Physician burnout: Why it’s not a fair fight

Every day physicians and other healthcare professionals are engaged in an invisible battle at work.

In one corner is our desire to help other people, make a difference and practice the skills we worked so hard to perfect.

In the opposite corner is burnout and it’s entire gang. Most of us don’t recognize burnout has a whole team on its side. We are outnumbered at least ten to one. I call this an invisible battle because the members of the Burnout Gang sit completely outside of our clinical awareness.

We do our best to focus on the content of the practice of medicine. We concentrate on the one-on-one interactions of diagnosis and treatment that are the lifeblood of the healing arts. That is difficult enough all by itself. Clinical issues alone can occupy all of our awareness and effort in a normal workday.

If the stresses associated with maintaining our clinical skills and practicing good medicine were the only weapons in burnout’s arsenal – we would be pretty evenly matched. Unfortunately that is not the case. Here’s why.

Our medical practice takes place in a context where clinical issues are sometimes the least of our concerns. This practice environment contains a myriad of additional considerations, stresses, outside forces and things that make no sense at all. Every one of these members of the Burnout Gang takes its little piece of our energy and nibbles on our very soul over time. It is the classic “death by a thousand paper cuts”.

I will jot down nine of these features of our dysfunctional practice context here … and note this is only a partial list.

9 members of the Burnout Gang

1. Being a doctor is stressful … period. The “most stressful” professions are characterized as having a high level of responsibility and little control over the outcome. We are not selling widgets here. This is a tough job that saps our energy every single day.

2. We work with sick people all day long. Our days are filled with intense encounters with sick, scared or hurting people … with all the emotional needs that come with an illness. In the absence of training on creating boundaries, our energy can be severely tapped by these emotional needs alone.

3. Balance, what balance? Medicine has a powerful tendency to become the “career that ate my brain”, pushing all other life priorities to the side. As we get older, with more family responsibilities, the tension between work and our larger life is a major stressor for many. Training on healthy boundaries would help here too and is rarely available.

4. A leadership role with no leadership skills. You graduate into the position as leader of a healthcare delivery team without receiving any formal leadership skills training. By default we learn a dysfunctional “Top Down” leadership style. Medicine and the military are the only professions where the leaders “give orders.”  This adds additional stress.

5. The doctor as the bottleneck. The team can only go as fast as we can – and we are often behind schedule. Pressure mounts to perform at full steam all day long.

6. Who’s paying for this? The financial incentives are confusing at best. The patient is often not the one paying for our services and many of them receive their care with no personal investment on their part. You may have to deal with over a dozen health plans with different formularies and referral and authorization procedures … of which the patient is blissfully unaware.

7. A lawsuit waiting to happen. The hostile legal environment causes many of us to see each patient as a potential lawsuit. This fear factor adds to the stress of all the points above.

8. Politics and reform. Political debate drives uncertainty about what our careers will look and feel like in the future. All the pundits share the same complete lack of understanding about our day to day experience as providers in the trenches of patient care. There is no track record of common sense. We simply don’t know what to expect.

9. Things eventually get stale. The ten year threshold when your practice suddenly seems to become much more of a “mindless routine”, losing its ability to stimulate your creative juices each week is a shock. All of a sudden it seems as if medicine is “no fun any more.”

Wait a minute, who’s on our team?

What skills and strengths are we bringing to this fight?

  • Our connection to why we are a doctor – to our purpose. The quality of this connection varies day-by-day, however it is a source of immense power and endurance when the connection is clear
  • We have invested over a decade of our lives in our medical training and are not going to give up easily
  • We get paid well enough to be in “the 5%”
  • We are a respected member of the community
  • Our families love and support us. We can draw strength from them
  • We have a life outside medicine where we can recharge and recuperate. You might think of this as “resting between rounds”

Just like Rocky Balboa, we can take a huge amount of punishment – take a lickin’ and keep on tickin’. We were trained and conditioned to use this tactic over a minimum of seven years of medical education. We know this coping skill right down to our bone marrow. It’s not subtle and it can only last for so long.

Remember you are outnumbered. The multiple members of the Burnout Gang hiding in the context of our work days ensure that no human being can beat burnout 100% of the time … no one. It’s ok. You did your best.

When you notice the three cardinal signs of burnout:

  1. Exhaustion
  2. Cynicism (especially in men)
  3. Questioning the quality of your work or whether you make a difference in the world

That’s burnout. Let’s call it by its real name. It is a red flag and a warning. You have been smacked around by the Burnout Gang. It was never a fair fight.

Time for a break, some balance, to take really good care of yourself, spend some time with your family and even ask for support. You’ve earned it.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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