9 Reasons For Physican Burnout, And One Way To Avoid It

"The burnout epidemic amongst our physicians is a predictable result of the medical training and the generally accepted definition of “success” amongst doctors."

-Dr. Dike Drummond MD Founder of TheHappyMD.com

Dr. Dike Drummond is a Mayo trained Family Practice Physician who has experience in medicine, coaching and personal improvement, and business development. His expertise in personal change was developed over 15 years as a family practice doctor and 8 years as a business coach working with physicians and startup entrepreneurs.

When I met Dr. Drummond, we discussed the reasons why so many physicians get burned out. He asked me how most doctors measure success? “Do they have a busy practice?” The answer popped out of my mouth instantly; it was almost a reflex. This is something you hear all the time. “She is doing well, working in a busy practice,” or “his surgery schedule is booked solid; he must be doing great.” This seems to make sense; after all, we are doctors, and doctors are busy. However using this one tool as your main metric of success can become a recipe for disaster. Unfortunately, this is not the only reason physicians get burned out, but the good news is, there is a solution.

Enter Dike Drummond

What follows are 9 facts about the practice of medicine that lead directly to burnout. The good news is you can do something about it.

1) Being a Doctor is Stressful. Period

The "most stressful" professions are those characterized as having a high level of responsibility and little control over the outcome. We are not selling widgets in medicine. This is a tough job that saps our energy every single day.

2) We Work with Physically and Emotionally Sick People All Day Long

Our days are filled with intense encounters. We spend our time treating sick, scared, and hurting people. In addition to the physical ailments, there are many emotional needs that come with any illness. Physicians do not receive proper 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 is something that we have ingrained into us during medical school and residency. 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 is 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) Medical Practice is 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."

The Solution

Keep your connection to "WHY" we are a doctors; to your 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. As physicians, we must deliberately work to keep that connection alive and well. When you have invested over a decade of your life in medical training, it's easy to feel stuck when you think your reason for becoming a doctor is gone or not possible. It's imporant to remember you have a great skill, with more opportunities than you probably know. Keep searching out and pursuing the opportunities that ignite your passion, and do not be afraid to ask for help. Sometimes another perspective can open your eyes to opportunities you did not choose to consider. 

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.

     (Sounds like medical school and residency)

It's 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.

To learn more from Dike Drummond visit The Happy MD

The Passion Manifesto: Why Every Medical Student Should Rethink "Traditional" Medicine. (Part 1)

A personal yet rational case for the pursuit of the moon, and stars... and throw the asteroids in while we're at it. Heck, wrap it all up for a "to go" order. 

I can’t push these questions out of my mind.

They seem to invade my skull with a fervor that can only be explained by the fact that the answers will determine what my future life will hold.

Will it be a life defined by passionless work, constantly feeling out of kilter in an environment that just wasn’t quite made for me? Will it be the romantic visions I indulge in of a man on a mission in the heart of a wild land, with an invaluable skill and zeal to match, righting the wrongs in a forgotten corner of the world? Will it be relegation to a large grey building filled with sick and dying people who in many cases won’t lift a finger to help themselves, but frustratingly expect to be cured by modern wizardry and a pill? Will it be the life of a nomad, drifting from here to there; in and out of towns and countless lives, cursed with an incurable nomadic soul? Perhaps the life of a key-clicking storyteller will be mine. Writing the stories that deserve to be told of the unsung hero, the underground hero that deserves recognition and a face.

These are the questions that have been floating through my cerebral cortex of late. They will not go away, they will not improve, I cannot banish them from my thoughts.

Some people seem at ease living a life unexamined. I cannot indulge thusly. I need my existence to mean something. I need my action to be meaningful and deliberate. I need the possibilities to be endless. I need to believe that I can be passionate about how I am living NOW and not just scraping for a grade, which will POSSIBLY eventually lead to a small measure of meaning. I need to be on top of my game and in the moment and full of the rapturous joy of living. Pain? I can handle it if an end is in sight. Disappointment, I can weather it if I am convicted of my cause. Grief, I can bear it if I see the purpose in it. What I cannot abide is an endless number of days filled with a transient existence… mere platitudes in exchange for a real life of weight and substance.

Money is fun, yes, but past what is needed to maintain some semblance of comfort it matters little me. I hold this view principally because I have little of it, if I possessed a fortune my tune would doubtless change. That very fact is a good reason to steer clear of fortunes. Money. That pitiless taskmaster under whose whip so many voluntarily bows their heads. That alter upon which so many sacrifice their souls and lives.

Embrace the gambler?

Some would call me a gambler. Willing to risk the safety and certainty of a “stable” and “responsible” choice in lieu of the moon. “The paradigm you seek is unattainable,” they say. “The reality you pursue is not measurable or concrete in a way that we agree with, and it makes us uncomfortable,” more accurately reflects the sentiment.

I am not lauding the senseless disposal of resources into that most heinous of bandits in need of a prosthesis, but at the gamblers heart is not evil. That misguided soul has hope, albeit of a gnarled and mangled fashion. They would turn nothing into something, if they had their wishes. All the gambler’s underpinnings are not sordid and ominous. They possess the ability to lay things of importance down, to detach themselves from the sure thing in pursuit of the dangling possibility. A gambler is really an entrepreneur, gone wrong.

To harness that talent means to be a successful investor, to over-indulge and misalign that same gift means to fall into that certain and stealthy abyss. Addiction or passion? The wafer thin wall that separates the two is often nearly translucent. That may be why so many won’t allow themselves near it, for fear of breaking through.

Passion is a strangely amorphous, yet universally desired, commodity. It as been directed at nearly every conceivable endeavor from the seemingly mundane act of button collecting to such adrenaline-drenched pursuits as hurling one’s body from a ledge wearing naught but a glorified sheet stuffed haphazardly into a backpack. The domicile of this enigmatic feeling is often hard to predict. It can spring up and take root in nearly any soil; no matter how seemingly desolate or blank the slate appears. Passion is also desired by nearly all humans, but in spite of all these favorable characteristics, this most sacred of grails is a painfully scarce commodity.

I am going to hazard a wager. My wager is this: that nearly every singular activity at which a passion has been directed throughout the whole of history could/ has/ or will be molded into a monetarily feasible proposition. Creativity and ingenuity will be required, more in some cases than others, but the POSSIBILITY is there to turn nearly every activity or passion into a business model.

Now I will take that last paragraph, blind fold it, and turn it loose in a different direction. Can a person find something they are passionate about doing, an activity that drives them to pursue perfection unharried, in virtually any existent professional circle? It is an interesting question to be sure.

Is passion even possible in medicine?

Sadly, medicine has one of the greatest potentials of any professional to be a soul sucking passion-sink. I have been a first hand observer of this throughout my life. My family is somewhat of a medical mafia family. The strange customs and rituals, the secretive and enigmatic lingo, the bleeding together of home and work, the all consuming nature of the "family business," and even the fact that a lot of blood flows in the course of doing business... all similarities between my medical family and the mob. 

I HAVE seen many family members use the profession as a means to do great good, while preserving and USING their external passions to do so and I laud them for this ability. I have also seen people in my family loose themselves, their spark, their drive and passion, because they pursued medicine instead rolling the dice on a dream. 

If one is going to "do medicine," without losing their soul... it is going to be a no-holds-barred royal rumble. It is not a profession that generally rewards the balanced individual. The individual that seeks a medical career, but also desires a sane lifestyle. People that work a normal amount of hours or try to work more efficiently are often viewed as being a slacker (I am experiencing this first hand as I try to keep balanced during first year).

In the established medical system, the gambler is wholly vilinized. Keep your head down and follow the protocal. Don't make waves. Don't suggest a good idea to an attending or you'll be singled out for a good old fashioned pimping. Work harder. Whether you are working smarter or not is of lesser importance. Give up your hobbies. Be consumed by the profession. Cover your ass in lieu of making the objectively correct decision.

These are generalizations sure, but too often accurate ones. The really sad thing is that many times the aforementioned traits are touted as preferable or morally superior in some skewed sense.  It isn't explicilty verbalized this way, but the predominent currents flow from these icy tenents. Going down this rabbit hole is supposed to somehow makes you a better doctor. 

This is NOT the case.

The new generation of doctors are beginning to realize this. As compensation decreases and information load increases, young would-be doctors are forced to take a hard look at medicine for it's face value. The days when benjamins could universally override doubt are slowly coming to a close. This article has some salient points and perspective on why this is the case. Suffice it to say that the ROI is often not good enough anymore to make people part with their less secure dreams and a "balanced life."

The status quo is being challenged. The "medical establishment" is realizing that it is having a harder time recruiting the top tier of innovators and free thinkers that will push medicine forward. 

Passion and innovation must be rewarded or this will continue to happen. The gambler must be embraced and utilized. Balance must be encouraged. A more human person will also be a more humane person.

Can a medical student (as I find myself) find passion in medical school by starting a medical school blog, even if they currently find their situation passionless? Can a previously stolid accountant breathe passion into his professional world by changing a venue, entering a niche, or altering a mental paradigm? Can a barista gain a passion for their work by starting their own mobile coffee cart instead of working at a major coffee chain that shall remain nameless (it rhymes with car-ducks). I posit that in many or most cases this is possible.

Not ALWAYS possible though... If medicine is not your passion GET OUT MAN! Make a responsible exit strategy and EXIT. If you can be passionate in a different part of medicine, CHANGE your course. Get into something that you think is FULLY great.

The tortuous road to the moon.

When a person sees that it is not a feasible proposition to turn their current pursuit into a passion... why then do they persist? There is no excuse for this! There are more niche market opportunities now than there has ever been in the history of the earth! That statement should be self evident in describing the possibilities. Allow me to provide examples.

There is a guy who’s living, his calling, his passion is to read the mail of complete strangers and expose their secrets to the world… His name is Frank Warren and he is the founder of Postsecret.com

There is a man named Jerry Greenfield who thought he wanted to be a doctor. He, in fact, applied on three separate occasions to medical school and was denied each time. He thought he wanted to be a doctor, but it didn’t seem to be working for him. He decided to take stock of his passions. He loved ice cream. He wanted to start a small business. He took a $5 correspondence course on ice cream making and promptly opened a small ice cream shop in Burlington Vermont with his long time friend Ben Cohen. You may have heard of his shop. It’s grown a little since then. It’s called Ben and Jerry’s.

There is an individual who was in medical school at Harvard University. During his time there, he found that he was spending much of his time writing instead of studying as religiously as many of his classmates. Realizing that art of the pen was his passion, he decided not to discard it and continued writing feverishly throughout his four years of medical school. When he graduated, instead of stuffing his aspirations on the back shelf and entering a full time clinical career, he began the risky proposition of writing full time. It turned out to be a good move for him, because in 1994 he became the only creative artist ever to have works charting at #1 in film, TV, and book sales simultaneously. If you have ever seen the film Jurassic Park, watched the television series ER, or read one of his numerous best-selling books, you have appreciated Michael Crichton’s decision to follow his passion.

Engaging in passionless work is one of the greatest crimes that can be committed against oneself and society as a collective entity. Creating a passionate place where one can use their natural gifts for betterment of humanity and fulfillment of self, conversely, is one of the greatest goods.

These thoughts continue to consume my mind. They will leave me no peace until I have donned the unitard of action and wrestled with my doubts. Will it require a roll of the dice or a calculated reshuffling of the cards I have been dealt? Likely Both. The platitudes must stop. My life can have passionate direction. It will. It must. This is my manifesto.

Through the slightly course language, this guy makes a great point.