I am Burned Out Now What? Causes and Solutions

In March of 1977, two 747 passenger planes collided on a runway.  583 people lost their life on Tenerife island that day.  After the Tenerife investigation, it was determined that their existed a culture problem in the aviation industry. In an industry where the pilot was viewed as “God,” co-pilots were often so afraid of speaking up to the pilot, that they would sit silent to avoid being reprimanded – even if it mean that their silence would kill 583 people, including the silent co-pilot.

Can you imagine being so afraid of the system that you wouldn’t speak up, even if it led to your death – and the death of 582 other people?

The investigation into this tragic accident led to a realization that has forever changed the aviation industry – fixing culture problems involves fixing the system that causes the problem.  It does not involve pointing fingers and expecting individuals, such as pilots, to change.  This way of viewing things is called Crew Resource Management.

Physician Burnout

The physician burnout epidemic has a lot to learn from the Tenerife tragedy and crew resource management.

Almost 50% of physicians are burned out.  It is anticipated that 400 physicians end their own life each year.  These are haunting statistics that point to a culture problem that exists in medicine.  It’s time that we performed our own investigation in our industry.

Let’s start by answering these three questions:

  1. Why are doctors burning out?
  2. How can we fix the burnout epidemic?
  3. I am burned out now what?

Why Are Doctors Burning Out?

The first time I realized I was starting to burnout, it had very little to do with my work place.  In fact, I love my job.  Are there things I’d like to change about it?  Yes.  But they were not the cause.

For me, it was caused by my lack of work-life balance.

My wife started a full-time job in July and that threw my world off-kilter.  In my view, being a good husband and father trumps work every time.

So, when the current responsibilities at work began to encroach on my life (because of my increased responsibilities at home), the embers of burnout began to kindle.

That is my story, though.  Many others have a story that is very different.

From electronic medical record requirements, pre-authorizations, and administrative requirements that take us away from practicing medicine to work-life imbalance and financial stress, the initial causes of burnout are almost too numerous to count.

Most of us went into medicine to help people.  When red tape, insurance companies, and unnecessary paperwork stands in our way it can be frustrating.  In fact, it often produces unproductive bitterness and resentment towards our work place.

Burnout is Systematic, but current Solutions are Individual

All of these causes of burnout are just the tip of the iceberg.  They are initial sparks, but they do not explain the forest fire of burnout that is consuming the profession of medicine.

The real reason is that when these initial problems are expressed by physicians, hospitals and their administrators often turn a blind eye.

Physicians feel helpless to change a system that results in depersonalization, feelings of inadequacy at work, and emotional exhaustion that were well described by Maslach almost 40 years ago.

In medical school, I was taught that “treating the symptoms and not the disease” is considered bad medicine.  Tenerife taught the aviation industry the same lesson.

In medicine, we enjoy learning lessons the hard way.  Many hospitals expect the physician to solve burnout by themselves. This includes recommendations to “fix burnout” through prayer/meditation, practicing gratitude, being in the moment, and other individual acts.

Such individual solutions miss the systemic and systematic causes of burnout.

We can see, then, why little progress has been made with physician burnout. The problem remains systematic/systemic; yet, the solutions are all individual.

How to Fix the Burnout Epidemic

Many hospitals in the health care system have adopted crew resource management when it comes to safety in the operating rooms, including the one where I work.  We keep patients safe by depending on a system with fail-safes and checklists to help catch individual errors or red flags.

The exact same process needs to occur in the realm of burnout.

A systematic solution needs to be proposed to help fix all of these systemic problems.  Of course, this will cost hospitals money, but the return on investment stands to be massive.

Hospital administrators and board members need to get together and realize that a happy physician is more productive and that when physicians decide to leave a hospital, the cost is exorbitant (ranging from $250,000 to $1,000,000 to replace that physician).

If ten physicians leave a hospital because of being burned out and unhappy, this will cost the hospital $2.5 million to $10 million.  If even a fraction of that money is spent reducing burnout by hiring scribes, improving resources, and allowing for more support and time with patients; well, that would be money well spent.

Additionally, any hospital that does this can expect to recruit the most talented physicians to their work force as word spreads about the over-arching desire to work on physician burn out.  This would lead to the most important improvement of all, an improvement in patient care.

I Am Burned Out Now What?

Despite the flowery language above, I realize that many hospitals simply can’t or won’t help fix this problem.  They will continue to pin the problem on the physician and their inability to deal with the job that they signed up for.

If you feel like you are in this boat, there are some possible solutions.  And, no, I don’t intend to tell you to pray or meditate more often (even if that has been shown to be effective for some).

Solution Number 1: Change your focus

If you are burned out, I encourage you to do the same thing with burnout as I encourage you to do with your money. Be intentional.

Sit down.  Write down a list with three columns. On the left, write down the parts of your job that you love.  In the middle, write down the things about your job that you cannot stand.  In the third column on the right, write down the goals that your employer has laid out for you.

For each part of your job that you would like to diminish, focus on something that matches your “love” column and your “employer’s goals” column.  Then, go meet with your chair/boss/whoever.

Explain to them that you would like to do less of that thing you hate, focus more on what you love, and that this will help them meet your employer’s goals as outlined in the third column.

This may mean focusing more on research, education, administrative work, or something else entirely.

If you don’t feel like you have any bargaining chips, remember how much it will cost your employer to replace you.  Your administration likely knows this information.  You are not powerless here.

Solution Number 2: Financial Independence 

If number 1 won’t work, then it may be time to focus on the tenants that are taught on this site: achieving financial independence as quickly as possible so that you can choose to practice medicine because you want to, and not because you have to.

When you reach this goal, you can do whatever you want – and no one else will have a say in that.

Even if you are not currently burning out, setting yourself on a path to FI is important.  Who knows what you will think of your job in 5, 10, or 20 years.

Solution Number 3:  Part-time work

“I can’t afford part-time work, what is he thinking!?!?”

I hear you.  This is a possible solution, though.

Going part-time may involve earning some side income that is unrelated to your main gig. After all, side hustles are the best kind of asset protection.

You may need to decrease your cost of living (which will likely result in an equal amount of happiness if we learn the art of contentment), or delay your time to financial independence.

Crispy Doc has a series of posts on doctors who have cut back.  The truth is that many physicians find that they still love their job when they just do less of it.  It’s often a balance issue, and part-time work can be a great fix.

If you have made wise financial decisions, then this should be an option.  Who cares if it delays your road to financial independence from 50 to 55, if it prolongs a career that you might love?

It’s certainly worth consideration.

Solution Number 4: Change Jobs

When the rubber meets the road, your mental health is more important than your job.  If your employer isn’t willing to change, and you have tried the three options listed above – it might be time to consider changing jobs.

This may mean going to work for another employer that has (supposedly) better balance than your current work place.  Locum tenens on your own terms is another option.

It may also mean leaving clinical medicine entirely.  Some physicians opt to go and work for industry, pharmacy, or insurance companies.  It may mean getting more involved in medical school education or some other non-clinical endeavor.

Never forget that your skill set is highly valuable. Working in the traditional “doctor gig” is not the only option.

Take Home

Physician burnout is a problem that is consuming the field.  It has impacts on patient care and – some may argue – is even a life and death problem for some physicians.

Like the aviation industry after Tenerife, our culture needs to change.  And, if it won’t change, our doctors need to be empowered with solutions that allow them to take matters into their own hands.

What do you think is the predominant cause and solution of physician burnout? How can we fix physician burnout?  What solutions have helped you in your journey?  Leave a comment below.

TPP

11 thoughts on “I am Burned Out Now What? Causes and Solutions

  1. Really love this post.

    It is wild, but I stopped here after I had visited SHS guest post on WCI and in my comment I mentioned the aviation industry. Wild we were thinking on the same page.

    You hit the nail on the head that too often we are not focusing on the etiology but rather trying to minimize the symptoms. That is the wrong way of thinking and is just a temporary bandaid put on a larger and larger gushing cut.

    I like your actionable steps that we as physicians have the power to do. I agree that it is far more financially beneficial to work longer for less than to flame out quickly and work yourself to death for a higher earlier salary (which is not as impactful as one would think because the progressive tax environment we live in takes a larger chunk of it out the more we make)

    • Glad we are on the same page! I think there is a lot to learn from the aviation and safety cultures that could be applied to burnout/wellness. Once that transition happens, it is only a matter of time before solutions really start to occur.

  2. TPP, you’re playing my song. Practicing less, more humanely, has been a life saver for many of us.

    Paradoxically, I’m more involved than ever in my hospital, largely because I now allot the time to choose passion projects over shifts.

    We are cut from the same cloth in not wanting to give our families the leftovers after medicine is done taking.

    Medicine’s response has been to either stigmatize (Dr. Badapple can’t hack it but she isn’t like the rest of us) or patronize (annual physician wellness day, we hired a yoga instructor!).

    Unless we individually create the balance we want, no one is going to offer it. FI provides the confidence to demand the unreasonable and find a way to achieve it.

    Thanks for the fine analysis, and the generous shout out.

    Fondly,

    CD

  3. There is something very subtle going on with this burnout problem. When I trained, we worked many more hours than current trainees, yet current trainees complain more. Perhaps it is because we expected to be exhausted all the time–in exchange for the opportunity to learn as much as we could. The surgical residents used to say, half-jokingly, that the only problem with being on call every other night was missing half the cases! Who would even think to say that now?

    I think the problem underlying burnout is the loss of control of the profession in so many areas. Financial control is limited as the rewards of private practice have decreased for most. Medical decision making control has diminished as third parties require “authorization” for treatment plans. Control of employment has diminished as contracts have shrunk from guaranteed 5 years to 1-2 years and cancellable with 90 days notice (for any reason!). Owning your own practice is becoming less and less likely–only 17% of physicians are in solo practice!

    When how hard you work is up to you and you see value in it, “burnout” is not the result.

    For me, locum tenens helped an enormous amount and led me to a permanent academic position (if there’s such a thing as “permanent” anymore!). Although I have little control, I still get to do many things in column 1 (things I love like patient care and teaching), so it’s OK.

    But burnout is real and has to be fixed or there just won’t be many good doctors out there anymore.

    Specifically, when I talk to talented, smart college students, the kind who used to want to go into medicine, they want to go work on Wall Street, where there’s a lot of hard work, but there’s a commensurate financial and lifestyle reward.

    Perhaps a lot of burnout is due to the fact that the financial reward in being a physician and working in medicine is no longer commensurate with the work and responsibility required?

    Oh, and doctors used to get some respect. A daily dose of respect would help combat burnout as well.

    • There are so many causes and possible solutions. It is a muddy picture. I think the vast majority of it has to do with various forms of autonomy (financial, daily tasks, how to do a specific task, etc).

      Locums does solve a lot of the problems, and for what it is worth I love my academic job, too. It’s a good fit for me.

  4. Hmm. Maybe a lot of our medical system is bad medicine. If “treating the symptoms and not the disease” is bad medicine, then most of us are terrible doctors. A cardiac stent or a CABG is not going to cure a coronary artery disease that is largely due to poor lifestyle choices. Most medications that doctors prescribe don’t treat the underlying disease. Statins, anti-hypertensives, diabetes meds, chemotherapy… they don’t really cure disease. They’re basically band-aids masking the primary problem. The truth is (with the exception of congenital diseases and certain genetic predispositions, of course) most of the problems we face today are diseases of lifestyle. If people just ate a healthier diet with mostly plants, got enough sleep, managed stress, maintained loving relationships, exercised regularly, and had other healthy lifestyle habits… many medical problems would be prevented.

    Sorry for the health guru / preventative medicine tangential rant. But I think this is all related. It’s part of our American culture to work hard, not complain, suck it up, eat a poor standard American diet, deal with the stress, etc. Our culture is working against us and it’s not making us well — physically or mentally.

    We need to change the culture. We need to change how we think about physician wellness and the health of society in general.

    I agree with all of your solutions. However, all of them are individualized and does nothing to address changing the culture. I think if a physician recognizes that they are burned out, all of your solutions are viable in helping him/her get out of it. But to change the culture, that physician can take it a step further and try to help other physicians. Possibly by forming a wellness committee.

    A lot of hospitals and health care systems are creating physician wellness committees. Some have chief wellness officers and champions. I am part of a healthcare system that promotes work-life balance and I am one of the wellness champions for our hospital.

    We offer quite a bit:
    – Wellness courses
    – Seminars to educate physicians about financial literacy, eating a healthy diet, stress management, tips to get better sleep, self care, etc.
    – Sending out newsletters of gratitude and recognition
    – Confidential second victims program for physicians dealing with the stress/guilt of an adverse patient outcome
    – Social events / happy hours / volunteer events / retreats / meetups / etc.
    – Courses that help physicians become more proficient in electronic medical record systems.

    Changing the culture is key.

    • I guess maybe my analogy needed to be fleshed out a little more. I guess I was thinking more of treating tachycardia with esmolol instead of figuring out why the patient is tachycardic. Point taken.

      I completely agree with you on the rest, but one of the big points in this discussion is that some hospitals and administrations are simply not willing to change. In those situations, all you are left with is individual solutions.

      That said, the culture must change and that is going to require the system changing. Your wellness iniatives sound incredible. Maybe I’ll have to get you to write a guest post on that at some point!

      TPP

  5. I know your blog is geared towards MDs but everyone in healthcare fields is burnt out. I’m in the Allied Health field that is in very high demand at my extremely busy hospital. I’m now the third person to go seek medical attention for chest pain with cardiac being ruled out. It is the same system-wide with nursing too. Overall, our medical system is turning into McDonald’s factory were we have to answer to high upper management with our productivity billing units. The focus is only about billing as many units as possible and at least inpatient-wise getting the patient out of the hospital to free up a bed.

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