Carmen Teague, MD, MC, discusses her experience changing practice models to recover from burnout and reclaim her love for medicine.

Carmen Teague, MD, MC

This transcript has been edited for clarity.

Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.

This week, Dr. Carmen Teague discusses her experience with burnout as a primary care physician, and the changes she made to recover and reconnect with her patients.

My name is Dr. Carmen Teague. I am a general internist practicing in Charlotte, North Carolina, and I’m the owner of Teague Internal Medicine & Enrichment, which is an MDVIP-affiliated primary care practice here in the Charlotte area. My practice is focused on prevention, enrichment outside of medicine, and restoring the joy of practicing medicine.

I would say that I have had a torturous path as an internist. I actually have an undergraduate degree in psychology and theater, didn’t take the first pre-med class. I then pursued a master’s in counseling, and in that experience, I spent a year working at a state psychiatric hospital for the criminally insane and the indigent insane in the state of Massachusetts. In that very bizarre setting, I fell in love with medicine. I had to go back and take all the prerequisites while I did Alzheimer’s research at Duke University.

I was almost 28 when I went back to med school. I jokingly say I was the grandmother of my class. I chose internal medicine because it was the medicine that I fell in love with, and I moved to the Charlotte area and completed residency here. I joined the largest multi-specialty group that was part of the big healthcare system in this area. That was probably early 2000s.

That was when healthcare reform was on the horizon. There was a lot of talk about healthcare changing, and I’ve never been very good at sitting in the back row, so I raised my hand for some local leadership opportunities. By 2009, I was asked to be the director of internal medicine for the second largest not- for-profit healthcare system in the country. That was a position that I held for just over 14 years.

Now, I did not leave practice. I continued to see patients with 50% of my time spent clinically, but I chose to be a part of leadership to try to work toward making healthcare better. In that role, I oversaw a lot of different things for healthcare management, including the hiring and firing of physicians, management of quality programs, budgets oversight, and driving and managing system initiatives. It was an amazing experience for most of that—until it wasn’t. Unfortunately, the role ended up being the sounding board for a lot of frustrations for many internists as healthcare continued to change, as we tried to do the best things that we could for our patients.

Over time, I watched our system and all of healthcare in general shift from patient-focused medicine to volume- and revenue-focused medicine. That was really difficult. I found myself like a lone wolf crying in these C-suite meetings going, “Wait a minute, whoa, what are we doing?” I became more and more frustrated.

And then COVID hit. Quite frankly, COVID put that trajectory on steroids. I found myself, two years into COVID, pretty burned out and disillusioned with the way healthcare was going. I left leadership, and less than a year after I left that leadership role, my successor walked into my office and informed me that due to budgetary changes, the office where I had practiced almost 24 years was going to be closed.

That was devastating. I was transferred about 13.5 to 14 miles to a suburb. Overnight, I lost the practice that I had built for almost 24 years. I was exhausted. I felt like I couldn’t care well for patients. And because I was a seasoned provider, I was seeing 24 to 28 patients a day. In that six months after the move, I lost 30 pounds, and I would say that I hit rock bottom.

My family came around me. My two daughters, who were at that time pre-med in college, came home for Christmas break. This was December of 2023. They took one look at mom and said, “What is going on here? Who are you? ” For lack of a better analogy, my family staged in an intervention and said, “Mom, you have loved your job your entire career. We don’t even know who you are anymore.” At that point, I hit my knees and said something has to change.

By pure dumb luck, I had a friend that I had known from undergrad, medical school, and residency, who practiced with an MDVIP-affiliated practice in the Atlanta, Georgia area. He happened to call, and he said, “Carmen, I have a better way to practice.” I was connected with MDVIP, and I left the big healthcare system in May 2024 and started my own practice in August 2024. I have not looked back. It’s been the best decision I have ever made in my career.

With all of the constraints on the quality measures, and the different things that have to be clicked off with a visit with a patient, doctors are averaging seven to eight minutes of face-to-face time, and that really is devastating. Patients are asked coming in the door, “What are the three things you want to address today? Anything else, you’ll have to postpone to another visit.” It’s frustrating for physicians because they can’t care for the whole person, and it’s really frustrating for patients because they feel like they came in with a list and the doctor doesn’t have time to manage it.

That’s just the doctor-patient relationship. You then have interference from insurance. You have these lovely processes called prior authorizations, which basically means that even though you as a physician know it’s the right test or the right medication for the patient, you have external forces having you go through multiple questions and approval processes to get the tests, medications, or procedures that you know are correct for a patient. It is exhausting for physicians, and it’s incredibly frustrating for patients.

I would liken my experience to a frog and a pot of boiling water. I don’t think I realized how much I was being boiled until I took a minute to step away. Every night I laid in bed and I questioned if I had done the right thing for patients. I was always worried I missed something because I was seeing so many patients. I felt like I was spread so thin. It was just more than I felt like I could manage appropriately.

And I had been an incredibly busy, successful physician within that healthcare organization. I kept up with quality standards. I had excellent marks on all of the ticks that I was supposed to do, whether that be quality, medication adherence, etc., but I felt like I was still failing patients.

I opened this practice and I actually had the opportunity to hire my own staff who share the same passion to care for patients in a different way. Every single morning, my staff and I stand in front of the list of patients on our schedule. We pray over the patients that need it. We discuss how can we best serve each patient. We round and have a plan for every single patient coming in the door.

It’s a time management thing as well. I see six to eight patients a day in this practice instead of 28 patients a day that I was seeing on some days in my old world. I get to schedule patients for an annual physical for 90 minutes, and that means I have the time to review all relevant testing, set goals, and build a thoughtful plan. I get to ask a patient, “What is important to you? What are your goals and what do you want to achieve with your health? How can we partner together to do that?” When I was seeing patients in seven minutes, there was no opportunity to do that.

I would say this particular model is incredibly rewarding for physicians and patients. The MDVIP membership model allows us to offer a battery of evidence-based diagnostic tests and screenings, most of which are not fully covered by insurance anyway, but it helps us spot trends early and focus on prevention. Instead of saying, “Oh, this is abnormal, you need to take this medicine,” we can get ahead of things and say, “Wow, we’re trending in the wrong direction here. How can we make lifestyle changes so that we can prevent you from needing a medicine or prevent you from needing an intervention in the future?” That is incredibly satisfying for patients as well as for physicians.

Recognize that you’re not broken, that this system is just strained, and that you may be dealing with burnout—I like the term moral injury better. I think burnout is just exhaustion with the task demands, but moral injury is what I think physicians feel when being asked to do things or see patients in ways that conflict with what you believe is right morally.

That term came out of military terms, where soldiers go into combat and are asked to do things that conflicts with what their moral standard would be. I think physicians have been put in that same angst by not feeling like you can address all of the problems a patient has, or not being able to get the tests that you know are right just because you’re constrained by third-party insurance, etc.

I would tell physicians to understand they’re not alone. In my leadership role, I was that sounding board. I heard the frustrations of hundreds and hundreds, if not thousands, of physicians who felt that way. I would tell physicians to step back and take an inventory. Look at how your current role aligns with your values, your clinical judgment, and your life outside of medicine, and give yourself permission to see that change is not a bad thing. If you cannot practice the way that you feel called to practice in the system that you’re in, explore other options.

Concierge medicine—I would say that what we practice is more “membership wellness.” There’s a slight difference. Membership wellness is paying a membership fee for the focus on prevention. But I would say it provides a choice. It is not for everyone, but it is right for some people, especially folks who are highly motivated around prevention or have really complicated medical history and need a quarterback helping to manage their multiple medical problems or multiple specialists they’re seeing.

I’m fully grounded in Western medicine, that’s what I was trained in. But having this flexibility and less structure helps me to encourage, research, and help patients look for nontraditional ways of treating different ailments or symptoms. I get to focus on prevention early and pick up trends rather than waiting for a crisis. That is so satisfying because often, in the traditional model, it was just throwing a pill at something or putting a Band-Aid on a problem that probably could have been addressed years before if you’d had the time to change lifestyle or make better choices with a patient.

Physicians and patients alike have choice, and I would encourage physicians who are listening to this to realize if you feel like you are a gerbil on a wheel and you are in a volume-based system, that there is a different way to practice medicine and you can certainly explore that. Again, this model’s not for everyone, but there are other models.

I would encourage patients, that if they feel that they are not getting the care that they need or not getting the time that they need with a physician, that they explore other models. This practice has been open a little over 18 months, and there’s a waiting list to join this practice, which is shocking and humbling to me, but it tells me that patients are hungry for a different experience when going to the doctor.

It has truly restored the joy in being a physician. I wake up every morning so excited to come to the office, and I’m so honored to care for the patients that walk through our door. It truly has transformed the way that I can be a doctor and deliver care. I think it’s been a transformative experience for patients as well. It’s very different. In my complex patients, we have prevented hospitalizations, averted crises, and kept folks out of the hospital, which is incredible because that saves the system lots of money from healthcare costs, and it also is just better care for the patients.

The name of my practice is Teague Internal Medicine & Enrichment, and the acronym is TIME, because that’s the one thing I wanted back with my patients.

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