Blank Walls and Signs

On May 17th, I walked away from the only employer I have known as a physician.   As I sat at my desk for the last time, I found myself staring at blank walls.  

Just days before, that wall was filled with memories and artifacts of a long career in medicine. Diplomas, awards, accolades, achievements, milestones-pieces of parchment that told the story of my professional life.  It wasn’t just that wall, it was every wall in all of my exam rooms.  By that last day, however, every wall was bare. A few crooked nails sticking out here and there, but nothing to remind me of a 24-year career. I pondered how I got to this moment.  

Just over a year before, I had been told that my practice location of 20 years was closing.  In July, I was transferred 12.3 miles to a new location.  Ironically, I wrote about that transition in my last blog.  I’ve been radio silent (or blog silent) since then as I was trying to embrace the move and make it work.   

Starting in July, my first month after the move, I found myself bombarded with new patients.  Initially, no one knew if my established patients would be able to travel the distance to the new location. I mourned the loss of my indigent patients who used public transportation to get to my office Uptown. There was no way they would be traveling to Matthews.  Knowing at least that population would not follow, no one wanted me to be idle.   So all restrictions were lifted on new patients. The result was seeing 7 to 8 new patients a day.  That was overwhelming, even for an old dog like me.  I consistently felt like I was failing to give these new patients the time and attention they needed because there were so many of them. 

In August, a new initiative sought to guarantee a primary care visit for every patient, even if not with one’s own physician. Because I was the new kid on the block, my schedule was overrun with cross coverage of patients from various other providers.  I had days wherein over 50% of the patients on my schedule I had never met.  I felt like I was running an urgent care. And that is not where Internal Medicine physicians thrive. I always felt like I was falling short in caring for patients that I did not know and did not have time to learn their histories.

By September, my established patients realized I had moved, but I had no available access to get them in.  I was getting messages from long time patients saying my next available appointment was in December!   I felt like I was disappointing the patients that I had served for years as I was not available to them.

By October, I still had no staff.  When the Uptown location closed, all staff (other than the physicians) had been given the opportunity to transfer anywhere in the system that worked for them.  The position for an assistant for me had been posted, but there were no candidates applying.  The solution was a memo informing me that I now needed to place all orders, process all referrals, and complete all clerical tasks for all patients.  In other words, I needed to do that job too. Frankly, I was terrible at it!  I lived in fear that I was ordering tests incorrectly, missing details on forms or botching the referral process and delaying appropriate care.  I was spending 2 to 3 hours every night previewing the charts of patients for the next day, over half of whom I did not know, trying to guess what orders would be needed and get them preloaded into the chart.  I was drowning.  

In November, an assessment was finally made on panel size and, shockingly, I had several hundred more patients attributed to me than I could possibly care for well.  The decision was made to start limiting new patients, but not until the beginning of January and no new patients would be rescheduled that were already on the books as we did not want to “turn patients away.”   So, even through the first quarter of 2024, my schedule included 7 to 8 new patients a week.  I felt helpless to care for the patients I had and more just kept coming.

By Christmas, I was a mess.  I found myself exasperated more days than not. My daughters came home from college for Christmas break and looked at me and said: “Geez, Mom, what is wrong with you?  You look awful!”   Let’s just say that my family staged an intervention—similar to what you would do for an alcoholic or a drug addict.  They sat me down and challenged me to recognize there was a problem and to do something about it.  Those two daughters are both pre-med at Chapel Hill.  How could I allow them to watch me floundering?  I’ve absolutely loved my career as a physician. I did not want them to see me losing that joy!  I felt like a shell of the physician that God had called me to be. What was I doing?  

At that point, I started praying for a sign. Yes, I know, you’re thinking: “Woman, you’re an idiot. Don’t you think the last six months were enough of a sign?”    Well, I’m a slow learner and I continued to pray for a sign.  God answered! (Sometimes praying for sign is like praying for patience. Be careful what you pray for!)  

A few days later, a long-time patient came in complaining of the inability to get a message to me by phone. He looked me straight in the face and asked me why I did not open my own practice?   I chuckled and asked him to pray for me!  (Over the next several weeks, at least 10 more patients said the same thing to me. Before then, no patient had ever asked me to start my own practice.)

The following week at the gym, I ran into a former colleague who works in a direct primary care medicine model. He asked me if I wanted a job.  Totally random.

Just days later, I had coffee with an OB/GYN, who has a private practice in the area.  She asked me what I was waiting for and encouraged me to explore an independent practice and be an entrepreneur.

Then, on one of the days that I came home crying, a dear friend from residency called to share her chaotic day. (Nothing like patients getting arrested in the parking lot to add spice to your clinic day!)  As I tearfully shared my situation, she stopped me dead in my tracks and said, “Carmen, you need to focus on wellness medicine. It’s in your DNA and I’ve known for years. That’s what you need to do.”  She connected me with another friend from undergrad and residency who practices membership wellness medicine in the Atlanta area.

Two days later, I had a three-hour conversation with that friend.  At the end of the call, I saw light at the end of the tunnel. I felt hope. Maybe there was a different way to practice Internal Medicine that put patients first.

I spent the next few months figuring out how to resign in way that was honoring to my employer and did not burn bridges.   I embraced the fact that I could not practice volume-based medicine anymore. I longed for more time with patients.  I realized that my employer was not the problem. It’s the current model of primary care.  I wanted to focus on quality and not quantity. I had to find a different way to be a doctor.  I sought counsel with trusted mentors who have walked me through my career. Without exception, they all encouraged me step out on faith. More signs.

The second week in February, I resigned with NO idea what was next.   I spent the next 90 days of my notice exploring options and ultimately moving forward with an affiliation with a national company that helps physicians launch independent practices.  It is the same company with whom my friend in Atlanta was working.

A month ago, I had the opportunity to attend the national conference of this company, MDVIP.  After the first day, I called Joe quite suspicious and told him either they were all high on laughing gas or there was an AMWAY pitch coming.  I’ve never been around so many truly joyful physicians who loved their jobs!  Over and over, every affiliate said to me that I was going to regret that I had not made this change sooner.  And, over and over, they talked about how patients were so thankful and grateful to have a different model of primary care.  Yet another sign.

When the last day in my office came a few weeks ago, I just stared at the blank walls. 

Should I be mourning the blank walls and the loss of a 24-year career with one organization?  Or, should I be celebrating a tabula rasa? 

Tabula rasa is a Latin phrase often translated as "clean slate" in English.  It originates from the Roman tabula, a wax-covered tablet used for notes.  The tablet was blanked (rasa) by heating the wax and then smoothing it.  The tablet could then be used again. 

Hot wax. That’s exactly how I have felt. The last few years have brought the heat. First, I left the leadership role, then, I lost the practice I had built for 20 years. I have been broken and melted.   I ended up in a puddle.  If ever I was a candle, the wick was snuffed out in sea of wax. 

But maybe that’s what God was trying to do all along.  I had to be completely broken and have my professional identity stripped from me for Him to be able to start rewriting my career story.  I needed blank walls, a tabula rasa, a blank slate. 

I went to the Scriptures to see God’s guidance about starting over. Turns out, he has a lot to say about a clean slate.  

Jeremiah 50:20: These people that I've saved will start out with a clean slate. 

Isaiah 43:25: I am He who wipes the slate clean and erases your wrongdoing. I will not call to mind your sins anymore.

Micah 7:18-20: Where is the god who can compare with you—wiping the slate clean of guilt, turning a blind eye, a deaf ear, to the past sins of your purged and precious people?

Hebrews 10:17: He concludes, I'll forever wipe the slate clean of their sins.

I don’t think that my 24-year career with a large healthcare system was a mistake or a sin. I think it is a part of my story that allowed me to grow as a person and as a physician.  That season granted me the honor to serve thousands of patients.  But, it is a chapter that needed to end so God could move me in a new direction.

I want the next chapter of my professional career to be all about kingdom impact. In the community and on the mission field, I want to continue to serve those who do not have access to healthcare. In the practice setting, I want to care for the whole person, physically, emotionally, and spiritually.  I want to take the time to listen to patients and partner with them in pursuing better health and wholeness. I want to spend each morning praying over my patients and with patients as appropriate.  I want to see their lives enriched with the power of the Holy Spirit. In fact, I named my practice around that goal:  Teague Internal Medicine & Enrichment. The acronym is TIME!!!  

I know that I will not have a job in heaven. No doctors are needed when you’re in the presence of the Great Physician!  But in the meantime, I want to be the hands and feet of God in helping patients be the absolute best they can be here on this earth.

So, I’m committing this next chapter of my career to the author and finisher of my story.

Proverbs 16:3: Commit your work to the LORD, and your plans will be established.

Although my doors won’t open until midsummer, I already have a sign!!!  

If you or anyone you know wants a different primary care experience, I would be honored to serve you!

Carmen I. Teague, MD, MC - Internal Medicine in Charlotte NC - MDVIP