Physician Burnout

September 25, 2009

Physician burnout does not just have an effect on our families and work error rates; it has a tremendous effect on the bottom line and is far more common than docs want to talk about. The solution, simplified: work smarter, not harder.

Why is an article on physician burnout on a site devoted to financial affairs? For two reasons - it has a tremendous effect on the bottom line and is far more common than docs want to talk about. To stay on point, I will leave the otherwise critical issues of personal unhappiness and its effect on our families and upon the error rate in our work to another time and, perhaps, venue.

When I say the bottom line, I am referencing studies that have been done on "workaholics," another softly defined term, that show in spite of increased hours and apparently focused activity, productivity in objective terms is actually less than more adaptive and organized people achieve with less effort in less time.

Even though most of us have witnessed burnout and probably experienced it, it's worth defining. As that noted seer Dr. Phil has said, "If you can't name it, you can't own it." And, although wry, it is not helpful to just fall back on an analogy to Justice Potter Stewart's notorious description of pornography: "I can't define it, but I know it when I see it."

Burnout might loosely be defined as the development of symptoms due to unresolved conflicts and other stress beyond the tools an individual has at hand to manage the load. The symptoms might be irritability, increased alcohol/drug use, fatigue, loss of sleep, anxiety, depression, increased spending, lack of leisure time and/or activities, and other symptoms of that ilk that you could probably could add to at length.

One symptom that is particularly common, and more noticeable than its practitioners realize, is becoming obsessively focused on making money. Our society values financial success and its visible results, and that is one of our primary drivers, but I am talking about the almost desperate air of someone who is no longer finding satisfaction in the other aspects of practice. I bet you can think of a few of these docs in your area.

Some of these folks come a cropper and end up compensating in any number of tragic ways. What I’m recommending is for those of us that are not yet in that much trouble, to either make some changes to improve our results, or better yet, prevent the decline into burnout. It's ironic that I recommend doing so to help the financial bottom line, but that's my job here and I am not above the occasional embarrassing paradox.

I also must acknowledge that managing your work and your emotional life is yet another area of medical training that is entirely lacking. We, and they of the academic establishment, are not comfortable with this stuff, even though it is mightily appropriate, so we are off into the world unarmed for this particular dragon.

In my own tested experience, I long ago came to the conclusion that it would be helpful to work smarter, not harder. The phrase rolls off the tongue nicely, but what does it mean?

First of all, it means that you've got to take a time out and take stock, a personal snapshot. Where are you, what do you want, and what is really causing the problem? It's tough and we don't want to do it. Weren't we selected, and didn't we self-select to be tough and self-reliant?

Fortunately there is a lot of help available now. Sure, there is still some stigma, but medical societies, hospitals, etc. increasingly have confidential physician-help programs. There are private resources and of course you can do much yourself. Just Google "physician burnout."

Whichever way you go, the first step is to take better physical care of your person. Stop kidding yourself - we are not immune to anything. And how many docs do you know who still smoke, eat too much, drink too much, don't exercise, don’t get a good night's sleep, don’t take a vacation, don’t see their own doc, etc?

Next set boundaries. Oh boy, are we lousy at this! Learn to say "No." Limit your hours, limit your patient volume, hire someone to do all the things you don't want to or can't do, which will allow you the time to do what you do want and can do well. Really. You probably can't afford not to.

Require yourself to take personal time for family, exercise, community activity and hobbies. I had an uncle who took me aside early in my practice and asked what I was doing outside of the multiple medicine-related activities I was involved in. He looked deeply into my eyes and told me I must always be giving back outside of my profession. It resonated coming from him and since that day I have always had outside venues. What a wonderful gift.

Don't think the grass is greener and that you can't fix your own yard. You can. And you will be happier for it, and earning more. You will be working smarter, not harder. Try it, it works.