Physician burn out

[typoncho]

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I've been reading a lot of articles lately about physician burn out. I wanted to get thoughts on it. Do you think those who are burned out are:

1. Any and all doctors who have been working for some time. OR
2. Doctors who have been working for some time and have slowly but surely seen their autonomy shrink and seen their colleagues somewhat forced into working as employees.

 

[slopes23]

I've been reading a lot of articles lately about physician burn out. I wanted to get thoughts on it. Do you think those who are burned out are:

1. Any and all doctors who have been working for some time. OR
2. Doctors who have been working for some time and have slowly but surely seen their autonomy shrink and seen their colleagues somewhat forced into working as employees.

Those are the only two possibilities as to why a physician is burnt out? Hmmm...

 

[W19]

Don't do ER or surgery if burn out is your 'worry'😛

 

[pathologyDO]

I've been reading a lot of articles lately about physician burn out. I wanted to get thoughts on it. Do you think those who are burned out are:

1. Any and all doctors who have been working for some time. OR
2. Doctors who have been working for some time and have slowly but surely seen their autonomy shrink and seen their colleagues somewhat forced into working as employees.

I think that you're trying to approach a complex issue with a very small arsenal of possibilities to choose from, meaning you need to read more about physician burnout. You should check out some medscape information. There are 7 pages in the linked article in case you do read it (easy to not notice.

It's really hard to say exactly what causes physician burnout but things like how many hours they work, the quality and difficulty of the hours worked, if they take call or if once they go home they're not going to be bothered or have to do outside work, are they satisfied with their job, satisfied with income, etc. etc. etc. all of those things are factors. Another issue I have read about is when a student envisions being a physician one way, and after they start practicing they realize it isn't at all what they had imagined (unmatched expectations)

 

[Stagg737]

2. Doctors who have been working for some time and have slowly but surely seen their autonomy shrink and seen their colleagues somewhat forced into working as employees.

Docs that are employed complain that they want more autonomy. Docs that employ themselves complain that they spend too much time on administrative duties/paperwork and wish they had more time with patients. The grass is always greener...

I think burnout is more common among physicians who either work a ton of hours for the duration of their career or more likely those who decide/have to go into a field for some reason other than it's something they really enjoy doing.

 

[Tired]

...

 

[Doudline]

Or, I don't know...

-high debt load
-long hours
-significant responsabilities
-dealing with death/illness/distress on a daily basis
-toxic, highly hierarchic work environment
-rampant alcohol and drug consumption
-God complex, aka thinking you're above seeking help
-etc

 

[Tired]

...

 

[Doudline]

So basically, being an adult causes burnout?

Whatever, grow up, you knew what you signed up for.

Honey, you're a mess - it's time to log off now.

 

[graviton]

People who burnout are p*****s. Simple as that.

That opinion makes your username and avatar combo quite ironic.

 

[BobbyB]

Winners never quit and quitters never win.

 

[TooMuchResearch]

Any field but medicine, we call it career change or retirement.

In medicine, we call it burnout.

 

[shopsteward]

Any field but medicine, we call it career change or retirement.

In medicine, we call it burnout.

This.

The easiest way to avoid burnout is to get your finances to the state where you are not a slave to your job just because of the money it provides. Pay your debts, live within your means, put the spare into investments (see WhiteCoatInvestor for details). Invest enough of your take-home pay and you'll be retired long before burnout is an issue -

http://www.mrmoneymustache.com/2012/01/13/the-shockingly-simple-math-behind-early-retirement/

 

[typoncho]

Just seems odd that the vast majority of doctors I talked to prior to applying for med school either tried to deter me or talk me out of it (as opposed to simply asking if I was sure that's what I wanted). Seemed reminiscent of when I joined the Marines "Infantry, huh? Good luck when you meet your team leader". As it turned out, I absolutely loved it. Same thing with having a kid "good luck with those sleepless nights". Well, I love that S#-t too. Maybe I'm noticing a trend of societies' overall pessimism and they need to STFU with their unsolicited advice. Either way, I'm undeterred as always, it will just be aggravating to work with a bunch of negative co-workers if that's the general consensus.

 

[Psai]

Cool story bro, you're the first one to think that because they toughed things out before that they can do it again
rip circulus vitiosus

 

[Mad Jack]

Any field but medicine, we call it career change or retirement.

In medicine, we call it burnout.

Burnout hits a lot of physicians merely years into practice. That's a big part of why it's an issue. Physicians can't just invest 11+ years in training and only last 5 years in practice before they're miserable and want to leave or our health care system will suffer terribly as a result.

As to my thoughts on burnout, most of the burnout I saw was a result of expectations that weren't in line with reality, if we're going broad with things. The lifestyle wasn't what was expected, the paperwork was far in excess of what was expected, malpractice and stress were much greater stressors than expected, etc.

 

[typoncho]

Oh man you're cold as ice. Ice, Psai.

 

[Mad Jack]

Just seems odd that the vast majority of doctors I talked to prior to applying for med school either tried to deter me or talk me out of it (as opposed to simply asking if I was sure that's what I wanted). Seemed reminiscent of when I joined the Marines "Infantry, huh? Good luck when you meet your team leader". As it turned out, I absolutely loved it. Same thing with having a kid "good luck with those sleepless nights". Well, I love that S#-t too. Maybe I'm noticing a trend of societies' overall pessimism and they need to STFU with their unsolicited advice. Either way, I'm undeterred as always, it will just be aggravating to work with a bunch of negative co-workers if that's the general consensus.

Good luck (accepted), you're gonna need it. You have no idea what you're in for and no words I can offer can prepare you. It's certainly survivable, but it is also painful. I've dealt with plenty of stressful life and death situations in the past, and nothing even came close to preparing me for medical school. I miss when the greatest stressor in my life was whether my patient was going to code, because it was finite, quantifiable, and had a certain outcome that was over when I left for the day. Medical school is your ass on the line damn near every day. You're one lazy week or one bad exam block away from being tens to hundreds of thousands of dollars in debt with nothing to show for it, and no matter how much time you put in, all you can do is try to soak up as much knowledge as you possibly can and pray that the stuff you missed doesn't pop up on exam week, because there's no way to know it all.

It's possible to be happy in school. But you will be stressed to all hell, and oftentimes wonder what the hell was wrong with you for signing up- and it's certainly not an experience to be enjoyed so much as humbled by.

 

[typoncho]

Good luck (accepted), you're gonna need it. You have no idea what you're in for and no words I can offer can prepare you. It's certainly survivable, but it is also painful. I've dealt with plenty of stressful life and death situations in the past, and nothing even came close to preparing me for medical school. I miss when the greatest stressor in my life was whether my patient was going to code, because it was finite, quantifiable, and had a certain outcome that was over when I left for the day. Medical school is your ass on the line damn near every day. You're one lazy week or one bad exam block away from being tens to hundreds of thousands of dollars in debt with nothing to show for it, and no matter how much time you put in, all you can do is try to soak up as much knowledge as you possibly can and pray that the stuff you missed doesn't pop up on exam week, because there's no way to know it all.

It's possible to be happy in school. But you will be stressed to all hell, and oftentimes wonder what the hell was wrong with you for signing up- and it's certainly not an experience to be enjoyed so much as humbled by.

That's exactly the thing of it. Nothing can prepare me for the gut check of med school. I will be humbled and beat down. I certainly wasn't trying to say that my hardest times are behind me, because they're not. I get it: I don't get it yet.

 

[DrBodacious]

With the shift to physicians being employees, it is analogous to Sea World (orcas in captivity). If physicians had fins, they would flop over permanently after being employed by a hospital.

 

[W19]

Cool story bro, you're the first one to think that because they toughed things out before that they can do it again
rip circulus vitiosus

Lol

 

[Mad Jack]

Winners never quit and quitters never win.

But these are mostly doctors saying they've already won the game and they're sick of it. You shouldn't have to tough something out for 50+ hours a week every week for the rest of your life, you should at least somewhat either enjoy it or be able to do it without absolutely loathing it. Something has sucked the joy out of medicine for physicians, and things need to change if we want to combat burnout.

 

[arewethereyet...]

We had a dinner/talk the other night with 7 female physicians in different specialties and they all loved their jobs. I think the commonality between them was that they all recognized when they weren't having fun and talked to people about it so they could do something about it. One did 2 years of FP hated it and switched to OB/GYN. Another was FP and getting burnt out, so now she just does OMM. The surgeon was didn't enjoy the people she worked with so she moved to a different group. Several of them were able to cut their hours to 4 days/week once they established themselves. And above all they had things that they loved to do outside of medicine. Also, all but one were employed by the hospital and still able to create autonomy for themselves.

 

[typoncho]

We had a dinner/talk the other night with 7 female physicians in different specialties and they all loved their jobs. I think the commonality between them was that they all recognized when they weren't having fun and talked to people about it so they could do something about it. One did 2 years of FP hated it and switched to OB/GYN. Another was FP and getting burnt out, so now she just does OMM. The surgeon was didn't enjoy the people she worked with so she moved to a different group. Several of them were able to cut their hours to 4 days/week once they established themselves. And above all they had things that they loved to do outside of medicine. Also, all but one were employed by the hospital and still able to create autonomy for themselves.

That's what I like to hear. Doctors finding their niche and fulfillment in their career, and everybody is the better for it.

 

[ChEMD]

Good luck (accepted), you're gonna need it. You have no idea what you're in for and no words I can offer can prepare you. It's certainly survivable, but it is also painful. I've dealt with plenty of stressful life and death situations in the past, and nothing even came close to preparing me for medical school. I miss when the greatest stressor in my life was whether my patient was going to code, because it was finite, quantifiable, and had a certain outcome that was over when I left for the day. Medical school is your ass on the line damn near every day. You're one lazy week or one bad exam block away from being tens to hundreds of thousands of dollars in debt with nothing to show for it, and no matter how much time you put in, all you can do is try to soak up as much knowledge as you possibly can and pray that the stuff you missed doesn't pop up on exam week, because there's no way to know it all.

It's possible to be happy in school. But you will be stressed to all hell, and oftentimes wonder what the hell was wrong with you for signing up- and it's certainly not an experience to be enjoyed so much as humbled by.

Wow, dramatic much? You make it sound like med school is the most difficult thing anyone could possibly do. Your ass on the line every single day? Please. I hope you're not talking about the preclinical years. Sure it can be pretty stressful at times, especially in the days leading up to an exam, but my experience hasn't been anything like you've described it. I dunno, maybe I'm an outlier, but I have absolutely enjoyed my time thus far and I don't imagine I'd be any happier doing anything else.

 

[Mad Jack]

Wow, dramatic much? You make it sound like med school is the most difficult thing anyone could possibly do. Your ass on the line every single day? Please. I hope you're not talking about the preclinical years. Sure it can be pretty stressful at times, especially in the days leading up to an exam, but my experience hasn't been anything like you've described it. I dunno, maybe I'm an outlier, but I have absolutely enjoyed my time thus far and I don't imagine I'd be any happier doing anything else.

See, I've heard there's largely two types of med students- the ones who find preclinic to be hell, and the ones who find the clinical years to be hell. I'm more in the latter camp, knowing my tendencies. There's also that minority that enjoys themselves all the way through, and a slightly larger minority that hates everytging. Preclinical, for me, is hell. I'll survive, but it is the worst prolonged experience I've been through in my life, and I've been through a divorce and seen a whole lot of people die, so that's saying something. Everybody is different though, you might very well have had a grand time.

 

[TwinsFan]

Concur on the preclinical part being a unpleasant non-stop factoid memorization-fest. When test questions require random picture captions to answer 3rd order minutiae you know the fun has ended.

 

[Troll-Like-Receptor]

Is this what the kids call Hot Boxing now?

 

[giantswing]

See, I've heard there's largely two types of med students- the ones who find preclinic to be hell, and the ones who find the clinical years to be hell. I'm more in the latter camp, knowing my tendencies. There's also that minority that enjoys themselves all the way through, and a slightly larger minority that hates everytging. Preclinical, for me, is hell. I'll survive, but it is the worst prolonged experience I've been through in my life, and I've been through a divorce and seen a whole lot of people die, so that's saying something. Everybody is different though, you might very well have had a grand time.

To counter point, I've worked a job I found way more miserable soul sucking than any year of medical school. Personal/marriage issues were harder than med school, because it wasn't just me. I hated third year w an undying passion, but it wasn't near as bad as the first two things mentioned.

Everyone is different.

 

[W19]

But these are mostly doctors saying they've already won the game and they're sick of it. You shouldn't have to tough something out for 50+ hours a week every week for the rest of your life, you should at least somewhat either enjoy it or be able to do it without absolutely loathing it. Something has sucked the joy out of medicine for physicians, and things need to change if we want to combat burnout.

These administrators and lawyers seem to be a heck of a lot smarter than physicians...

 

[Donald Juan]

This.

The easiest way to avoid burnout is to get your finances to the state where you are not a slave to your job just because of the money it provides. Pay your debts, live within your means, put the spare into investments (see WhiteCoatInvestor for details). Invest enough of your take-home pay and you'll be retired long before burnout is an issue -

http://www.mrmoneymustache.com/2012/01/13/the-shockingly-simple-math-behind-early-retirement/

It often seems like the physicians that are the most stressed are the ones that feel like they have to buy a big house and nice car, and they have to let their spouse quit their job and stay at home and shop with a huge allowance, and they have to send their kids to private school and private university, and before long they have to work 70-80 hours every week just to get by.

 

[typoncho]

It often seems like the physicians that are the most stressed are the ones that feel like they have to buy a big house and nice car, and they have to let their spouse quit their job and stay at home and shop with a huge allowance, and they have to send their kids to private school and private university, and before long they have to work 70-80 hours every week just to get by.

I could see that. Every physician should do Financial Peace by Dave Ramsey and crush their debt so they can live well (better). American dream = massive amounts of lingering debt. A few years of living like you're broke and you can be free for the rest of your life.

 

[jeffk805dent]

A few years of living like you're broke and you can be free for the rest of your life.

easier said than done.

 

[jdh71]

Just seems odd that the vast majority of doctors I talked to prior to applying for med school either tried to deter me or talk me out of it (as opposed to simply asking if I was sure that's what I wanted). Seemed reminiscent of when I joined the Marines "Infantry, huh? Good luck when you meet your team leader". As it turned out, I absolutely loved it. Same thing with having a kid "good luck with those sleepless nights". Well, I love that S#-t too. Maybe I'm noticing a trend of societies' overall pessimism and they need to STFU with their unsolicited advice. Either way, I'm undeterred as always, it will just be aggravating to work with a bunch of negative co-workers if that's the general consensus.

Most people need to learn to hack. I mean @Tired is getting some crap for his responses, but people need to learn to sack up a little. Sure. Of course. There are some physician jobs that were just unsustainable in the long run and people burn out, but for the most part you should know what you are getting into. Even those supposed "super sweet" doctor specialties actually usually have more hours and stress than you might think, especially in private practice. Don't listen to people just bitching, whining, and moaning.

Though maybe there is something to say for those folks who when told "lead, follow, or get out of the way" decide to get out of the way . . . maybe it's best for them, the system, and patients to have found a new job.

 

[jeffk805dent]

Even those supposed "super sweet" doctor specialties actually usually have more hours and stress than you might think, especially in private practice. Don't listen to people just bitching, whining, and moaning.

maybe I'm in the minority here but I feel this stems partly from baby boomers. The baby boomers I shadowed all seemed to say the same thing - "don't do it for the money." Which I understood given the stamina needed to survive in healthcare but I found it odd that they would have a mercedes or porsche parked outside. Baby boomers nowadays say they dont recommend being a physician or dentist bc they're not used to the new demands.

 

[jdh71]

easier said than done.

True. It's very doable for motivated single folks, still possible enough for that couple that just wants to tough it out, but becomes much much harder with a family and competing interests.

To me, my thinking is that we could live completely like that, but why? I work hard enough that I should enjoy some of the fruits of my labor. If that means I'm out of debt years later than if I had just sent every possible dime to the loans, it seems like a reasonable tradeoff to me. I don't live fancy, I don't own a luxury car (though I did get a almost new truck!), I don't live in a gigantic house on a golf course, but I do have a little plot of land with views, I do buy regular outdoor gear and guns, I do take a few vacations a year with my family, and when I want to get a new pair of shoes or a new coat I just buy the ****er.

I do send all of my bonus money to my loans. And I max out my 403b and 457.

I don't feel bad about any of it and I don't live like a resident.

I'm not saying that the "live like a resident" strategy is bad or wrong or even stupid. It appeals to part of me for sure, but my way works too. You'll just have to figure out what works for you.

 

[typoncho]

True. It's very doable for motivated single folks, still possible enough for that couple that just wants to tough it out, but becomes much much harder with a family and competing interests.

To me, my thinking is that we could live completely like that, but why? I work hard enough that I should enjoy some of the fruits of my labor. If that means I'm out of debt years later than if I had just sent every possible dime to the loans, it seems like a reasonable tradeoff to me. I don't live fancy, I don't own a luxury car (though I did get a almost new truck!), I don't live in a gigantic house on a golf course, but I do have a little plot of land with views, I do buy regular outdoor gear and guns, I do take a few vacations a year with my family, and when I want to get a new pair of shoes or a new coat I just buy the ****er.

I do send all of my bonus money to my loans. And I max out my 403b and 457.

I don't feel bad about any of it and I don't live like a resident.

I'm not saying that the "live like a resident" strategy is bad or wrong or even stupid. It appeals to part of me for sure, but my way works too. You'll just have to figure out what works for you.

You're definitely a minority. You're not living outside of your means like so many people are, but you're also not sacrificing valuable years of your kids' lives (I'm assuming, since you mentioned family vacations). You're giving them experiences that they will remember for the rest of their lives, but you're also responsible with your money. My wife and I were eliminating debt at a rapid rate until I decided to go to med school. We had nice (outside of our means) vehicles and we sold them and now drive reasonable but paid off vehicles. We trimmed the fat, we make a budget a month in advance every month and stick to it. Once we started doing that, we saw the insane amount of money we were hemorrhaging every single month on useless BS that did nothing for our happiness (I, like you, still have a guns and ammo allotment because that is happiness for me) We no longer have the luxury of a debt snowball now that I'm going to med school and will be taking out minimal amounts of loans. And I will agree with you that financial sacrifices need to be made so that kids can have an actual childhood and we'll do the same, but as soon as I'm out of residency (holy hell that's far off) we'll be rolling the debt snowball back out, dumping into retirement, and saving for land because I cannot stand this postage stamp lot metroplex living.

 

[typoncho]

easier said than done.

Definitely easier said than done. It's rough.

 

[Tired]

...

 

[Donald Juan]

This is what I was aiming for, but you put it much more eloquently than I did.

This life is tough, but no one can honestly say anymore that they didn't know what they were getting into. Shadowing, prolonged clinical education time that is pushed back earlier and earlier into medical school, progressively longer residencies, SDN... no one can claim ignorance anymore.

This is a high-risk, high-reward profession. If you're burning out, you're potentially threatening your patients' well-being, and it's time to take a break or get out. So as you put it, time to either sack up or bail.

I agree with you. To add, I'd be curious to know the outlooks of some of these physicians who are "burning out" throughout their career. We use the term burnout which implies that they were once on fire, but it seems like I see so many residents, young physicians, and even med students late into 3rd year who seem so distraught and bitter about medicine. Are these the people who are burning out--i.e. people who never had it? Obviously that's not everybody, I'm sure there are some gung-ho individuals out there who started off with nothing but promise and started feeling distraught 20 years into their career, but I wonder how much of this burnout (as well as a lot of these physicians who answer surveys saying they wouldn't choose medicine again, aren't happy with being a physician, etc.) is just from people who hated their career from the first day they stepped into a clinic.

 

[Tired]

...

 

[shopsteward]

I don't think distraught or bitter is related to burnout. Burnout involves giving up. I can count on one hand the number of true "burn-outs" I've met in medicine. And I graduated from school almost a decade ago.

Burnout is about being unable to carry on. "Giving up", on the other hand, might be better characterised as "I retired" or "I got a life" or "I left to do [x] before I burnt out" or "I found another passion to follow".

There should be no shame either in burnout or in leaving medicine for other reasons.

 

[Zebra Hunter]

Wow, dramatic much? You make it sound like med school is the most difficult thing anyone could possibly do. Your ass on the line every single day? Please. I hope you're not talking about the preclinical years. Sure it can be pretty stressful at times, especially in the days leading up to an exam, but my experience hasn't been anything like you've described it. I dunno, maybe I'm an outlier, but I have absolutely enjoyed my time thus far and I don't imagine I'd be any happier doing anything else.

Having finished up, I have to agree with this. I know several students that have had similar experiences to Mad Jack, but they were all the type that you expected to have that sort of experience. The worriers, the type As, or the individuals on the verge of flunking out. If you have an easy going personality, do decently in your courses, and don't get rattled easily med school will still be tough, but hardly the doom and gloom that you often hear.