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I am a Doctor and I Hate My Job: The Cure for Burnout

By Jimmy Turner, MD
The Physician Philosopher

My kids love the movie “Ralph Breaks the Internet.”  The two main characters, Ralph and Vanellope, are video game characters trying to find a replacement for a broken piece to Vanellope’s outdated racing game.  If they don’t find a replacement, her game will be shut down permanently. As they search for the missing piece, Ralph and Vanellope walk up to a desk called “Knowsmore,” which is meant to symbolize a search engine (e.g. Google, Bing, or Yahoo). As Ralph begins to talk, the Owl running the search bar tries to finish Ralph’s sentences to direct them to the right information. Ralph stutters, “Um” and the owl responds, “Um…brella, umbrage, umami?” Of course, this is exactly what happens in real life, too.  If you start typing into a search engine (i.e. you start to “google” something) it will come up with the most popular way to finish your thought so that the search engine can most quickly and accurately answer your question. How many of us would finish the sentence, “I am a doctor and…”  For some, they would say that they are miserable in a profession that was meant to be a calling.

I am a Doctor and I Hate My Job

According to the 2019 Medscape Physician Burnout and Depression survey, approximately 45% of physicians are burned out with three specialties (urology, neurology, and PM&R) having burnout rates that exceed 50%. For any of us who have known the lonely and cold road to burnout, this makes sense.  To those who still don’t understand why wellness is important, it is probably a shock. I’d argue that every one of the top ten reasons for burnout found in the Medscape survey maintains one major theme – they are each a part of the job we are powerless to change. In other words, we have a lack of autonomy despite the thousands of hours we spent learning how to do our job. For example, according to the survey, the top three contributors to physician burnout were:
  1. Too many “bureaucratic tasks” (records, charting, paperwork, etc)
  2. Spending too many hours at work (i.e. poor work-life balance)
  3. Electronic Medical Records
See how these items are outside the control of the physician? Given the relationship between autonomy and job satisfaction (it’s one of three key components to enjoying your work), the increasing rate of burn out makes sense. Naturally, it begs the question: how do we get more control over our life?

The Cure for Burnout

In past surveys, physicians have felt that getting paid more might help, and I’ve previously discussed why this is a ridiculous idea.  Most physicians are so financially illiterate that more money might make the problem worse.  Not better. In the 2019 survey, the most common ways physicians are dealing with burnout includes exercise and talking to friends and family. However, this ignores one major causal relationship: the amount of time spent at work, which directly corresponds to burnout rates. The survey showed that 36% of physicians working 31-40 hours admitted to being burned out compared to 57% of physicians who worked 71 or more hours. Given the linear relationship between hours worked and burnout, I would propose a different solution, cutting back at work.  We could also consider the other readily accessible options to treat burnout. Aside from cutting back to part-time work or chipping away at the parts of the job that we hate the most, one of the best ways to combat the physician burnout epidemic is to control what we can – our personal finances. It is one thing in our control that wields enough power to prevent the bitterness that can often build when the hospital doesn’t love us back. There is no reason to feel locked in a cage if we hold the key. We can work towards limiting lifestyle inflation, and widen the gap between our income and spending. Then, we are free to invest our money wisely.  This is a quick recipe to achieve early financial independence, and freedom from administrative tyranny. A financially independent doctor has a choice.  They can keep working full-time at work, or they can start pursuing Partial FIRE where they cut out the things they don’t like, or go part-time if that is what is needed.

Financial Freedom for Doctors

You might wonder why I am so quick to link burnout and financial freedom.  The reason is that I see them as intrinsically linked. There are two core beliefs that led to me starting this site.  [The following is copied and pasted directly from my “about” page.]
  1. I believe that a financially independent physician – or one who at least has a clear path to getting there – is a better doctor.
  2. When we choose to practice medicine because we want to (and not because we have to), everyone benefits – including our patients.
Financial independence provides freedom for doctors. This freedom can stave off the worst possible burnout. Why? Because if it gets worse, we can always walk away.  That’s true autonomy.  Some call if “F-You” money, though I am not quite so bold. Either way, we must realize that our lifestyle choices lock us in a cage. If we sell the cage (our expensive house, cars, private schooling, and designer gadgets), we might find that freedom we’ve been looking for. In the end, these “things” are not really what produce meaningful happiness anyway. Is personal finance hard? Yes.  But figuring it out is also worth it to deal with the burnout epidemic we are currently facing.

Take Home

Like Ralph and Vaneloppe, we can find success if we learn where to find it. If you are saying, “I am a doctor and I hate my job” I hope you will consider taking corrective actions that place you on the path to financial independence.  It just might save you. It is important to avoid making the burnout worse through lifestyle inflation.  We should consider part-time work.  Or cutting out the parts of the job we do not enjoy. If we lack autonomy at work, we can find that autonomy in our personal finances.  Control what you can; otherwise what you can’t will control you. Have you ever felt trapped in a job?  What were the drivers of your disatissfaction?  What was the remedy?  Leave a comment below.
TPP

20 Comments

  1. Xrayvsn

    That is an interesting observation regarding the Google search results and nice inspiration for a well thought out post.
    It is sad though it is used as an example of the benefits of cutting back but even with low hours over 36% of docs still report burnout. More than 1 out of every 3 docs in a less than or equal to 1.0 FTE still report burnout!
    Something in medicine is gotta give or docs are going to hit FI and leave in droves

    Reply
  2. PICU MD

    What’s interesting is that a few points down on the google search is, “I am a doctor and proud of it”. Not trying to invalidate the burnt out since I think it’s very real. I think the key is to make sure your work has meaning.

    I would rearrange your points a little:
    As far as the EMR, the big problem is really point 1. The EMR is really designed to collect data for payers, the government and quality overseers more than to help us take care of patients. If the beaurocracy went away I think EMRs would be sleeker and streamlined. If the interface to place orders in my emr was as easy as using amazon fresh to buy groceries or to schedule a test as easy as using opentable to book a restaurant we’d see EMRs as less of a problem.

    I also think a big problem is lack of respect. It used to be that doctors were leaders of care. When you walked in people would be like oh, the doctor is here and everyone would pause. Now we’re just another cog in the wheel, another group of human capital to be managed.

    I’m curious also about your point about work life balance. It seems like the lack of work life balance has pretty much gone hand in hand with medicine even in the “good old days”. Doctors have always had high rates of suicide etc. It seems like burn out is more common now. Is that because it’s better recognized or the balance of clinical and busy work has shifted?

    Reply
  3. Wealthy Doc

    FI is the key for sure.

    Just because you reach FI doesn’t mean you have to retire early. It gives you options.

    I chose to cut back to part-time clinical. I feel so much better. The financial impact was minimal but the boost in QOL was awesome.

    A lot of doctors don’t realize that personal financial mismanagement is a driver of the problem. They feel pressure and have to see more and more patients with more charting in less time. When I suggest they should take more time per patient or cut back their hours they insist “they can’t.” Only after probing that response about why they feel they can’t do we get at the financial issues. Often mortgage debt, private school tuitions, student loans, alimony, etc. They rarely see spending or debt as a problem.

    Even more disheartening is that about 1/3 of those doctors think that just a little more money would solve the problem. Wow. If you can’t cut it on $300K, $330K isn’t going to solve anything.

    Reply
    • ThePhysicianPhilosopher

      Cutting back or at least changing the parts of the job you loathe is a key to work satisfaction. Financial independence is the leverage we need to have those conversations

      Reply
  4. Kpeds

    That is a sobering Google search.

    I am currently unable to do what is right for a very sick kid because of an insurance company.

    This child is suffering because some beurocratic process won’t move any faster.
    It is very disheartening.

    One of my colleagues asked me today if I thought the new job would be better in this regard. I said yes because if only for the reason that I would have fewer patients and so fewer opportunities for this to happen.

    Side note, I’m not a fan of those auto fill features because they influence how we think. It’s creepy and weird and seems somewhat totalitarian.

    Reply
    • ThePhysicianPhilosopher

      That’s terrible, Kpeds! I am sorry to hear that is going on. The process really can be a beat down sometimes.

      Reply
  5. Crispy Doc

    You’re playing my song once again, TPP.

    Well-being is tied to being able to allot your time in accordance with your values. I’ve known saints, zealots and martyrs in medicine, but most physicians don’t fit into any of those categories.

    Most of us want a sense of purpose; time with those we love; the ability to master a skill set.

    The more that modern medicine puts us at odds with those goals, the more of us will find a solution in cutting back. This is a healthy adaptation to an unhealthy chronic stressor, and one that I fully support.

    Should a tipping point of financially literate physicians reduce their commitment to medicine en masse such that staffing becomes problematic because not enough doctors are desperately enough in debt to accept crappy jobs, it’s my hope that the environment will change of necessity.

    Or so I dare to dream…

    Reply
    • ThePhysicianPhilosopher

      I agree that a tipping point is coming. Eventually, people will “wise up” and demand the work-life balance that they are seeking. You and I will be able to look back and say, “I saw that coming.”

      Reply
  6. Dr. McFrugal

    Totally agree whole-heartedly.

    We should only worry about what we actually can control. And that is our expenses, our lifestyle, and our finances. Everything is little bit more beyond our control and dependent on other factors (a boss, EMR, work environment, etc.). It’s unhealthy to overly obsess and stress about things that are completely out of our control.

    I’m surprised that urology and PM&R are included in the top rates for burnout. I would have thought family medicine and primary care is higher on the list. I understand neurology because it can be frustrating and it’s more diagnostic than therapeutic. But urologists actually fix stuff. And I thought PM&R stands for “plenty of money and relaxation” 😉

    Reply
  7. Sebastien St-Laurent

    If you don’t like the job, that’s fine. Reconsider your options and move forward. But unfortunately they don’t… And from my own personal experience over the last decade, 90% of the ones I met could not give a crap about the patient’s quality of life.

    Oh, you have IBS, 2 hernias, difficulty swallowing food and bad cramps most times I have to go to the bathroom. Oh well, that sucks. Take some Nexium (that I won’t refill when you call it in) and come back next year.

    Therapist that just want to do talk therapy when you were CLEAR on the first visit that you wanted something more structured.

    A few other symptoms that only get Physical and a CBC (I mean, if it was fine last month and the symptoms are still there, it’s probably still fine). Why won’t anyone even bother investigating.

    Come in and wait 30-40 minutes to get your 5-10 mins max with the doctor where they will focus on what they want to and simply dismiss the patients complaints (had a doctor who only honed in on my seasonal allergies and never bothered looking at any of the other symptoms).

    At this point, I have ZERO faith in the medical profession.

    In the end, if you didn’t learn what the profession entails or if you only jumped on because of the pay, just go somewhere else. You have the right to not be happy with your job. But people’s well being are in your hands. So if you can’t cut it, go somewhere else and stop messing other people’s lives.

    Reply
    • ThePhysicianPhilosopher

      Medicine is a complicated and ugly mess right now. Unfortuantely, I think most of the physicians on the front line want to help, but they are not placed in a situation where that can happen much of the time. 10 minute patient visits are insane. It’s just not possible to get everything that needs to be done accomplished in such a short time.

      Reply
    • toast

      Admire your honesty. Being on the receiving end of a partial listening and action sometimes is worse than inaction. To have the gatekeeper role and close the seeing professional eyes leaves no excuse and is somewhere close to “Let them eat cake”….a place where having it all is comfortable and not wanting to know about those that don’t is also more than comfortable. Are we obstructive to the “poor” patient when we either do not do enough, or focus on our agenda to save ourselves?

      Reply
  8. Anonymous

    I cannot even imagine making a salary like those referenced here. NYC, highest cost of living in the country, 80h a week or more, 170k at the max and really high taxes and crappy benefits. Kids 2 years out of college make more than I do in anything financial. Medicine = life mistake, at least financially.

    Reply
    • ThePhysicianPhilosopher

      That’s a tough spot to be in. Are you tied to that part of the country in such a way that you couldn’t leave or find happiness elsewhere?

      Reply
  9. Elizabeth

    Even living like a resident, saving 50% of income, investing smartly in index funds, paying off debt agressively, and essentially doing all the right things financially, it still takes many years of working as a physician to acheive financial independence without finding a lucrative side hussle. How do you combat burnout while working towards FI?

    Reply
    • ThePhysicianPhilosopher

      Honestly, it took me a while to figure this out, but it was through life coaching that I learned the tools to deal with my burnout and overall stress. I no longer blame my circumstances for my feelings and actions … Instead I’ve taken back the autonomy over my life through a ton of thought work to get to where I am today.

      Reply
      • toast

        Really appreciate your site and replies. I have just come to the site and love reading the genuine stuff in replies as well as yours. I have just cut back my time at work and started to address my bad feelings. Toxicity. It seems to be at work , but as much or more in me / in my attitudes and unconscious thinking. I can totally relate to the ” zealot , martyr, saint” comment above and see those roles sitting in the audience of my mind. But the guilt that they speak of is part of the whole work ethic that got me here. Maybe , too, the conditioning I went through in education…you know, shame of failure/ driven to success/ always got to do better/ can’t look bad to peers nor patients.
        Increasingly profit driven work culture infiltrates most of our behaviour and thinking and efficiency becomes the norm with a dollar centred fulcrum. The internal moral dilemma to keep the patient first simply cannot withstand the corporate. Let’s face it , health is a money machine and we are a cog in it.

        Reply
  10. Rufadee

    I was a doctor. Hated much of it for multiple and complex reasons. I cured my so-called burnout very effectively by leaving the profession and doing something completely different. I’d heartily recommend this strategy to anyone who can do it and either has an alternative or is willing to discover one for themselves.

    Reply

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