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Responding To Burnout In Medicine

You show up to work and get overwhelmed by the littlest things. While at home, you wish you could be at work practicing your art. You’re on the brink of losing your shit but nothing is seemingly so wrong. You feel on the inside as though your whole world should be on fire and yet… nothing.

My career burnout started in early 2014 and coincided with when I increased my work hours. It wasn’t until late 2015 that I considered burnout an option and by 2016 it had gotten so bad that I was getting panic attack in the exam room. Responding to burnout was urgent but I handled that pretty poorly.

 

Your Options Become Limited

Being burnt out is like being in an unhappy marriage – not a terrible marriage, just one where you’re more miserable with the person than alone.

Responding to burnout is difficult because you are in fight or flight even if you don’t feel or appear that way.¬†Your options are limited because you’re trying to do damage control and everything feels like a giant hurdle to have to overcome.

3 Common Desperate Options

I’m not saying that these are good options, just the most common pursued by the desperate:

  1. moving horizontally within the medical career
  2. trying something completely different
  3. going out on your own

By the time you are left with these 3 options you’ve already tried taking a long vacation, you’ve maybe tried a leave of absence or pretended that you got disseminated gonorrhea and hence unable to work for a few months.

1. Moving Horizontally

In this scenario you’re blaming your immediate work environment and coworkers and possibly the stress placed on you in your current position. You look for a similar-ish position but in a different department or at a different clinic doing the same exact job.

The good thing about this move is that it will mask your feelings of burnout – for a minute. But responding to burnout by delaying the inevitable often means that you’ll soon find the same problems at the new place of work.

2. Trying Something Completely Different

For the average doctor in a large medical group trying something completely different might be taking on an administrative role. Or if you’re in private practice, you might sign on with a large medical group. Or if you’re doing OB then you might switch to doing Gyn. Same with outpatient to inpatient and from taking call to only rounding.

The upside with this move is that you’ll feel the burnout symptoms a lot less but you won’t feel relieved because responding to burnout by creating a superficial change only masks the symptoms.

3. Going Out On Your Own

In this scenario, the burnout is blamed on the employer and being micromanaged. Medicine is still okay, after all, you enjoy medicine and you still laugh and cry with your patients. Reading a nerdy medical journal still gives you a chubby.

The biggest problem with this move is that it’s already hard enough going out on your own. And though wanting to be your own boss is a perfectly legitimate reason to want to go solo, responding to burnout just took a backseat to you finding a suitable office space, setting up insurance accounts, finding an EMR, hiring an MA, and marketing.

Acting Out When Burnt Out

One of the worst things you can do is act out when burnt out. I am not sure if this befalls women as much men. But I’ve seen it more with the XY chromosome – dating coworkers, doing drugs, drinking too much, missing work, being more careless with patients, and sabotaging yourself otherwise.

It’s perhaps a subconscious effort on our part to get fired so as to not have to make the decisions for ourselves. Like when you want the other person to break up with you because you don’t want to tell them that you’re not into them any longer.

You’ll Get Very Little Support

In my experience, very few people will understand that you’re burnt out. And the fact that a high percentage of your colleagues are walking burnout zombies, it’s unlikely that you will find commiseration.

Family will say you need a break or blame a symptom of burnout on being burnt out in the first place.

Colleagues are unsupportive because admitting you are burnt out would mean that they are burnt out and as we know of a marriage, it’s much better to just suffer silently than do something about it.

 

What Is Burnout?

Burnout is depression. It’s hopelessness. It’s being overwhelmed while being 100% capable and competent. It blows your mind because you still enjoy medicine yet can’t stand the sight of practicing it.

Being burnt out is like telling someone¬†you are on fire and they look at you and talk to you like everything is fine. You’re burning up and you both are having a conversation about how the crosswalk button thingy works.

Burnout is having everything that others are jealous of and yet you secretly wishing it could all blow up in a blast so you wouldn’t have to deal with it anymore.

Gaining Control

As an inmate in prison if you aren’t given some control then you’ll tear the place down. Even if it’s the illusion of control, it’s offered to prisoners to curb riots. Force and fear tactics don’t work.

If you can come up with a way to feel in control of your schedule, your time, your workflow, your hours, or your income then at least you’ll feel in control despite feeling burnt out.

1. Plan An Escape

My solution was to plan an escape. And I’m not sure if this was an unhealthy coping mechanism or a brilliant tactic but somehow it worked out in the end.

If you can become financially independent and be less reliant on the income from the job then you’ll feel more in control.

If you identify with your position as a healthcare profession and it defines your identity to a great extent then it would be wise to find something else that describes you even better.

2. Stop Working

Use FMLA, go on disability, quit your job, go on unemployment, live off of your cash savings for a while – but get out if you’re burn out!

It’s not “running away” from your problems, it’s not “giving up” – it’s you dealing with a nasty problem and trying to prevent something negative from taking over your life.

My theory is that there is a point of no return. The longer you delay dealing with being burnt out the more likely it is that you’ll get to a point when you can’t turn back. Even looking at your stethoscope will make your heart race.

3. Trust Your Instinct

If you get the sense that making a horizontal move will just delay the inevitable or that going out on your own will add even more headache to your life then avoid taking action when no action may be needed.

Perhaps the correct response is to just walk away for a while, take a break, and come up with a way to lower your expenses, increase some side-income, and recover from the burnout.

 

Figuring Out The Finances

If you have an $8,000/mo mortgage, $2,000/mo in car payments, $3,000/mo in student loans and credit card debt on top of your miscellaneous overhead, then you’d have to get quite radical to figure out the finances.

On the other hand, if you have a much more manageable household overhead of somewhere in the $4,000-$6,000/mo range then you can definitely get by for a year or more on just your savings alone.

I am not a fan of cashing out retirement accounts in order to buy a boat or get a boob-job, but to save your ass from a crispy burnout – it could be a worthwhile option.

Cut Your Overhead

Really get down to the basics, cut as much of your overhead as possible. If you’re going to be jobless for a year or so, don’t bother with a cell phone plan. Get rid of cable TV and don’t drive your car as much – even better, rent your car out on Getaround or Turo.

Cook as much of your meals at home as possible and set your expensive hobbies aside for a while. You won’t ‘recover’ from a burnout by traveling or spending more – you’ve likely already tried that and it failed.

Downgrade your living situation.

If you own then rent out a room. If you are renting, see if you can find a cheaper place to live.

If you’re not going to be earning money for a calendar year then you can qualify for quite a few government benefits including Medicaid. Despite its terrible reputation, you can get by on Medicaid quite well for a year.

Earn a Few Pesos

Seeing patients when you’re burnt out is a bad idea because it only makes things worse. By responding to burnout through leaving your job for a bit instead of brushing it under the rug, you’ll gain some needed energy to make a little money on the side.

A side job won’t make $5k/month but you can earn a couple thousand doing some work. Whether it’s doing a little virtual medicine or consulting or reviewing medical charts – who knows, you might have a little left in you to do that.

5 replies on “Responding To Burnout In Medicine”

I agree with your definition of burnout. It is a form of depression. I have the hardest time articulating this to my spouse. My work drains me emotionally if I work too many hours. Good post dude

It’s another reason so many PC’s and urgent care doctors burn out when they just chase the high paying jobs. They’ll accept really hectic locum tenens positions or go to work for the prison where they throw money at your like it’s going out of style.
I don’t know a single long-term happy prison doctor. The money is like $200/hour for a primary care doctor but you last a few months and come out burnt out. If we only have our eyes on the short game and end up losing the long-term game then what’s the point?

I grossed over $400k in 2014 but I got burnt out from all the work and from getting a high dose of the same work environment 60 hours a week. In my opinion the extra pay isn’t worth it if it means working extra hours or doing much harder work than what your profession calls for.

Dr. Mo,
Great article. Glad to see that you’ve been able to pull yourself out of burn out in the nick of time. It only gets worse as time goes by I hit rock bottom in 2011 and simply couldn’t get back to work. Thought had recovered sufficiently enough to return to work a year ago, only to discover that I was not able be able to respond to situations effectively and have to quit work again. These last few months, I had lost all hope. My Kaiser therapist thinks that I’m just being lazy and that I have no motivation to care for myself because my family does everything for me. Despite the fact that it’s been 3 years since I had lived with family.

BTC ,
I think depression, anxiety, hopelessness are just symptoms of the burnout dependent on other physiological and psychological factors. Sending warm vibes for a healthier and happier 2018.

I think most people around us are well intentioned but few have the patience or the understanding unless they’ve gone through it and have enough insight to really be able to recognize it in others. And we have a go-getter society where emotional weakness is a sign of failure which is why postpartum depression is poo-poo’d and doctors who are burning out feel so alone. Many are great at suffering internally and they can just take it out on loved ones without the rest of the world knowing or they take it out on themselves. The rest of us suffer externally and can be considered weak or a nuisance.

Once again, thank you Dr. Mo for an excellent post. I agree with taking time off or doing something else. Time is too short to stay miserable.

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