By Alaina Trivax, WCI Columnist
When I first got married, I worked at a boutique consulting firm. It was a very demanding job; there was a “whatever it takes” culture–an expectation that we would work relentlessly to ensure that our clients were satisfied. My boss would often send over projects at 9 or 10pm, requesting completed products by the following morning. This job had me exhausted, overwhelmed, and just generally miserable.
My husband, Brandon, who was halfway through his PM&R residency at the time, sat me down one night and said so bluntly, “Alaina, you do not have to do this job. You can quit.” That should have been an obvious option, but it wasn’t. I had worked hard to get to this role, and I really thought I should make it work. Until he pointed it out, it hadn’t even occurred to me that I could leave.
We made an exit plan for me that night. I began applying for teaching jobs again and got excited about heading back into the classroom. That conversation led me to the job I’m in now as a middle school teacher—a job I find fulfilling and enjoyable and one that allows me to (at least somewhat) balance my professional and home lives.
I’m sharing all of this because I want to be clear: this is my take on physician burnout, and it’s not a simple story of a good wife creating a happy home for her doctor husband. Marriage is a commitment by both partners, and each partner has a responsibility to support the other. Brandon intervened when my job was sucking the life out of me; I would hope to do the same for him if ever necessary.
So, What Does the Doctor Say?
Overall, my husband, who’s now been an attending for almost three years, actually feels pretty good about his job and all that it demands, but we both keep an eye out for any signs of overwhelm and disillusionment. I asked him: what do I do that helps? What else could I do? I’ve shared some highlights from our conversation below.
Alaina: I try hard not to be resentful of the demands and time that your job requires. Every choice you make is with our family at the front of your mind–you’re working the hours that you do in order to support the life we’ve chosen to pursue. How would you say this comes across to you? I’m sure (I know!) there are times when things get the better of me and some bitterness comes out. What kind of impact does this have on you?
Brandon: I appreciate the fact that you try to make sure I can focus on my job—even when I have to bring the work home. I mean, in theory, I could get everything done at work—I’d just have to stay later and would miss the evenings with our kids. So instead, I come home for dinner and bedtime with the plan of finishing notes after they go to bed. Often, this means that you’re cleaning the kitchen while I sit on the couch doing notes.
Alaina: Yeah, that’s usually the thing that makes me nuts—when you’re sitting down to finish notes while I’m frantically trying to prep our house for another day.
Brandon: It’s important to me—and I think to you, too—that I’m home to spend time with the kids on the weekdays, and this is part of that balance. I imagine I would feel a lot more resentment toward my job if I weren't able to have these evenings with our family. And, sure, I’m sitting down on the couch doing the notes—but it’s not like I’m actually relaxing. I hope you understand that I try my best to help you in any way I can. However, sometimes I recognize I lack in this area.
Alaina: It’s so hard to balance it all! I do appreciate that you are home for dinnertime every single day. You’ve been working some extra weekends these past few years to help pay off our student loans. These additional shifts are tough on you and tough on me. Neither of us gets any sort of a break for that whole stretch. We’re just coming out of the latest double weekend, scheduled back-to-back for 19 straight days of work. Do you worry that taking on these extra shifts could lead you to burning out?
Brandon: No. The student loan debt is far more likely to cause me to burn out compared to a few extra weekends. The fact that over half of my monthly income has to be allocated toward our debt is a pretty big burden on me. Working these extra weekends allows us to send some extra money toward student loans so that they are paid off sooner. As soon as we have that student loan debt gone, I plan to stop taking on any additional shifts.
Alaina: Yeah, that’s fair. Did you see we're down under $190,000 on those loans? Making progress [we were a little over $330,000 when Brandon started as an attending in July 2020.]! Remember that consulting job I had when we first got married? What was it that made you realize I’d reached a breaking point with that role?
Brandon: I’d say it was pretty obvious from the outside. You were not in a good place emotionally. At all. And, there was no reason for you to be that miserable.
Alaina: I was definitely unhappy in that job. I’m curious–what do you think it would look like if you reached your breaking point?
Brandon: If I truly got burnt out, I’d likely react by withdrawing. I’d become unmotivated, not wanting to engage with work or family stuff.
Alaina: That’s helpful for me to know. Let’s talk a little about our work schedules. As a teacher, I get the holidays and summers off with our kids. You know I’m all about taking them places and doing things—I have to leave the house so I don’t lose my mind! Are you ever resentful of the adventures that I take the boys on without you? How does that impact your feelings about work?
Brandon: Yeah, sometimes. I’m not resentful of you and the fact that you’re having fun with the boys. I’m glad you get to help them have all these experiences. But yes, sometimes I’m frustrated that my job prevents me from being able to do all those things with you and the boys. I do try to remind myself, though, that your schedule doesn’t really compare to any other job. You work long days during the school year, but when you’re off, you’re off. Even if I were in a different field, it would still be unlikely that I could join you guys for a morning petting zoo trip on a random Tuesday in June.
Alaina: There are definitely times I feel guilty about taking the boys to do stuff without you. Not that a day on the lake with two small children is relaxing for me, but I do feel bad that you’re missing out on the fun. This past year, you’ve started getting really into golfing as a hobby. I’ll be honest: at first, I was a little irritated that you were spending your half-day afternoon at the driving range. I get a lot of vacation days throughout the year, but it’s rare that I have a day without the kids, so the idea that you could go do something fun during the middle of a weekday without the kids annoyed me a little. I’m sorry about that. I really did try to turn it around and be supportive of this for you. Has exploring this hobby impacted you and your overall wellness—both as a physician and as a husband and father?
Brandon: Well, it was great, but two things. 1) It’s like an hour once a week. Definitely not a whole afternoon. 2) I haven’t been able to go for like two months now. These daycare germs keep sending our kids home, and they are wrecking my schedule. But when I was going, it was nice to have a little bit of time to myself—I would put headphones in and just focus on my golf game for an hour. It was good to get away from my job and away from the demands of our life at home for even just a little while.
Alaina: I think that pursuing a hobby has been really good for you. I can imagine it’s nice to have something other than work to focus your energy on. Overall, do you think you’re at risk of burning out as a physician? Is there anything I could do to help prevent that or to just better support your career in general?
Brandon: Yes. Of course. The job is hard. I’m pulled in multiple different directions, and administrative work on top of the actual medical work that I trained for makes it hard to maintain a work-life balance. As far as what you could do . . . I don’t really have an answer to that one. I’m not sure if there is too much you can do to prevent me from getting burned out. I suppose keeping an eye on how I’m balancing things and checking in during the tough stretches is helpful. Honestly, I think most physicians are at risk of burning out—it’s tough to find any sort of work-life balance in this field.
Preventing Burnout in Your Physician Spouse
That was a pretty tough conversation. Honestly, I was a little surprised to hear that there’s not much I can do to prevent him from burning out in his career. There are times when I’m tempted to take on a few extra chores in an attempt to make his days easier. Sometimes, it works out—I’ll make the baby’s bottles in the morning if he’s needing a few extra minutes to run through patient notes. Other times, though, I just end up feeling resentful that I’m having to “pick up the slack,” and that really isn’t helpful for either of us.
As I said in the beginning, I don’t mean for this to sound like a directive to create a happy home for your doctor spouse. That is absolutely the job of both partners. Still, I know my husband’s job is hard. His days are long; the work is exhausting. If he were to reach the point of burning out, it would have a big impact on both of us and our kids. The logistical changes and emotional blow of having to find a new job would be tough. He’s happy in his role right now, and it’s important to our family he stays that way. So, moving forward, I honestly might just ask: “It seems like work is really overwhelming this week. What can I do to help?”
What strategies have you or your spouse undergone to prevent burnout? Have you found something that works? Is the threat of burnout constantly in the back of your mind? Comment below!
We know you visit The White Coat Investor to learn about investment strategies and planning, and we’ve always strived to teach financial literacy to physicians, high earners, and anybody else who finds their way here. But the COVID pandemic has also shined a light on physician burnout and its dangers. That’s why we feel compelled to run articles and columns like the one you just read—to make sure white coat investors stay mentally healthy. We know mental wellness is what leads to a long, fruitful financial life, and we’ll continue to run pieces like this because combatting burnout has become such an important part of everybody’s financial journey.
I think you’re right that you can’t do much about your spouse’s burnout risk since it’s an occupational problem, not a home problem. Obviously being happy at home is helpful for life generally, just as being unhappy at work can affect home life. It’s valuable for any spouse to recognize the limits of your influence on the quality of your partner’s experience at work so that you yourself don’t burn out at home. Managing a home is a full time job, after all, and can be accompanied by its own forms of emotional exhaustion, depersonalization, and loss of efficacy.
One thing that’s important in a relationship with a physician is recognizing when your spouse needs to make a change at work. Interestingly, Brandon did for the author in this story. My own experience has been similar, both at home and when talking to other friends in professional marriages: it often seems to be more obvious to the spouse when their partner needs to cut down on work hours or make a career change altogether. Maybe as professionals we’re overly conditioned to hard work and delayed gratification, and it takes a while to become aware that a job is no longer working for us.
Despite all the interest in resilience, burnout has a lot more to do with the job than it does the individual. The widespread burnout in medicine and nursing is an occupational problem, not a sign that the people going into these jobs are uniformly defective. It’s really helpful if your financial priorities are in order so you can support your spouse in making whatever changes are needed. It would be really hard to make meaningful changes if your spending is out of control or you’re living paycheck to paycheck. In the sense that you have to be past survival mode and financially stable enough to realistically deal with it, burnout is a little bit of a first world problem.
I appreciate this column. That said, more balanced division of chores and childcare is more likely to reduce resentment between spouses. This is far more important to reducing burnout as a whole. Role expectations which propagate emotional tension at home are not worth the benefit of paying back loans a year earlier.
One of the general limitations of physicians is that we think burnout is unique to us. It is not; it is a manifestation of certain perversities in our capitalist individualist society on top of eternal aspects of the human condition . So burnout also happens with stay at home parents, teachers, caregivers, police officers, etc. We have to be careful to cultivate a marital and familial life that is both a refuge and anti-fragile. The first step is not thinking that we get a pass on the grind of maintaining a household.
Really? Burnout “ is a manifestation of certain perversities in our capitalist individualist society”?
So no burnout or displeasure with one’s lot in life in the gulags of the Soviet Union or today’s North Korea? I’m not sure I’m buying it.
Not that communist societies have a monopoly on misery. I suspect most third world subsistence farmers struggling to avoid starving to death would happily trade places with wealthy first world doctors who only have “burnout” as their burden to bear.
Work fewer shifts, hire help for your least favorite household chores, move away from a job with toxic management, do volunteer work in the developing world for patients who appreciate your expertise. Eliminate debts, live within your means, and get to a point where you don’t have to work but the work is meaningful enough that you want to work.
You can do this just fine in a capitalist society like ours or a social democratic society like Sweden or Finland. Heck, if you’re convinced that the Finns have it that much better and U.S. medicine is irredeemable, start learning Finnish and emigrate. If you aren’t bothered enough to learn a new language, try medicine in Canada, the UK, Australia, New Zealand, India, or some other place where English speaking doctors can practice. You may like it better or you may find that the grass isn’t always greener on the other side of the fence. Either way, it sounds more productive than complaining about the “perversities of capitalist society” like an English major working as a barista.
Note that I said that these perversities are layered on top of the human condition. Boredom, ennui, dhukka, suffering, toil, pain, etc are part of the human condition. In my opinion, burnout has a different character that is influenced by our present capitalistic individualist society. It’s a tradeoff to some of the good that our society produces. Recognizing and arguing that should not result in ad hominem attacks.
For example, our society has done away with any sense of a Sabbath or normal work hours. We expect people and goods to be always available. Large companies and hospitals schedule workers at chaotic un-family friendly hours and load them up with work (“billable” notes/EMR is but one manifestation) to produce higher returns to investors/holders of capital. We are promised and then grow to expect services at any time of the day or night. People are treated as dispensable things and then start to view themselves as dispensable things – how can this not lead to de-personalization? Then add on the never-ending dis-satisfaction that is propagated by our “personalized” phones and computers…we come to live in a burnout society.
This burnout article activated my post traumatic burnout disorder…just kidding.
This sounds so familiar to me. My spouse worked at a Montessori School for twenty years and was able to take all of our children to work with her as students there. All of the entirely young female staff helped each other and supported each other. Most of them breast fed their children at work. Since my wife’s boss was also one of her best friends, she never experienced the “corporate world” that I lived in as an employee physician.
At my jobs, your security was as good as your most recent productivity report. There was little support for any parental role. You were expected to act as if you were childless. Even childless physicians had little empathy for any child need or events. My wife always took the kids to their appointments. Any time she needed a few hours off, she got them. Me? I’d have to go in early and finish early to go to kid’s sports events. I missed going to some but did my best. Precious few in corporate medicine care two hoots about your home life and personal wellbeing.
Anytime my job encroached upon dinner time, I was frustrated. I left a job that required a 45 minute commute each way and had two hours of “paperwork at home” with the darn EMR writing notes. I became more and more protective of “my time” and would tell employers I wanted a “real lunch hour” and minimal after hours work.
My first job went from psychiatrist to Medical Director to Department Chair and head of QA/QI at a hospital in seven years. It was frequently 0730 to 6 pm. I eventually grew to hate it, burned out and quit to go to a brand new unit that I could build from scratch. No clinical care for six weeks. It saved me. It was really 40 hours a week, but had 10 hours of commuting each week and also 15-20 inpatient (paid) weekends a year.
This job lasted 11 years until a new CMO came on board and presented a contract that two of the three of us would not sign. I can still hear this fellow in my head: “What’s up with this lunch hour swimming? That’s got to stop. Lunch is a half hour. And who told you this was a forty hour per week job? I answered, “ my contract”. He said, not anymore, and proceeded to request an 0730 to 600 pm type of schedule with my hour commute on top. Of course, I quit again. So did one of my colleagues, leaving only one psychiatrist in the whole system.
In my whole career, I took jobs that paid the student loans (our combined loans were $125,000 in 1994) and NEVER moved the family. They stayed in the same house and school from 2003-2022. I minimized the impact of my job changes, went to almost all the kids sports events, and took as many family vacations as we could.
Thank goodness for my wife, taking a larger share of care of the kids and the work at home and being supportive when I was burned out. I also thank her for being frugal and being willing to downsize. We are a team.
Some people wonder why I’m so happy now…working much less. No boss asking for sixty hour weeks, no half hour lunch, no 45-60 minute commute, and only two days a week from home. No student loans, no debt, no worries and no working spouse (my wife retired at age 50). Only four weekends a year instead of twenty. No holidays in the hospital except the one a year I choose. Couldn’t be any better unless I had saved more and was done completely.
All my side gig weekends were worth finishing full time work at 58. All my efforts to not be the “absent doctor dad” mostly worked, but I changed jobs about seven times in 30 years. The boss who ruined my best and longest job (11 years) was fired six months later. Good. My wife supported my efforts throughout. Priceless.
There is light at the end of the tunnel of corporate medicine. It was early retirement from full time work for me. For others, it’s having their own practice and being their own boss. It always goes better with a supportive spouse.
I appreciate you going through this exercise. I think what I was struck with the most was the “extra shifts” to pay off the student loans. In 10 years, you will not care one bit that you paid your student loans off slightly faster. You won’t get the time back with your family, and clearly there is some resentment building.
In your mind, being home for dinner justifies sitting on the couch and doing your notes. I have learned to never use my wife and kids’ time to do notes. Stay at work and finish them, seriously. Then, when you are home, be a dad and a husband and leave work at work! This might mean you miss dinner with the family from time to time. If you limit your work days to 15-16 per month and get your notes done at work, you will be more present with your family at home and still make more than half of the family dinners.
Of course, for you, it will seem harder because you will get home with nothing to do and start the second part of your work day, which is helping to get the kids to bed. This change will pay huge dividends in your marriage and your relationship with your children. Don’t be the dad on the couch doing notes. That all needs to be done out of your family’s sight while you are at work. Be the father and husband who is 100% present at home, willing to help out around the house and caring for the children, and relax once they are in bed.
Your biggest risks are burning out and losing your wife. Mitigate both of these by cutting back at work (no more than 15-16 days per month) and getting all your notes done so you can help around the house and be fully present for your family.
While I agree that working 16 days in a row is not healthy/sustainable and not worth paying off loans a bit sooner, I think there is some reasonable middle ground between that and waving some magic wand to be off for a week+ each month. Since mom is teaching the kids must be in school/care from Sept-May. Who is he going to hang out with on those weekdays? Seems much better off at work and getting those loans paid off. You just have to keep an eye on the cost and benefit of those extra hours and stay away from the diminishing returns.
I’m not saying there isn’t room for creativity with the schedule. Trying out a half-day or two a week may be a great trade-off for this family. I also wouldn’t presume to tell him it’s better to finish the notes at work. That’s his wife’s call.
Cutting back hours was effective for me.
Several years back I reduced my work week to roughly 30 hours and refused to take call at the local hospital. These changes made a huge difference.
You have got your debt down from $330k in July 2020 to $190k today. Roughly $140k in 31 months. $4,500 / month. If you keep going at this rate, you will be ‘done’ in 3.5 years, or Sep 2026.
Everyone has their own views around debt. I see 4 kinds:
– Good debt: Appreciating assets. Things like most real estate and many degrees where the asset gains more value over time.
– Bad debt: Depreciating assets. Cars, boats, status symbols.
– Ugly Debt: Credit card, payday loans
– Toxic Debt: Money borrowed from Friends and Family
I do not hear any hint of toxic or ugly debt around you. I’d be surprised to hear you allowed anything more than a necessary minimum of car loan into your lives. I’d guess that you don’t even have that. Great! If you had the toxic debt, or the ugly debt, I would applaud the level of sacrifice you are making.
It seems that you only have good debt in your lives. I am assuming you have life and disability insurance. You are on track to pay off the investment in your education just fine. Whatever happens.
I do hear the threat of burnout in your lives. From where I am sitting, your whole family has paid significant dues already and earned the right to pay that debt off over 4 or 5 years rather than 3.5. Figure out a repayment date and rate that really works for all of you. If you were stretching it over 10 years that would obviously be wrong . But 3.5 years seems to be bringing more stress into your lives than it is removing. Give up on the extra shifts. Or agree to a set number per year. Yes, you go in to cover an emergency, but not just to knock a week or two off the repayment date.
Interest on good debt counts just as much as interest on bad debt. The debt doesn’t care what you borrowed it for originally, it acts the same.
Appreciate your work on the article. Creative post.
However, I’ve never really liked the term “burnout”. I wish we could use a term with a more concrete (or more clinical) definition. The term burnout is too loosely defined.
How would YOU define burnout?… for me, a working definition could be “feeling discouraged about your work-place”???
I mean, it’s fair to be discouraged about your work-place if you are paid less, rewarded less, or work more, or work more intensely than you think is appropriate. And then long-term, if you don’t change the situation, then… yea, you may become so discouraged that your feel you just have to quit working
Kudos to the both of you for having this brave and raw conversation. You are both in the thick of it with parenting and early career challenges as well as debt servicing.
One question that Alaina may not even know to ask Brandon is are the other providers in your practice/ specialty spending this much time on documentation? It can be helpful ( albeit painful) to ask why am I different than my more efficient colleagues? Just as we become more proficient in procedures and patient care with experience, many of us can work on our documentation skills. I used to bring work home in my early career, and the solution for this was not cutting back FTE ( although that is something I was able to do once I had less debt) but improving my documentation speed by getting pointers from my more experienced peers.
How great would it be to be fully present when you arrive home for your wife and kids while leaving work at a reasonable hour. Obviously, I could be way off base in this situation.