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In the United States, we have one messed up medical system. Almost no one is denying that.
From the patient’s perspective, it’s crazy-expensive, confusing, and too often, not as effective as it could be.
From the physician’s perspective, there are far too many barriers to providing efficient, quality medical care and many layers of costly and unnecessary bureaucracy.
What’s a doctor to do? Dr. James Turner, an anesthesiologist, author, and physician coach has spent much of the last year gathering data and his thoughts on the subject.
The result is Determined: How Burned Out Doctors Can Thrive in a Broken Medical System. This 226-page book, released on July 19, 2022, is a great read for both physicians and those who work with them and hire them.
For the first week after its release, you can snag a Kindle copy for just 99 cents!
About the Author
You may be familiar with Dr. Turner’s work over the last five years or so at The Physician Philosopher where he hosts both a blog and a podcast.
He’s had his own issues with burnout and has helped coach hundreds of other physicians via the Alpha Coaching Experience as they’ve navigated career challenges of their own.
Initially, Dr. Turner’s focus was primarily on personal finance and the role of financial independence in mitigating physician burnout. His first book, The Physician Philosopher’s Guide to Personal Finance, is an excellent overview of how a young physician should approach money matters. Personal finance remains a major focus in his growing Medical Degree Financial University (MDFU) community.
With five years as an attending anesthesiologist under his belt and the experience of working with hundreds of other doctors in various stages of burnout, he is better equipped to address the causes of physician burnout (or moral injury) and suggest certain systemic solutions and personal approaches beyond the financial that can help alleviate this pervasive problem.
Profit over People
Dr. Turner notes that organizations tend to prioritize either their profits or their people.
He holds Costco up as an example of an organization that prioritizes people. They’ve long offered pay well above the minimum wage with generous benefits for their employees. They please customers with quality merchandise and a lenient return policy.
By treating their people well, they retain 94% of their employees after year one. Sam’s Club, on the other hand, which looks like a similar operation, does not prioritize people in the same way that Costco does, and as a result, only retains 56% of its first year employees.
In the medical community, you will find organizations that focus on profits and those that favor their people, knowing that profits can be as good or greater when you have an engaged workforce that feels appreciated.
Given the high cost of replacing a physician, estimated at $250,000 to $1,000,000, and the high percentage of physicians (about half) who leave their first job within 5 years, a hospital system should focus on taking care of its people so that its people can take care of their patients.
When evaluating potential positions, try to get a sense of where the organization’s priorities lie and look for those who value their people over profit.
The Arrival Fallacy
Twice in the book, Dr. Turner discusses a concept known as the arrival fallacy that is probably oh-so-familiar to you, even if you didn’t have a name for it before.
“Do you remember feeling that when you got to residency, things would be better than medical school, only to find that you were burned out in residency?
Did you think that the burnout of residency would surely get better when you became an attending physician making a physician income?
When that didn’t work, did you think that getting promoted to partner or advancing in the academic ranks might improve your situation?”
In the words of Gertrude Stein, all too often, there is no “there” there when we arrive at a place where we expected to find more in terms of accomplishment, satisfaction, and “arrival.”
I can certainly relate to the letdown that can come with advancing from one education or career to the next. While I truly think life did get better in some ways with each level up, it’s paramount to enjoy the journey in whatever way you can.
If you expect to find a pot of gold at the end of the career rainbow, you may be disappointed to learn that the rainbow is just one big circle, and it’s up to you to decide where and how it ends.
Knowing that the joy that comes with educational and career advancement can be fleeting, Dr. Turner reminds us to enjoy the process, not the product.
Guilt Versus Shame
Given that our emotions play a prominent role in burnout / moral injury, Dr. Turner spends some time differentiating between guilt and its unhealthy cousin, shame.
In the words of Brené Brown, guilt is a feeling that happens when we make a mistake.Shame is a feeling we experience when something goes wrong and we feel like we are the mistake. Guilt is a focus on the mistake. Shame is a focus on our identity.
Yes, we all make mistakes, but few of us are mistakes, and that’s an important distinction to remember when practicing self-compassion, an important tool in the burnout battle.
Money Helps, But It’s Just Another Tool
As stated earlier, money matters are a consistent focus of The Physician Philosopher, but Dr. Turner reminds us not to rely too heavily on monetary incentives alone.
He illustrates how we can shoot ourselves in the foot by telling the story of Rhett, a physician who was unnecessarily sabotaging his career and marriage with a singular focus on becoming financially independent as quickly as possible.
Rhett and his wife loved the city, but they moved to a rural area where he could make more money, even though that meant putting her doctoral work on hold.
Dr. Turner asked Rhett some pointed questions and helped the good doctor realize that even though a move back to the city could delay financial independence by 5 to 10 years, they could be happier for all of that time.
All’s well that ends well; Rhett and his wife moved to the city for a lower-paying but better job, and she was able to finish up her doctoral degree. He also bought himself a BMW that he’d been denying himself. I’m not sure I see that last tidbit as a victory, but “Jimmy” is a self-professed “car guy,” so I can see how he’d consider that calculated splurge to be a tick in the win column.
Schedule Your Priorities
I can’t help but be in awe of someone like Dr. Turner. This is the second book he’s written. I’ve talked about writing one for years, but have made zero progress.
He’s created several online courses, first selling them individually, and later making them available with the MDFU membership (get 2 weeks free). I’ve only toyed with the idea of creating a course of my own someday.
All of this while he’s the father to three kids younger than my two and while he works as a 0.7 FTE anesthesiologist, whereas I haven’t seen an operating room in nearly three years.
How does he do it?
Stephen Covey, author of The 7 Habits of Highly Effective People, said, “The key is not to prioritize what’s on your schedule, but to schedule your priorities.”
As Dr. Turner puts it, “Instead of letting your schedule dictate what happens in life, you set very intentional priorities and make sure that your schedule reflects that list.”
If I had done that, perhaps I’d be sound asleep rather than staying up past midnight to complete this blog post in the wee hours of the day the book comes out!
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Learning from Powerful People
Interwoven throughout the book are anecdotes and quotes from prominent figures who have helped shape the world in which we live.
The book opens with the story of Nelson Mandela and how he refused to kowtow to those who imprisoned him. They could capture his body, but not his mind and its thoughts.
Later, another wrongfully imprisoned man, Rubin “Hurricane” Carter, is quoted with a remarkably similar statement.
The book also takes inspiration from the words and actions of people like Thomas Edison, Maya Angelou, Sugar Ray Leonard, Steve Jobs, Martin Luther King, Jr., and Rosa Parks.
While leaning on the contributions and quotes from these legendary men and women, Dr. Turner also relays the stories of everyday physicians just trying to balance career and family life. You’ll likely find some familiarity in the struggles that these doctors have faced and overcome.
On Coaching
Dr. Turner unsurprisingly advocates for the role of coaching in the fight against physician burnout and moral injury. He has benefitted personally from both career and business coaching, and he offers a coaching program by physicians for physicians.
There is evidence, referenced in this book, that physician coaching has a positive impact in reducing physician burnout. A Mayo Clinic study published in JAMA Inernal Medicince in 2019 found that just 3-5 hours of group coaching by telephone led to a reduction in emotional exhaustion and burnout and to an increase in quality of life.
The Cleveland Clinic has estimated that physician coaching has saved them $133 Million due to a decreased physician turnover rate.
Determined does a good job of introducing some of the concepts used by physician coaches to help clients understand and address the issues that are troubling them.
This includes the ABCs of the self-determined physician (Autonomy, Belonging, Competence), a thought model that decreases negative emotions and outcomes, and how to choose to be a hero rather than a victim in the story that is your life.
While these coaching strategies are interspersed throughout the book, they’re not proposed as the only solution, but as a tool in the arsenal that some people have used to beat burnout.
For a physician to thrive in this messed up medical system, it’s imperative to recognize problems as they arise, understand their root causes, and to act in a way that doesn’t allow those circumstances to get the best of them.
In Summary
Dr. James Turner gives the physician reader a solid overview of why physicians experience moral injury or burnout along with strategies and mental models that can help stave off or overcome this career-threatening disease.
If you suffer from even mild symptoms of burnout or if you’d simply like a better understanding of the topic from a physician’s perspective, I highly recommend picking up Dr. James Turner’s Determined.
Again, for a limited time, your Kindle copy is only 99 cents, or the cost of one cheap taco that’s much less likely to extend or improve your physician career.
2 thoughts on “How to Thrive as a Physician in a Broken System”
It is popular to call the US medical system broken, and it may be from some perspectives, but as a Medicare patient with good supplemental and prescription policies I’ve found it to be incredible in terms of patient care versus cost to me. I pay about $4,000 a year and for that, with virtually no additional out of pocket, I’ve had four major surgeries at an out of state clinic of my choice, with the leading surgeons in their field, with no paperwork to speak of and no delays. And in one case the procedures were so advanced that the specialists in my state were not even aware they were within the realm of possibility. The lack of knowledge of my local doctors was the only “broken” part I experienced. But that was not a problem because like any informed buyer should do, I did my own research into my options and found my best bet to involve a 2,000 mile road trip. I find my care under Medicare is as good or better than my prior company provided or self paid health insurance. Not questioning how things work for doctors, but I am definitely a happy patient who could not have gotten my defects repaired as quickly, inexpensively(to me) or expertly anywhere else in the world, in my opinion.
I’m happy to hear you’ve had a mostly good experience. I think many seniors are surprised at the amount of out-of-pocket costs you incur with Medicare, but I know you’re in a position to afford those without worry.
One problem with Medicare from an anesthesia perspective is that it doesn’t pay nearly enough to cover anesthesia costs. For some reason, they reimburse anesthesia services at about 1/3 the rate that private insurance does. So other patients end up paying more to make up for the inadequate payments from Medicare and Medicaid patients.
That’s just one example. I agree that you can get some of the best care in the world, but it’s costly, and there are no simple answers to fixing the issues.
Cheers!
-PoF