A common proverb teaches that “The road to hell is paved with good intentions.” Medicine is a world where people have good intentions. Yet they fail to change a system that is broken and continues to produce burned out, depressed, and suicidal doctors. If academics are honest, we can see their final destination, look back, and realize that we helped pave the road to physician burnout.
In this post, I want to hammer home the purpose of The Physician Philosopher and how I am trying to reshape this road our doctors travel. This is why I write. This is my purpose.
Imagine a world in which a young person decides to pursue a noble profession. All the while, they sacrifice their 20’s to chase after an altruistic calling. This is the plight of doctors in training.
Doctors miss weddings, funerals, concerts, kids’ soccer games, and family dinners. Many have secondary PTSD from pediatric drownings, women dying just after giving birth to their child, and the patient diagnosed with terminal cancer whose family blames the doctor.
Medicine teaches us to turn off our emotions.
The profession beckons us to put our hands to the plow, put our heads down, and to push. Like soldiers in battle, those to the left and right of us might be falling, but we are told to “shut our mouth, do our job, and keep pushing”.
Through these daunting tasks – as we witness chaos, death, and destruction – we constantly remind ourselves of our higher purpose. As the tunnel gets darker – and burnout, depression, and even suicidal thoughts set in – there is one hope: making it to our 30s and finishing training.
Becoming an attending physician is the light at the end of the tunnel.
When The Light Isn’t So Bright
The problem is that when we finish training, many find out that the burnout often persists. We fall into a world run by administrators, insurance companies, politics, and policy. The hospital certainly doesn’t love us back.
And, after all that training, the doctor is not the captain of their own ship.
We spend less time with patients, and more time with computers. Less time healing, and more time getting hurt. We feel less support from administrators and have more non-clinical demands. There is no time to deal with devastating outcomes, and the thought of taking time simply feels weak.
We find that our expectation – the one that kept us going while we pushed through in training – is much different (and often worse) than anticipated. This difference between our expectations and reality fuels the burnout into a raging fire.
Can we make it better?
In an attempt to improve our happiness, we buy the house, cars, and private school educations that are befitting of a doctor. Unfortunately, these purchases do not provide happiness – and often act more like water placed on a grease fire. We think it’ll help us, but it actually makes our problem worse!
Many of us learn the art of contentment the hard way, or sadly the lesson comes too late. As our consumerism culture consumes us, the inflated lifestyle increases the already massive debt burden that we bear.
When we finish training we are supposed to be basking in the bright light at the end of the tunnel. Instead, we feel choked by the all consuming student loan debt, inflated lifestyle, and decreasing job satisfaction.
Once this vicious cycle starts, it is challenging to stop.
The Road To Burnout Helped Me Find My Purpose
The purpose of this site is (and always has been) to help burned out doctors through financial independence. I write because a financially independent physician is a better doctor. FI provides complete control of your job, and allows for work-life balance that will increase satisfaction, productivity, and efficiency at work.
There is a physician wellness problem in our country. My dream is to be a part of the movement that helps change this reality for our medical community. This is one reason I also decided to become a life, career, and money coach for physicians.
People need to know that there are options. The option to work as an autonomous physician with limited constraints. The option to Partial FIRE through part-time work or to retire early if the system refuses to change. It allows us to vote with our feet.
All people – and particularly doctors – need to learn that contentment can be found today and that the consumerism culture in which we exist is not the answer. Living a frugal, but intentional life allows us to spend money on the things that bring us true joy, satisfaction, and fulfillment.
Ultimately, The Physician Philosopher exists to help prevent all of these problems before they happen in the first place. I want to equip our future and current doctors with the tools necessary to achieve financial independence, avoid being a financial target, and take control of their lives.
They need the freedom to design the life that they want to live.
The Road to Hell is Paved With Good Intentions
The Physician Philosopher is all about disrupting the system that got us here and that continues to pump out doctors who make financial decisions that not only fail to treat their discontent, burnout, and depression – but make all of these things much worse!
The road to hell is paved with good intentions, but on this particular well-intentioned road, I want to serve as the sledgehammer to those stones that we paved to get us here. This road needs to be destroyed, removed, and re-routed to the promised land that we all hoped for when we finished training.
Why did I start this blog that consumes so much of my passion and my time? Because teaching others about the route to financial independence just may help save one doctor, one marriage, or one family.
That’s why I write. Why I fight. And why I’ll continue to do so. I hope you’ll join me in this journey.
Are you burned out? How are you helping solve these problems?
Will you join me in this journey? Leave a comment below.
Amazing blog. A true battle cry!
After spending some time in the VA and seeing the effects of PTSD first hand, I always felt bad saying I had PTSD from abusive training and compassion fatigue. I wonder how you got to the term “secondary PTSD?”
Last month a 20 something year old kid died from a progressive mold infection. I had told him two weeks before he was going to die if it counts didn’t improve. When he did die I felt nothing.
I remember feeling before; I remember crying. Is now the time to get out of medicine?
Or is now the time to work on the third leg of the burn out problem: financial independence? Being FI, you choose to go to work each day to care for others before yourself and family. You choose a noble profession and pretty good remuneration. Sledgehammer on!
I am sorry to hear about your patient! That’s rough.
The term secondary PTSD is one of the words used to describe compassion fatigue – which is exactly what your described about your feelings towards your patient that died.
I write more about it here:
Great post man! The similarities of the Doctor journey sound a bit like the military in some ways, especially the ‘turn off your emotions’ part. We’re humans, our emotions don’t have convenient switches like that.
We certainly shouldn’t have switches! But the emotions often get trained out of us. Sometimes you flip the switch too many times and the fuse breaks.
I’ve written about that in my own life here:
Thanks for stopping by, Dave!
I do hope that this battle cry against burnout takes hold. It is hard to change a system that has been ingrained into culture for so long. Medical students and residents often wear it as a badge of honor of how little sleep they get or how many hours they put in a week in the hospital.
We’ve made it almost like a sign of weakness if you can’t keep up with this demanding schedule and therefore many people suffer in silence.
The quest for financial independence is getting harder and harder as the margins for mistakes is getting slimmer with increasing tuition and decreasing reimbursements making a deadly combination.
Keep writing like you do, as will I, and hopefully a percentage of physicians will get the message and make the change. We have a long ways to go, but hopefully a movement can get started.
It is definitely an up hill battle. I think that the culture can be changed. And that’s the most important part before any concrete changes can occur.
I also agree that with the increasing rates of loans, the margin for failure is much smaller. If lifestyles are inflated while in this crippling debt, it will certainly compound the problem as I describe above.
Glad to have some teammates on this journey to change the system!
What a refreshing view and call to action for physicians. Every doc I talk to, including my own expresses frustration with the system. They’re seeing more patients spending less time with them, suffering stress and burnout.
Your voice is an important one. I hope the word spreads. Speaking with your feet is something I doubt will take hold for the very reasons you cite (debt, lifestyle inflation, etc.). Those things keep people stuck. Physicians come out with so much debt it’s hard to see the light at the end of the tunnel.
Keep pressing on, man. It’s a great cause. Yours is an important voice.
Thanks, Fred. Your words mean a lot!
I really appreciate your encouragement. The cause is clear. We just need men and women who are brave enough to join in the chorus. I’ll keep on signing until others join me.
You’ve so eloquently nailed why I write about burnout, though I’ve gone about it in a different way. I’m glad we’ve started to have these difficult conversations out in the open. Keep on fighting the good fight!
We are on the same team, M! It’s an important message that needs multiple ways to get it across. Glad to have your company on this journey to change the way doctor’s see these tough topics.
Hi TPP: Very nice meeting you in person at FinCon.
I love this paragraph from your article:
“In an attempt to improve our happiness, we buy the house, cars, and private school educations that are befitting of a doctor. Unfortunately, these things do not provide happiness – and often act more like water placed on a grease fire. We think it’ll help us, but it actually makes our problem worse!”
Oh so true!
Good to meet you, too, man.
Consumerism certainly isn’t the answer!
Most physicians already work too many hours. Do you find that writing is part of your self-care? Do you find it difficult to balance your needs to sleep, mentally unwind, but also contribute to this side project? How much time do you commit to The Physician Philosopher each week?
At times, I wonder how much my side project contributes to an increased sense of burnout, even though it’s a passion and I’m willing to prioritize it over other activities.
For me, writing is a bit of catharsis. Helping other people while doing it only adds to the joy it brings me.
It doesn’t feel like extra work. It feels like a hobby that I really love. I’ve never felt like it adds to my burden.
Keep up the great work.
I was getting there (maybe Crispy?) but didn’t realize it until I cut back and felt so much better.
I share your passion for writing, teaching, and the importance of FI.
Glad to have teammates on this journey! Thanks for setting a great example.
Well said, TPP. Our missions are well aligned.
Thanks, PoF! Glad to be on a good team!
‘Wherever the art of medicine is loved, there is also a love of humanity. Cure sometimes, treat often, comfort always.’
Any physician who does not recognize this quotation ought be cautious is their own priorities.
It’s been said that the ability to observe yourself from outside yourself, is the highest form of intelligence. Is this the essence of reason; intellect of its highest design? Ignorance is not lack of knowledge, it’s the lack of effort to understand, and therefore a surrender of your freedom and responsibility. Striving for self realization and self knowledge sets the stage for personal responsibility and freedom- freedom to change.
Change is the only certainty. Change is life. Change is power -power to grow. Never give your power away. Subjugating primarily to the needs of others rewards you with discomfort, distress, disappointment and dependence. So, as Corporate health care strips you of the opportunity to learn, change and grow in your practice, and political quacks convince people that they need not participate in their own wellbeing while demanding that you accept duty to their self-inflicted ills, be certain to understand the difference and draw a bold line between compassion and empathy.
Compassion allows growth; empathy kills. The difference lies within you to save someone vs. trying to help someone. Use compassion to allow the pain of others to flow through you; to build strength and understanding. The pain of others is not yours to hold -you can’t take another’s pain and save them agony. Our culture is eating its tail and the more you empathize with, and harbor the pain of those who are destroying themselves, the more you become like them, gradually losing your way in the haze of altruism.
Stop focusing of what you want to become, and begin realizing who you want to be. Seek out help from others in all the fragile moments that come together to shape your life. Your ‘Truth’ is action; a search; an inquiry or scrutiny, not an endpoint. Let truth be your motivation and you will find peace, even within Corporate predatory medicine. There is always light when you keep interest outside yourself because it is only through learning and knowing others that we come to understand ourselves. And, it is your own suffering that gives measure to your power to heal.Then be grateful you have this opportunity.
‘Getting older doesnt make you more wise, it makes you more careful’.
Please be careful with comparisons to the military.
While there are some similarities, I suspect most physicians do not fear for their life or their battle buddies 24/7 for months on end. And I also doubt many physicians have actually been in combat or engaged in an actually firefight.
There are some similarities and I can see how the comparisons may be attractive to write about.
But as a combat vet with multiple tours and also a EM doc I can assure you it is very different. Even on the very worst day in the ED, it’s no where close to being in actual combat.
It’s an important topic and good discussion
No intention to compare the two as much as to use a simile to prove a point. As a son, grandson, and great grandson of veterans – I have a tremendous amount of respect for the military. I meant no disrespect, if it was taken that way.
And thank you for your service to our country.
I have already reached burnout and retired early at the age of 61, 3 years ago. I now have to get my own health insurance through Obamacare (which I never liked.) I feel like I am still recovering from PTSD from training and chronic lack of sleep from working all those years. I feel like I have abandoned the people I was going to help, but my soul isn’t in it anymore. I think if I write a book it may help. Young medical students need to learn how to prevent burnout before it happens to them. I am glad you are writing this blog.
It can be a rough road. I completely agree this message needs to be shared early and often to help prevent as much of this as possible.
You like to use the editorial “we”. I haven’t given you permission to speak for me. “We” don’t all have the same devastating, demoralizing, depressing, draining experience that you describe. There are joys, and higher purpose, and camaraderie, and intellectual wonder, and… I didn’t sacrifice my twenties. I made a choice about how I spent my 20’s. Your characterization of everything as torture is immature, not realistic and less balanced than the system you describe. We are following this path by choice, and can leave at any time. I’m not a victim. And suddenly – sunshine and rainbows appear because we have financial freedom by your method. Because someone follows your system, all else (which doesn’t change) suddenly becomes a spring breeze. It would be insulting if I took you seriously. You hope to profit by capitalizing on the vulnerability of tired people who might also benefit from learning ways to shift thinking, find moments that make it all worth it, and even feel gratitude for the privilege of a career in medicine. Medicine isn’t for everyone, but we do have some control over how we experience it.
I get the feeling some are rediscovering “Walden Pond”. Good for you all. Sooner the better. And if you faked reading HDT in H.S. maybe you should pick up “Walden Pond” and read it cover to cover. Your H.S. American lit teacher perhaps was not as uncool as you thought.
Are you a high school American lit teacher by chance?
I always thought Thoreau was pretty good.
Main problem of not being the Captain is that Scotty by the Teletransporter is the one that decides how the ship is run. And that is so wrong,
New clothes for the emperors(read lil managers) Have become too exxpensive for healthcare providers to support. Administrative greed for power is based on thei predatory values.
A new balance should be brought onto the formula and those that —I knpw that time is money—-and money gives you time. Bur burnout is extremely related to exploitqtion of our skills.
Please dont read my expressions as hostile—hostile is the way that Md’s are subjexcted by those they willingly serve and those that abuse and bully us.
Many are leaving what medicine has become to start concierge services or to start groups on their own to avoid some of the problems you mention. Many docs will continue to vote with their feet if things don’t change
I agree wholeheartedly with your message especially as I’m feeling the fires of burnout lick at my heels. However, many of us like being in hospitals because that’s where the sick people are. How do we regain control? How do we push back from within? After all, if all of us do the “financially independent “ small outpatient practice, who will take care of our patients?
I don’t necessarily think that the answer is to leave medicine. That’s why you will very rarely see me talk about early retirement on this blog.
I do preach financial independence because I think that provides you leverage and options to negotiate with the people who do have the “pull” to make changes that matter. It also might allow you to become one of those people, too.
After all, if you don’t have a seat at the table, you’re likely on the menu.
Great description of the timeline that a typical physician follows to a point of ‘burnout’ and of contributing factors that lead to physician ‘burnout’, depression and suicide. I see the process beginning in the first year of medical school as every basic human need of likely well-balanced individuals is challenged. These optimistic, well-intentioned, brilliant people begin that long road of training with ongoing financial and physical sacrifice, delayed gratification, isolation from family, friends, and, really, mainstream society. We learn to accept the gradual process of depersonalization and dehumanization. We learn not to expect to get what everyone arounds us needs. We sacrifice food, water, sleep, time with loved ones, self-esteem and esteem of others, as is expected of a real doctor- who never complains. We start to believe that it isn’t only necessary to make these sacrifices in order to learn and practice medicine, but we don’t even expect to have these most basic needs acknowledged by anyone, or met. We are not treated like other people. The hope of achieving self-actualization, growth and contribution, or a sense that everything we did to finally become a doctor was really worth it- fades away as we realize that, after all of that- we have no control, nor will we have control, as doctors, over our life, or career. Have you noticed that it doesn’t even take a medical degree to practice medicine, anymore? Our jobs are being filled with ARNP’s. Isn’t it interesting that physicians do not speak up for themselves or rebel against the outrageously dysfunctional healthcare system that is as dangerous for patients as it is for us? Do we remain silent out of fear and intimidation? Is this ‘Learned Helplessness’–a term that Amnesty International uses to describe survivors of long-term abuse, including dehumanizing tactics, sleep deprivation, food insecurity and isolation? Perhaps, this is why physicians do not choose to escape their situation, even when they are given an opportunity to do so. It would be normal to react this way…. since doctors are- after all- human. We deserve to eat, sleep, to be treated professionally and with respect, to make a salary that compensates us for our expertise, work reasonable hours, spend time with our families and loved ones, have the opportunity to grow in our fields of interest, and contribute to others as we wish. Our value is not defined by quality metrics and productivity, and the cure for ‘burnout’ is not ‘resilience’. The cure begins with understanding and acknowledgement of the root causes that lead a physician to the point of perhaps negative or destructive behavior, loss of close relationships, depression or suicide.
In my opinion, doctors need to, first, give themselves permission to be happy- we have earned it, and– deserve it. May you each find a path that leads to happiness, peace and balance.
I’ve heard it said by the CEO of Kaiser that research shows medical students being the happiest and most fulfilled going into their graduate school program, and being the least coming out. There is something wrong with the system given the all time high rates of burnout, suicide, and the number of doctors leaving the field all together.
I agree that something must be done.
Maybe it is time for doctors to unionize or at least organize. I don’t resent PAs and NPs (I am a former PA). I resent everyone who doesn’t actually touch a patient who somehow has the power to dictate my life.
Amen!!! I am so sick of the toxic work environment for physicians in this country and the resultant suicide epidemic we are facing.
Thanks for helping fight the good fight!
Thanks, BC! Just glad to be part of the community trying to help fight it.
The information you described in the above article is pretty good. I think you should write more on this and related topics as well so that I can send more users on your article. It helps me a lot.
I intend to. Thanks for the positive encouragement.
This piece is as if you had ‘read me’. I believe this article should be assigned to every pre-med, medical student, physician, and patient. After all, aren’t we all, but an inch of becoming a patient our selves
There is NO lone ranger without a ‘Tonto’.
I think this story is a common one for many people in medicine! And keeping that perspective (that we are all an inch from becoming a patient) is important.
We need to set ourselves on a glidepath for success while we can.
I am passionately on board! We are blessed to have the connections of social media to share the similarities that so many live isolated and alone. Physicians have so many admirable traits and intentions which have allowed us to serve our patients but at the same time have lead us to become victims of a runaway profession that is out of our control and suffocating our spirits. There is so much to say and discuss that I’d call it Missing Conversations in Medicine. But no more!
It is certainly a community effort. Encouraging the conversation can really only be a good thing in this arena.
Not a physician, but I work in healthcare on the clinical informatics side and can definitely say that the sentiment of your post has been shared with me by many clinicians. The struggle to find a balance in life is challenging.
I wholeheartedly agree that achieving FI is one of the keys as this allows people, physicians, to live more on their own terms and to perhaps find a less demanding schedule which allows for self-care as well.
Glad to be on the same team!
Well done TPP. As an emergency physician, I have seen and felt much of what you have written about. While still working clinically I am focusing much of my non-clinical time writing on physician wellness.
A study recently came out in the Annals of Emergency Medicine (https://www.annemergmed.com/article/S0196-0644(19)30064-2/fulltext) highlighting that 76% of graduating emergency medicine residents are experiencing some symptoms consisting of burnout.
I completely agree–a financial independent physician is ultimately a better and healthier physician. Thanks for all the work that you do.
That is an insane number! 76%? I’ll have to read that paper. Thanks for sharing.
And thanks for commenting! Burnout is tough enough. No need to fight it on our own!
I too have been going through a life transition. I however suffered from developmental ptsd and complex ptsd before I started medical school. The white coat became the armor around which I organized my life.
In my transition I was a coinvestigator in a study which compares open label placebo to a mindfulness intervention. What was exciting about our results was how powerful the placebo effect was. It truly represented the Healers Power- which we all have and no administrator can take away. I love my patients and practice. I hate medicine as a hamster wheel of check boxes, insurance approvals, over scheduling.
The challenge you and your white coat investors have is possibly the victims of burn out and trauma are too tired to carry through with your advice. I think we need support circles that are trauma sensitive to get these people (us, me) help. There is great shame in not being financially with it- when we should, right?
That taboo (“shame”) as you call it is a huge part of this problem. We have to allow people to be open and honest about their mistakes and to show them a way out of this mess.
They might be too tired, but it is our job to lift them up.
This post really resonated with me!! I am one of those ~50% or so who went through burnout, for the exact reasons you mention. I was not paying attention to my finances and the concept of FI was nowhere in my universe.. Now at the age of 53, I am making the conscious decision of retiring from medicine, with the bonus that our innate frugality and some smart investing by my partner, will allow it financially. I definitely feel like I have paid my dues to society and have no sense of guilt to finally feel like I am taking back control of my life. I have actually seen first-hand the devastation stress in medicine has caused a number of my colleagues, be it with their health, lives or relationships. Kudos to you for being such a champion for the well being of physicians!
Thanks, BY! This is the reason I do all of this. I am just hoping to be a part of the solution and to guide people to be the heroine/hero of their own story if the system refuses to change!
Thanks for the encouragement!
Hope I don’t offend anyone, as I am not a doctor. I am a teacher. We have a very similar struggle. The burn out and compassion fatigue are real, but the pay isn’t.
Thanks for the article.
I don’t mind at all. My wife is a teacher (actually a kindergarten coach now) and she sees it every day.
Thanks for the post TPP. Couldn’t have said it better myself. I really like what you said about contentment. It’s a great reminder. What will satisfy us in the end isn’t in the pursuit of more. It’s in the appreciation of what we’ve already got around us. It’s a good frameshift that I constantly need to keep making. Appreciate your work.
It is am important shift to make! Glad to help. I struggle with this, too.
Good choice not responding to FAC. Clearly you hit some kind of nerve. Must be a big chip on that shoulder.
Keep up the good fight. WE know there are many who feel trapped in their current situation. And I’d say a fair amount of sunshine, roses, and fluffy unicorn farts start happening right about the time financial Independence becomes visible. Just saying.
Thanks for the support! (And sorry for the delayed response as I was in D.C. at FinCon last weekend!)
Your description of the cycle that leads to burn out is spot on. In my training I definitely felt this and it became particularly difficult towards the end when I realized that things would not magically get better just because training was over. Action was needed. I truly believe that financial well being makes us better doctors as you say so well in this post. I am at the beginning of my journey but looking forward to the rest of it. Thank you for continuing to be such a great voice spreading this movement and I will do my best to do the same!
I very much enjoyed this article. I have been following your blog along with WCI and PoF for some time now and they have been really helpful in giving very practical guidance to avoid burnout. For me, that was going part time at age 55. I have also started reading “Your Money or Your Life” which has been recommended multiple times on your blog and others.
Great article and very validating of the struggles that health care providers endure! It is wonderful for physicians to have coaching as a proactive and constructive means of correcting their life path without having to worry about confidentiality of using health insurance. I have found a lot of satisfaction in helping physicians, health care provider and pain patients through coaching. Coincidentally, when I began to feel burned out as a pain psychologist (mostly due to Worker’s Compensation), I expanded my practice to include coaching. Although my focus is more on the emotional sequelae for health care providers, than the financial or administrative struggles of physicians, I have found it immensely rewarding to assist doctors and health care professionals in improving their emotional and physcial wellbeing. Keep up the inspiring articles!
A “light in the darkness” post. Extremely well written and heartfelt expression.
Hi, I’m not a dr but I’m a med tech and struggling to find meaning outside of medicine. I am going for a career in data science now but am struggling to find a sense of purpose like I had with medicine. Unfortunately, the hospitals seem to not let you do meaningful work, so I had to leave because I was burned out. Thanks for writing this blog. Very helpful and meaningful!