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Burnout. Search any physician forum and this subject is one of the most talked about. It is the typical battlecry heard when like-minded physicians get together in their quest to retire early.
It is quite fitting that this community adopted the moniker of FIRE (Financial Independence/Retire Early) in order to avoid burnout.
Medscape National Physician Burnout and Depression Report 2018
The lifestyle of a typical physician is quite demanding.
Starting with medical school/residency we have been indoctrinated that we have to cram ungodly amounts of material into our heads and work ungodly amounts of hours and if we don’t it is a sign of weakness.
Even with legislation enacted in 2003, the allowable limit for a medical resident still was 80 hours/week, double the normal 40 hour work week the general population “enjoys.” Before that legislation it was literally the wild west on hours a resident could be forced to work.
Before switching to radiology, I had several rotations where I averaged 120 hrs+/wk.
Think of your life as a burning candle which will eventually flame out.
Various external forces can accelerate this process such as stress, lack of sleep, poor nutrition (doesn’t this pretty much describe a typical physician’s life?).
We have all heard of the common idiom, “To burn a candle at both ends.” Essentially that candle is consumed twice as fast and this is the main issue we are dealing with as physicians.
You want to preserve this candle as long as possible
Now I, and I assume many of you, hate going to work on Mondays.
Why is that? It’s because a typical weekend allows you to not have any work responsibilities and gives the opportunity to relax and have fun. In 48 hours your body and mind acclimates to this less regimented schedule and then gets shocked back into the work routine each Monday.
Is this a sign of burnout?
Probably not. But it is telling how your mind reacts when it realizes it has another work week to plod through before it can get back to the next free weekend (and for those individuals whose next weekend offers no respite (with either call responsibilities or family obligations) it only makes that flame burn faster and stronger.
Burnout most likely lies on a continuum. Mild annoyance/dissatisfaction at work may hint to more impending problems down the line. If however you feel impending dread starting off the workday and also see changes in your personality when interacting with others, you may be in the very clutches of physician burnout.
Burnout can strike at any age.
Medscape National Physician Burnout and Depression Report 2018
During my first two years as a surgery resident I could tell that it had a negative impact on my life.
I no longer had time for pleasantries. Phone conversations with friends and family were terse. It was like I was trying to do a quick history and physical of my contacts in the quickest time allotted.
When family members started commenting on changes in my personality I quickly came to a realization that this was not a sustainable career path for me.
I made the very difficult decision of completing switching specialties, choosing radiology as a more suitable avenue.
All too often we hear of stories in the news of physicians committing suicide (at a rate more than double the general population). There are many factors to why this may be the case.
Medscape National Physician and Burnout Report 2018
Physicians as a whole are held to a higher standard by society.
We are expected to always keep our knowledge base current, jumping hoops like continuing medical education (CME), MOC (maintenance of certification) mandated by individual specialty boards, and board recertification.
Couple those requirements with added stresses such as government agencies to maintain an EHR (electronic health record), increasing paperwork, decreasing reimbursements (forcing us to increase volume just to maintain salary), as well as always having the threat of a potential devastating malpractice suit hanging over us, and it is no wonder physicians become disenchanted with the system and feel burnt out.
So how can we protect ourselves from burnout? Recognition is key.
If you find that your work issues have spilled over and now causing discord with family interactions it is time to take a step back and assess what the source of burnout is and ways to minimize it.
Medscape National Physician Burnout and Depression Report 2018
Personally I have started tapering my work hours and started employing a 4-day work week.
Yes there were financial consequences for cutting down my clinical time, but because I had previously made myself debt free, the overall impact to my life was minimal. Because I found myself in the highest tax bracket, those dollars that I did not bring home were taxed the highest anyway (marginal rate of 39.6% in 2017 for example).
I do realize some specialties in medicine have an easier time cutting back clinical hours, particular those that are primarily shift based (ER, anesthesia, radiology are a few examples).
With locum tenens staffing pretty much available for all specialties, a viable option can still be found to allow some respite.
If you are in a group practice there may be partners that are willing to take on more clinical time especially if they are early in their career and have the energy to do so (and more pressing financial needs)
In the past I was notorious for not going on vacations and just powering through the year with little time off. In fact whenever I did take time off I would do a mental calculation of how much this was going to effect my bottom line.
What I really should have done was calculating the impact it had on my health. As my debt disappeared I noticed that I no longer felt bound to sacrifice time for money. I now view vacations as a way to recharge my batteries and help combat burnout.
Superpower Take-home points:
- Realize that burnout is on a continuum and recognition of early signs can help prevent more serious consequences
- The balance between work/family/money is delicate and requires conscious effort to maintain it
- The stress reduction from achieving financial independence and being debt free is one of the most powerful tools to combat burnout
- It gives you more options such as scaling back work hours or increasing vacation time
Have you experienced burnout? What are some of the ways you have found to counter this?
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I like this idea of burnout as a continuum rather than a simple “yes or no” issue. Its not as simple as “this year you are not burned out and the next year you are”. Its a gradual, insidious process. Unfortunately there are no easy answers. Being able to work less seems like an obvious solution, but as you mention that is easier for some specialties than others. Locums is an option, but that often involves time away from family and can cause even more stress. I guess this is just one more reason taking control of your financial life… Read more »
It is definitely an insidious onset. Too often it is recognized too late when the damage is already done. In regards to the locums I actually meant hiring a locum to cover a shift for you and that might alleviate some issues. Even one day off every other week by hiring a locum can do wonders for the psyche
Xray, you did a nice job of laying out the framework of burnout. I also agree that it’s a continuum….. In my first specialty (OBG), sleep deprivation played a huge role….one I didn’t recognize. Because I practiced in a small town, I was frequently on call, and even if not on call would be summoned to help if someone had a complex case . After changing to anesthesia, and doing that residency….(and a subsequent fellowship), I finally got in a practice that allowed me to catch up on sleep. It was (as you said in the inverse) a personality change.… Read more »
Thanks planedoc for the comment. I am glad you recognized the symptoms before it became advanced. And as a fellow doc who changed specialties I know what a hard decision that must have been, especially if you already completed the first residency (I only made it through 40%). But like all things that require hard choices and sacrifice the end result is worth it in happiness
it was hard after being an attending for 17 years….to go back to the bottom of the heap….but well worth it.
Wow I didn’t realize it really was a mid career change. Mine was easy by comparison (just lost one year credit)
Now that I review out medical careers, I realize we would dial up or down our work to suit our lifestyle since we have always been self employed.
But I really disliked residency and having to do odd tasks for attendings that I would never do in my own career. The best part of training was to witness how I never want to practice and set up my life.
My husband and I decided from the start that quitting and decreasing work was always an option. Money could always be made back later if needed.
Residency definitely was a teaching point for me and not just on medical knowledge but like you said observing how established attendings have their practices set up. You and your husband definitely have made some great choices and because of them have preserved your sanity, kept your relationship together, and still built a great nest egg. Unfortunately a lot of docs prioritize money in the beginning (to keep up with their increased lifestyle/living paycheck to paycheck) and a lot of things suffer, most important of all the emotional issues.
You are very nice XRV!! Most people who trained with us would openly say to our face “Gee I’m surprised you two are still married!” About the only thing we got right was the decision to allow one another to stop whatever we were doing if we really didn’t like it. We have witnessed too many doctors trapped due to having to “earn the income” or sunk costs thinking. We even allowed one another to quit specialties after training. Since you never really know if you love it until you practice it for a few years. For years my husband… Read more »
I’m glad two like minded people got together. It makes for all the difference in the world. That is smart policy of allowing each other to stop doing a particular job if you didn’t like it. That decision is made even easier once you become financially independent.
I agree burnout is a continuum. When I feel work is getting to me, I try to throttle back and plan for a day or two off. That four day work week is pretty awesome. Sleep is awesome too.
I think a 4 day work week can extend one’s career by many years. I know it has mine. I want to get to a point where I have more days off than I work (3 day work week sounds amazing) and still be considered part time to take advantage of the medical insurance benefits.
I didn’t realize it was so stressful for Physicians. When I was a kid, I thought about going into the medical field, but just couldn’t imagine being in a hospital or clinical environment. That alone would stress me out. I think varietyin work and taking on different projects can also reduce the risk of burnout.
I think there is a growing group of physicians that are starting to get disenchanted with the profession. I recall a decent amount of physicians that chose to just retire when the government mandated electronic health records to be in place. For many private practice docs, the cost of implementing such an expensive system was the final straw and did not make financial sense to do so. And the days when a physician can just order an advanced imaging study (CT/MRI) are long gone. Now have to plead cases with insurance companies that the test is a necessity. Requires either… Read more »
It is a difficult balancing act between working hard towards financial independence and avoiding burnout. Whenever I feel myself getting extra crispy I immediately dial back the work load. It is amazing how simple things like sleep, exercise and family time can recharge your battery.
That is why the journey to financial independence is just as important to enjoy as the end goal. You will accelerate burnout if FIRE is your only focus
This is the first post that I’ve read explaining about burnouts and how it happened, how to avoid it. Very rare like kryptonite! I’ll be sure to access my worktime and condition.
I appreciate the comment. I actually started feeling a bit burnt out myself and have taken active steps to reduce it in future. Key is to recognize early before it becomes too late
[…] burnout. Burnout doesn’t happen all at once – it sneaks up on you. Xrayvsn talks about The Burnout Continuum and how to fight […]
Thank you so much for including me in your blog roundup