Better to Burnout than Fade Away?

Physician burnout is a hot topic lately.  The trade magazines, e-mails, and even popular media have been featuring stories on physician burnout.
In case you haven’t been paying attention, here are 10 links from a quick google search:

§  New York Times
§  Physicians Weekly
§  Medscape
§  Consumer Affairs
§  Americain Medical Association
§  Huffington Post
§  Washington Post
§  Chicago Tribune
§  Hospitals & Health Networks

What is burnout?

How is burnout defined?  In this context, it is described as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.  In another context, it might be the guy who started smoking weed in 7th grade and now hands you the stub from your movie ticket, keeping the other half for his employer.
Of course, in this post, we’re talking about physician burnout brought on by increasing bureaucracy, increasing hours and expectations, decreasing time with patients, pay for performance, unfair ratings systems, etc…  It wouldn’t be tough to come up with a list of 101 ways a physician’s life can be made more stressful.

Why Does Burnout Matter?

Why should we care?  On a personal level, burnout is not a good feeling.  A burned out physician may not be able to give every patient the level of care they’re expecting.  A burned out physician may be more likely to make a mistake.  A burned out physician may not be at his or her best at home, leading to marital conflict, decreased life satisfaction, making work even more difficult to stomach every day.  It’s easy to envision a cycle that repeats itself, becoming a downward spiral that can’t possibly end well.
The repercussions are not good for patients.  Would you want to be seen by a physician who dreads coming to work each day?  A physician who is more likely to abuse alcohol or other substances?  One who is more likely to contemplate suicide?  The stakes are that high.

The Prevalence of Burnout

How common is burnout?  Quite common and increasing.  A recent article published in the Mayo Clinic Proceedings showed at least 1 symptom of burnout in 54.4% of physicians in 2014, up from 45.5% 3 years earlier.  Satisfaction with work-life balance decreased from 48.5% to 40.9% over that time.  A 2012 articlepublished in JAMA showed 45.8% of physicians exhibiting at least 1 sign of burnout, and physicians having an overall burnout rate about 10% higher than the non-physician worker.  Dissatisfaction with work-life balance was about double when compared to the non-physician.
What can be done?  There are big, system-wide answers and there are tiny, change-your-routine answers.  I won’t pretend to have them all, but I can at least tell you what others have done or suggested.  Stanford is rewarding emergency physicians with its time banking program, offering “meals, housecleaning and a host of other services — babysitting, elder care, movie tickets, grant writing help, handyman services, dry cleaning pickup, speech training, Web support and more.”
A recent newspaper editorial suggests the public needs to rally around its doctors like it has its teachers, who have been subject to the myriad of metrics in the recent past.  The AMA has released its STEPS Forwardprogram to help physicians gain control of their professional lives.
Common recommendations to relieve burnout are the usual suggestions to relieve stress:  eat better, take time for yourself, exercise… I’m just not sure how many of us can yoga our way out of professional misery.

My answer to physician burnout

What do you suppose I would suggest to help prevent or alleviate symptoms of burnout? Can you read the words at the top of the page, you know, that whole FIRE acronym?  I believe working toward a goal of Financial Independence, and seeing real progress toward that goal, can do wonders for the psyche.  If you are experiencing burnout, but can see a sliver of light at the end of that career tunnel, and you can watch that sliver expand and shine brighter, your outlook on your career and life might start to glow brighter as well.
When you are saving like Dr. Anderson, you know that you won’t be stuck in this position forever.  Starting from scratch, you could achieve Financial Independence within about 10 years.  That may seem like a long time depending on the stage of your career, but it’s less than the combined years you put in to college, medical school, and residency.
Once you have achieved FI, you’ll have options to lighten the load you’re carrying.  You can work fewer days or hours if your position allows.  You may be able to drop the worst part of your job, while maintaining the part you enjoy.  For example, The White Coat Investor is dropping his overnight E.D. shifts now that he’s got a sizeable nest egg.
You will be empowered to enact the changes you need.  If the only appealing option is to be done entirely and stop working, you can do that too.  And let every day be a Saturday.
Personally, I would rather remain gainfully employed than walk away at the age of 40.  I haven’t taken a formal survey or questionnaire, but I would guess my burnout score would be pretty low.  Some workdays are tougher than others, but I don’t dread them or end them feeling overwhelmed and exhausted.

Burnout varies by specialty

I may be in a specialty that is somewhat shielded from the bureacratic nightmares that plague primary care. The term “prior authorization” does not factor into my workday; I don’t have to worry about dotting enough i’s and crossing enough t’s to magically transform a clinic visit into a Level 3.
The 2015 Medscape Lifestyle Report show anesthesiology having a burnout rate of 43%.  That’s not as low as the dermatologists, reporting a survey-low 37% burnout rate, but quite a bit better than the 50% to 53% seen in emergency, internal, and family medicine, general surgery, and infectious disease.
In My My, Hey Hey, Neil Young tells us that it’s better to burnout than fade away (a worldview repeated by Def Leppard in Rock Of Ages).  I think I’ll ignore their collective wisdom, and do my best to fade away when I’m ready for my career to wind down.  From what I’ve read, burnout can be downright ugly.
What do you think?  Feeling burned out?  Why or why not?  Would progress towards or achievement of Financial Independence change anything for you?  Sound off in the comments below.

By Physician on Fire

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