Editor’s Note: Want 2 FREE CME credits?  Did you sign up before the 2-Day Training called The Rise of The Self Determined Physician yet?  At this live event, we will be teaching doctors how to defeat their burnout and find work-life balance without leaving medicine.  Plus, two FREE Category 1 CME credits will be available if you attend live.  Click here to learn more.

The culture of medicine is on a spectrum that I call The Healthcare Culture Continuum.  On one end you have the cultures in healthcare organizations that result in physician burnout.  You can think of these as the cultures that foster moral injury and lead to the individual phenomenon of physician burnout.  These are the cultures that make doctors feel trapped in medicine by electronic medical records, insurance pre-authorizations, non-competes in your contract, and high student loan burdens. The cultures that prevent you from getting on home on time for dinner and make you find a new source of childcare for the 5th time.  This is the culture that devalues physicians and makes them feel like a cog-in-the-wheel.  

On the other end of The Healthcare Culture Continuum (on the right) are cultures that produce Self-Determined Physicians.  These are the cultures where physicians feel valued and respected. Healthcare cultures where doctors have control over their work and their schedules.  They feel attached to their calling and the deeper purpose they serve.  And where impostor syndrome is a thing of the past.

With each decision that the administrators and leaders in medicine make, they are pushing their culture further toward physician burnout on the left or toward self-determination on the right.  As the votes built up, that is how healthcare systems have led to epidemic rates of physician burnout and dissatisfaction.  Before we can talk about what individual physicians can do when they are stuck in a bad system, let’s talk about the giant elephant in the room first.  

Burnout versus Moral Injury

Many doctors feel that the term burnout is not the right word because it blames the victim. Yet, I think identifying as a victim is THE most damaging belief in all of the medicine for doctors.

Think about it.  Do all doctors who assume the role of victim really defeat their moral injury? No. They don’t. In fact, it can often make their burnout worse. This is exactly what the healthcare system wants.  For doctors to remain silent while the insurance companies and administrators in control continue to reap the rewards. 

You can choose bitterness, anger, and defeat.  You can change jobs, go part-time, or try to create the financial freedom you need to leave medicine completely.  In so doing, you have positioned yourself as the bitter victim trying to break out of jail.  

And this, my friends, is the problem.  When we choose the role of victim, we have already lost in the most important way. We have lost control of our own thoughts, feelings, and the way we show up in this world.  

Maya Angelou warned us about this in one of my favorite quotes… 

“You should be angry. You must not be bitter. Bitterness is like cancer. It eats upon the host. It doesn’t do anything to the object of its displeasure. So use that anger. You write it. You paint it. You dance it. You march it. You vote it. You do everything about it. You talk it. Never stop talking it.”

You are NOT a Victim

When we identify as a victim, we have chosen the way of bitterness that Maya Angelou warned us against.  

Think about it.  Is this really what we want?  To self-identify as a victim? No.  It is not. And it will not lead to the change you want.  How do I know?  Because when I was burned out, I labeled myself as a victim, and I’ve seen countless other physicians do the same.  There were months on end that I sat on the back porch drinking an IPA while complaining to my wife about the state of medicine. While it felt good to commiserate and to blame everything on something external to me, labeling myself a victim and commiserating did not help.  I wasn’t able to move forward.

I get why some doctors prefer the term moral injury, though.  They feel that the term burnout blames doctors.   In a society where victim-shaming and victim-blaming are on par with things like racism or sexism, this can cause problems. 

Moral Injury Causes Burnout

Instead, some have suggested that we use the term “moral injury,” which implies that the injury is happening TO the physician instead of being self-inflicted BY the physician.  To the unacquainted, moral injury occurs when medical professionals have the ability, knowledge, and know how to help a patient, but are unable to do so because of systematic failures that prevent the care from happening.  

In other words, moral injury exists when doctors feel that the system is causing harm to their patients and colleagues and that they are helpless to prevent it.  This phenomenon causes profound moral disorientation and emotional trauma.  It is also distinctly different from burnout.  For this reason, I want to state this loud and clear…

The causes of burnout and moral injury are systemic and systematic in nature. The causes happen TO doctors not because OF doctors.  The medical system is broken.  However, that it is not mutually exclusive to work to fix the system WHILE we help individual doctors who are trapped in systems that burn them out.

I Refuse to Let Physicians Burn Out

It is not a mutually exclusive goal to want to fix the systemic nature of moral injury while we help burned out doctors, too.  I for one refuse to sit idly by while doctors are burning out saying “it isn’t my fault the system is broken” while I watch a bunch of doctors go down with the ship.  

Like Maya Angelou teaches us, we can (and should) remain angry at the broken medical system. However, we should do this WHILE we work to help individual doctors who are in need of help!  This false dichotomy that many would make between burnout and moral injury is not necessary.  Let’s fix the morally injurious medical system while we also work toward helping the physicians who are burned out by it.

And how we do that is by helping doctors become Self Determined Physicians even if their system refuses to change.  Even when the hospital does not love us back.  

We Can Help Burned Out Doctors

The way that we empower individual doctors is to give them choices. Because far too many doctors feel like they have no choice.  But… You. Always. Have. A. Choice.  

It is a choice to go to work.  To complete the online module. It is a choice to respond to emails within 24 hours. Doctors have a choice to create non-clinical money so that they can experience financial freedom.  You have the choice to go part-time, change jobs, or seek locums tenens work.  You can say no when someone asks you to sign up for the committee, quality improvement project, or write that book chapter.  

And when you realize you have a choice, this is when you can start to set boundaries.  You can set boundaries with your time.  With your money. You can stand up for the change that you know you need.  

And when we have enough Self Determined Physicians who can determine for themselves the best course of action… only then will we have enough doctors who feel empowered to stand up for the change we all know the system needs.  To put a stop to the moral injury that burns so many doctors out.  

…but we HAVE to get past this false dichotomy that we can either fix the system or help individual doctors.  We can (and should) be doing both.  We can fix the broken system while we help doctors who feel trapped in medicine. 

Empowering Physicians

The way that we do this is by empowering doctors to set boundaries with their mindset, their money, and their time.  Boundaries that our employers must respect.  These are the 3 key pillars to reclaiming control over your personal and professional life.  

And when you take this journey to become a Self-Determined Physician, not only will you take back control.  That is also when you will find your people. The people who are on the journey to creating a life they love. One with work-life balance. A community of doctors who choose to say no so that they can say Hell Yes to what matters most.

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