In 2004, family physician Wayne Strouse, M.D., temporarily shuttered his practice in Penn Yan, N.Y., packed up his family and moved to New Zealand. It would have been his ninth year as a rural doctor, but Strouse sought refuge from burnout in his family's travels to the harbor town of Gisborne. The year away gave him perspective that fueled positive changes in the way he now lives and works. He recently shared his experiences and what they taught him with AAFP News.
Wayne Strouse, M.D., and his wife and daughter make the most of their sojourn to New Zealand. The yearlong stay was Strouse's strategy for digging out from under his bout with professional burnout.
Q: When did you start to feel overwhelmed by your career?
A: I came to Penn Yan to start my practice in 1997. It was fun. It was exciting. It was something I always thought I wanted to do. As time went on, our call group got smaller, and other issues in medicine were becoming more difficult. My billing person was really good about getting initial stuff out but was not very good about following up. My income was going down. I was worried about it. I was working really hard, and it would be difficult to work harder. Keeping my practice viable became more of an issue. I knew that I was starting to burn out.
My daughter was a preteen, and there were things that she was doing that I wanted to make sure I didn't miss out on.
Q: Why New Zealand?
A: I was up to my ears in the practice. The only way to take a look at what I wanted to do was to really get away.
The way we got to New Zealand was a little hokey. We were on vacation, eating at an Outback Steakhouse. My wife and I had been talking about how it would be interesting to go to a different place and practice. We hadn't said much because we didn't know how our daughter would take to it. We basically asked her, "What do you think about this?" She said that'd be OK.
So we went to a Scientific Assembly of the AAFP, and we went to the Global Medical Staffing booth. We told them we were interested in going to New Zealand. We always intended to go for just a year, which is why we picked New Zealand over Australia. New Zealand was small enough to see in one year.
Q: What was it like in New Zealand?
A: The year exceeded all my expectations. The country was absolutely gorgeous.
It was tough closing down and leaving, but once the plane took off, we were excited. We wanted to see what (a) single-payer (health care system) was really like.
In the first six months, my wife -- a psychiatrist -- worked, and I was instructed to set up the household and get my daughter settled in school, so I only worked part of the time during those first six months. I worked full-time for the second half of the year.
We were embraced by the medical community there. We had a gathering every Wednesday evening. We talked about stuff. We didn't talk about insurance companies. We didn't talk about how we were getting screwed over by the system. It was about whose kid was coming to visit, who was going where on vacation, and maybe there was an interesting or perplexing patient. It was wonderful.
Every quarter, we had a meeting with all the physicians of the city. Two or three of us would put together a talk about something in our field. The last talk I gave was about how American physicians get paid. I did it very tongue in cheek. At the time, George W. Bush was president, and the New Zealanders uniformly hated him. They thought that he was going to use nuclear weapons. I talked to them about our billing codes, and then I said, "What are they? Are they the nuclear codes?" At the end, when I asked if there were any questions, the only question I was asked was, "Why are you going back there?"
I entered no codes on anything while I was there. A couple of times I consulted with government physicians on prior authorizations. It felt like we were on the same side, and that we were just making sure the checkboxes were checked. It was so refreshing.
It's much more laid back in New Zealand. That's what I needed to decompress and say, "OK, now what am I going to do?"
Wayne Strouse, M.D., says his time in New Zealand showed him that "being happy has a lot of value in and of itself."
Q: How did your experience in New Zealand change you and how you practiced medicine?
A: My New Zealand friends said to me: If you're making enough money -- you have a comfortable living, you have enough stuff and things are good -- why do you need to make more money? It was so obvious when they said it, but it was something I just hadn't thought of on my own. I felt like I'm working so hard, I should make more money. Now, I thought, maybe I should work less hard and make less money, and that's OK because we have enough. That was something I learned there that I'm not sure I could have learned here. Being happy has a lot of value in and of itself.
I had been seeing a patient every 15 minutes. When I came back (to Penn Yan), I changed that to one patient every 20 minutes. I adjust visits to be 20-, 30- or 40-minute visits. That allows me to get to know my patients. That, to me, is what medicine is all about.
Q: Let's talk about advocacy. How did that become part of your wellness strategy?
A: That's definitely part of it. I was not really doing any kind of advocacy before New Zealand. The more I read about the New York State AFP, the more I realized this is a group of kindred spirits. I went to the Congress of Delegates. The group was really welcoming. There wasn't much rural representation. I felt like it was important for me to be there. I was giving a perspective that was quite different.
That's one of the things that helps keep me going. We need more of the young people to be part of it, and I think they may need the organization to help them.
Q: What advice do you have for other physicians who want to improve their wellness?
A: The starting point to avoid burnout is when you're in your first job, and you're really making good money compared to anything you've made up until that point, try to live on half of what you're making. Retire your debt as quickly as you can. Live like you lived in your residency because then you can afford to slow down and not work so many hours. If you have overwhelming debt, you start working so hard you can't enjoy the money you're making. Emotionally, you're keeping your head just above water. You're heading toward burnout.
One thing I learned in New Zealand was the stuff that we have, most of it, we don't really need. What we had in New Zealand was maybe 10 percent of what we had back in the United States, and we didn't miss it even a little bit.
Make sure you do fun things. If a place that you're working is getting too onerous, stop working there. Take time off; maybe do some locum tenens. Take time to recharge your batteries.
Teach others. You can feel better by taking in a resident or medical student and working with them. There's a certain energy they bring in, and there's nothing like it.
The good news is that burnout is being talked about by medical organizations. What I'd really like is to take the next step: How do we prevent it? I think that's part of the reason why the national organizations of medicine need to stand up to the insurance companies and say: You may not do this anymore because it's burning out our doctors, and we won't stand for it.