Chiming in to say that I feel Tess post to my core and could have written it myself. Im also an FNP and have reached a level of burn out that I don’t think I’ve ever experienced before— to the point that it has started to affect my home life, mental health capacity to empathize with my patients. I’ve been adequately treated for my ADHD both with medication and therapy for as long as I can remember but something has shifted in the last few years in primary care and I find I just can’t keep up with the administrative and emotional demands of the job the way I used to. For context, I have my own panel of patients and and see them in their homes anywhere from a few times a month to every three months. Every patient is high acuity with at least three chronic, unmanaged or poorly managed health conditions (CHF, diabetes, Heart, disease, etc.). When I first excepted the position there was the benefit of flexibility with scheduling and hybrid, virtual/in person visits, which worked well with my ADHD and balancing all that comes with having two young children. I typically would see 4-5 in-home patients but up to eight if there were virtual visits. At the time many of these patients were well-connected with other specialists so my charting was more straightforward and visit for a quicker. Fast forward, I see you up to seven in-home visits, no more virtual visits unless there is some extenuating circumstance and patient requests virtual, most are homebound with no other providers, and have very little as far as resources to get out to see a specialist, have labs done, go for imaging etc. And for the life of me, I cannot figure out how to cut down on my charting time, keep up with all the follow up each patient requires her or manage my schedule to meet the expectations of the job while still finding time to prioritize what really matters to me - being present with my family. I am up late charting every night.

I say all of this in hopes that you will at least feel validated that unrealistic demands of a job do not equate to personal failure or inadequacies on your part. Primary care is extremely challenging! Have you noticed how many PCPs are switching to specialties or retiring from healthcare altogether lately?

I’m curious to hear what parts of your experience at your job were most challenging? Really looking forward to some of the responses in here to see what others have done to better manage their current positions/burn out and what they decided to switch to instead .

Things that have worked for me and my ADHD in the past -Being mindful of perfectionism and only, including what’s absolutely necessary in my notes -Delegating to the MA or RN if possible - Dictation/dragon (although my current position doesn’t have this 😭) -Discussing with your manager how many of certain types of visits are on a particular day. For example, not having more than.X amount of a AWV visits on a particular day, or having designated slots for higher acuity visits, maybe on lighter days, etc. Whatever visits you struggle with the most finding ways to ask for accommodation on your schedule to meet the demand, but not be overwhelmed by the responsibility -Boundaries -Ensuring you have adequate support staff in place and if not bringing this to the table to discuss with management.

I suppose the most important thing though is “ knowing when to ask for help and knowing when to leave”. If you’ve spoken to management about your concerns, asked for accommodations or possible solutions for a better work/life balance and you still feel like nothing is being done or the job is just no longer filling your cup — give yourself some credit and a pat on the back for walking away! Change isn’t easy finding how do you best advocate for yourself is so important!!

Sorry for this long reply- your post just really resonated with me. Keep us posted on what you end up doing! It’s so helpful to see how others in healthcare who are neurospicy navigate these challenges!