I returned after a 13 year absence. I studied for 1 1/2 years while preparing to return, completed over 800 hours of CME, and aced the ABIM re-certification exam. I contacted physicians in my old network and found an employed position.

Many (most?) states have no written criteria for obtaining a license after a prolonged absence; they evaluate case-by-case. I applied to two states where I held licenses in the past, and both approved. No problems.

My current job is very stressful (relative to my recent work in financial services), but much less so than the last go-round when I started a solo private practice from scratch and was overwhelmed with work. The advent of hospitalists has helped a great deal as well.

If I could take a mulligan, I would have taken a few months off to breathe and then found a part-time position that allowed for a life, but either way, you can return.

I’ve burned after 11 years as an attending. There isn’t an easy way back into practice after a prolonged recovery. There should be physician a way to return to practice.

I should write a post about it. Cultural attitudes and institutional traits are difficult to change in ways that we can control. It seems like nothing is changing, then all of a sudden everything is different one day. We start by openly discussing these problems until there is an awareness. No one was writing about this stuff 10 years ago, now it is everywhere. As different generations and cohorts of people make their way through the workforce the cultural attitudes will shift. The way we train and the way we view medicine will shift as a culture. What it changes into I have no idea.

I recommend starting simple: cultivate empathy towards our colleagues, talk about our own struggles openly and simply be more kind to others day in and day out. We have to embody the change we want to see.

We may never know. Every time a young doctor dies I tend to assume the worst, not because I am fatalistic but because I have seen it too many times. I hope we can get an answer, even if it isn’t the answer we want to hear. May she rest in peace.

Yeah, I think that medicine tends to attract people who have a difficult time admitting that they might feel overwhelmed or need help. And we’ve created a culture of medicine where it’s really difficult to be able to admit those feelings out loud to anyone without feeling shame or a sense of failure.

I’m interested to hear what thoughts you have on how physicians might be able to shift those cultural attitudes.

I agree with your observations. It is a balancing act. I think the big question is how do you make tough, resilient physicians without burning them out and driving 2% or more of them to suicide? I don’t have all the answers (but I do have some of them and I will write a follow up article soon!)

When I look back, I see so many emotionally unhealthy people in medicine, but it all seemed sort of normal at the time. I think one thing we can all do is to have more empathy. Even without changing the system we can listen to people and give them permission to be burned out. We can normalize it and say ‘what you are experiencing is a normal response to this stress’. If we don’t give people this permission then they become the failure and experience shame. This is a dangerous place to be.

Good point. There is a big difference between inefficacy and inefficiency, although they often go hand in hand. We can be very efficient at things that don’t matter at all as you mention. In my case I think it was less efficiency. I still had a defined pile of work to do, and it was important I did it well. I could not escape it, I just had to plow through. I found it harder to stay present and focused. It took me longer to get through cases. I think that is what was so scary about burnout from my perspective as a physician. I could not allow myself to become less effective. Not to be all dramatic, but lives depended on me. It was not an option to become less effective because there was no one to pick up the slack. I would burn myself to the ground before I let that happen. Every doc I know is like this. Thanks for the comment.

I think lots of physicians are smart, hard working people who start off as big fish in a small pond who are used to their smart, hard working ways really dazzling other people and being pretty special. And those dazzling and pretty special ways are really effective at getting things done the way you want them to be done early on in life for many people who go into medicine.

But medicine is a super humbling field. Not only do you funnel into a group of other really smart, hard working people where you no longer stand out just be being smart and hard working.You also funnel into a job where you have to heal and calm the sick and those are really, really hard things to do even when you are smart and hard working. There are so many factors in medicine that are beyond the control of just working hard and being smart. I think it’s the first time many of us have to smack up against a problem that our smartness and hard working-ness can’t always solve perfectly.

And I think it feels exhausting and somewhat pointless and demoralizing to have put in all this effort for so long and realize that at the end of the day, your smartness and hard work only go so far.

I know some current residences are trying harder to be sensitive to the fact that doctors aren’t robots but are humans with feelings but for those of us who trained 15 or more years ago, we were all trained with a mind set that admitting that you ever felt overwhelmed, or frustrated or sad or even just tired was the same as admitting that you were being a big wuss not cut out for medicine.

I know that I struggle with listening to current residents complain about their work load. It triggers a Pavlovian response of feeling like they must be “weak” in some way because “in my day” we weren’t even allowed to talk to our attendings about our work load. You just sucked it up and kept working until you felt like a worn out nub. And then you still kept working.

I guess if I there is any point I’m trying to make, I just feel like being a doctor is hard, demanding work and that many of the people who go into medicine aren’t used to being overwhelmed by something hard or demanding and that the training of most doctors reinforces that any admission of how hard it is is a sign of personal weakness that needs to be overcome instead of acknowledging that the job itself is pretty hard core.

I think it is a challenge to get the personality type that goes into medicine to openly acknowledge that some things in life are really hard and that it is not personal failure to feel the stress of that hardness.

Having burned out myself (in the IT and software fields) and helped others also self-diagnose and self-treat, inefficiency is merely a possible symptom. Becoming increasingly efficient at irrelevant tasks seems a common coping mechanism, as I’ve seen both first-hand and from organizational folklore over the past few generations.

As well, inefficiency has many other causes besides burnout. That changes one’s approach in dealing or healing.