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Am I burned out?
Maybe a little.
Could I continue working in the same capacity?
Absolutely.
Yet, I have felt compelled for quite some time now to do something different. What spurred the change of pace just a dozen or so years into my anesthesia career?
Financial independence. Defined as the ability to do whatever my heart desires with no concern for the income I may or may not generate.
As The Physician Philosopher will tell you, having that feather in your cap can save you and can actually save your career.
Did you know that the good doctor is a published author? Not only that, but his book is now available as an audiobook. Give The Physician Philosopher’s Guide to Personal Finance a listen and I guarantee you’ll learn something new.
Why are Doctors Burning Out? Three Ways Financial Independence Can Save Them
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 compounds (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 perform a student loan refinance ladder 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.
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 paper work, 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 counter action 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.
5 thoughts on “Why are Doctors Burning Out? Three Ways Financial Independence Can Save Us”
Doctors are burning out by intention. The intention is to replace us with cheaper providers who have been trained to not act independently but strictly to corporate policy. At some point there will no longer be a supervising physician. I recently had surgery and home health care including a nurse and PT. What I got was a standard format experience, delivered according to a script that was designed to meet the letter of reimbursement and nothing more. Their presence did not address my issues, but they were VERY persistent in collecting every vital signs every 5 minutes. The PT actually was good, but the nurses clueless when it came to medicine.
I later went to cardiac rehab. Another joke. It was run by a mid level nurse manager, think BIG NURSE from Cuckoos nest. Everyone on here knows BIG NURSE. They are the ones who spend their days flying from meeting to meeting eating cheap cookies only to come to roost and lower the corporate boom on the worker bees. The ones who actually care. Physicians are virtually excluded because they are not easily controlled. The ultimate control is exercised by applying policies of “disruptive behavior” which give admin broad power to threaten physician livelihood if they don’t fall in line with policy regardless of doing what is actually needed for individualized patient care. Sometimes, in fact most times people don’t need what policy dictates but they need what they need. Oh yes don’t forget the super billing device called the electronic record. You better check all those boxes. My home health spent the entire visit checking boxes on a tablet. Once they got all the boxes checked it was on to the next victim.
That’s why physicians burn out. You can’t practice medicine any more, only administer corporate policy according to the box checks, which is designed to maximize profit, but in the end the buck stops on us. We are the ones left to pick up the pieces when you give an inferior antibiotic because the real juice, the best choice, isn’t on formulary. We are the ones left to face the patients while the jokers in the C suites are off getting drunk at some resort.
Who wants to do that for 50 years? “Medicine” is playing the long game. They can afford to wait us out, so wait us out they will. Attrition will do the job for them.
This rings true on so many levels. After 32 (mostly very good) years of practice, I’m downsizing to part-time later this year, and will likely retire in the next 2-3 years. Medicine has changed, and I am finding it increasingly difficult to practice pediatrics the way it should be. Counting down the days, and grateful for FIRE….
True. True. And True. I found myself cycling through burnout every 3-4 years or so. Even worse, I was working so many hours that my youngest daughter asked if “daddy was coming over tonight?” I was watching my life pass me by while grinding through endless hours of patient care and never ending documentation (you know the story, you live it). In a drastic lifesaving (my own life) move, I resigned and took my family to spend six months in a quiet town on Maui’s North shore where we had the time to reconnect and reboot. Through locums work we’ve been able to come back and spend another summer at our new favorite spot. We’re working on the partial FIRES part, but being able to spend time with my family has been priceless.
No one should underestimate the power of the “FU money”. I noticed that people, including my manager and several of our clients, who are aware I am FI actually hesitate to pressure me too hard, because they know I can walk away from the job at will and have no pressure to find another one.
Sure beats the heck out of the days when I felt I just had to buck up and take their mistreatment, because I needed the job to pay my mortgage and other living expenses.
It’s a good thing you decided to retire because now, you can focus on your side hustle and work online quietly to achieve “side hustle millionaire” status. Working a traditional job is slowly becoming obsolete. And with your medical preactice and all, I’m not sure if there are days where you feel you don’t want to directly deal with people and look at their faces, but working online helps you to earn quiet $ gUaP $ without looking at anyone, nor dealing with issues from customer service. And working a regular job or business does create feeling of burnout. I know. I worked regular jobs for a very long time and got “sick & tiyad” of my energy levels going to an all time low and looking at managers and co-worker’s face day in and day out.