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Better to Burnout than Fade Away?

Physician burnout is a hot topic lately.  The trade magazines, e-mails, and even popular media have been featuring stories on physician burnout. 



In case you haven’t been paying attention, here are 10 links from a quick google search:

Better to Burnout than Fade Away?

What is burnout?


How is burnout defined?  In this context, it is described as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.  In another context, it might be the guy who started smoking weed in 7th grade and now hands you the stub from your movie ticket, keeping the DSC_2275tallother half for his employer. 

Of course, in this post, we’re talking about physician burnout brought on by increasing bureaucracy, increasing hours and expectations, decreasing time with patients, pay for performance, unfair ratings systems, etc…  It wouldn’t be tough to come up with a list of 101 ways a physician’s life can be made more stressful.


Why Does Burnout Matter?


Why should we care?  On a personal level, burnout is not a good feeling.  A burned out physician may not be able to give every patient the level of care they’re expecting.  A burned out physician may be more likely to make a mistake.  A burned out physician may not be at his or her best at home, leading to marital conflict, decreased life satisfaction, making work even more difficult to stomach every day.  It’s easy to envision a cycle that repeats itself, becoming a downward spiral that can’t possibly end well.

The repercussions are not good for patients.  Would you want to be seen by a physician who dreads coming to work each day?  A physician who is more likely to abuse alcohol or other substances?  One who is more likely to contemplate suicide?  The stakes are that high. 


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The Prevalence of Burnout


How common is burnout?  Quite common and increasing.  A recent article published in the Mayo Clinic Proceedings showed at least 1 symptom of burnout in 54.4% of physicians in 2014, up from 45.5% 3 years earlier.  Satisfaction with work-life balance decreased from 48.5% to 40.9% over that time.  A 2012 article published in JAMA showed 45.8% of physicians exhibiting at least 1 sign of burnout, and physicians having an overall burnout rate about 10% higher than the non-physician worker.  Dissatisfaction with work-life balance was about double when compared to the non-physician.

What can be done?  There are big, system-wide answers and there are tiny, change-your-routine answers.  I won’t pretend to have them all, but I can at least tell you what others have done or suggested.  Stanford is rewarding emergency physicians with its time banking program, offering “meals, housecleaning and a host of other services — babysitting, elder care, movie tickets, grant writing help, handyman services, dry cleaning pickup, speech training, Web support and more.”

A recent newspaper editorial suggests the public needs to rally around its doctors like it has its teachers, who have been subject to the myriad of metrics in the recent past.  The AMA has released its STEPS Forward program to help physicians gain control of their professional lives. 

Common recommendations to relieve burnout are the usual suggestions to relieve stress:  eat better, take time for yourself, exercise… I’m just not sure how many of us can yoga our way out of professional misery.


My answer to physician burnout


What do you suppose I would sugges to help prevent or alleviate symptoms of burnout? Can you read the words at the top of the page, you know, that whole FIRE acronym?  I believe working toward a goal of Financial Independence, and seeing real progress toward that goal, can do wonders for the psyche.  If you are experiencing burnout, but can see a sliver of light at the end of that career tunnel, and you can watch that sliver expand and shine brighter, your outlook on your career and life might start to glow brighter as well. 

When you are saving like Dr. Anderson, you know that you won’t be stuck in this position forever.  Starting from scratch, you could achieve Financial Independence within about 10 years.  That may seem like a long time depending on the stage of your career, but it’s less than the combined years you put in to college, medical school, and residency. 

Once you have achieved FI, you’ll have options to lighten the load you’re carrying.  You can work fewer days or hours if your position allows.  You may be able to drop the worst part of your job, while maintaining the part you enjoy.  For example, The White Coat Investor is dropping his overnight E.D. shifts now that he’s got a sizeable nest egg. 

You will be empowered to enact the changes you need.  If the only appealing option is to be done entirely and stop working, you can do that too.  And let every day be a Saturday.

Personally, I would rather remain gainfully employed than walk away at the age of 40.  I haven’t taken a formal survey or questionnaire, but I would guess my burnout score would be pretty low.  Some workdays are tougher than others, but I don’t dread them or end them feeling overwhelmed and exhausted. 


Burnout varies by specialty


I may be in a specialty that is somewhat shielded from the bureacratic nightmares that plague primary care.  The term “prior authorization” does not factor into my workday; I don’t have to worry about dotting enough i’s and crossing enough t’s to magically transform a clinic visit into a Level 3. 

The 2015 Medscape Lifestyle Report shows anesthesiology having a burnout rate of 43%.  That’s not as low as the dermatologists, reporting a survey-low 37% burnout rate, but quite a bit better than the 50% to 53% seen in emergency, internal, and family medicine, general surgery, and infectious disease.

In My My, Hey Hey, Neil Young tells us that it’s better to burnout than fade away (a worldview repeated by Def Leppard in Rock Of Ages).  I think I’ll ignore their collective wisdom, and do my best to fade away when I’m ready for my career to wind down.  From what I’ve read, burnout can be downright ugly.



What do you think?  Feeling burned out?  Why or why not?  Would progress towards or achievement of Financial Independence change anything for you?  Sound off in the comments below.

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15 thoughts on “Better to Burnout than Fade Away?”

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  5. As one who has been in the deep dark abyss that is burnout and emerged out of that pit on the lifeline of sequential endorphin surges from focusing on my physical health, I am a believer in burnout being very clandestine in its effect. The process is insidious and the erosion of your joy is a masterpiece of still shots.

    I for one, am encouraged that there is now a greater awareness of the problem. When I went through it, I felt alone and that was not a good place to be. It is no wonder that colleagues are suffering so much that they choose death over life.

    It is my hope that we continue to talk about this. Share our burn through stories and support each other. Not everyone emerges from that abyss unscathed and able to reclaim joy again.

  6. reducing hours, doing some things other than medicine have helped immensely. Most of what read about “combatting burnout” isn’t really that helpful…(“eat right, exercise, think happy thoughts”)….doesn’t really help the whole bureaucracy “do more for less, with less respect” that I think is at the root of the problem.

    • Indeed, a root cause analysis will point to extrinsic factors leading to burnout. We can only do so much intrinsically to ease the burdens that are brought on by external factors and the system in which we are required to navigate.


  7. A quick jostle to physicians, based on how the small-business world reacts to similar burn-out: Hire some help.

    Even part-time filing or other delegation of drudgery might well tip quality-of-life back into positive territory. I’ve seen many sales professionals reinvigorated when they brought in someone to handle much of the administrivia they dreaded. Virtual assistance have reason to exist; I suspect some specialize into medical and health-care.

    Brainstorming sources of folks that make sense for whatever you might delegate. Medical students with a few hours a week, wanting to build relationships and solidify their learning? Nurses otherwise on maternity leave or child-rearing break? College students apprenticing or auditioning for positions in medical practices? Spouse, or children’s older cousins? EMTs or paramedics handling case transcription or scouting the literature for you?

    Your particular burnout triggers might not be amenable to direct intervention like this. Many business-folks bring in housecleaners and gardeners, then apply the newly-gained time to slowly extract themselves from lower-level work.

    • Your thoughts are appreciated, sabbaticalia. Stanford has implemented some ideas like this with the Time Bank. Clinics have benefitted from adding “scribes” who are basically live transcribers that follow the physician from room to room and do the bulk of the computer documentation. Of course, they are only as good as their training / experience, and if you are employed (like many / most docs these days), you have to convince your employer to hire them.

      Working part-time can certainly alleviate some of the stress, particularly for the busiest physicians.

      Thanks for the ideas!

  8. Hello, avid reader here. Thank you very much for all the wonderful material you put out here for us.
    I’m a Pulm critical care fellow on my final year of training and I am suffering from significant burnout – so much that all I think about is FI and RE. I am looking for attending jobs for next year and I am finding it very overwhelming and difficult to Ignore my desire to achieve FI as early as possible. For example, the amount of money I have been offered at different jobs is probably taking too heavy of a weight on my decision of which contract to sign. Any advice on how to deal with this phase of a physician’s life?

    • Hello, Fellow. I was blissfully unaware of the concept of financial independence when I started my post-training career 10 years ago. I’ve been a saver all along, but it’s only in the last couple years that I realized what I was saving for.

      No matter what you do, you’re got a number of years ahead of you, so you will need to find a way to be comfortable and satisfied in your career. It does get better in terms of hours and obviously pay when you transition from fellowship to practice. The best paying job may not be the best fit, particularly if it involves more hours or a location that is less than ideal. I have communicated with a number of physicians who have battled burnout by working less, and making less.

      You may already be familiar, but if not, Dike Drummond, MD has a site dedicated to combatting physician burnout @ https://www.thehappymd.com/

      Best of luck to you,

  9. Burnout is huge, and it’s sad to see my coworkers hate their patients and their lives and feel trapped. Having a good nest egg let me work part time, so no more nights or holidays, and it has made a fantastic difference. It even gave me the time and the head space to figure out a new life coaching career.

    • I’ve heard from a number of physicians who have gone part-time or half-time and are loving it. It sounds like I can add you to that list. Happy to hear it’s working for you.


  10. Burnout is real, and a big problem. I think at the root of it is medicine is becoming less satisfying and more demanding. When these two factors are not in balance burnout is almost guaranteed. The solution is multi-factorial. Developing some sort of mindfulness/meditation practice is just too simple not to do, and it does have limited effectiveness. Other more radical options are part-time work, early FI and radical practice transformation (search for ideal medical practice). Everyone will have their own path. Unfortunately physician suicide is about twice the national average, so in spite of burnout being a hot topic there are still those that need our help.

    • It would be great to see the people and corporations that are making our lives more difficult show some accountability. There doesn’t seem to be much incentive for our insurers, administrators, JCAHO, specialty Boards, etc… to make our jobs easier to perform efficiently and effectively. Satisfying all of those looking over our shoulder is quite onerous.

      • I think real lasting change will have to come from the inside out. Physicians can’t rely on administrators or insurers or specialty boards to advocate for them – they all have their own agendas and they don’t align with physicians in many ways.


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