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Burnout is a hot topic among medical professionals. Some call it moral injury; others refer to it as a lack of resilience.
Personally, I probably had some mild symptoms, but knowing that I had a clear pathway to a different life kept burnout at bay. It helps to know you can walk away. It’s the opposite of feeling trapped.
Physician burnout is being addressed from many angles, but there’s only so much the individual can do. Yoga, meditation, and happy thoughts won’t hurt, but they’re not going solve the larger systemic problems, either.
What else can one person do? Dr. James Turner hypothesizes that pursuing financial independence can be one way to help combat the insidious onset of burnout. Based on my experience, I think he’s on to something.
This post was originally published on The Physician Philosopher website.
Why are Doctors Burning Out? Three Ways FIRE Can Save Us
The burnout rate in practicing physicians and doctors in training is alarming. Why are doctors burning out? The problem seems to stem from decreasing autonomy, unhelpful/encroaching administrators, and the ever increasing financial burden of our student loans.
While you may think that physician burnout only impacts doctors, evidence shows that it unfortunately leads to bad medical care for our patients, too. What would you think if I told you that financial independence may have the power to save our physicians?
The Impact of Burnout
When medical students graduate from medical school, they have accumulated on average of ~$200,000 in student loan debt. That gets compounded (usually with interest rates between 5-7%) over a three to seven year training paradigm. It can often turn into $200,000-$300,000 in debt by that point.
Even worse, that number above doesn’t include undergraduate debt. I work with residents with as much as $500,000 in student loans.
It can seem insurmountable.
Further Reading: Learn more about how to manage your student loans here. If you are wallowing in debt, you might consider a student loan consult, too.
Compound this on top of the long hours, lack of sleep, the loss of autonomy, and difficult life happenings outside the hospital; and you’ll find a recipe that is ripe for burnout and moral injury.
If the above wasn’t bad enough, burnout rates and suicide rates are climbing, too. Physicians have the highest rate of suicide of any profession. Dr. Pamela Wible, one of the leaders in this arena, has compiled a list of nearly 1,000 doctors who have killed themselves.
These catastrophic events impact more than just the physicians and their families, too. Medical errors occur more often in overworked and burned out physicians, too.
Why are doctors burning out?
Burnout, first described in the 1970s by Herbert Freudenberg, is characterized as emotional exhaustion, depersonalization (impersonal or apathetic feelings towards others), and feeling a lack of accomplishment in your work.
Juxtapose this description with that of someone entering medical school: people who want nothing more than to help others, to be good at it, and to feel like their work is truly changing lives for the better in this world.
All the opposite characteristics of a burned out doctor. How does this transition happen? The answer is that it is complicated.
Studies have shown that the three leading determinants of satisfaction at work are autonomy, competence, and support at work (aka “relatedness”).
When the opposite occurs (lack of autonomy, feelings of incompetence, and lack of support) this is what causes burnout.
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Autonomy at Work
Autonomy means self-governance, or independence. Something many physicians today no longer experience. Many doctors do not feel like the captains of their own ship. The ship is owned by bureaucrats, insurance companies, and hospital administrators who don’t know how to eat last.
We are expected to see more patients in less time. And when we deem a certain modality the appropriate route to diagnose or treat a patient, the insurance company must agree with us first. Otherwise, it doesn’t happen.
It’s not just insurance companies, though. Patients also have demands.
We often feel the hate if we don’t write for that opioid prescription or give patients the antibiotics they demand for their viral illness. Patients have certain expectations they feel must be met (even if they aren’t the one with the medical degree).
Physician Support
Autonomy isn’t the only problem.
Doctors often can and do feel a complete lack of support from administrators who enforce rules without ever talking to the medical professionals on the front line.
More paperwork, more documentation, better compliance. The list goes on and on.
Here’s a personal example from an email I received earlier this year from a person in medical billing and compliance. Her message said that I “forgot to attest for CPR” so that we could bill for it. That night the biller was referencing was a rough night for me. I had a young trauma patient die on the table.
There was nothing I could do to prevent it,
but a loss of a life is troubling no matter how it occurs.
A more appropriate email from the biller may have read “I am really sorry for the patient that you lost last night. That must have been tough. When you have some time, we do need to complete some documentation, including attesting for the CPR you administered.”
Further Reading: Sometimes we just have to understand that the hospital won’t love us back.
Nope, none of that. The point was made clearly. My job is NOT to be a human being that thinks and cares and cries. We wonder why doctors lack empathy. The lack of autonomy and support leads to utter dissatisfaction and burnout at work.
Is there a solution to save our doctors?
Financial Independence to the Rescue
At first glance, you might think that I am making the point that “as long as doctors earn enough money” the problems listed above won’t bother them. That couldn’t be further from what I am saying.
Financial Independence reliably provides some direct counteraction to the causes of burnout mentioned above. It doesn’t fix all of the problems, but it does help with many of them.
I’ll mention three specific remedies that FI provides:
Remedy 1: A Way Out
Many physicians who get burned out do so because they feel stuck in the rat race. Like there is no way out. The financial burden is suffocating, and most doctors feel forced to work long hours to pay back their loans.
Financial Independence allows for increasing autonomy over our life. Maybe we pursue Partial FIRE and cut back to 70% of an FTE. We could also retire completely, though that’s not the message I normally preach.
Maybe we use that extra time to become human beings again who has hobbies like playing an instrument, writing, dancing, brewing beer, or playing sports.
Or maybe the additional time will let us be present for the people we love. It would be nice to put our children, spouse, parents, siblings, and friends first instead of putting them on the back burner.
In fact, a bigger picture of burnout suggests that physicians often lose their self-identity in their profession. FI allows us to get back to our roots and to re-examine what makes us who we are.
That 142nd email of the day can wait ’til our day off.
Remedy 2: Less pressure to keep up with the Dr. Joneses
In the tale of two doctors, there is Dr. Jones and Dr. EFI (Early Financail Independence). Far too often, doctors follow the example set by Dr. Jones. These doctors are notorious for being bad with money. In part, this is because we have certain expectations placed on us by society, others in medicine, and even ourselves.
We should buy (a.k.a. finance) the right house, the right cars, and the right school for our kids.
The FI community can save us from this, because FI is part frugality and part aggressive savings rate. When doctors are exposed to the frugality of the FI community, they feel a freedom to no longer need to keep up with the Dr. Joneses.
This freedom provided by FI allows them to avoid the catastrophic financial mistakes most doctors make when they finish training.
They realize that the right house, the right car, and the right school are the ones that help them accomplish the big picture goals that they have personally designed. Not what makes them look good to others (who probably don’t care about them anyway).
When they doubt themselves or want to learn more, they can turn to the vibrant and blossoming physician finance community. Here, they can find support for their ideas, which will provide some sanity.
The freedom that FI provides can release them from the shackles that bind them and their future!
Further Reading: If you need help figuring out your financial priorities, I encourage you to go through the Three Kinder Questions.
Remedy 3: The Support Yourself Fund
One of the other causes of burnout I mentioned above is the ever-encroaching presence of administrators. They love to tell those of us on the front line how to do our jobs even if they have never done our job (or haven’t practiced in a decade and can’t do our job anymore).
Upon achieving financial independence, a certain amount of courage exists that simply wasn’t there when we first finished training. It’s part of joining the financial independence cult.
When administrators tell us how we are going to do our job and we find the change to be unhelpful for our patients or us, we can simply say, “No.” We aren’t going to do it.
There is real power in a Hell Yes Policy.
Replacing a physician costs a hospital between $250,000 and $1,000,000 depending on the physician’s experience, specialty, and abilities.
Diplomacy should always be used first. However, if diplomacy fails, simply telling an administrator, “Well, if that’s what you are making me do, then I’ll go ahead and turn in my two weeks notice” will end that conversation pretty quickly.
People often call this an “F-Off” or “FU” account because you can tell the boss exactly what you think when they want you to do something that you disagree with.
I just see it as a fund that helps you to support yourself when others won’t. There is power in saying no when someone isn’t valuing you or your time.
Financial freedom never felt so good!
Take Home
The FIRE movement has been good for many professions. While I don’t focus as much on the RE aspect of FIRE, I do feel that the FI aspect is crucial to the future success of medicine.
When the medical community learns the doctrines of FI, it provides a remedy to the lack of autonomy and support physicians receive. It also gives us the power to destroy the financial burden that plagues our doctors. FI helps free them to have time to find their self-identity, which is often lost during medical training.
So, while the rates of burnout, depression, and suicide continue to climb in the physician community, I look forward to fighting fire with FIRE.
Do you know a burned out doctor (or are you one)? Have you ever? How did financial independence fit into their solution to the problem? Leave a comment below.
7 thoughts on “Why are Doctors Burning Out? Three Ways FIRE Can Save Us”
I have read through the comments and I truly appreciate this blog as it opens up my eyes to what physicians are experiencing. Most clients and people in general under estimate the daily expenses most physicians are subject to. Thanks for sharing!
Living below my means has given me the freedom to feel more autonomy in my work. Perhaps I don’t really have that much autonomy, but when the workload gets heavy, I know in the back of my mind that I can afford to cut back by 10 to 20% if I choose. Knowing that I choose to work annoyingly long hours because I am saving to give myself more freedom later, rather than having to work to pay for the new car or the mortgage on my second home, gives me the feeling of independence.
I always find posts on burnout interesting because they rarely discuss what is actually known about burnout.
That is if you look at the occupational health research burnout occurs most often when people have high perceived responsiblity for an outcome but low perceived control over that outcome.
And all the yoga, exercise, ‘free massages’ in the world do nothing directly to address that ratio.
However, it’s much easier for a health system to say, “We’re offering free yoga classes to help physician burnout!” than to actually address crucial issues in delivering safe, effective, and meaningful patient care.
The fact of the matter is until systems actually start empowering their clinicians to feel as if they are making a substantial difference in their clinical practice burnout will continue.
But do you really think most health systems want empowered clinicians rather than simple cogs in the hamster wheel?
(You’d think they’d want them because they’re the most passionate about improving care but that isn’t what I see happening.)
The other option is for clinicians to start identifying where and how they can increase control over their lives and practices.
Fiscal responsibility and FIRE fit well here.
The spouse adds quite a bit of stress to being a doctor as well.
They can be unhappy about your time away from home. They can spend a lot to make up for their sacrifice.
For men at least, the house, school and the wife’s car are the wife’s call. FI isn’t on their radar because they don’t feel the stress of your working!
It’s not easy to find the “right” spouse either. First, people change. Second, you don’t get a test run to see how your wife will spend money 10 years hence when the money rolls in. The doctors who claim a great spouse choice were largely lucky. Like investing in Facebook instead of MySpace.
Finally, men typically marry out of their weight class by being doctors, and keeping the trophy wife happy is a second full time job. And that costs money.
And don’t even get me started on the costs to maintain the mistress.
Great article, would like to try and put your article in a historical context. Medicine in the USA is being disrupted by forces wishing to control costs after a period of time in our history in which costs were for the most part not controlled. The method of controlling costs is similar to what happened to many other industries. The effect on the “workers” is also the same. See if this fits…There was a time when all shoes were custom made by skilled shoemakers. This was a respected profession because it required skill and i imagine on a typical day you could point to customers feet walking by your (own) shop. The shoes also were really expensive. //until the 19th century, shoemaking was a traditional handicraft, but by the century’s end, the process had been almost completely mechanized, with production occurring in large factories. Despite the obvious economic gains of mass-production, the factory system produced shoes without the individual differentiation that the traditional shoemaker was able to provide. shift to making mass production shoes turned respected artisans into assembly line workers. This is what is happening to docs today, and the only thing keeping them working is the student debt, so don’t expect to see that going away soon. This guy has a similar take, probably states it better. http://highplainsmd.com/2018/11/01/modern-medicine-assembly-line-burnout/
Thank you for another very well written article! I am a Veterinarian and not a “human” Physician. I have been following your blog for quite some time now. Our professions are quite different, but we share a many of the same issues! The suicide rate among veterinarians is astounding. Females are 3.5 more likely to commit suicide than the a member of the general public. The CDC Is now studying this phenomenon! Imagine the stressors you listed above including the $300,000+ student loans. As well as pay that tops out at $85,000/year. Also, add on the fact that your clients think that we are just making medical recommendations to make money. It is truly an epidemic of our profession. I write this in solidarity. I promote FIRE (especially the FI) to many of my colleagues as a way to truly be able to step back from the profession if needed. I also promote hospital ownership. This allows us to be in the drivers seat and not have the problems with administration! Once again, thank you for the article and be kind to your vet!
We love our Vet! And so do our two dogs and my daughter’s rabbit!
That debt to income ratio is bad enough to make my head spin. It is no surprise that you are battling many of the same things that we do in human medicine. Keep your head up!
And thanks for your kind words about my post,
TPP