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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  • Anonymous

    Well said.

  • Anonymous

    Perfect
    The only thing I would add is to cultivate non-physicians as friends or part of some group so that you have other things in your vocabulary besides medicine

    • http://www.thehappymd.com/ Dike Drummond MD

       I agree completely. The more activities and interests you have outside of medicine … the easier it is to recharge and come back to your practice refreshed.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

  • http://www.thehappymd.com/ Dike Drummond MD

    I only put 9 non-clinical stressors in the article and I know that is not an exhaustive list. What are the top non-clinical pressures that You feel in your office day?

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • http://twitter.com/askmarie Marie Guthrie

    Just as we cheer the spirit of a true athlete, so too let us cheer the spirit of the true physician.  It is a choice to be inspired – filled with spirit – courage, tenacity, commitment, honor, respect and humility. It is a choice to be dispirited – hopeless, dejected and defeated. Spirit is a highly pragmatic cause – it is the difference between life and death, victory and defeat – ask any military commander, coach and CEO. When physicians lose their spirit, they die. True for us all.  Seems that the best cure for these burnout physicians is for them to connect with others, be inspired – filled with spirit – again.

    • http://www.thehappymd.com/ Dike Drummond MD

      I agree Marie … and the take home message from the research and my clients is that Burnout has so many forces acting in concert against us … everyone must be on guard and working an active prevention plan to stay healthy. One thing doctors don’t do well is ask for support (especially the men). You and I are working on creating supportive communities for leaders like physicians. More to come for sure.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

  • http://empoweredpractice.com/ Trista

    Just as Marie pointed out, everything is a choice. Having been in the health field I can relate on a different level than physicians about the burnout that comes with career choices. I respect and have a completely different outlook on doctors and their families now that I have been among them. MDs certainly have to make tough choices when trying to balance their careers and life. I wonder how many really knew what they were getting into? I have to say I didn’t mind the idea of marrying a doctor until I actually realized their work schedule. You mentioned in #3 “Training on healthy boundaries would help here too and are rarely available.” I can’t agree more. Possibly the ‘training’ is not made available through med school or provided by the clinic/hospital, but there are great opportunities through coaching, which I believe is what Marie and yourself do at some level. Realizing your purpose, re-evaluating your values and accepting that you are always doing your best and making the best decisions with what you have and where you are now can make a huge difference in living your full potential. Don’t give in to the ‘burnout gang,’ there is always a way to persevere.
    -Trista 

  • http://twitter.com/sarasteinmd Sara Stein MD

    The best success I’ve had with burnout has been to shift my professional focus – at one time research, later administration, writing, now Functional Medicine. Always with an immersion in learning that reached into my brain and stimulated my creativity and excitement and enthusiasm – the same way I felt in med school 25 yrs ago. I find that I change my focus every 6-7 years – maybe that’s a natural timetable for burnout and boredom. The time constraints, the paperwork, the regulatory and legal requirements that I despise pale for the most part in comparison with the fun I’m having.

    My suggestion? If you’re a burned out doc, and you most likely will be at some point, change your focus, even if it’s just a little. Aim for mastery, then change your focus again.

    Cheers,
    Sara Stein MD

    • Anonymous

      I agree, though I would state it differently.  Best cure for burnout is is to leave clinical medicine. Find some other means of gainful employment, which may or may not be medically related, depending on your preference.  May take some time, may well require that you go back to school and get some other qualifications, will absolutely require that you become an active job seeker,but well worth it.  Best move I ever made.

  • Anonymous

    This is very timely, and I appreciate the work that you’re doing to help your colleagues.  Burnout is a serious problem, a dangerous problem.  Medicine is an absolutely fascinating discipline, but the non-clinical aspects  of the “practice” of medicine can take a major toll on the physician’s daily outlook.  There are so many competing forces (regulations, paperwork, insurance companies, etc.) trying to get in between the patient and the physician that patient care and the physician-patient relationship are impeded.  A next logical step after burnout is full-blown depression.  With 300 – 400 physician suicides per year (the equivalent of 3 – 5 medical school classes) committing suicide every year in closer to 1:1 rather than 4:1 male:female ratios, we have something of a crisis.  Not only is the healthcare system losing physicians, but families are also losing fathers, mothers, sisters, brothers, sons, and daughters.  I’ve often wondered who the physicians, pastors, and therapists talk to – after all, they are the ones who are supposed to have the answers.  It is difficult sometimes for a physician to find a physician who will treat them like a patient rather than a colleague, and it is often equally difficult to find a non-physician who can forget about the medical degree and treat them merely as a fellow human being who has problems and challenges just like everyone else.
    Thanks again for the work that you’re doing.  Just blogging about it reminds physicians that they are not alone – that feeling of isolation makes everything worse.

  • Anonymous

    “In the opposite corner is burnout and it’s entire gang.”   “it’s” = it is or it has   “its” = possesive, like “his”, “hers”.

  • http://www.facebook.com/people/Greg-Mercer/100001786695804 Greg Mercer

    Like many people today, Physicians often seem to busy and distracted to see all the options available to them.  One obvious answer to burnout is to stop demanding so much of yourself: find a work arrangement requiring fewer hours and pressure.  Take on fewer patients, accept making less money, spend more time per patient.  It is arguably worth significant wealth to enjoy more satisfying work, a better and more balanced life.  It is also a far more sustainable path.  Compared to most people, who earn less, most physicians have more ability to accept less income without loss of anything but luxuries – in this sense such options offer more to gain and less to lose than they do for most people.
    Physicians are unusually intelligent, talented, and resourceful people: surely you can find new & workable ways to practice, if you pool your resources and make it a priority.  It sure beats slowly sinking within current arrangements, doesn’t it?

  • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

    To make matters worse, not all of us are compensated well enough to land in the “top 5%” or earners in this country.  The MGMA-ACMPE report was just released regarding academic physician salaries, and primary care academicians on average earned $167,943 annually.  When I was working in academic medicine, my FTE salary didn’t even come close (my salary not only didn’t put me in the top 5%, it didn’t land me in the top 10%).  For the amount of work we do and the stress we incur (as well as our student loans), this was one more reason to add to the burnout gang list. While I was happy to be employed, being so non-competatively reimbursed definitely took its toll in the face of educational debt.

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