[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]
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 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.
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