Burnout and Fractures

Burnout and Fractures

I was reading an MRI the other day on a young runner with hip pain. There were the tell-tale signs of a stress fracture. If she kept running on it she would certainly completely fracture it at some point, but the pain would probably self-limit her activity. The treatment would be rest to let the bone heal naturally, and of course, to stop running.

The very same day I read an x-ray from the ER of an elderly woman who had hip pain and couldn’t walk after a seemingly insignificant trauma. Her hip was shattered and would require surgery to fix. Even though the stress on her bones wasn’t nearly as great as on the young runner, the underlying osteoporosis made her bones much more susceptible to fractures.

In case you were wondering, there are two general kinds of fractures:

1. Stress fracture where you apply abnormal stress to a normal bone.
2. Insufficiency fracture where you apply normal stress to an abnormal bone.

The end result is the same though – the bone breaks.

Our Career Can Fracture

It dawned upon me that burnout from a job is much like a fracture. Sometimes it is a stress fracture (toxic job) and sometimes it is an insufficiency fracture (unhealthy person). Usually it is a mix of both, and one can cause the other.  Prevention is different in each of these cases.

There are all sorts of things that cause bones to become abnormal and fracture – tumors, osteoporosis, metabolic disorders, malnutrition, medication complications, etc. The treatment is the same if you know the bone is unhealthy though. You try and fix the underlying problem.

Now if the bone is normal in the first place there is nothing to really fix. The treatment is different. You avoid applying too much stress to the bone. You use it as intended. You don’t go out and run 20 miles without gradually building up your run distances over time.

Not Either/Or

I’ve noticed that when people frame (physician) burnout it is sometimes thought of as one or the other. Some people always blame the job.

“If only we could change the system to be more humane and not abuse our workers then no one would ever burnout.”

Others blame the person.

“Look at all these other people that are doing just fine. This person that has burned out is just weaker than everyone else.”

But people (and bones) are complex. It is usually never one or the other, but a measure of degree. If you put enough stress on a bone it will break. If you put enough stress on a person they will burnout. But it depends on the person and depends on the stress.

This is why if you are burned out you need to approach the problem from both sides and figure out which to focus your energy on. This will not always be possible because when you are inside of it, it is difficult to recognize the all of the issues. Sometimes it is only knowable in retrospect.

You can get clues of course. If everyone is miserable in your organization, there is high turnover, or general malaise you are probably in a stress fracture situation and should leave immediately. Strengthening bones may help a little, but you are still at high risk of a fracture.

If on the other hand your job seems pretty good, people are generally happy and not overworked, there is low turnover and most people seem content, but you are still burning out, it may be that it’s time to figure out if there are ways to strengthen your bones to prevent an insufficiency fracture. It may be that you can salvage things by focusing on changing other things in your life.

There is a third possibility though. Maybe your bones are entirely normal, but they were just better designed to do something else. A job may be perfectly fine, and your coping skills more or less normal, but maybe you are just not a great fit. Maybe you need to switch jobs or even careers.

Food for thought!

As an aside I was a guest on another podcast. Please check it out by clicking the link below, especially If you like to hear me ramble. It’s not long and I think you will enjoy it 🙂