Nov 29

Adventures in Burnout: One Physician’s Story

burnout

[Editor’s note:  I’m excited to share a guest post with you today from a virtual friend of mine, Vagabond MD. The author is a recovering private practice interventional radiologist (20+ years), a regular reader of my blog, an occasional guest blogger on various physician sites, and a prolific contributor on the White Coat
Investor forum (@Vagabond MD). He has no conflicts of interest (but is receptive to having some) and currently does not maintain his own blog or website (but he should). Enjoy – HP]

 

The Descent

 

I had not been sleeping well for weeks now. There had been an unexpected outcome from a routine procedure that I couldn’t get out of my mind. The cold faint light from the alarm clock seemed to be taunting me, and I knew I wasn’t going back to sleep anytime soon. I quietly slipped out of bed, not wanting to wake my wife whose peaceful and rhythmic breathing was making me a bit jealous. I slowly walked into the adjacent office and found myself in front of the cold steel filing cabinet that held all those important documents they say you should not get rid of.

 

After a few minutes of fumbling around I found what I was looking for – a copy of my life insurance policy. I don’t know why, perhaps it was due to the sleep deprivation, but I needed to know if suicide was covered.

 

Apparently I was not quiet enough, because after a few moments I heard my wife enter the room. She asked me what I was doing, and I told her the truth.

 

 

Burnout

Burnout is a significant issue for the physician, directly affecting patient care and having negative reverberations throughout the healthcare system, including worse outcomes for the patients that we wish to serve. Typically characterized by symptoms of emotional exhaustion, depersonalization, and the low sense of personal achievement (Maslach et al.), burnout is believed to beleaguer nearly half of all physicians to some degree, with all three of these symptoms present in up to one-third.

 

You probably won’t hear a serious discussion on burnout in med school classes or in residency. It is the dark underbelly of the practice of medicine, a subject that is taboo to discuss in doctor’s lounges, in offices, in hospital hallways, and in C-suites. In fact, if you mention burnout to otherwise well-intentioned colleagues, they will usually advise you to keep it quiet, as if it were a death sentence or contagion…and maybe it is.

 

 

How My Burnout Evolved

Without much warning, burnout snuck up on me. First, there was cynicism, fueled by stress and anxiety, later a sense of overload and exhaustion, and before I know it, I dreaded going to work.

 

I’ve noticed that certain people seem especially susceptible, those that are perfectionist, those who like to be in control and take ownership, and those that are most responsive to criticism or praise. [HP: most physicians] Certain specialties, too, seem to rank higher in the reported burnout— emergency medicine, OB/GYN, and primary care (internal medicine and family medicine) top the list, but all specialties have unacceptably high rates of burnout, and the prevalence is rising at an alarming pace.

 

Over the course of my own professional life, with the usual trappings of a successful career arc in medicine, the claws of burnout took hold. I was a go-to guy, “The Man”, and I owned the role, but that did not mean that I was never wrong, never made a mistake, or never had a regrettable interaction with a patient or colleague. These were fortunately rare, but the personal damage nonetheless accumulated over time, an ever increasing load of unwanted emotional baggage.

 

I did my best, every day, but sometimes my best was not good enough. At times I felt my work was futile. I was mentally exhausted and felt trapped. Fears that my performance was declining were pervasive. I wanted to be anywhere but work. I started second guessing my decisions – all of them – clinical, administrative, and personal. I was beyond cynical; I was becoming a nihilist.

 

Somewhat surprising, especially in retrospect, I was able to hold it all together. My star was shining brighter and brighter within my organization and in the medical community. I was given new roles and honors. Outside work, I was in great physical condition, maybe my best shape ever, and could be the life of the party. I had numerous hobbies and interests and many friends to share them.

 

But as marvelous things looked on the outside, they were as bad on the inside. Underneath the facade, everything was crumbling. As wealth, achievement, status, and recognition continued to escalate, disenchantment and internal discord were rising in lockstep.

 

I think that I would have been okay if I could leave the negativity at work, but it was with me all the time. It sat beside me in the car driving to and from work. It walked my dogs with me after work, it ran with my friends and me, it ate dinner with my family, and it read in bed with me at night. Burnout traveled with me domestically and abroad. It was always there, my unwanted constant companion.

 

After a devastating outcome that occurred in a routine procedure, my situation became more dire and unbearable. I felt so much shame walking down the halls of the hospital that I was afraid to make eye contact with colleagues, afraid that “they knew”. (They didn’t.) One day my CEO called me to ask for a quick meeting, and I was sure he was calling to boot me from the medical staff. (He was actually calling to give me a great honor).

 

I  don’t know why I was looking through my life insurance policy that night, or why my wife woke up and thought to check on me rather than go back to sleep. I still remember the look of horror, disbelief, fear, and sadness on her face. While I was not then or ever truly suicidal, burnout can lead to depression and suicide, the latter uncomfortably rampant and underappreciated in the physician community.

 

Yup, things were pretty bad. Burnout took me places that I never wanted to go. So the question is, at this very low point, can a very intelligent, charming, and disarmingly handsome doc mired in burnout turn it around? Well, you will have to ask one, when you see him, but keep reading, and I will tell my story of redemption.

 

sky

The Ascent

 

Needless to say, this morbid curiosity was a wake up call for us both and prompted my wife to press me to do whatever I could to get out of my funk. My knee jerk reaction was to quit, get out of medicine and do something else. I strongly considered it and discussed it with anyone who would listen. I had some really fabulous (okay, mostly ridiculous) ideas– opening an ice cream shop, starting a national park travel agency, building a teen party surveillance service, launching a career in the financial services industry, coaching for fitness and weight loss, utilization review, and other random brainstorms. Alas, though tempting, a quick escape was a fantasy, not the solution.

 

I embarked upon a journey to figure this thing out and attempt to rehabilitate my career, and, in retrospect, can now summarize it in five steps:

1. Recognize the Burnout

Like many problems, unless you realize that there is a problem, it is unlikely that it is going to be solved. For me, the middle-of-the-night shuffling through life insurance documents was a turning point. I could freely admit that I had a problem. Without this awareness, you will continue to suffer (wallowing in negativity, depression and or addiction), do shoddy work, lose the respect of your colleagues, friends and family, leave (or lose) your job, perhaps leave your profession. Maybe lose it all, and then some. Recognition of your burnout is critical.

 

 

2. Seek Help

I enlisted help from two outside resources, one a physician career transition coach (remote) and the other a social worker (local). I had meetings with both over a period of years and still connect monthly with my coach. She has morphed into an overall career coach, and we still discuss where I am professionally, how I feel about it, and what’s in the future. The social worker acted as a general counselor for anxiety/depression, and after the fog of burnout lifted, I felt little need to meet with him. My wife was very supportive of me engaging with both (she really had to coax me to initially meet with the social worker), and it was valuable for me to have her (and other family) in my corner. I also appreciate the numerous unofficial mini-coaches and mentors including my running mates, a few close physician friends, and even a couple of administrators that I work with.

 

Connecting with one physician friend in particular, a buddy from residency for whom I had great respect and admiration, was instrumental in getting me on the right path. We reconnected after about ten years of only limited contact. Rekindling our friendship, we had a few amazing long conversations while hiking. I quickly realized that we had remarkably similar professional lives and were both going through an eerily identical period of negativity. Having someone who had literally walked in the same shoes as me and understood what I was going through was extremely helpful. Anyone can be sympathetic, but having someone who knew me and knew exactly how I felt made me feel less alone in my journey and less like an outlier. There are lots of docs out there suffering from burnout, and it could be extremely helpful to connect with one who shares your story.

 

I cannot stress the importance of having people to be a sounding board and offer advice in a safe, nonjudgmental manner. We are not on this journey alone. If you think you are burned out, think you might need help, dread going to work, are up at night perusing the fine print of life insurance documents, etc., GET HELP. [HP: Good advice that I didn’t really follow. It’s possible to do it alone, but in retrospect much more difficult.]

 

3. Assess your Options

For me, everything was on the table- quitting, changing jobs, working part time, moving, trying to establish a new non-clinical career in health care, building a business outside health care, etc. Everything. Quitting without a forward plan was a consideration, and at a couple points along the way, I was close to pulling the trigger.

 

Financially, we were in a position where I could walk away, and knowing that was a relief. Being financially secure gives you a lot of options, including exploring significantly lower paying jobs or a sabbatical. Even if you are not currently on the burnout trajectory, achieving early financial independence is especially critical for docs. It allows you to see the world in a different light. If you are constantly forced to grind to keep up with bills and obligations, burnout is tougher to overcome.

 

4. Peel the onion

 

Early in the process, I was convinced that the burnout was so ingrained in me that leaving the current job would be the only solution. Nonetheless, with little expectation of success, I tried to alter my current work circumstances. Like an onion, I gradually peeled off the layers of my professional life that were causing me the most stress and aggravation, the ones that smelled bad and made me want to cry. Some were easier to jettison than others. The first to go was my administrative role, as a department chairman and leader of the professional group, roles which earlier brought me great satisfaction, but had become a burden that I could no longer bear.

 

Next was ridding myself of a heavy, punishing weekend call responsibility, one which disrupted a normal work-recharge cycle. Then, there was ditching my sub-specialty concentration, which regularly put me in a position to do high-risk complex procedures in critically ill patients, sometimes against my better judgment or with low likelihood of technical success or benefit. The final change was to create a part time position, allowing me to just do less.

 

Every burnout situation is going to be unique, and figuring out what needs to be peeled will be trial and error. There is a decent chance that if you were once content in a job, this can be achieved again. Ultimately, if the peel process does not work, you may have to move on.

 

 

5. Be Kind to Yourself

 

Perhaps this should be the first thing on the list, but I think that this should also be present throughout the process and emphasized at the end. You are not a weak person, a bad doctor, or a problem. You are working conscientiously to survive and thrive in a truly fucked up system. You are swimming upstream to do your best for your patients and your colleagues. You care. The game is changing around you, and, despite the constant adjustments that you are inevitably making, it is easy for a person to become uncomfortably out of sync. I used to say that the me coming out of training 20 years ago would not agree to the job that I do today.

 

In fact, rather than punishing yourself, treat yourself extra well with nice vacations, enriching hobbies, family activities, an active social life, healthy food, outdoor exercise, and meditation, to remind yourself that life is great and to motivate and energize you to give your burnout the ass kicking that it deserves.

 

Now that I have had my own adventure in burnout, I have greater recognition and appreciation for the burnout in other colleagues, present and past. When you walk into the doctor’s lounge at your community hospital, the outpatient clinic, or the OR holding area, about half off the docs you lay eyes on may be suffering from burnout. Two private practice senior partners of mine were horribly burned out, in retrospect, by the time they hanged it up – one making uncharacteristic errors and the other with an anger management problem. They did not just become careless and mean. If you see burnout in others, reach out and try to help them.

 

All in, it was about a two year journey, from recognition, the file cabinet moment, to apparent resolution. It was not a linear path—there were ups and downs, clear progress followed by unfortunate regression. While I cannot be certain that burnout will never again resurface, I believe that I now have greater awareness and the tools to limit its impact over me, and that this common sense approach can be widely applied. I am sharing my own personal story to increase the awareness of the problem of physician burnout, to put another face on it, and in the hopes that someone else who is suffering might find comfort or inspiration to move forward.

 

I would like to thank The Happy Philosopher for allowing me to recount my burnout adventure on his blog and thank him once again for being a virtual mentor for me. Listening to one of his podcast interviews during a horrendous holiday weekend work stretch was inspirational and a turning point for me. Thanks, man, I owe you one.


Thanks Vagabond MD. I know a lot of people can relate to this story, and thank you for taking the time and putting in the effort to write this up.

What is your burnout story? Please share your thoughts and experiences with burnout in the comments below. – HP

49 comments

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  1. Thanks for sharing your story and for the great advice. Those who really need it may not take the time to read it, but we need more of this out there. I’m going to Dike Drummond talks and workshops later this week. I think he is a great resource too.
    I was starting to head down the burnout road, but didn’t realize it initially. I started reading about it to help my colleagues when I recognized some of those three signs in myself. Fortunately, it was early. Dropping administrative work and going to part-time helped me keep what was good but drop what I couldn’t manage.

      • VagabondMD on November 29, 2017 at 5:54 pm
      • Reply

      Thank you for reading, and for your comments, WealthyDoc. I think the problems recognizing burnout, especially in one’s self are related to the gradual, insidious nature and not knowing exactly how you are supposed to feel. If everyone around you seems miserable, it is easy to fall into the trap that “misery is normal” when it is not.

      1. It is a slow burn in burnout. This is a topic that needs to be out there and the more information that can be gleaned the better. Recognizing burnout in my residents and in some of my own tendencies led me to start my own website on Wealth & Wellness. I appreciate all of you guys who have gone before me to set an example on how to lead by talking about burnout.

        Far too often people remain silent while the slow burn continues to the point of complete burn out.

    • Dr. Curious on November 29, 2017 at 10:17 am
    • Reply

    Thanks for sharing, Vagabond. My knee-jerk response after reading that you were financially independent was, “Why didn’t you just quit?!” But choices are rarely that simple. Filling up those 50+ hours of time each week that would suddenly appear after quitting a full-time job can be a recipe for disaster in itself. It sounds like you approached it in a measured and gradual way, and I’m glad to hear it worked out for you.

    Thankfully, I don’t sense even the early stages of burnout yet (I am a diagnostic radiologist about 6 years out of training), but I’m glad that reading articles like this will help me recognize if it starts to creep up on me.

      • VagabondMD on November 29, 2017 at 6:00 pm
      • Reply

      Dr. C, I have enjoyed your blogs. Quitting without a forward plan, which I call pulling the “Q-trigger”, was indeed on the table, but as you pointed out, filling the time with something useful and productive would not materialize overnight.

      There were a couple times, with my wife’s support, we agreed that if this or that does not happen, proposed changes that would improve my working condition and state-of-mind, it would be time to pull the Q-trigger. I was able to mostly get in place what I needed to continue working. Now, I am happy at work and looking forward to the part time schedule, to pursue some paid consulting roles and to figure out what to do with the rest of my working life. Who knows, it might just be Radiology!

  2. Vagabond, appreciate your putting yourself out there in this guest post and in your frequent insightful comments on the various forums (fora?) where you remain a formidable presence. I, too, was feeling the burn ~15 years into an emergency medicine career, and similarly fantasized about dropping out of medicine completely. Like you and HP, cutting significantly back on my shifts was a remarkable tonic – both the ability to reassert control over my time and the added time to refill my reservoir between shifts.

    I’d add that making “invisible friends” by blog, forum or other online support systems can serve as an added source of support.

      • VagabondMD on November 29, 2017 at 6:05 pm
      • Reply

      Thank you, Dr. Crispy. Without people (wife, family, colleagues, partners, friends, coach, therapist (yes, I just typed that word), etc., in person, on the phone, or online, I would not have made it to the other side. Sometimes, it is a small thing that is said or done for someone else that makes a huge difference. Going forward, I hope to be the guy that says or does that small thing for someone else who needs it.

      I have not cut back on the hours yet, but I already have peeled the onion enough to feel pretty good about things and am optimistic about the future.

  3. Thanks for sharing the story. Burning out is definitely something people often face when you work in a high paced, stressful job. Interesting that you mentioned about being FI and I had the question of “why not just call it quit” in my mind while reading. But I guess whether to call quit or not when you’re already at FI is a personal choice.

      • VagabondMD on November 29, 2017 at 6:10 pm
      • Reply

      Like I said earlier, quitting was an option. I even read a book about quitting (Quitting, Streep) to better understand the psychology of quitting. Ultimately, I decided to make adjustments in my work conditions that allowed me to regain my mojo.

  4. Glad that you were able to identify the issue and resolve it. Over the course of how many years of practice did this sort of evolve? I have found that over the past 2-3 years the work environment that I’m in tends to lend itself to burnout. As many others would agree, much of the problem has little to do with practicing medicine itself.

      • VagabondMD on November 29, 2017 at 6:15 pm
      • Reply

      I would be hard pressed to pick a moment when the flip was switched, but I think the foundations of burnout, especially the cynicism and low sense of achievement were probably taking root before I finished residency, 20+ years ago.

      If I were to do a RCA of the problem, I think that the three contributing factors that played fairly equal parts would include my own personality, “the system”, and the nature of the work itself.

      I remember very well years ago when a senior radiologist (an attending in training who later became a personal/professional friend) told me that all of his friends who were IRs had switched into Diagnostic Radiology around their 40’s. But no way that was going to happen to me… 😉

      1. I have a classmate who seemed chronically malcontent even during medical school too. I wondered why someone with that personality would was clearly gifted would take up a coveted spot in one of the top medical schools in the country. She is still (but significantly less) disgruntled and only works about 6 shifts a month–she is an ER physician. Her husband is an ER doc too who is independently wealthy. With an n=1, that tells me that if you don’t have to work to live, the burden is going to be significantly less.

        IR is not easy–I strongly considered doing it and my friend is a neuro IR. You really have to get the numbers in to make sure that you stay fluent in the high-risk procedures if you opt to be in neuro-IR. He is tied to a large academic center, and has dedicated much of his life to the field.

  5. This spoke loudly to me in a very similar way to the recent podcast that the Happy Philosopher did on ChooseFI. You describe a place that I’ve been to, and I’ve made changes, but not enough. My burnout is manifesting itself in anger management. In recent months I have shouted at a senior partner. Not a very edifying performance and not something I am proud of. But these are all signposts that I need to heed.
    So I found your concrete advice very useful; but the key difference between us is that I am disarmingly handsome 😉

      • VagabondMD on November 29, 2017 at 6:22 pm
      • Reply

      Damn, I knew you were going to be disarmingly handsome! Yeah, the anger management manifestation for burnout. The only bright side to that is that you do not keep it all bottled up inside (like the senior partner I mentioned, who was also a mentor and father figure to me). The negative, of course, is that you can make people around you anxious and not want to be around you.

      So I think there is still some work to do. Steps 2 through 5…and don’t cut any corners! 🙂

      Best of luck!

  6. Thanks for sharing your story. I’m not a real doctor (just Ph.D.) but it seems there is a theme in burnout/suicide for otherwise happy healthy people in the medical profession. That theme is brutal work schedules. Doctors have long hours coupled with schedules like night/evening/holiday shifts that make it even worse. Long years of this plus the emotional stress of the profession seems like it would drive any human to unhappiness. In the examples I’ve seen on this blog and others, cutting back to part time has helped many doctors find happiness again, in both their life and work.

    I’ve never seen a good study showing a link between very long hours and depression but I suspect there is one. I certainly have become unhappy and negative when working over 65 hours a week in my career. Maybe we should focus on better progress as a society on “healthy” hours at work. I certainly would rather have my doctor happy and rested before opening me up in surgery.

      • VagabondMD on November 29, 2017 at 6:32 pm
      • Reply

      Hello, SIBF,

      Thank you for your comments.

      I do not know if there is data, and, to be honest, it was not the long hours that did me in. I had a reasonably civilized work week, probably averaging 45-50 hours and ample vacation (8 weeks). I did have a brutal call schedule, however, that kept me one phone call away from whatever “emergency” (real, perceived or otherwise) that was on the other end of the phone at any moment, 50% of the time.

      Not that I have dropped that call, I find myself working more hours (in the Hospital or office), but with less wear-and-tear. Being on-call sucks, it is compensated poorly, if at all, and it is a significant drain on your reserve. I am looking forward to working less, though, and it just might lengthen my career.

    • ToothCarpenter on November 29, 2017 at 11:47 am
    • Reply

    It was great to hear your story. I liked how you said it’s not linear. I experience periods where I think “I’ve got it pretty good” and others where I wonder if I’m wasting my time/life and burning out. It’s so frustrating. Even though things are actually pretty good here, I’m almost just waiting for the next problem. Who will be caught stealing and fired, who will be pregnant and we’ll have to cover for 2 months….

    Unfortunately, I have a bit of a “Golden handcuffs” problem. I am a partner now and I make so much that it would be foolish to quit for about 5-7 more years and hitting FI. It’s also not as bad as others have it, so who am I to complain? Anywhere else would drop my income to 25% of my current one and bring a whole other round of unknown potential problems. I really about killed myself to get here. Once I’m FI – then I’ll need to make some decisions. Right now I’m just trying to optimize my situation as much as I can. Working out and losing weight has helped me a lot. This last 15 lbs are a total bitch. I need to get some more hobbies going and focus my studies more on stoicism and buddhism. My study of those topics has helped me a lot. I’m not sure about a coach – my biggest fear is the barrier to entry is so low, will they be good or just an expensive waste of time?

    I actually kinda enjoy my job, I just wish I could only do it 2 days a week and offload administrative stuff to others…but my attempts so far have failed. When I delegate quality slips too much, which is a reflection on my training of that person I guess.

    Hope you do some follow up posts!

      • VagabondMD on November 29, 2017 at 7:16 pm
      • Reply

      Thank you for the comments. I think there is an ideal (not perfect) job for everyone, and it is our duty to find it (or create it). If we are not happy, it is doubly important to do so.

  7. Wow, first off you’re a really good writer, and as HP said you should have your own blog. I’m not a doctor but I did experience what I’m assuming was burnout, probably mixed with lots of “I hate being a senior manager” thrown in. I went part time, and it’s only 2 months in but I feel myself trying to heal and detox. Other bloggers out there pitch the idea of an entire career that jumps between work and “mini retirements”, and after reading stories like yours I’m wondering if that is perhaps a better way to approach life.

      • VagabondMD on November 29, 2017 at 6:36 pm
      • Reply

      Thanks, THP was kind, and he gave some significant help. It is my story, but it certainly has his literary stamp on it.

      The physician career is very difficult to work in pieces. The more you jump between jobs, the less able you are to find the next job. Plus, there are non-competes, malpractice tails, state licenses, credentialing, etc. And if you stay out too long (two years seems to be the number), you are essentially out.

  8. I knew you were in a funk a while ago, Vagabond, but I didn’t know just how deep that funk went. I’m pleased to hear the changes you’ve implemented are having a positive effect on your outlook on your career and life in general. I’ve participated in several discussions with you on the WCI forum when some of these changes were being contemplated prior to being acted upon.

    Part – time work seems to be an answer that many of us have come up with. The Happy Philosopher, Wealthy Doc, WCI, you, and I have all cut back on our clinical work and seem to be in a better place as a result.

    Cheers!
    -PoF

    • SAHM on November 29, 2017 at 2:18 pm
    • Reply

    How is US medicine a ‘truly fucked up system’? Is it the over prescription of drugs (the influence of the pharmaceutical industry) and lack of a holistic approach? Is it the hours demanded of physicians or the ridiculous cost of healthcare in the US? Perhaps all. If someone you knew wanted to go into medicine, what field would you recommend if any?

      • VagabondMD on November 29, 2017 at 6:40 pm
      • Reply

      I would answer your first question by saying that our healthcare system virtually demands perfection within an obviously imperfect world, and it continues to throw up roadblocks between you and perfection.

      I think that there are viable career paths in medicine (Derm and Ortho), but the list is shrinking. I am glad that I took the path that I did, when I did, and would do it again. I wish that I recognized my problems earlier and found constructive solutions sooner.

        • SAHM on November 30, 2017 at 5:40 pm
        • Reply

        Thank you for your reply. My daughter has expressed interest in medicine, so it’s good to see that knowing what you know you would do it again.

        1. Sahm,
          If your daughter wants to go into medicine, I would encourage her to continue. I personally love medicine as a career. I use my brain and skills. I help people. I’m treated with great respect. I make income in the top 5% of U.S. earners. If you don’t like medicine you can change what you do or how you do it and adapt. Medicine is a great background for a lot of other fields.

  9. Great post. Thank you for sharing your important story, which I imagine was difficult to do. As an early career physician (a little over 2 years in), I can already see some signs of burnout in myself, so this is an important piece for me to read.

    I totally agree with the value of early financial independence for physicians. In the past two years, I’ve achieved a positive net worth and saved up about 1/6 of what I need to retire. I’m looking forward to having enough that I could walk away if I wanted to, although I am hoping that won’t be necessary any time soon.

      • VagabondMD on November 29, 2017 at 6:44 pm
      • Reply

      Thank you for your comments. You have two advantages that I did not have:

      1) An awareness of the problem of burnout. No one was talking about it until recently. Now, a lot of people are, and that’s a good thing!

      2) A plan to become financially independent. Again, we all knew that we needed to save money, invest, etc., but the quality of the information and conversation is really outstanding.

      BTW, if you haven’t, I strongly suggest that you read the book, “Never Eat Alone” (Ferrazzi). It’s outstanding. 😉

  10. Thank you VMD for sharing such a personal and often frowned upon subject. As an occupational therapist, I know the symptoms of burnout all too well. I see them in my colleagues all the time and I experience it myself too. It is one of the biggest issues within our profession too, but similarly nobody wants to talk about it. Everyone just sucks it up and continues to attempt to do the best job that they can do given their situation. Its a sad thought to consider that so many of our healthcare workers deal with this every day, with no end in sight. How are they expected to take care of others, when they are struggling to take care of themselves.

    I love the comment about having options because of financial independence. While it might not make the actual burnout better per se, it allows for opportunities that can have a direct impact.

      • VagabondMD on November 30, 2017 at 6:50 pm
      • Reply

      Thanks for reading and commenting, Mrs.Wow. There are certainly common threads in the burnout experience across different settings and different industries. It does seem to be pervasive in health care these days.

    • Txcoqui on November 29, 2017 at 9:21 pm
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    Thank you for brutal honesty! Exposing our vulnerabilities is not encouraged in our profession. I recently changed jobs in part to battle my own burnout. I now only practice in my own subspecialty instead of also trying to do primary care. And even within my subspecialty, I find myself drawn to certain aspects and eschewing others that are not particularly fulfilling. Previously, I was interested in “keeping all my options open.” Now I feel much more comfortable only pursuing only those aspects of my specialty that I enjoy most. Now trying to achieve FI in the next decade.

      • VagabondMD on November 30, 2017 at 6:52 pm
      • Reply

      So true! But only by recognizing our vulnerabilities can we move forward. It sounds like you peeled the onion the right amount for you. Good luck and thanks for reading and commenting.

    • hatton1 on November 30, 2017 at 8:43 am
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    I missed this post yesterday. You have outdone yourself with your topic and skill at writing. I know I have been in and out of burnout several times. I see it in a lot of my peers. It is hard for most docs to admit they have any kind of problem. The only time OB/GYNs openly talk about burnout is when they are sued. I believe I suffered from PTSD after my malpractice trial. I won the case but I just started uncontrollably crying and this lasted for several days. I guess I would of committed suicide if I had lost. I can honestly say that I look forward to work now. Since I went part-time it made a huge difference. I guess I have some free time now so I enjoy the virtual world of blogging.

      • VagabondMD on November 30, 2017 at 6:55 pm
      • Reply

      My good (virtual) friend, Hatton1, thank you for commenting here (and there). I am sorry for your bad experience in the malpractice arena. No well intentioned person deserves it, yet we and our colleagues are mortally wounded in this way all the time, I am looking forward to meeting you in person in Park City. 🙂

    • Ted Yaeger on November 30, 2017 at 8:55 am
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    I left private practice, working 50-60 hours and on call every third weekend, to join a university position as an associate professor. What a huge difference! I reconnected with my wife and sons, joined a very social church, participated in community events…essentially got a ‘normal’ work-life balance. In retrospect, I believe private practice is no longer viable in the current highly regulatory environment. Even the constant nag of potential malpractice went away with patients treated by consensus.

      • VagabondMD on November 30, 2017 at 6:58 pm
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      I am glad that this move worked for you. I am hearing from some academic docs that they are getting burned out by the clinical load, teaching responsibilities, grant writing deadlines, and publishing expectations—oh, and making less money!

      Every situation is unique. Thanks for reading and commenting.

    • Owl on November 30, 2017 at 12:27 pm
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    This is so helpful to me (experiencing burnout in a different profession). Thank you for sharing.

    Also loved the alligators & kittens piece : D I’ve read that before—eliminate the negative for greater happiness payout—but this helps me understand it (and remember it) in a whole new way!

      • VagabondMD on November 30, 2017 at 7:00 pm
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      Burnout is burnout, and we can all help each other get through it.

    • Karl on November 30, 2017 at 9:07 pm
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    Appreciate you taking the time to share your experience. After about 25 yrs, I walked away from providing patient care due to complete burnout. Started to despise every aspect: the patients, the charting, billing, ridiculous checkboxes, worrying about missing a finding, administration, etc, etc, etc. Left at the point when I could financially, but it meant a drastic change in the family finances, but we are doing well. It’s been over a year and I’m still debating if I even want to return in a part time status. It’s a tough situation when due to professional reasons you can only confide in a spouse. Helps to have a supportive spouse. Sure counseling would have been the right choice, but getting sick wasn’t allowed, let alone scheduling therapy sessions on a regular basis. Spent time searching online for as much on burnout as possible, but there really isn’t much out there, just the same study referenced again and again.

    In hindsight, I was developing anger issues and if something didn’t go properly for something, I’d let it out on an undeserving customer service representative. I don’t think I was depressed, but more angry about every aspect of work. I found myself participating in sports/activities that were higher risk or intensity because they required 100% focus, and only in those situations does could I not think about work. Fortunately didn’t get into drinking/drugs because I had the common sense to know that would only make things worse (let alone not being conducive to being on call).

    Ironically, when you’re going through burnout, you develop a bit of a sense of “burnout radar.” I could see it in colleagues (suffering in silence), and can always see it when I’m getting care from a provider who has some burnout.

    But maybe things happen for a reason, and now I get to be a stay at home parent, work on some unrelated part time (at best) side business things, sleep in, and participate in hobbies/activities at will. A priceless outcome.

      • VagabondMD on December 2, 2017 at 10:59 am
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      Hi, Karl,
      Thank you for posting and sharing your personal experience with burnout. 25 years is a lengthy career, and it is courageous for you to walk away. Sure, more money would have been nice, but instead you can be the person you want to be, not the one you had become. As you say, priceless.

    • Coloradodoc on December 2, 2017 at 9:21 am
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    Thank you for so eloquently addressing this growing problem, and methodically illuminating a PRACTICAL and empowering path forward!

    Your outstanding piece brings MANY thoughts to mind. First, and most importantly, this thought: you were, are, and always will be “the man”. Your ability to work diligently through this seemingly insurmountable and heart wrenching challenge, then turn your focus toward helping others, speaks to the person you will ALWAYS be. I’m proud and lucky to count you as a dear friend.

    Second, I had a couple of thoughts on the question “being financially independent, why didn’t you just quit?” It’s a great question. For me, there are a lot of reasons. But, there are three that dominate. 1) quitting medicine (for a lot of reasons) is virtually always an irreversible decision, thus one that requires absolute confidence, at a time when one’s mind is filled with self-doubt. 2) “financial independence” is an uncomfortably relative term, especially when contemplating turning off the primary spigot that produced that relative abundance. 3) perhaps most importantly, we, by definition, are not quitters.

    The first two reasons are pretty straightforward. And, I think anyone, regardless of psychological makeup, can wrap their head around them. The third reason is also seemingly straightforward. But, it isn’t. It speaks to a dangerous trait that I believe virtually all physicians share with virtually all Navy SEAL’s. I’ve come to the conclusion, it is a trait that most “normal” people do not possess, or understand, which prompts them to quite reasonably and innocently ask, “why didn’t you just quit?”.

    The primary goal of the notoriously rigerous SEAL training, is NOT to select the strongest, smartest or most technically adept warriors. Rather, it is to rigorously weed out anyone with even an ounce of quit in them. From that carefully selected pool of anomalous individuals, they then create the elite warriors known as SEAL’s. But again, as the starting point, they absolutely want (need) people with a true psychological defect that does not allow them to quit, ever, even when continuing will clearly kill them. They know they can’t teach that. It isn’t an acquired trait. It’s intrinsic to the individual. Part of their core makeup. They were born that way.

    The primary goal of our rigorous training, is to produce great doctors, not to select for people with a pathological inability to quit. But, because it is such a long and rigorous process, the “unintended consequence” is, like SEAL training, it DOES select for those of us who were born with a true inability to quit, even when we know, and everyone can see, that continuing forward is harming us, perhaps even killing us.

    People without the defect don’t understand us. As a trivial example, to our dismay, they quite logically turn back on hikes that are no longer fun. Yet, to their mutual dismay, by God, we continue toward, and reach the lake we set as a goal, back when the journey seemed like it would be an enjoyable one, “even if it kills us”.

    We tend to glorify this trait as something others could (should) aspire to, rather than recognizing it as a true “defect” that is unique to a subset of the population (docs, SEAL’s, extreme athletes, etc). As a result of the defect, the highs are high, and the lows are low. It is the defect that propels us to great success, through tremendous adversity. But, it is also the defect that irrationally impares our ability to make any change that might look anything like quitting, even when it might literally save our lives.

    I don’t want to endlessly blabber. But, one other quick thought. I think it is important to point out the difference between your approach, and the MUCH more common, hospital administrator-approved approach to burnout. You advocate a methodical and analytical approach, focused on carefully identifying the causes of distress (the root problems), and then changing or eliminating those sources of pain, all in the context of each unique situation and individual. Most (see the grand rounds schedule at your hospital), shamefully make the physician the problem, suggesting that we simply need a “one size fits all” solution to address OUR inadequacies. Typically, we are told we simply need to be more resilient (the currently favored euphemism) or better at suppressing feelings of anger, when they endlessly add to our load or overtly throw us under the bus. The unreasonable expectations / massive workload / toxic environment isn’t the problem. We are. Toughen up, butter cup. Obviously, I feel strongly that your approach is the right one. The empowering one. The one that actually works.

    Thanks again for this excellent piece, and for your invaluable friendship. Cheers!

    • VagabondMD on December 2, 2017 at 11:32 am
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    Thank you, Coloradodoc for your excellent contribution, here and in person. Our times together and talks were life changing, especially the snow pack hike over spring break a couple years ago, where I learned not only that I was not alone, but that someone who I admired so much was in a similar place.

    I have spent some time studying the psychology and science of quitting, and you are dead on with your remarks.

      • Coloradodoc on December 2, 2017 at 12:38 pm
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      Hoping we can rebuild the onion with some sweet layers, in the form of a few fine outdoor adventures in the near future. 🙂

  11. Thanks for sharing. I’m sure it feels good to get it all out. I got burnt out this past year after my partner left me without resignation with an early 3 doc practice alone. I had all 3 symptoms you describe. Quitting wasn’t an option because what the hell am I going to do all day? Plus, I wasn’t really totally financially independent yet.

    I didn’t contemplate suicide, that is a big deal that you wrote that down to share.

    I knew something was wrong when i slammed my fist into the desk one afternoon when a new patient was put into a room. I just hated life in and out of work. I wants recovering between weeks. I felt very isolated, I didn’t have a partner to confide in and did not want to share this with anyone for fear of everything you describe: loss of peer confidence, loss of privileges, respect, self respect etc.

    Eventually one of my colleagues in another state told me he was having similar issues. We talked things out for a while. I decided to go to my administration and she was very receptive. This was the move that made everything ok. She lightened my load, found more locums, told the staff to lay off my moodiness and stop tattling, etc.

    I’m on the road to recovery and am going to take a lower paying situation very soon to avoid this and spend more time with family, which suffered with me during the burnout. I won’t let it happen again, I’m on the wagon. I do feel like it needs to be treated like an addiction becuase docs love to say yes and are people pleasers. We need to practice being not burnt out. Medication was also a big deal.

    Thanks again for sharing.

      • VagabondMD on December 3, 2017 at 1:48 pm
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      Thank you for reading and sharing your story. It is really great to have a professional friend, like @Coloradodoc for me, to commiserate and help one another throughout. Most docs probably isolate themselves and do not seek help when suffering from burnout, and that is not an effective strategy.

      I am glad that you were able to peel your onion and end up in a better place.

      1. I want to correct my second to last sentence. Meditation, not medication, was a big deal. Although I’m not scrutinizing the use of medication in this scenario. You mentioned meditation, I agree.

  12. Thank you for sharing your powerful personal story. I’ve experienced the fringes of burnout many times, but not the full blown effect. Each time, I am able to talk to my wife about my feelings and she pulls me back. She will force me to take some PTO and get out of town, so to speak. As physicians, unrealistic expectations are placed on us – see more patients, read more studies, don’t miss anything. Perfection is impossible because we are human. An old and wise attending once told me, “mistakes are the cost of doing business in our field of work”. It gives me some comfort when I make a miss, but it still messes with my state of mind.

    • VagabondMD on December 3, 2017 at 1:52 pm
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    It sounds like you have an effective strategy in place and your wife is a teammate in your battle against burnout. Well done.

    Yes, the expectation of perfection is as brutal as it is unrealistic and no doubt a major contributor to physician burnout. Most people do not make nearly as many impactful decisions in a day as docs, and in no other career are the stakes so high.

    • DadsDollarsDebts on December 4, 2017 at 8:20 pm
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    Man Vagabond, great story…though I can imagine not a great experience through go through. But it is the tough times that make us appreciate the good and congrats on finding a way to make medicine engaging again. Burnout is real. I have some degree of it currently and am trying to figure out how to process and adapt to it. Part time work is not in my future for at least 1.5 more years when I make partner…for now I will keep on chugging away.

  13. Thank you to Vagabond for sharing your story. My husband is still in training so we’re not out of the tunnel yet. Some days we long to get done quickly for more stability for our young kids, sleep, and the ability to crush student debt. But we know the end of the tunnel is just a different life and that the idea that things are always bright and cheery from there on is shortsighted.

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