Surviving Medical Practice After Workplace Upheaval

Melissa Walton-Shirley, MD


December 15, 2016

Over a year ago I stared into a mirror and asked myself a hard question. How much will you sacrifice to be happy practicing medicine? The comfort of lying on a pillow next to your husband? The opportunity to hold the hand of your parents if they become ill again? The company of an excellent partner, friend, and practitioner? Could I move away from my church, best friend, brother, and beautiful in-laws and leave behind a practice of thousands of patients that we had built over the past 3 decades? Staying put would require that I accept a position that didn't meet the goals and priorities my partner and I established when we set up our practice. I did a lot of praying and soul searching, and for the first time in my life, I began to understand on some small scale what the word sacrifice could really mean. I quit my practice and moved to a new state to begin again.

It's been a long 14-month stretch since I watched my south Central Kentucky home shrink in my rearview mirror. The lump in my throat, a battle between exhilaration and sadness, morphed moment by moment as I left behind the flat rolling farmlands of Kentucky for the soaring green hills of Tennessee. Jack, the first dog I've owned since childhood, a loving and needy 45-lb Labradoodle, was enlisted as my new companion. He stared at me as I drove, head cocked sideways, confused by my vacillating emotions. Behind me lay a huge cardiology practice of loyal patients. I am certain I shed a tear for each and every one of them. They weighed heavily on my decision the night before as I stood beside a conference table where a kind lawyer and an accountant watched as I kissed my wonderful professional partner of 24 years goodbye. Jim is a man who did not deserve to be abandoned by a partner who loves him still. I sent him a birthday basket in March, but I've only spoken to him twice since I left because I could not choke back childish sobs. Last week I managed it. My eyes were wet, but proudly, I did not allow a single tear to slide down my cheek. Perhaps I am healing.

Jim and I succumbed to a perfect storm heralded by the sudden death of our most excellent director. He was only 50 years old. His passing struck our community like a bolt of lightning, which ultimately led to the split of a cohesive rural community of practitioners. Despite the fact that my partner had established the first cardiology practice in south Central Kentucky, sacrificed family and personal time for years, it was not received well when we declined acquisition. We were independent practitioners who opened the first cath lab in our area, cathed with no net for 7 years, served a referral base of five counties, and drove initiatives for our community and our entire state. We partnered with Harvard in the ER-TIMI-19 trial to examine the outcomes for prehospital thrombolytic therapy. We were proud to practice "big-city cardiology" in a small community, and we were successful. We were a great, compatible group until that perfect storm destroyed us.

Jim and I held out; our established patients were still coming, but they came in the door with test results in hand, a result of shifting priorities on the behalf of our referral base, most of which had been acquired.  The fact that we had state-of-the-art equipment and provided the same good-quality work didn't matter anymore. That, among other reasons, drove me to make that hard decision.

My husband, Tony, and I have been together since we were 16. I'm ashamed to admit, though, that until we faced the challenges of separation and the destruction of our independent healthcare community I never really appreciated how firmly Tony was always in my corner. He and our daughters Kate and Aaron had finally won. For 3 years they had organized many family interventions, lamenting my misery and pointing out that it was not too late to reinvent myself, consider my options, and start over. My partner would not consider it. He's in the twilight of his career and 17 years my senior with nothing to gain from a move.

My career change came by accident. A former colleague asked us to dinner in Florence, AL. Soon we were being introduced to his CEO, who was looking for a cardiologist. At that point, I began to agonize over the possibility of leaving my practice. The pull of the huge gray moon over the muddy Tennessee River where bawdy blues music was born drew me to the area. I could have lived there forever, but I could not justify a 5-hour drive from my ailing parents and my husband.

The Alabama experience motivated me to approach St Thomas Heart in Tennessee whose administration shares my "patient-first" philosophy. I witnessed that caring approach firsthand when they successfully deployed a MitraClip for my dad, who had spent the preceding year drowning in heart failure. I moved there 14 months ago. I have a new Cleveland-Clinic–trained partner who is as adept as he is astute and as kind as he is competent. I gained an instantly loyal and kind staff that can't do enough for my patients or for me. There are multiple subspecialty clinics waiting for my referrals with plenty of gadgets and folks who know how to use them. I'm honored to be a member of this program and am not quite sure I'm worthy of it.

For all the great things I gained, moving was a baptism of fire. It's easier to get a key to Fort Knox than to obtain a license to practice medicine in Tennessee. For weeks my kitchen table looked like a strategic planning zone at the Pentagon. I had to drive an hour further south to the mother ship to get a BP check, do the employee health thing, take a TB skin test, and get a flu shot. I even had to get an MMR shot like a prepubescent eighth grader. All those efforts were far less complicated than getting an official Tennessee residency status. I had to prove I was an earthling, married for 32 years, and not a felon or a terrorist. I had to get a new driver's license. After being rejected twice, I asked the less-than-amused police officer, "Am I on candid camera?" Each time he sent me back to Kentucky to retrieve documents that I wasn't quite sure still existed.

Then came the challenges of no longer being a kept woman. With just over a year until his retirement, Tony and I were forced to live separately for a week at a time. An hour's drive might as well be 10 during the week. You can't go back and forth when you are on call. I knew that living apart could produce stress in a marriage, but our relationship had survived the fires of medical school, residency, and a fellowship. The joy of raising two children permanently forged it. If anything, the long distance made us appreciate each other even more.

Living alone with a history of thumb surgery meant staring at the same jar of peaches for a week because I could not open them. My loathing for taking out the trash and push-mowing my small lawn had to come to an end or else I might endure the wrath of neighbors I barely knew. I felt guilty that I had actually chosen this temporary misery and thrust it upon my family. I also gained a new sympathy for the struggles of those who live a single life, many not by choice.

For all the miserable hours of self-imposed solitude I spent on my couch eating too many low-sodium potato chips and endless suppers of cottage cheese and peaches (from an easily opened plastic cup), there have been a million perks. I was invited to participate in a strategic planning meeting for our cath-lab remodel—it's been a long time since a CEO asked my opinion. I enjoy again the camaraderie of colleagues who value and request my expertise. I am back in the ICU, my first love of the practice of medicine. Our competition is kind and welcoming, so we enjoy the occasional lunch together. I was invited into the inner sanctum beneath the Tennessee Titans stadium to film some promotional information for our cardiology services. I was asked to go to downtown Nashville to speak for "Go Red for Women" day.

It has been a great do-over, but I readily admit, I'm still a little sad that I'm not doing these good things for patients in my hometown. I have to learn to be satisfied doing them for these very nice folks in Tennessee. It heartens me that I still get to see three to five families from my old practice per office day. I'm grateful because their visits go a long way to sooth the homesickness I feel some days.

The memory of the first few weeks here when I did not think I could survive is becoming dim. It wasn't just difficult emotionally; a change of this magnitude, though good in the long run, can be a detriment to one's physical health. The stress of having to learn two different electronic health record systems caused my blood pressure to soar.

I've learned a lot this year, and I'm grateful for all of the lessons. I have learned that medicine is not all there is in this world, despite my putting it first for 25 years. I have corrected that notion. I have learned to forgive those who have not asked for forgiveness and I've forgiven some who do not deserve it. I've developed a new appreciation for the daily challenges of those who live alone. Most of all, I love my family and my friends more than I've ever loved them in my life, because they have never forsaken me and never stopped loving me, even when I could feel nothing and was so sad that I could not love myself.

I have survived 14 months in a place where I knew no one and where nothing was familiar. Thanks to God and family, I have found happiness again. Next week, I will be lying on a pillow next to the love of my life. I am a giddy teenager again. Most of all, I am grateful that I can still look at myself in the mirror, having answered that hard question. Because I did not compromise I am becoming happy and whole again.


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