American College of Physicians: Internal Medicine — Doctors for Adults ®


Five strategies for physicians to overcome burnout

From the March 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

If you've reached the point where you never want to walk into another exam room, it's probably not the right time to rush out and switch jobs.

"When physicians call me and say, 'I'm burned out and I just can't do this anymore,' they're looking at alternative careers for the wrong reasons," said Jennifer R. Grebenschikoff, vice president of the Physician Executive Management Center, a physician executive search firm in Tampa, Fla.

Being burned out is no way to launch a successful new career. That's because even if you change where you work, you haven't dealt with another major factor in burnout: yourself.

"It's a myth to think that you can just walk away from one setting and everything's going to be fine," said Larry Vickman, MD, a former emergency medicine physician in Meridian, Idaho, who is now a consultant on burnout issues.

Burnout is especially tough for physicians because many fall into what Peter Moskowitz, MD, director of the Center for Professional and Personal Renewal in Palo Alto, Calif., and a physician career counselor, calls " 'the John Wayne School of Medicine.' Because we are trained to solve problems ourselves, we unconsciously believe it's a sign of weakness to ask for help." When physicians can't tap into other resources, Dr. Moskowitz said, they end up thinking that they have no alternatives but to quit.

Here are five steps that can help you fight burnout:

  • Take care of yourself. First, take stock of your own self-care program. While you might think physicians religiously practice good exercise, nutrition and sleep habits, "the vast majority don't, in my experience," Dr. Moskowitz said.

    Taking care of yourself includes having fun. When you're under stress, it is more important than ever to stay connected to your family, hobbies and interests.

  • Seek out resources. Take advantage of the many different resources that are available to help you cope with stress. On a personal level, find someone who can be a confidante. If like most physicians, you don't want to talk about your problems with colleagues, find a former medical school classmate, professor or older physician mentor.

    You can also turn to the spiritual community, which has professionals skilled in listening, or to psychotherapy--a field that physicians find suspect, Dr. Moskowitz said. Part of the problem, he noted, is that physicians don't like talking about feelings—especially their own.

    Other professional resources are available, including career coaches or recruiters if you want to change careers, as well as financial planners and attorneys.

    And look for a new College feature this month in the Career Resources section of ACP-ASIM Online. This feature lists recommended books, Web sites and speakers that address burnout and physician renewal.

  • Set boundaries. Take a hard look at your practice and see where you need to draw the line. Perhaps you need to change your hours, your patient load or the number of committees you're on. "It's saying 'no' and learning that other people are better at many of these things," Dr. Vickman said. "Pay them and give them autonomy."

    More and more physicians are also drawing the line on contracts that are unprofitable or otherwise onerous. "Physicians now are able to say, 'I want a smaller practice that really works,' " Dr. Vickman said. "This is the evolution in our system."

    And remember to set boundaries to your professional life, making sure there is more to your life than medicine. "Being a physician should be what you do," said Dr. Vickman, "not who you are."

  • Take a personal snapshot. When you're under stress, it is time to also take a good look at yourself. What are your professional values and passions? What are you skills—and what do you hate doing?

    "Burnout, stress and dissatisfaction largely arise from a mismatch between a physician's skills, values and interests on the one hand," Dr. Moskowitz said, "and workplace expectations on the other."

    Based on that self-assessment, you might want to consider another type of practice. Back in 1997, when he was 54, Seattle endocrinologist Peter T. Capell, FACP, knew he wasn't ready to retire. But after 23 years of practice in a private clinic, he was tired of payment hassles, the crush of productivity, mounting overhead and growing discord between generalists and subspecialists.

    His solution was to leave private practice to do clinical work at the University of Washington School of Medicine, where he discovered that "less is more." He now makes 30% less money, but that's not a problem because his children are out of college and married.

    He has less paperwork and hassles, and his workweek has dropped from 85 to 65 hours. A quarter of that time is spent with residents and endocrinology fellows, a very satisfying part of his new position.

    Most importantly, he is much happier. "I wanted to be the image of the old general practitioner," Dr. Capell said, adding that he doesn't regret his years in private practice. But at this point in his life, academic medicine "is a lot closer to what I want to do."

  • Fight the grass-is-greener syndrome. While these certainly are turbulent times in medicine, a quick review of the stock market's recent highs and lows should convince you that constant change dominates every profession.

    "We've entered a time of continuous whitewater, so physicians have to develop skills that will help them manage change," Dr. Moskowitz said. "They have to expect instability and see change as something that creates opportunity, rather than something to resent."


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