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Stages of Burnout in Medicine

I’m sure others have written far better posts on burnout in medicine. But I thought I would focus this post on the stages of burnout based on my experience and that of colleagues.

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Stages of Burnout in Medicine

Recognizing the stages of burnout in medicine is probably the hardest thing. When you’re knee-deep in it, all you see and smell is shit. You are too consumed and overwhelmed to imagine the alternatives.

Your heart is telling you to run, your mind is reasoning with the situation. This reasoning is probably what keeps most of us trapped and unwilling to make a meaningful change.

My panic attack might be your diarrhea. My high blood pressure might be your psoriasis flare-up. Some of us will act out publicly, others will sabotage their relationships.


Stage 1 – Anxiety

Stage 1 is the anxiety stage. You feel anxious while at work. You feel more irritable when talking to staff or get snippy with patients.

The night before going into work, anxiety often presents as panic attacks or insomnia. You’ll try to draw out the night as long as possible, your denial resulting in inadequate sleep.

The morning before going to work you consider jumping off a bridge, calling in sick, wishing for a car accident, hoping you get cancelled – anything to avoid going into work.


Stage 2 – Fighting Your Feelings

Your heart is making you feel the anxiety which slowly starts manifesting physically.

Your mind constantly fights your heart and tries to snap you out of it. It tells you to fight the feelings and push through. That it’s probably temporary and that the cold & flu season will soon be over. New associates will be hired and you’ll have more support, soon.

As soon as there is even one good day, or a restful weekend, you tell yourself that it was all in your head – it’s really not all that bad.
Or you look a few months ahead when something new is expected.
You’ll look forward to a vacation.

You might rationalize that you’re being a prima donna or that you don’t value what you have – what an ungrateful doctor! You give yourself examples of other physicians who seem perfectly content in their roles.


Stage 3 – Physical Symptoms

Stages 3 is about the physical manifestations of burnout. It might be hypertension, insomnia, or alcohol and substance abuse. You might start losing weight or stop working out. Your diet and appetite changes. You get more acne, you start having random pains.

Some lose weight, others gain a ton. A1C’s creep up or Tg’s spike.

You might watch more porn or have sudden drops or surges in sexual desire.

Headaches, dental caries, back pain, facial pains, heavier periods, fat redistribution, and bloating are other classic physical symptoms of early stages of burnout in medicine.


Stage 4 – Action

That’s it! You’ve had it and you’re going to do something about it. Welcome to stage 4.

Your mind reasons that the you are burnt out only because you’re working with a shitty medical group. Or that your particular position is shitty. No, you know what, you’re just working too much. Too many days on-call, too many early mornings, or way too many late-night shifts.

You ask your boss to do more admin work.
You switch hospitals.
You switch medical clinics.
You take a lower paying job.
You get the highest paying job available.
Commonly, you work even more.
You buy more gadgets.
Upgrade your home. Move to a new city.

Immersing in more work distracts us. There is so much work, so much new shit slapping us across the face, it’s impossible to have a moment to experience the feeling of burnout.


Stage 5 – Sabotage

The stages of burnout in medicine may not appear chronologically. But at some point we will find ourselves sabotaging our careers or life – stage 5.

Showing up to work late or showing up to work drunk or stoned.
Calling out sick excessively.
You pick fights with staff or bosses in a subconscious hope of getting fired.
Getting DIU’s.
Sleeping around with coworkers.
Stealing from work.

You may not complete your CME’s, knowing full well that an audit would add even more stress to your burnout.
You might fail your board certification.
Lie to your partner.
Pick fights with patients.
Have sex with patients, or have sex with staff in the exam room.


Stage 6 – Surrender

Ever seen a broken down horse pulling a carriage? Ever seen a miserable spouse in a shitty relationship? That’s surrender. It might even seem peaceful to outsiders.

The stages of burnout in medicine will end with surrender – stage 6. Surrender will look strikingly similar to acceptance or contentment. The difference is that you no longer care about the things you used to care about.

Medicine becomes exactly what it was meant to be in the US – a robotic, choreographed set of actions leading to a medication, surgery, or a defensible death of the consumer.

When you’re suffering every day in medicine and your career seems miserable, the thought of surrender really isn’t all that bad when compared to the alternative of suffering.


I have written other posts on the topic:

Responding to burnout in medicine.

My own experience with being burnt out.

Using FMLA in case of burnout in medicine.

Switching over to urgent care before you are fully burnt out.

Taking a break from medicine.

Should you change jobs?

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