The 3 killer B’s of physician burnout


Is it possible to break down a complex phenomenon like professional burnout into a simple triad? We do it for exotic diseases all the time, so why not?

I still remember my salad days in med school vividly. Bouncing between the cockiness of amassing an entirely new body of knowledge and the awkwardness of having nary a clue how to use it, it was excitement I hadn’t felt before or since. Sure, I could have done without the anxiety of finding a specialty and city to train in, but even those choices weren’t carved in stone.

The novelty of medicine wore off, of course, a process abetted and accelerated by the awfulness of residency. Setting aside the misery of training, however, there was still an evolution in my relationship with the job, from novelty to competency to mastery (at least with the easy stuff).

Then one day, after a number of years on the job, three seeds were sown that would grow, fester, chew me up and spit me out as a functional doctor. I call them my “killer B’s” of burnout: bleakness, bureaucracy, and boredom. I’m also willing to bet I’m not the only doctor they’ve consumed.

No matter how sunny our dispositions, or how fortunate our patients may be in their social status or genetic makeup, tragedy is inescapable in medicine. While it can be cathartic to journey alongside your patient with cancer, or comfort them through a period of grief, there are too many people simply beyond our ability to heal. There’s only so much of yourself you can give to victims of trauma or mental illness before your tank runs dry and your sense of efficacy strains at the margins.

Bureaucracy is inescapable in medicine as well, in its endless variety of flavors: lawyers’ letters; insurance applications; government forms; College documentation; ethics submissions; peer assessments … and every certificate from birth registration to warrants for cremation. I challenge anyone to deny that it’s only gotten worse, thanks in no small part to the costly false messiah of electronic records.

Then we come to boredom. Unlike the other two “B’s,” getting bored with medicine is an entirely subjective experience. Still, it’s often beyond your control as well. Some days almost none of your patients will have interesting complaints, or the ones that do will beget little more than a referral on your part. It takes remarkable foresight to know what will and won’t keep you stimulated in your career. Sadly, the metastatic nature of modern medical bureaucracy is making it all the more difficult to keep things fresh.

As with any disease triad, one or two of the killer B’s are manageable. You can sleepwalk through a dull day, even one with a deluge of paperwork, but can’t if every patient wears you down. You can hear sad stories all morning and fill out forms all afternoon, but adding drudgery will ruin your mood. And most days you can handle the same tragic patients telling you the same tragic stories, so long as you’ve got the evening to unwind rather than draft letters.

It’s the combination of all three that’s hazardous, eating away at your sense of satisfaction at your job, and leaving you feeling powerless to escape. I went through it for months, maybe even years, before I could objectively see that I’d become a liability to my patients and colleagues. I was blessed to have supports that kept me safe from the fatal spiral of depression and self-destruction, but many, many others don’t.

Don’t ignore the killer B’s, in yourself, your colleagues, your students, or your loved ones. Even their slightest sting can prove ultimately fatal.

Franklin Warsh is a family physician who blogs at Impatient Care and can be reached on Twitter @drwarsh.

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