Vagabond MD , a radiologist and favorite guest of the blog, reached out to me with a fresh take on what I'd thought was a settled debate. He asks if rather than a state of apathy and depletion to be avoided at all costs, burnout might in reality be a painful stop on the road to defining a balanced career in medicine (and developing an intentional approach to living). He puts it better than I am able:
It is a foregone conclusion that physician burnout is bad, really bad. It is bad for the doctor, bad for the patient, and bad for the system. The doc feels lousy, the patient sees a professional who is not at the top of his/her game, and the health care system potentially suffers from lower productivity and lower quality. Volumes have been written about the causes, potential solutions, and impact of physician burnout, and no one has yet suggested that it might actually be a cause for celebration. Until now.
What if burnout is just a phase, something that many physicians pass through, on their way to a more joyful professional existence? In my own experience, despite the fact that I was pretty miserable for a period of time, looking back, it was also a time for exploration and growth. With the assistance of coaches and counselors, I learned quite a bit about myself. I read blogs and books about personal finance, wellness, personality types, and new careers. (You would never believe how many blogs there are about running an ice cream shop.)
Along the way, I took action, doing things that I never thought I could do before. I discarded leadership roles. I dropped out of my demanding subspecialty and its toxic call schedule. I cut back my overall work schedule. I refreshed my professional network, and I picked up new skills. And then I found a part time job in my dream location.
In the end, having navigated the rough seas of burnout, I landed in a much better place. I like work again. I have new skills. My attitude toward my work has turned 180 degrees, from dread to (almost) pleasure. From reading his blog, I think CrispyDoc might share some of this sentiment. And the same goes with many of the other physician bloggers and thought leaders in the field of burnout.
Paradoxically, deep burnout might have saved me from a chronically low-level, unsatisfying medical career. If you are suffering from burnout, the steps that you take to shed your burnout might save you, too.
I love Vagabond's ability to re-frame one of life's low points as a necessary nadir preceding a blossoming of perspective and maturity, a sort of career adolescence.
The chrysalis of burnout might hurt, place you at risk of succumbing to predators, or otherwise impose constraints, but if you regard it as a stage on the way to coveted butterfly status it might be a stage worth passing through. It hurts to shed old skin, but the new one is glorious.
Furthermore, the opportunity cost of living a mediocre life of scarcity (insufficient time / happiness / health / investment in relationships) instead of a transformed life of abundance (so many cool new projects to undertake / interesting people to connect with / skills to master / athletic challenges) is an enormous risk for those of us not banking on reincarnation.
Thanks, Vagabond, for sharing your perspective.
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It seems strange to say “burnout is good”. But if it becomes the impetus for change, then it can been a very good thing. My personal path mirrors Vagabond’s quite closely. Once a level of professional expertise is attained the accompanying demands on time and performance can be onerous. While I would never wish the burnout experience on anyone, I have emerged on the other side with a life and lifestyle that for me is engaging and sustainable.
Author
GasFIRE,
I suspect many of us who feel drawn to the physician FI community have shared your and Vagabond’s experiences with burnout as a transformational time we’d frankly have preferred not to experience. Might that ring hollow to the spouse of a physician who committed suicide? The Happy Philosopher has written a guest post on WCI about it better than I could.
Like most questions in medicine, I suspect the answer to whether burnout is good is “it depends.” Right person, right mindset, right timing can make all the difference.
Appreciate you,
CD
What a novel approach with a glass half full outlook.
It really does make sense though. For me my worst period in my life was going through a horrendous divorce. But that painful moment in time made way for a life I love now because I got rid of all the negativity and anchors in my life.
If my marriage did not deteriorate to the level it did, I may have been able to “grin and bear it” and tolerate an unsatisfying life forever for the sake of my daughter, etc. I would be far unhappier now in that situation. So the quick pulling off of the band aid was the impetus to a much better life.
Burnout definitely shares a lot of similarities. If you don’t get to a level of burnout that makes you reassess your own life, you may just constantly be hovering in the 3-4 range of happiness and not make any changes. Getting to 0 and acting on it can maybe get you to the 7-9 range of happiness.
Author
Xrayvsn,
You are a great example of someone who rose from the ashes. Vagabond’s point speaks precisely to your shared experience – a brutal low that opens the door to a high you might never have achieved otherwise.
There remains the reality that for some, burnout can lead to extinguishing that flame instead of redemption and recovery. The suicide epidemic among physicians suggests that not all of us will emerge intact from experiencing extreme lows.
It’s a fraught topic, but I, too, appreciated the attempt to reframe it as an opportunity for growth.
Fondly,
CD
Wow. I completely disagree.
I know what you’re trying to say. That a bad thing can be used for growth, and you can come out on the other side in a better place. I agree with that. But it does not follow that the bad thing was good, or desirable, which is implied from what you wrote. Growth can happen without damage. And growth can happen in spite of damage. Regardless, one should not call that damage good. Or a cause for celebration.
Why does this matter? Vagabond MD is better off now. Can’t we just celebrate with him, rather than nitpicking his post? No. For two reasons.
First, physicians already feel a lot of shame* when it comes to burn-out. We tend to be over-achievers who feel like if we just tried harder, or if we were better people, we wouldn’t be burned out. The typical, and counter-productive, response to burnout is to work harder (study more, start meditating, exercise more, eat better, start volunteering in the community, start painting on weekends, etc.). Presenting burnout as a phase, or necessary stage of growth, simply adds more burden and shame. Not only do we feel shame for being burned out, we can now feel shame because we haven’t grown and improved because of that burnout. Given the high rate of suicides associated with burnout, this is a very dangerous idea. This post minimizes the very serious possible outcomes of burnout. (Also a ‘phase’ implies something that is normal to go through, and that you very naturally grow out of. Neither is true of burnout.)
*definition of shame: https://www.thrivephysician.com/blog/2019/4/28/guilt-and-shame-after-adverse-outcomes-what-is-the-difference
Second, burnout is not being overworked. It is not a lack of sleep, or lack of self-care, or lack of family time. It is accumulated moral injury due to systemic problems in healthcare.* We desperately need to change the system. But if, as implied by your take on burnout as a driver of personal growth, burnout is an individual problem with individual solutions, and can be a positive to boot, neither physicians nor non-physicians will be motivated to do the very hard work needed to change the system.
*moral injury: https://zdoggmd.com/moral-injury/
https://www.idealmedicalcare.org/not-burnout-not-moral-injury-human-rights-violations/
You said, “What if burnout is just a phase, something that many physicians pass through, on their way to a more joyful professional existence?”
Sure. Like a heart attack is just a phase that many type-A men pass through, on their way to a more healthful existence.
Yes, some people use a heart attack as a wake-up call, and start eating right, exercising, and reducing stress. But others have permanently decreased function, and still others die.
Some people come out of burnout, and change their lives for the better. But not all do. Some die. Let’s not forget that. And let’s work to change healthcare so that future docs don’t have to deal with “burnout” at all.
CarolinePF, I can tell you feel strongly about this subject! I also feel that burnout is more plague than opportunity for the vast majority of folks. I am overjoyed that for some, burnout acts a trigger for self renewal and self actualization. But for many others, it smolders, numbs, and ruins both work and home life.
Alarmingly, I feel myself skittering along that edge of burnout some weeks. But I am taking solace in working towards financial goals, writing my blog, and increasing my resilience. And it’s working. I feel renewed with each step I take towards my non-work goals.
This is a provocative subject, but I am glad for the opportunity to discuss the issue.
— TDD
Author
Caroline,
First and foremost, thank you for your thoughtful and well-articulated counterargument.
The broken system inevitably deforms us – acknowledging and responding to the burnout that results should not let that system off the hook or enable its continued abusive practices.
At the same time, the transformation that ensues is a very individualized response, and as Vagabond, GasFIRE, and Xrayvsn all suggest – that’s the part we can control.
You can redesign your life to recover from burnout while still being a voice for changing the health care system – the two are not mutually exclusive.
Vagabond has written about his experiences with burnout elsewhere and needing to find your own source happiness, and despite the tongue-in-cheek title of the post, his at times lighthearted voice has spent time in dark places.
Perhaps stating that burnout can be “good” (instead of the more accurate “therapeutic”), which I perceived to be a deliberately provocative title, was the root of the offense.
Burnout is not a character-building punchline that makes for humorous Calvin and Hobbes cartoons, and no one who has experienced burnout would wish it on another person.
For a subset of us the resilience, realization that we had the ability to set limits on what we’d allow medicine to take from us, and the unexpected career satisfaction that resulted from the changes we implemented are valuable consequences of our burnout. This was my reading of Vagabond’s article.
Thanks for being vulnerable and putting your views out there,
CD
CrispyDoc said: “For a subset of us the resilience, realization that we had the ability to set limits on what we’d allow medicine to take from us, and the unexpected career satisfaction that resulted from the changes we implemented are valuable consequences of our burnout. This was my reading of Vagabond’s article.”
That was my read, too. As I said at the beginning of my comment: “I know what you’re trying to say. That a bad thing can be used for growth, and you can come out on the other side in a better place. I agree with that.”
I only object to the framing of the burnout itself as good. (And, no, ‘therapeutic’ is not any better.) Burnout is NOT good. The RESPONSE to burnout can be good. This is an important distinction we should not gloss over.
“Burnout is good” can send the following messages:
To someone who has lost a loved one to burnout – new pain in their grief
To someone in the midst of burnout – extra shame that others turned burnout into gold, but I am too tired and worthless to make things better.
To someone who is at risk of burnout – false reassurance that may prevent them from making early changes and avoiding burnout altogether
To non-physicians, like hospital administrators – burnout is a personal problem and a blessing in disguise. I can safely ignore physicians complaining about it.
But, based on your responses to the other comments, you do understand why this minor distinction is actually important.
CrispyDoc said: “There remains the reality that for some, burnout can lead to extinguishing that flame instead of redemption and recovery. The suicide epidemic among physicians suggests that not all of us will emerge intact from experiencing extreme lows.”
CrispyDoc said: “Might that ring hollow to the spouse of a physician who committed suicide? ”
I wish you had included these points in the original post.
I agree. It’s like saying “Forest fires are good because there’s regrowth.” Sure, some trees will slowly regrow. But it’s no help to all the trees that have been razed or animals displaced or killed.
In our case, wonderful people have been lost and sidelined.
Individuals may make changes in their own lives because of burnout. I did. Good for at least four of us individuals here. Meanwhile, I seem to remember 50-60 percent of Ontario physicians have reported burnout. I won’t pretend that my personal changes have helped thousands of doctors in trouble.
No, burnout can’t be universally lauded as good. The title is clickbait.
Thanks for speaking out, CarolinePF.
Happy Doctor Day to all of us.
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Caroline,
Points well made. I’ll make it a priority going forward to better frame things in the proper context so that they are less likely to be misinterpreted as condoning acceptance of burnout as inevitable or healthy.
Thanks for your willingness to engage,
CD
I may not be burn out per se but as one of the many (divorce, accident, death of a loved one, disease…) events that forces us to change our perspective.
Most of us run our lives as zombies, work, money, vacation, routine …in a state of quasi hypnosis, where the years pass, almost identical.
Until a hypothetical retirement which is also a zombie dream.
But when it hits, we have to wake up and change is mandatory.
Alertness shows up. We realize we were sleeping all these years.
That’s where the silver lining is.
It’s also an opportunity to slow down, focus, redefine and go for where our soul leads us.
If only we listen.
Author
Caro,
You are correct, the wake up calls are there if only we listen, and remain open to effecting change.
From your lips to our colleagues’ ears, my friend.
With great respect, I must disagree. As CarolinePF has pointed out, the stimulus is being confused with the response. It is the response to burnout that can be healthy and good, not the burnout itself. It is not a foregone conclusion that without burnout most physicians would be doomed to a career of miserable mediocrity.
This is a topic worth thinking about, I just disagree with the conclusions. There are cognitive biases at play justifying events of the past, de-emphasizing alternatives.
We all have a narrative we tell ourselves about our life that defines our identity. When something traumatic happens, like burnout, this trauma must be incorporated into who we are – it changes our story about ourselves. The bigger the trauma, the more the story changes. Because the story IS our identity, we naturally become attached to the trauma itself – it is woven into the fabric of who we are.
It is why the quadriplegic can be glad of glad of the accident that caused their injury, the cancer survivor is grateful for their experience, and the rehabilitated burned out doctor can appreciate their experience as essential to who they have become. Because we can’t know who we would have become otherwise, we justify the trauma. In justifying the trauma, we justify ourselves. But the trauma was not a necessary “phase” and certainly not good.
Author
Matt,
You and Caroline both articulated something that I could not adequately say. Thanks for distinguishing between a healthy response and an unhealthy (and unnecessary) stimulus. Your point about internalizing our narratives, including hardships suffered, makes it easy to grasp how surviving an adverse experience can lead us to mistake that experience as having been a necessary precondition to our evolution.
With gratitude,
CD
Burnout is not unique to physicians, workism is a parallel term gaining visibility: https://amp.theatlantic.com/amp/article/583441/
Interesting debate on whether this is a consequence of capitalism economics: https://www.stitcher.com/podcast/the-ezra-klein-show/e/60197403?autoplay=true
David Brooks has another take on the social aspect:
https://www.nytimes.com/2019/05/01/books/review/david-brooks-second-mountain.html
The ego, a necessary construction, can also become a burden. In its unrelenting focus on power, achievement and sensual gratification, it breeds a culture, both inner and outer, of oppression, insecurity, addiction and loneliness. Enough is never enough. There is always someone richer, more accomplished and more successful than you are… The rampant individualism of our ego-obsessed culture is a prison, he declares, a catastrophe.
Sorry to leave @crispydoc hanging out to dry on the comments, but I have been on vacation.
Of course, burnout is not “good” or necessary experience for a fulfilling medical career. We should all have professional lives with benevolent administrators, selfless colleagues, and grateful patients, working 9-3 (noon hour off for yoga), Monday through Thursday, with generous compensation packages, one week off every three, robust pension benefits, support dogs in the workplace, and a no-fault malpractice environment.
Unfortunately, some of us work under less optimal conditions and work in them for quite a long time. There are those that silently seethe and fester along in a low level of discontent. Others (like myself) invariably sink to lower lows and experience what we would now define as “burnout”. All I am saying is that the nadir of burnout rescued me by forcing me to change myself and my circumstances, removing me from the longer term funk. Or maybe it’s rationalizing or trying to identify the silver lining.
At any rate, I am quite content in my career and sending along rainbows and unicorns (and lots of connoli) from Sicily. Ciao!
I would love feedback and tips on Sicily VBMD! Planning a trip for this fall
This is an interesting one and I like the alternative perspective. The thing about resilience and personal growth is that it requires some adversity to develop. I think it is kind of like muscles. When you train, you are actually breaking down and damaging muscle. It sucks. Especially the morning after. Even more so after age 40.
With a heavy workload or the stresses associated with burn-out, there is definitely the damage and breakdown. A couple of key components though.
One, it is important that the stress be a “healthy one” that promotes growth and doesn’t tear the muscle. We need to find a balance of training and not over-training. This is why I think that having a strong financial base helps doctors. It allows us to control the training programme rather than be pushed around by a sadistic “coach”.
The second is the host-response. Some people respond well to some stressors. A blade tempered and forged by fire. Others simply quit or break. Medicine generally does not have many “quitters”. So, I still think our focus, as a profession, needs to be on taking back control of the training regime.
-LD
Author
Loonie Doc,
I love your analogy. There is an order(s) of magnitude difference between resistance training and resisitance-is-futile training. I’m thankful you are one of the Mr. Miyagis in this Karate Kid’s life.
Fondly,
CD
I absolutely agree with the silver lining sentiment of this piece. Currently at the turning point of my journey, I am finally starting to feel like there is light at the end of the tunnel even though I am counting on working for another 18-20 years. Hope that those years are filled with more content than the prior 12 years of endless , alternating IR and Diagnostic call. Sometimes burnout and whatever other misery that comes your way makes you look within and look around. That leads to renewed understanding of WHY and HOW we want to practice medicine and build our lives.
Author
Mosly,
I’m glad you’ve reached your turning point – it’s a huge relief to know that it will get better.
A reverse engineering course might help during medical school, although many of us are leading very different lives when we enter the meat grinder than we do as we exit.
Starting with life priorities and seeing what type of jobs fit the life we want to lead seems a more sane, if rarely pursued, strategy for intentional living.
Happy to have your visit,
CD
My husband’s burnout drove him to increased etoh use, an affair with a colleague and suicidality. It certainly has resulted in him choosing different priorities, both to maintain sobriety and the option of staying married to me. Yet neither he nor I would ever use the word “good” in the same breath as burnout when discussing that time period or the fallout from it. He has dropped to less than full time hours, dropped out of multiple committees and basically does his job and comes home. He attends multiple 12 step meetings per week and actively works with sponsees. So, yes, his burnout certainly resulted in a changed, healthier lifestyle. Still wasn’t good, and still wasn’t a necessary life “phase” to move him to the “better” life he has now. I have to say, from my perspective, I could have done without ALL of it!
Author
Cathy, I’m so sorry to hear that you became a casualty from the shrapnel of your husband’s burnout. I write a great deal about the toll it takes on the physician, but your voice makes clear that the consequences can create devastating fallout beyond the affected individual.
I’m listening loud and clear to the (entirely appropriate) feedback that while some who survive burnout can eventually develop the insight to make a major life pivot and consequently end up thriving, many others end up permanently scarred from the experience if they are fortunate enough not to succumb to depression and suicide or have their lives implode in other ways.
No low that poses such grave risk should be considered a precursor to intentional living, even if that might a positive side effect of experiencing that low.
I hope that both your husband’s recovery from burnout and your recovery from the betrayal you experienced continue to allow the creation of a sustainable, valuable life worth spending together.
-CD
VagabondMD is right. “Burnout” is ubiquitous, cyclical, and a double edged sword that can cut both ways for good and bad outcomes. Burning through burnout and its visceral pain is a path to exponential personal growth and understanding. Burning through FI can leave one hollow and without purpose on the other side of the fence. Don’t underestimate the power over media spin on this issue.
The Spectrum of Moral Injury to Compassion Fatigue to Burnout is as complex and dynamic as it comes across the life work balance spectrum. It is not black and white, but very very grey. MI is extrinsic and systems based dehumanization and corporatization; and healthcare now suffers greatly from this insidious disease like never before. The end-station of short term/midterm/longterm BO is depression and suicide. Most of us live in the messy middle between the bi-poles. Our math and emotion batteries get depleted and need recharging internally and externally as we attempt to set aside financial and emotional reserves not only to battle through our daily minefields again, but to eventually “retire” to creative peace and leave the world a better place than we found it. We do not strive to merely survive, but to thrive. We cannot do this alone in our silos, our cubicles. We need help and we need to help. We must give and we must receive. We must be vulnerable and relinquish control at the same time that we must make sense and out of and find manageable patterns in our personal and shared chaos. We must be intimately human and recognize the power of building a healthy tribe. We must stay the course, burn through the “burnout” pain in the messy middle and grow and remain relevant in the conversation of life. Peace, contentment, and enough are our elusive goals. Let us achieve them together…
Author
Amen, Bill. Beautifully articulated.
I’m chuckling reading the comment about opening an ice cream store.
I did just that. An Artisan Ice cream store.
I’m a veterinarian experiencing who has experienced tremendous burn out. But as you wrote so well, burn out can be a time of change and moving forward .
Thank you for your post!
Author
Kelly,
Artisanal ice cream sounds like the perfect remedy for burnout – and who knew it was so popular? Maybe some Freudian theory of regression in returning to the one thing that never failed to make you smile as a kid?
I’m starting to observe patterns among friends. Burnt out docs want to start ice cream shops. Burnt out lawyers want to start yoga studios.
Any other profession-specific trends you can think of?
Appreciate the moment of levity,
CD