want to report it and I felt like a failure and so that the moment I decided that I am not going to continue to feel this awful forever, I feel that that was the tipping point and so I feel very fulfilled in the way that I can say professionally, I am continuing to serve my patients. I am working clinically part-time right now.

Dr. Shabbir:

For me, that was the choice that I had to make between leaving medicine completely, which again it contributes to that feeling of loss and feeling of failure and feeling of heartbreak when you work so hard to get to where you want to be and then to have to leave it completely. But there were moments where I just I looked at my husband and I said I want to walk away completely from everything, and that includes medicine. So now I feel really good that I am practicing part-time. I am getting to spend time with my patients and I'm realizing it's not that I'm practicing part-time. It's like a slur when you use the word part-time and sometimes it just lands very differently with people. I feel very proud of the care that I deliver because when I'm with my patients, I'm with them. I'm with them 110%.

Dr. Shabbir:

I'm really focusing the rest of my energy with my coaching practice and my current focus with that is to help other early career physicians that are just starting out and that are suffering in so many different ways. Sometimes, when I share in my posts that are specific to early career physicians, I'll have some other colleagues that are more seasoned say I still feel like that. It's not just you guys, it's like all of us, and that makes me sad but also gives me this sense of a shared human experience that we're all part of when we're in the practice of medicine. But that also proves my point that really caring for our early career attendings yes, there is the care that you give residents and medical trainees, but there's also that care that needs to be given during transition points that is so important and is so overlooked. That needs to be there. So right now my focus is on helping as many early career physicians as I can.

Dr. Shah-Haque:

I really love that because you're right, we train so hard in medicine medical school, residency thinking it's going to be one way, but then when we get out it's a completely different. It's a different world. It's a different world and we don't have a lot of control over, for example, like insurance and how things are structured. But one powerful thing is that you have the power of choice and it's I think it's something we overlook as physicians because of the training, because there are so many hoops that we have to jump through in medical school and residency and then to become an attending, we really give, for a short time, sometimes a longer period of time. We give that power up or we think we give that power up. We can always take it back. There are consequences, but we can't take it back. What is one of the biggest struggles you found yourself having as an early attending? For example, mine was learning how to okay, what are your top three issues and coding for insurance purposes.

Dr. Shabbir:

Yeah, so I think that mine was operating under the fallacy that I had no choice. I would to drive the point home initially, as you said, it's conditioned out of us in a way that we are powerless, and I will say that I still see many friends operating under they continue to operate under the same fallacy that, yeah, you have no choice. This is what happens. You graduate and then you get a job and then the people at the job tell you what to do and then you keep doing that and then you hate your life and that's it. That's being in medicine, or you hate your life most of the time. Of course, what we do when we're providing patient care gives us all joy, and that joy when it's completely bailed out, that's not good. But I think that was one of my biggest learning points and biggest challenge On the day to day. I felt that setting boundaries with time was so important and the fact that boundaries need to exist, boundaries need to be there and you can say the B word without feeling horrible and all the other social conditioning that came along with it being a female of color and all the other things. So I think that the moment and I did I took them very seriously For me. I love to stay on time on our time and I was going home at like 6, 7, 8 pm some days because I would not say no when a patient showed up late and I would see them. And then I also felt terrible if I was late because a couple of patients were late, and so the problem starts to happen is when we're exhausted, we're tired, we just keep up with like okay, let's just keep the day going. I don't want to have a conversation surrounding this, because the moment you start having a conversation, not your problem. But if you, let's just, I'm going to go ahead and extreme use, an extreme work, if you just shut up and show up and just do your work, then you're a good doctor. And I think that most of us forget our choice, forget that we have a say, and it's such a disempowering place to be in and I felt disempowered consistently the day I realized that I have choice and the day I started setting I just started with time boundaries and I swear it was really difficult to do that, but when I set the boundary like a boundary and not like a request, then it slowly started to seep in.

Dr. Shabbir:

I also did a lot of education with my patients. I told them that I just have 15 to 20 minutes to see you. In that time you're going to be checked in at the front desk, the medical assistant is going to be taking your vitals and I'm going to go through all your medical issues. That's not a lot of time. A lot of patients were actually shocked when they heard that that this is the time that's allotted and they actually were very sympathetic. They committed with me that the US healthcare system needs some help and this is not perfect, and then they started to make an active effort. So I communicated with them.

Dr. Shabbir:

It wasn't just a uni-directional. You need to do this. I got by in and over when I left my patient panel. I used to have and this is unbelievable almost zero late patients. I had a very high patient satisfaction score without prescribing any questionable medicines. I was well loved. Let's just say that. And setting boundaries did not make my patients hate me. You just started aligning and matching with the people. That match with your energy and your principles. Using that, I couldn't agree more.

Dr. Shah-Haque:

I mean, when I say those things, I'm talking about boundaries, because for me, when I started, they were non-existent. I said yes to everything, and yeah, you don't want to create new ways because you're the new one, and that's yeah, exactly. And gosh, the way you said it was gosh. I kind of did sign up for a miserable existence, didn't I? But that's not the truth. And so thank you for sharing those reminders of boundaries and choice and to really trying to create what you want to see, because it's not this box that we have to stay in, the box of misery, it's not a box we have to stay in. And so how can people reach out to you on social media and so on and so forth?

Dr. Shabbir:

You can reach out on Instagram it's dramna. What's your name? My website is also dramneshibircom, and I'm pretty active on LinkedIn and Twitter as well. Just type in my name and it will pop up. I have created a free ebook, which is a resource that has found resetting, among other tips I wish I knew on the first day and the first couple of months and, I would still argue, some for the first couple of years when I started as an attending. So if individuals are interested, they're welcome to go ahead and grab that free resource.

Dr. Shabbir:

I'm hoping to share more free resources and I have just launched my second venture with only exclusively focuses on early career physicians. It's called early career physician coaching and I'm hoping to create a platform that creates not just it's not just coaching, but other resources that are all consolidated in one spot as you transition into your role as an attending, and not just that. There is that initial honeymoon period with some people have Mine was burnout, but some people have a good time while your clinic is ramping up and you're not feeling it that much. But afterwards, a year or two years in, you can start questioning is this it and that's normal. We need to normalize that. So I'm going to be sharing some resources on those lines as well. So really it's okay. You don't have to be 50 before you realize your burnout and I'm using a number and I probably shouldn't, because some people start their medical education journeys later as well.

Dr. Shabbir:

So you could be a young physician in the terms of, like medical education, you know. And it's okay, because I had some comments handed that were sort of a just in a way, because you're so young, what have you done? Why are you already so burnt out? Let's not compare and despair. Misery Like I have 20 miserable years under my belt, like what you just only have, like the first one.

Dr. Shabbir:

No, and this is this kind of dangerous conversation is what leads to dangerous outcomes when people then don't want to ask for help. So my goal with this platform is to normalize, not just asking for help after, like, as the WHO definition of health and wellness goes right, it's not just the absence of disease. You have to actively invest in your well-being and you have to advocate for yourself. I really want to highlight this point. Physicians are very passive and I think that needs to stop, and that's where the whole concept of choice comes in. If enough physicians start making active choices the system can change, and I'm feeling very, very positive with our younger. Physicians are trying to think outside the box, and so I'm very hopeful.

Dr. Shah-Haque:

I've seen that as well and I share that same hope. But I thank you for pointing that out, because burnout can happen at any time. But I love the fact that you're focusing on new attendings, but the thing is is that life is nuts and things hit you when you least expect it. So it's silly to sit here and say like you can't be burned out or more injury because you're just new. And I think research has shown that, like in the first five years, that's one of the when it hits within the first five years and that's a high risk population. So all this will be in the show notes and what is one last pearl of wisdom you have to leave for the listeners Ask for help.

Dr. Shabbir:

Don't wait. Wait till you are feeling physical manifestation of what I alluded to earlier as existential distress things. If they don't align and if they don't match, and if every day you go home and you just don't feel good, that is symptom and sign enough for you to go ahead and ask for help. And help is available, help is out there. Please take that first step.

Dr. Shah-Haque:

Thank you very much for that, and just thank you for everything you're doing.