By Dr. Jim Dahle, WCI Founder
What Causes Physician Burnout?
In my opinion, there are really four factors affecting burnout, some of which are unique to medicine and some of which are not. Here they are:
- Abusive work environments
- Professional stresses
- Personal factors (aka lack of resiliency)
- Financial factors
Now this pie chart suggests that all four of these factors are equal. That is very unlikely to be true, but since I don't really know what percentages should be assigned to each of these four factors, I just made them equal in the pie chart. A few months ago I asked readers how much they thought personal factors accounted for physician burnout and this was their answer (you can vote too if you like).
Loading ...As you can see, only a tiny percentage of docs think personal factors play NO role at all in burnout.
The Four Factors of Physician Burnout
Let's describe the four factors contributing to burnout, one by one.
#1 Abusive Work Environment
A decent amount of physician burnout is simply really crappy jobs. There is a surprisingly high percentage of these in medicine.
Lack of control is frequently cited first as a contributing factor to physician burnout. In emergency medicine, only about 8% of doctors own their jobs any more. The rest are hospital employees or employees of contract management groups. These doctors no longer have the same control over their job and work environment that a democratic group like mine enjoys.
We decide which patients we don't send a bill to. We decide how to split up the evenings, nights, weekends, and holidays. We decide how to staff the ED (i.e., how many patients we'll see per shift on average). We decide how the compensation will be split up.
Over the last twenty years, more and more physicians have transitioned from jobs they owned to employee jobs. I suspect this is the largest single factor contributing to physician burnout. Yes, you can get burned out at a job you own, but at the end of the day, you have the power to make substantial changes to that job. It is far easier to be content with stresses you chose to take on than those that are thrust upon you.
Add in some abusive hospital and practice administrators, overwhelming volume, lack of support staff, lack of respect, an EMR designed to maximize billing rather than patient care and physician efficiency, inadequate equipment, long hours, ridiculous amounts of call, and you have what amounts to a terrible job. No surprise that it burns people out.
The real tragedy with this cause of burnout is that people often do not realize that this is job-specific. They assume the entire profession is this way and it just isn't. Keep looking. Not every job is abusive.
#2 Professional Stresses
However, there are some very real professional stresses that exist in the vast majority of doctor jobs. There will always be sick and injured patients. We are not surprised to see soldiers return from the Middle East with PTSD after seeing bodies blown to bits day after day but we are when it happens in doctors?
Give me a break. This is a hard thing we're doing here. Death, trauma, child abuse, socioeconomic messes, rare/uncurable illnesses, memory-robbing dementia…the list goes on and on and on. Some people see this sort of thing once or twice in their life and shy away from it. Doctors see it every week and run toward it. That wears on you. You can tell yourself that “The patient is the one with the disease” as much as you want, but it doesn't always work.
How about ridiculous licensing requirements and costs? Board Certification and Maintenance Of Certification that feels like another money grab? $100K malpractice insurance premiums? Frequent lawsuits and threats of lawsuits (even if the risk of personal loss is ridiculously low). Don't forget the paperwork– who decided 10 systems reviewed pays one thing and 9 systems reviewed pays half as much? Insurance pre-authorizations? Disability paperwork? The list goes on and on.
Some of these things can be improved with systemic change, but many of them cannot. They are simply the stresses of the profession. It is a difficult profession and always will be.
#3 Personal Factors
At the risk of getting even more hate mail, I'm going to throw this one in there because I think it is ridiculous to leave it out. A big chunk of physician burnout is just depression in disguise. Depression is the leading cause of disability in people 15-44. Major Depressive Disorder exists in 6.7% of Americans at any given time, and the median age of onset is 32.5, about the time docs come out of training. 2/3rds of people with depression don't seek treatment. I'm sure that number is even higher in doctors. And when things get really bad, the medical knowledge of what can actually kill a person likely contributes to the high suicide success rates among doctors. But far more than 6.7% of doctors report burnout symptoms. Usually, that number is over 50% with at least some symptoms. It clearly isn't all just depression.
Some of it is lack of perspective. This is the target Side Hustle Scrubs focused much of his post about. We sometimes forget that most people don't like their jobs. It's called work because someone has to pay you to do it and I'm sure we've been complaining about work for millennia. I doubt most of the Roman Legionaries felt super fulfilled marching across Germania for months to go fight some Gauls. There's a support group for people who hate their jobs, it meets on Friday nights down at the bar. Yes, medicine takes a ton of work to get into, requires difficult hours, can be physically and emotionally demanding, and carries high liability. That's why it carries a fair amount of prestige and relatively secure, high pay compared to most jobs.
Some of it is a lack of resilience, although I actually think medical school admission committees do a pretty good job of selecting for highly resilient people. It takes a certain amount of resilience to get good grades in difficult classes, score well on a tough test, do research, gain leadership experience, develop health care experience, and learn to love serving others. The application process itself selects for persistence. That's probably not a bad thing as the most important trait in doctoring is attention to detail and hard work rather than sheer intelligence.
Most of the people who go into medicine are very idealistic folks, and when the student hits the third year (or perhaps intern year) and that idealism is smashed into a brick wall of reality, it can be pretty traumatic for these idealistic people. I remember when I got a Notice of Claim from my first month of internship and then another from my second month. Some small portion of the person who applied to medical school died, and I think I'm still more idealistic than most docs! I like being one of The White Knights of Medicine who always get to take care of people whether they can afford to pay me or not–Anyone, Anything, Anytime.
Some of it is work-life imbalance. There's definitely a culture of suffering and workaholism in medicine.
“You know what's wrong with Q2 call? You miss half the good cases!”
And, of course, there are too few doctors to go around in many locations.
But lots of this lack of resiliency results from bad choices we make. We choose to eat like crap. We choose not to exercise. We choose not to spend time with family and friends. We choose not to pursue outside hobbies and interests. We choose not to care for ourselves but to martyr ourselves on the altar of medicine. Then we're surprised when medicine carries through and finishes us off.
It's easy to blame the systemic issues above under #1 and #2 because then we carry no blame, no guilt, and no responsibility. But it is an intellectually imbecilic argument. All doctors are functioning under the same flawed system. Many doctors have crummy jobs. But all doctors aren't burned out. Some are clearly more resilient than others when facing the same stresses. So why not work on the doctors at the same time you are working on the systemic issues? It seems silly not to.
#4 Financial Factors
Here is where I have chosen to focus a large part of my energy in decreasing the burnout problem. Doctors generally do not start earning real money until they are the age when many FIRE advocates are already financially independent. Doctors usually finish training with a dramatically negative net worth. Perhaps -$200K, perhaps -$500K. Sometimes worse. And some people don't even get to the end of their training and that high salary that represents the light at the end of the tunnel.
Many doctors fail to match, and that number is rising. The problem of doctor level loans without a doctor level job is particularly acute for Caribbean medical graduates, where the match rate is in the 55% range.
Add a lack of financial literacy and business sense taught in medical school, dental school, and residency to a societal expectation that doctors are rich and you have a recipe for a lot of financial disasters despite a high income. These stresses cause sleepless nights full of worry, an inappropriate focus on what pays best, and most importantly, working too much.
Despite my own successful side gig, I am amazed at how many doctors feel like they need one because medicine just doesn't pay enough. The average physician wage is approaching $300K/year, which places doctors solidly in the top 2-3% of Americans. As I tell the medical students who come over to the house once a year — if you can't live on $300K you have a spending problem, not an earning problem.
How to Help Combat Physician Burnout
So what can be done? Well, let's take these factors one by one.
Toxic Jobs
The best way to eliminate toxic jobs is to stop taking them and if you mistakenly find yourself in one, leave. You may have missed the memo about the doctor shortage, but you have a very particular set of skills and they are highly portable.
Don't be afraid to pack them up and walk away to somewhere that will appreciate them a little more. Yes, it's a pain to change jobs. It might take six months to get licensed and credentialed. But you've proven to yourself already that you can suck it up and do anything for six months. Maybe there are family or location issues that make it a little harder for you to leave. Or maybe you feel called to serve these particular patients more than any others.
Sometimes toxic jobs can be changed, but you need to recognize what the problem really is and start working on it. Saying “No, that's ridiculous” can go a long way.
No, that's ridiculous for me to be on call every night for six months.
No, that's ridiculous for you to pay me at the tenth percentile for my specialty.
No, that's ridiculous for you to expect me to see four patients per hour.
No, that's ridiculous for you to expect me to do that paperwork at home for free.
No, that's ridiculous for me to operate with poorly trained staff.
No, that's ridiculous that your nursing turnover rate is 150% per year.
Systemic Professional Issues
Some of these can be changed. The revolt against MOC in Internal Medicine has put the other specialty boards on notice. Lobbying your legislature for legal changes that reduce malpractice premiums can actually make a difference. We can stop taking insurance with ridiculous pre-approval processes.
But some of the professional challenges we face are never going away. Supporting each other through these difficult times can help a lot. Lots of hospitals and clinics have implemented strategies that make a difference here. Mostly, they are about giving people a chance to step back for a bit and reflect and especially to feel appreciated. I am amazed at what doctors are willing to do for a simple thank you. A dedicated parking spot and a few free meals don't cost much, but they go a long way.
Personal Factors
Why not work on this at the same time as everything else? As St. Augustine said, “Pray as though everything depended on God. Work as though everything depended on you.” Change what you can and try not to focus on what you cannot change.
- Take some time off. If you're offered vacation, paternity leave, or maternity leave–actually take it.
- Try to eat a little better.
- Implement an exercise program. It is clinically proven to improve pretty much everything.
- If you have depression, get on some medication and go talk to someone. If you see someone struggling, reach out to them.
- Build and maintain important relationships with your immediate family, your extended family, and your friends. Get out of the medicine bubble. Even better if you can get out of the upper-middle-class bubble. That sure helps with perspective sometimes. If all of your friends can afford to go heli-skiing with you, you need some more friends.
- Do the yoga, meditation, breathing, prayer thing. It has clearly helped lots of people.
- Find a balance between work and other interests. Work is a healthy thing that adds value to your life. But it's hardly the only thing and it can only do so much. Don't expect too much from it.
Financial Factors
The interesting thing about financial factors is that taking care of business financially can help ALL of the above issues. While financial planning is not the only solution to burnout, it is really hard to get burned out at a job you no longer need.
Toxic job? That's what that six-month emergency fund is for. A good financial position puts you in a good negotiating position. A doc with $500K in student loans and a $1 Million mortgage is not negotiating from a position of strength.
Professional stresses? Want to do some admin work to improve your work environment? Serve on your specialty's committees? Lobby the legislature? Having your financial ducks in a row allows you to cut back and do that.
Want to work on your own resiliency? Money gives you the ability to cut back and create the time to exercise, spend time with those you care about, pursue hobbies, or see a therapist.
Financial problems? Yup, making better financial decisions fixes those right up. Not always instantaneously, but the hope that comes from knowing you have a plan and are heading in the right direction starts immediately.
Exhausted? Cynical? Unproductive? You might be surprised to see how much of that goes away when you cut back to full-time. Not enough? Try 3/4 time or even half time. Most doctors can pay for a reasonably nice life working 20-30 hours a week, especially if they already took care of business by paying off student loans, paying off mortgages, and saving up a decent nest egg. What does it take to cut back or even retire completely? Nothing but the ability to manage money well combined with a physician income.
There you have it. This post won't be read nearly as much as the previous one because I didn't put “Stop Whining” in the title, but it reflects my current thoughts on physician burnout, its causes, and its cures.
What do you think? What are the major contributing factors to physician burnout? What can doctors as a whole do about it? What can an individual doctor do about it? Have you been burned out? How did you come back? Comment below!
Outstanding overview and well-thought and addressed from every angle.
Burnout is pervasive among physicians and quite fixable. I would only add that some of the traits that are ingrained in the typical doc, especially the perseverance and self-sacrifice of med school and residency, are counterproductive toward preventing or escaping burnout. Action items like quitting a toxic job, seeking mental health counseling, and cutting back to part time fall into that “simple but not easy” category.
This. This. And THIS.
I found that the biggest obstacle to me identifying that I was burned out (and later admitting that I was also depressed) was part of the reason I was in that predicament to begin with : everything but excellence feels like failure. I fell victim to the “if they are coping, I need to toughen up” mentality and it’s really just a downward spiral from there.
Excellent article, WCI. I’m not surprised that it hasn’t blown up like its predecessor; to translate a phrase from my mother tongue “you called us by our ancestors so we pretended to die too” which means you pointed out something about us that we don’t want to see/hear but that we can’t objectively dispute so the easiest thing to do is simply ignore it. I have a lot to think about.
Agreed.
I remember when that post first came out and I was like wow, this is going to be a real doozy.
Side Hustle Scrubs had a ton of great posts on his website but he will probably be most remembered for this particular guest post on your site. I could only imagine the flack he took in the comments. I am not sure if it is a coincidence or not but I think shortly afterwards he stopped blogging and I believe a few months ago his website was officially gone (probably did not renew host after a year was up). It is a shame because he really had a great way of articulating things and his posts were witty.
You definitely have much thicker skin than I do Jim. Fortunately I have not had too many negative comments, although I have had some which made me shy away from those platforms that they occurred in (unfortunately it was mainly in the WCI forums that I had some of the worst of it and I just chose to bite my tongue and avoid it altogether). Probably not the most healthy strategy but I had to hold myself in check when, In a momentary lapse of judgment I defended myself and attacked at the same time in a response I was not particularly proud of but was a heat of the moment thing. I could see how flame wars can easily escalate between two anonymous commentators protected by the isolation in front of their computers.
As far as this post, I think you drove home the points that align with my philosophy of burnout. I will tell you that from a personal standpoint, money/net worth does not necessarily cure burnout but it can diminish it. There are bad days now and then and you can feel burnt out by it whether you have 2 zeroes or 7 in your bank account.
Maybe it doesn’t diminish it. Maybe it even increases. But more money absolutely makes it easier to cure!
There is something about having enough money and assets to walk away that makes medicine more tolerable and enjoyable as a career.
There is also something about having enough money and resources to walk away that makes doing inane and unproductive tasks (like EMR stuff, pre-auths, jumping over the next bureaucratic hurdle, providing free care to alcoholics and drug abusers with no insurance for off hours “emergencies”, etc.) more intolerable. (This point speaks to the @PoF perspective, and I have felt this way at points in time.)
I believe that these two forces are in tension, and the key is doing everything possible to limit the inane and unproductive stuff from your professional life. Part time is one way. Changing jobs or roles is another.
People always want someone else to blame for their problems.
Blaming obesity on society, stress, lack of time.
Blaming money issues on spouse,kids, family, society.
Blaming burnout on loans, jobs, expectations.
Yes all these things contribute but the part that is left out is your reaction to these stressors. Your reaction is the only thing that you can fully control. However it is daunting to take control and do the hard part be it diet, decrease spending, or look for a better job. It is much easier to blame others, feel defeated,and complain.
You have to look at all the parts and fix what you can.
Thank you for addressing this surprisingly controversial issue. I hope you don’t get as much hate mail this time.
Thank you Jim for laying out one of the most reasonable and inclusive examinations of burnout factors I have seen. (seriously, just the your thoughts part is longer than manuscripts I have read on the topic). I have to agree with you about the lack of autonomy from the drastic shift to employed status over the past 10-15 years in combination of financial stressors is probably a large part of it. Many younger physicians thing the grass has always been greener, but there have always been uncertainties and large swings in compensation across specialties.
The good news is that we now live in an age and time where everyone is aware of these issues and best practices are being freely shared and disseminated. Heck, just this blog post alone means that thousands(more?) eyeballs will read about causes and actionable advice for how to address their own personal circumstances.
I do agree that a lot of the time it’s easy for folks to get caught up in bubbles. We spend so much time in training stuck in small rooms surrounded by other people in the same area of work with similar backgrounds that it is very easy to lose perspective. Then I come home from my cushy hospitalist job and see folks mowing lawns and replacing roofs in 105 heat index weather. I did construction work before medical school, did both of those things, and wouldn’t go back to it for any amount of money. I am very grateful that I stumbled into medicine and ended up where I am.
I think the factors you’ve identified are operative in creating burnout in its various forms.
Like a lot of medicine, some issues are specialty specific but the broad strokes are as you say in my experience.
I had fairly tough job turn in to a “toxic job” from 1994 to 2001, before EMR and other factors were in effect. I worked too many hours, became the unpaid Department Chair, and was expected to see four patients an hour. It was horrible at the end, so after whining for 18 months, I quit.
I went to a different branch of psychiatry (geriatric) back when you could grandfather in (pun intended). It was an hour away but has a slow ramp up as we opened a new unit. I essentially had three months of ADMIN to recover and did well. I lasted eleven years in that job as a Medical Director with a fair amount of autonomy. In 2008, I got a “bad boss” and he ruined the job and forbade me swimming at lunch for stress reduction. So, I quit.
I’ve had several jobs since 2011. None have lasted more than three years. I think I’ve been resilient in leaving when it becomes toxic…but recently they start out fair and become ridiculous in about two to three years.
With a side hustle in place since 2008 to hasten FIRE, and a financial plan that includes significant downsizing, I’ll be able to work prn by age 58.5 and will have dropped my expenses to get to “freedom” at that age. Hope it works out. The plan is working.
I exercise (a lot), do some Yoga, take 6 weeks of vacations a year and this has helped. Good luck to all. Leaving a toxic job has become my go to solution for decades now. Abuse me and I’m gone. It’s challenging and stressful, but there are many jobs in Psychiatry and we are in high demand.
Profound analysis. I would add that part of the problem is that a lack of personal resilience makes all of the other factors worse. If you are not resilient, a crappy job is that much worse, professional stresses weigh you down more, and it is harder to deal with financial issues and the inevitable times when the market will turn against you and send you losses instead of gains. Preventing burnout starts with “sharpening the saw”.
Love the Coveyism.
Great post, maybe one of your best. I didn’t have a problem with the original article, because it made me realize how easy it is to have a woes me viewpoint. I am certainly guilty of this myself. It is certainly a good exercise to try and identify stressors of your job and implement a plan to make changes. Usually there is a solution, but you may have to sacrifice something else. For example, the idea of being available 24 hours a day 9 weeks out of the year for call is a big stressor for me. I can eliminate this by paying other people to take it if I wanted to, so if I am a financial position to do so I can happily make less money to have a better quality of life. I am not doing this yet, but once I am FI in a few years the prospect of doing it becomes a lot more attractive. There is certainly a give and take to everything, but being on solid financial ground gives you the power to eliminate most of the burnout stressors of practicing medicine.
I imagine that if I (and my family) were dependent on my income I would have a better attitude towards work. Or I might feel even more desperate. Unfortunately, right now any bad day makes me question whether I should go to work the next day or give notice anyway. Good for me to have that freedom, but a potential disaster for the economy and country if everyone did? Any way I believe if I were not FI, I might have a more committed attitude towards the job. Who knew I’d probably work longer if I were paid less?
Jenn, I had to smile at that one. Being FI leads to zero tolerance for BS–never thought about the point of view that it gives a WORSE attitude! I just find that I roll my eyes at ridiculousness; so far nobody at the poker table has called my wager and asked to see my cards (i.e. do this or you’re fired)…. I guess I would say that I’m not excited because of FI or have a worse attitude about FI, I’m just ambivalent about whether I stay or go and that has led to a more Zen outlook, on balance. (But I still have a ways to go to find true enlightenment.)
Jim, good article. I kinda wish you had published the really hateful stuff that you alluded to. I find that the docs who complain the most are the ones that haven’t had a prior career of digging ditches are nailing shingles or putting up hay etc.
Physician on FIRE (now the Physician that did FIRE?) felt the same way. FI made him enjoy his job less. I think I enjoy mine more with FI though.
I think not working nights makes everyone enjoy their job more!
I like my work a lot more since reaching FI.
I work less and get stressed less.
So what if I have to type into an EMR. I can get better at it. And it is only 3 days out of every 7 that I have to do it.
There are other things that occur that add to medicine in general burnout. Uncompensated time to do horrible prior auths after you prescribe many common drugs, take “free” calls from patients who have a million more questions after their appointment is over (lawyers bill you the second you call.) Many things are out of our control – for example, fee schedules that don’t change (or get worse) and having to pay staff more and more and rent goes up and you get less and less, etc. What other business model doesn’t allow you to raise your prices to match expenses? Patients now come in with huge deductibles and you have to have a whole discussion about what things may cost. Medicine will never get any better in its current form…..the ship has sailed, and the average patient (or politician) doesn’t feel badly for us.
I’m continually reminded at monthly partnership meetings how terrible a business medicine is (especially when I compare to my monthly WCI staff meetings.)
The phone calls thing is easy. Don’t do phone calls. Everything that cannot be answered by your staff gets an office visit.
I never talk to patients on the phone unless it’s a new cancer diagnosis or abnormal fetal genetic test results.
Those two things seem like they really should be an office visit. I’d hate to break that news on the phone. It’s bad enough telling an out of state family member the patient is dead from a car accident.
The problem with an office visit for those is that to make it happen my staff has to call and say “the doctor wants you to come in to discuss your test results” so already the pt figures it’s something awful. If I’m really worried about cancer when I’m doing the biopsy I will have them schedule a follow up in 1 week to review results. Also, I don’t do amnios myself so anything abnormal on fetal genetic screening I do is far from definitive- next step is see MFM
Excellent Overview!
Sermo is such a dark place that I haven’t been there in years- I left it after a couple of weeks because the negativity was overwhelming. I can’t believe that a simple call to self-care and taking charge of your life would be seen as negative.
I see it all the time – Would you believe it that I have had to teach Doctors Compound Interest Calculator in my coaching sessions?
Another excellent post, Jim. You really hit the nail on the head on a lot of these issues, in my humble opinion.
Great post Jim. I am responsible for wellness in our department, and its a hard thing to tackle. Like you mentioned, the culture in medicine is to be a martyr to medicine, and its perpetuated among physician colleagues. A colleague of mine, stated to me that neurosurgeons are morally obligated to work more than 40 hours a week, because of their set of skills. Reminds me of when POF post on doximity got so much backlash for FIRE, i.e. “what a waste” “should have given up your seat in med school” etc. The culture of medicine needs to change overall, and I think it is, slowly, especially with social media.
NEJM came out with something a while back (https://catalyst.nejm.org/physician-well-being-efficiency-wellness-resilience/) one thing that they didn’t have in their article, that you address is Financial Factors. You’ve done such an amazing job enlightening docs that reach your site on financial security, wish that will trickle into the solution of physician burnout and wellness.
I agree. Jim thanks for doing such a great job on the financial side. My burnout is mainly financial. Most of it stems from that I’m so F-ing pissed I got screwed into buying whole life insurance and lost out on 50K- thanks Northwestern Mutual. But I think this huge mistake resulting in my hate of medicine reinforces that the financial factor is the most important contribution to burnout. I’m also convinced that finances are the main reason for burnout through the lens of the founding partner in my now sold out practice.
The head of our practice, Joe, had almost the same non-finance factors for burnout mentioned in this article despite being 40 years older in a different generation- the more things are different, the more they are the same. This was back in the late 70’s. He had an abusive work environment where one of his partners in the early years verbally fought on everything, and one day he came to the office to find that he was locked out. His partners had locked him out over a practice disagreement. Also he had the same sick patients, socio-economic messes that we see today. Finally, he also was was upset regarding the sacrifices he made b/c of being a physician, such as missing the birth of his 3rd child as he was seeing an emergency patient in the hospital.
But he retired with no regrets and never had feelings of burnout through his career because he never had the last factor mentioned in this article- the financial factor. He always drove BMW’s. He had a 5000 sq ft house in Tenafly, NJ, a high COLA, and has also a house in Lake George, NY and a condo in South Beach. He loved being a doctor, not only because he loved medicine like most of us do, but also the financial benefit trumped the other factors that can contribute to burnout.
Burnout has only now become more of problem in medicine than in the past, and only the financial factor has been the major change, between declining salary and increased student debt. The main way to eliminate burnout is to have docs graduate with little to no student debt and get paid similarly to what they did in the past. If I was making bank like Joe, I can tolerate much more abuse, much more personal sacrifice, and even forgive Northwestern Mutual for conning me.
Included in personal resilience should be what kind of attitude you choose to have. Last night I was driving into the hospital at 1am for a pt in labor, and I was actively thinking “I can either be upset/angry/flustered/annoyed/etc that this lady went into labor in the middle of the night on my call shift, or I can just roll with it. It’s part of the job. It’s really not that big of a deal. And I’m about to be there for one of the most amazing moments in her entire life”. I chose to not be upset about it. Made the whole experience more pleasant for me.
This was my comment to the original article…
“Most of my patients from the “greatest generation”, would read this title and agree completely. The article points out the reason why. Do whatever you want with your life….but stop whining about it.”
I still agree with that response. Sad to hear that Side Hustle Scrubs stopped blogging. Hopefully it wasn’t because of the backlash. 191 comments for you though. All those clicks had to help 😉
Also, I really enjoy the GIF’s you are including. Especially the Star Wars GIF above. Only the Sith, Borderline personality disorders, and the majority of far right and left wing politicians deal in absolutes.
Great article! Everything you said is spot on. I’m 11 years in as an attending and when I think about the times burnout crept in and why…working too much to pay down debt plus a toxic job plus a ridiculous commute of an hour was the perfect storm. Now at a different job, commute of 10 minutes and in a much better financial situation (huge thanks to you) things are much better. Things are toxic at times, Medicine stressors still exist but without the other stressors I just grin and bear it. Frustrated at times…yes, Burnout…no.
One thing I wish you would address is this – many of us are burnt out – working too much and sacrificing our personal lives precisely BECAUSE we are seeking financial independence. I’m “living like a resident” working 6-7 days a week. And I’m exhausted. I don’t have a stay at home wife, I don’t live in Utah with super cheap housing and I didn’t get most of my education paid for by the military. And I’m also not driving a Maserati or living in a million dollar mansion. Most of us are somewhere in the middle just trying to pay off our student loans and mortgages as fast as possible while raising kids and funding our retirements. It’s tiring. It’s not easy. And it will get better but it’s damn hard right now.
“Working 6-7 days a week…..I’m exhausted.”
Cause…..Effect
Stop it. It sounds like at least some of this is self-inflicted.
Career longevity matters a lot more, even financially speaking, than paying off the loans or the mortgage a year earlier. Moderation in all things.
https://www.whitecoatinvestor.com/moderation-in-all-things/
I don’t recall ever advising an attending to work 7 days a week. Even residents aren’t allowed to do that these days. When you are feeling so crispy that you’re making ad hominem attacks on some yeahoo’s blog, you know it’s time to take a few days off! I can’t imagine how you’re feeling about your patients right now. I know by the end of my third 12 hour shift in a row my compassion-meter is on zero. And you’re doing that twice a week indefinitely. It’s not good for you, your finances, your patients, or your loved ones, so make a change ASAP.
From a strictly financial perspective it is FAR better to make $100,000/year for 45 years than it is to make $200,000/year for 10. Do the math…it’s quite easy. Longevity matters.
Your work should be enjoyable. Don’t work so hard up front just to pay off loans and become FI just to immediately retire and remember after 1 year how many things you actually enjoyed about medicine (or whatever field you are in). Now, if you can work hard and enjoy it the whole time, then even better for you. Finding that fine line is sometimes tough, but very important!
Good luck!
Thoughtful analysis. Been retired 13 months now, date established at a low ebb as a birthday present to myself for my 62nd birthday. Gave me something to work toward. Financial independence certainly helped.
What’s missing from pretty much any analysis of burnout that I’ve seen is some of the most basic of scientific reasoning. I’d expect that from physicians who are emotionally involved or experiencing the situation themselves. My expectations of the academics doing targeted analysis and research could be better. In any statistical review that I have come across, whether physicians are classified by age, specialty, income, or type of employer the fraction of self-reported burned out physicians is less than 50%. Withbout getting into whether self-identification is even proper, certainly something not permitted in clinical studies which have firm eligibility criteria for inclusion, that consistency of a 50% prevalence suggests there is always something protective that directs some physicians and not others. Despite this problem having devastating professional and economic adverse effects and occurring for more than a decade now, I’ve yet to see any systematic study of what makes the two groups different and keeps those who avoid burnout in at least a small majority. Until somebody figures this out, all advice is speculative and shaded by the druthers or prestige of the person giving it, not that different than diabetic diet that changed every four years for ninety years because it was never really tested in a controlled way.
This is a good pre-covid article. I hope you’ll update it because those on the front lines were taxed in all kinds of ways, and couldn’t go exercise and didn’t necessarily have time to talk to someone, and couldn’t step away from the task at hand in the early days of the pandemic. As I’m sure you know as an ED doc. And while they can do that now, that still doesn’t address the “trauma” that occurred before, and how to cope or work through it now. I look forward to the update!!