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Medical Burnout

medical burnout

As someone who works with those in the medical profession to help organize their financial lives, repay student loans, and invest wisely I felt it necessary to address burnout within that community.  Those who work in the medical field face some unique and some universal factors that affect burnout, so it is important to know what these factors are and how they can affect you. For this entry I will look at what burnout is and ways you can experience burnout, some of the causes of burnout, as well as ways to fight against burnout.  I want to finish this article by addressing some of the stigma around burnout and why medical professionals are uniquely susceptible to feeling its effects. 

What is Burnout?

Burnout can be tricky to pinpoint as it manifests itself differently in every individual.  While I will address the stigma of burnout at the end, it needs to be pointed out that burnout symptoms have many similarities to depression.  Like depression, burnout is the feeling of exhaustion you get when you have been working under stressful conditions without the ability to effectively handle that stress.  Part of what makes burnout so problematic is that it is not simply about taking away the stress factors, it also requires effective stress management to overcome. This means that if you are experiencing burnout it will likely require working on yourself, which is not always easy.  

Burnout affects your mental health and the enjoyment you get from life and your work which can lead you to abruptly change careers and abandoning the medical field altogether.  While often overlooked in the medical field due to the mentality of sacrificing yourself for the well-being of others, burnout can seriously disrupt your life and derail your career.  From the physicians and nurses that I talked to in preparation for this article, burnout has become increasingly common and needs to be taken more seriously by those in charge of the healthcare systems.  

Ways to Experience Burnout

I mentioned previously that burnout has many similarities to depression which means that feeling burnt out can be the same as feeling depressed.  That being said, everyone experiences burnout differently and it can simply be that you feel drained throughout the day, or it could be something as serious as being disinterested in your work.  This disinterest in your patients can lead to mistakes or reduced care for those who are truly in need. Burned out providers and nurses can also increase the likelihood of medical complications for patients and lead to serious and potentially fatal circumstances.  I do not necessarily want to over-dramatize the effects of burnout, but I do want to convey that burnout can have serious implications not just for the healthcare provider but for their patients as well.  

Another way that burnout can rear its head is through substance abuse and dependency.  Many in the healthcare field come home after a long day and don’t have other ways of unwinding so they turn to alcohol or other substances in order to fight their feelings of depression and burnout.  This chemical dependency and substance abuse can not only increase feelings of burnout and depression, but lead to many of their own problems as well. While it may be ok to have the occasional glass of wine or beer after a long shift, getting blackout drunk to escape the stress of work only ends up compounding the issues you will end up facing.  Because of how serious these issues can become, it seems odd that relatively little attention is given to the plight of these medical practitioners facing burnout by the healthcare systems that employ them. Unfortunately, given the stigma around burnout and depression, it can be very difficult for those undergoing these issues to seek help or reach out to their peers for insight into how to appropriately overcome this hurdle.  

Causes of Burnout

Just as burnout hits people differently, so do the causes of burnout vary by your job and the system in which you work.  I want to dig into this a bit so that at the very least you can be forewarned about some of the causes of burnout and work to mitigate their influence.  While everyone who is affected by burnout is unique, it seems that the overarching causes of burnout can be distilled into four major categories. There are poor work environments, medical field related stresses, individual factors, and last but absolutely not least is financial stress.  There are plenty of reasons for burnout, but they seem to fit somewhere into those four groupings, so we will look at each one in turn.  

Poor Work Environments

Bad jobs in medicine exist throughout every level of the system, whether you are a nurse, physician’s assistant, physician, or anything else the one unifying factor is that there are terrible jobs out there.  For nurses and support staff it may look like a clinic that works for the greater good but is severely underfunded and therefore cannot afford to properly staff the clinic. Regardless of how much you love helping those around you, everyone has a limit to the amount of work or the amount of patients they can handle.  If you work in such a clinic, the general path they take is to continue overloading their staff in the hopes that it brings in more money. While this may make sense for the clinic, ask an overworked nurse if they feel a high level of job satisfaction and you will mostly get an answer like “I can’t wait to get out of here.”  This type of work environment can make the profession of healing a grind fueled by business concerns which can take the passion out of your job. While doing your due diligence before jumping into a job can help screen out those kinds of places, it can be easy to initially overlook or not research those factors because of your desire to help in communities of need. 

Doctors also face poor work environments in the form of the overall changing of the healthcare system.  Speaking with an experienced physician about burnout, one of the major changes she has seen throughout her career is the loss of control over care.  It used to be that doctors were able to have the final word on patient care and were able to make sure that each patient was treated properly. However, that has changed as insurance companies have now claimed more and more control over patient care and dictate the types of care that can and cannot be received by patients.  It can be a very jarring experience to work for so many years to get to a position of perceived control only to find yourself essentially working for an insurance company. This fuels another point the physician made, which was that medicine has turned from a profession of healing into a business. Most of the people I have talked to throughout my life have sought a career in medicine because of a passion for helping to care for those around them.  When you finally are able to take a job in that field and find out that the clinic is simply piling more patients on regardless of support staff or that now an insurance company tells you how to do your job, it can be a painful smack in the face. Therefore, it is no surprise that people who simply want to help others get easily burned out in positions such as these. 

Medical Field Related Stress

While working in a dysfunctional clinic or a hospital system run by insurance companies can wear down even the most tough-minded practitioner, we should also address that simply working in the healthcare field is difficult and stressful all on its own.  Depending on what your specialty is you are being asked to deal with death, trauma, child abuse, incurable patients and more on a regular basis. This secondary trauma can be devastating and can manifest similarly to PTSD. Very few other professions are forced to face mortality in such a real visceral manner on such a regular basis, and that absolutely wears you down.  All of this combined with high costs of maintaining your licensing, malpractice premiums, and the mountains of paperwork required makes working in medicine a very tough profession. For doctors, there used to be time and space to meet with colleagues to de-stress and discuss work in order to effectively deal with the unique stresses of your day. However, with the insurance companies at the helm you are more isolated as you’re forced to fill your time with catching up on paperwork and spend less time creating a collaborative work environment.  

Individual Factors

There are plenty of individual factors that play a part in a person’s susceptibility to experiencing burnout, but I wanted to discuss just a few as I am not trying to create a medical journal.  As I have mentioned, burnout carries most of the same characteristics and symptoms of depression. If we look at some of the criteria for burnout, such as having a loss of interest in your job, potentially turning to alcohol or drugs to relax, and always having low energy then it can be easy to see how there is overlap between burnout and depression.  In fact, depression can simply be masquerading as burnout and no matter what changes you make to external circumstances, there won’t be real improvement until you take the time to work on yourself. While there is certainly a stigma (I promise I will get to that) around depression especially in the medical community, it is far better to address these issues than simply letting them go untended.  While depression and burnout are not the same thing, they can lead to similar places.  

Another big factor is your experience in med school, and how resilient you are to stress.  Most people are relatively good at dealing with stress, but med school and residency tend to push your limits of effectively managing stress.  With not a lot of rest time between medical school and residency and residency and being on your own, the stress can compound over the course of years.  When the years of compounded stress lead you to a toxic work environment, this can all bubble over into burning out. Always feeling like you are struggling just to stay afloat is a terrible situation, and that’s especially true when you are responsible for helping people get healthy.  Many of those who enter the medical field are idealistic about being able to go out and help people, no matter what the circumstances. But, when you finally get through your training and land a job, reality sets in and sets in fast. With the prevalence of bad jobs out there as well as uncaring medical systems, you can become disillusioned with healthcare pretty quickly.

The last individual factor I want to discuss relates to taking care of yourself.  As I mentioned at the beginning, it is not simply the external factors but also your ability to take care of yourself and be resilient.  Medical professionals are notorious for not taking care of themselves in the ways that they suggest to their patients every day. I understand that your schedules are busy and you do not have time for extraneous activities, but the problem I am talking about is choosing not to do things that will help you.  Many people choose not to exercise, or choose not to spend time with family and friends, or choose not to pursue hobbies or non-work activities in favor of taking paperwork home or doing other job related tasks with their free time. There is this mindset that you must give all your time to the profession of medicine and carry that burden on your back.  I can certainly see how this came about and having people in this world who are willing to sacrifice for others is incredible, but there needs to be balance. It makes no sense to sacrifice your own time and happiness to serve others if you get so burned out you quit working after 5-10 years. Instead, focus on yourself when you are outside of work and make sure your happiness and well-being get their fair share of your attention.  

Financial Stress

Last but not least, we have the financial stresses that come with entering the medical profession.  While most of the attention is given to doctors due to their high student loan bills, PA’s and nurses put themselves in precarious situations as well.  First, we will take a look at the student loans because that is usually what is on the forefront of everyone’s minds. For doctors and dentists, you can have upwards of $500,000 in student loans depending on specialty, PA’s can have $200,000 and nurses can have around $100,000-$150,000 depending on their situation.  First of all, these are all high numbers and to saddle those who want to spend their careers trying to heal other people seems broken to me.  

However, these are the numbers many people are working with, which is a steep hill to climb and can wear on your mental health.  This is not even talking about the people who take out this much in loans and then either do not finish their training or who do not match after medical school.  The only thing worse than taking out several hundred thousand dollars in loans is then not getting a high paying job to help repay those loans. For most of the nurses, PA’s, and doctors I talk to the conversation begins with student loans.  When you start that far in the red, the initial conversation is not about how invest properly or make good financial decisions, but more about how to get back to broke. Given the starting point for many who choose medicine as a career, it can be easy to be blinded by that huge loan amount and make poor financial decisions in the pursuit of being debt free. 

The student loan issue is compounded by a general lack of financial literacy being taught, reduced compensation, and the assumption of a large salary which brings a societal expectation that you have a lavish lifestyle.  Many people graduate from their programs and look to immediately upgrade their lifestyles, which can be a trap. This trap is all the more dangerous as salaries are being reduced, especially for those working in primary care.  You are stuck working just as hard to earn less money and less time off, which can lead to feeling burnt out as well as hopeless about a job change. When upgrading your lifestyle, becoming house poor or even car poor can lead to you always being in a cycle of paying off debt which has severe ramifications for your mental well-being.  If you feel as though you are stuck and simply spinning your wheels in advancing your lifestyle, while also being overworked in your career, it can be the perfect recipe for burnout. Making sound financial decisions can help alleviate stress and allow you to focus on other areas of your life.  

Fighting Burnout

So now that we’ve gone through a long list of what burnout is, how it can affect you, and why it is happening, let’s take a look at how to fight back against burnout.  I will go through these in order, and hopefully provide you with some good tips from those who have experienced burnout before. We will start with work environments.

Fighting Poor Work Environments

This can be a bit tricky, but you need to work on doing your due diligence before accepting a job.  What’s the best way to deal with a bad work environment? Don’t work there. I know that is easier said than done, so what about if you do find yourself in a poor work environment?  There are essentially two ways to deal with this situation: you can leave and find another job elsewhere and do your due diligence, or you can try to change the environment. I know that packing up and leaving leads to time spent credentialing and getting licensed, but it could be well worth it to find a job where you are satisfied.  If you want to stay and try to change things at the current job, you are going to have to get really good at saying no. Most times, the actions that cause burnout can be subtle and you do not want to feel like you are letting your colleagues down. For example, taking paperwork home to do for free. That not only extends the hours you are working, but also reduces or eliminates the free time you have to spend with your family or relax.  Maybe your job wants you to be on call all the time. Maybe they are paying you well below what you are worth. There are plenty of ways to create a toxic environment, and saying no is your weapon against it.  

Fighting Medical Field Related Stresses

This one is a lot tougher.  By working in the medical field you have (hopefully) knowingly signed up for a high stress profession.  As anyone who has seen a large bureaucratic body in action, you will know that it can be very difficult to change the system.  While fighting for improvement and better conditions is great, it may not yield immediate results. By devoting time to lobbying for better conditions or trying to improve conditions, it may require you to reduce the time you are putting in at work.  This can be a great way to make changes, but make sure you are in a good financial situation so that you can afford to reduce your working hours. In order to combat the burnout caused by work stress, make a point to support your fellow colleagues. Create a space for everyone to de-stress and discuss work.  Changing the system takes a long time and is a hard fight, so in the meantime focus on ways to lift each other up.  

Working in healthcare can be very isolating, whether you are working long shifts, are forced to take paperwork home with you, or you work through lunch there is a certain isolation that comes with the job.  By focusing on communication and collaboration with your colleagues, you can help de-stress not only yourself, but those around you. I know it seems very difficult to find time to break away, but focusing on yourself and lifting up those around you will pay great dividends to you and your colleagues.  Changing the system is a long, hard process, but making sure that you have time and space to socialize with your coworkers and take time for yourself is a great way to fight off the stresses of working in the medical field.

Fighting Individual Factors

Fighting against some of the individual factors that can lead to burnout is tricky.  It requires knowing what the problem is, understanding how it is affecting you specifically, and then implementing a solution that works for you.  Luckily, you work in healthcare, so you should have ample knowledge of diagnosis and treatment plans. If it helps, separate yourself from the process and look at it as if it were another patient dealing with burnout.  We discussed how burnout and depression act the same way in terms of the symptoms that manifest, so that can be a helpful guide on how to deal with the effects of burnout. Some of the advice I got from experienced physicians were to find hobbies outside of work, take great care not to let work bleed into your home life, and take vacations when possible (especially if there’s a conference happening in that location).  

Another great way to manage burnout is to take stock of what you enjoy about your work and what drains you and work on tipping the scales in your favor.  By spending more time at work doing the tasks that you enjoy, you will be able to get more out of your days. That being said, don’t rely on work to be the only fulfilling aspect of your life, there are plenty of other activities and ways to spend time outside of work that will bring joy and fulfillment.  The common thread to these options is that you need to focus on your own health and well-being while working in a profession that puts a premium on ignoring that in favor of helping others. When in doubt, remember what they tell you on airplanes which is to put on your own oxygen mask before helping others.  Healing is a supremely noble calling, but do not forget to take care of yourself.  

Fighting Financial Factors

Finances are a double edged sword, especially for healthcare professionals as they deal with so much stress already.  If you are in debt and making poor financial decisions it can drag you down like an anchor and accelerate the burnout process.  On the other hand, by making good financial decisions and putting yourself on solid ground can alleviate many of these other problems by being in a position to make changes.  It can be scary to leave a job you hate when you don’t have the money to support yourself for several months. If you have an emergency fund built up, there’s far less chance you will accept a dysfunctional work environment.  Want to change the system? Having your money working for you will allow you cut back on your hours and get involved in fighting for a better system. Are you suffering from burnout or simply want to work on shoring up your ability to deal with potential burnout?  Making sound financial decisions allows you to look for time to exercise or meditate or however you want to build up your own defenses. Obviously making good decisions with your money helps take care of the added stress that money issues bring.  

I have gone into detail about some of the financial decisions to make as you progress through you career, so I will not rehash them here, but by taking control of your financial well-being you can put yourself in a position to enjoy the work you do and have a long career in the field of medicine.  

The Stigma of Depression

I have mentioned several times that burnout acts and looks very similarly to depression, which may ruffle some scrubs.  While a lot of these issues do in fact stem from burnout, there are also cases of depression that should be addressed as well.  I know that it is not easy to admit that you have depression, and that goes doubly or triply so for those who work in healthcare.  There is a stigma that exists about depression that is tough to overcome, and because medical professionals are taught to care for others at the expense of their own well-being, it can be even tougher to admit that you need to focus on yourself.  However, if you take one thing away from this post please let it be that it is ok to focus on yourself. While many of the causes of burnout or depression are out of your control when you work in medicine, there are some that are absolutely within your control.  Take the time to identify what you can change and work on making sure you give yourself and your health enough of a focus to live a happy life.  

It was truly a learning experience for me to talk to some of the physicians and nurses about their experiences with burnout. It can be tough to see people who are so passionate about helping others get overwhelmed by the system, their jobs, or their financial situation and have to leave the healthcare field. If you are dealing with feelings of burnout, take some time and focus on you for a bit, you certainly deserve it. If you are interested in making good financial decisions, please reach out to me and we can go over your financial life to make sure you have a solid foundation.