Burnout is a complete mental and physical collapse from overwork. Psychiatrists define it as “a job-related dysphoria in an individual without major psychopathy.” Which means—your job sucks. You’re normal.
When your job is sucking the life out of you, deep breathing won’t save you. Mindfulness is not the solution. Emancipation is. Burnout is a diagnosis of oppression that blames you, not the perpetrator. You’re just not fast enough, smart enough, dedicated enough.
Guess what? It’s not your fault.
Remove the smokescreen. You’re a healer not a factory worker. I walked away from churn-and-burn medicine to be a real doctor. Follow me. And be free.
Pamela Wible, M.D., has helped hundreds of physicians reclaim their happiness and their careers. She has been named the 2015 Women Leader in Medicine for her work on medical student and physician suicide prevention.
This is an email subject line from a doctor. Letter published with permission.
Hello Pamela
I have become so disillusioned with medicine. I do not know who to talk to any more or what to do with my life.
I work one week a month in the ICU. I spend the other three weeks of the month in an outpatient clinic. This is a nightmare. The Electronic Health Record they have in place makes me so slow and inefficient I want to scream when I come to work everyday. They want me to see new complex pulmonary consult patients on the hour every hour. Frequently, just to review their imaging, labs and special studies takes 15 minutes before I even walk in the door to meet the patient. Today I saw 8 new patients in eight hours. I need at least 60 minutes per new patient and a buffer of at least 15 minutes between patients to complete my EHR charting. I am so frustrated and just want to walk away but where does one go. It is the same everywhere now in the USA. EHR’s and conveyer belt, output-driven medicine. I feel trapped and betrayed. I did not go to medical school to sit on my butt for four to six hours a day doing data entry in a computer.
I feel so deflated and trapped. Have to work to pay for the kid’s college and have health insurance for them and yet there is no joy in the work anymore. I find the hospital and the ICU more stimulating but the pace and the hours are brutal. Therefore, I decided to give this more lifestyle friendly version a try. My hours are meant to be 8am to 5pm but I arrive at 7am and leave at 7pm to try and keep up with the EHR communication method and clinical charting. I get every Monday off but it does not make up for the frustration of the four days I do spend in the office.
I know I am being extremely negative and I can not seem to see the forest from the trees. I have lost my joy and my soul is sad. I never used to feel this way about medicine.
Any suggestions Wise One ??
Wise One to Sad Soul:
1) You are not alone! You’re having a normal reaction to an inhumane health care system—a sad soul.
2) People don’t complain about things they can’t fix (like gravity). You complain about EHRs and assembly-line medicine precisely because you know there’s a better way.
3) The real problem is—us. Yes. Doctors are to blame. We’ve relinquished control of our profession to those with divergent ethics. We’ve allowed ourselves to be abused en masse. You can’t be a victim and a healer. Choose one.
4) YOU can free yourself from the paper chains.
5) A dysfunctional medical system can only exist on the backs of disempowered physicians—the precursor of which is abused medical students.
6) Medicine is an apprenticeship profession. Liberate yourself and you liberate the next generation of doctors.
7) If you do not know who to talk to any more or what to do with your life, start hanging with happy docs. Can’t find happy doctors? Click here to meet some.
~ Pamela
P.S. Anyone else with advice for sad doctor? Please leave your comments below.
Pamela Wible, M.D., is a pioneer in the Ideal Medical Care Movement. She has helped hundreds of physicians reclaim their happiness and their careers at her physician teleseminars & retreats. Dr. Wible has been awarded the 2015 Women Leader in Medicine.
I just got to hang out with a graduate of my physician retreat, Ann Cordum, M.D., who now has a successful ideal medical clinic is Boise, Idaho. Here’s what Ann has to say about her new life:
PW: So this is your office!
AC: This is my office in Boise, Idaho! Ya!
PW: So tell me what it is like here working for yourself.
AC: It’s night and day different from before. It’s awesome! I am walking distance from my house or we can ride our bikes. We are open the hours that are convenient for us, by appointment. So life is really good. I have a partner, Kristen Fiorentino, M.D., and we exercise in the morning and then come to work. We’re happy! It’s totally different than routine clinic medicine. We actually get a lunch break. We go to business lunches with colleagues. We are ready for our patients when they walk in.
We often greet them in the parking lot and walk them in, especially the older patients, serve them tea and coffee. We do all that ourselves, Take them back. Do their vital signs, see them, take care of them, check them out ourselves, and I think they’re pretty happy, and then they refer other people if they have a good experience, which most of them have.
So it’s ramping up. We’re only in month 6. So we still have a ways to go, but I am actually pretty confident that it’s going to work. It just feels good. It has good energy. And I’m rested. I feel happy.
PW: So what was it like before? Had you always been an employee?
AC: I had always been an employee or contract worker. Ya know, up and down before. Lots of fatigue before. Times of cynicism and feeling beat down. I guess one of the biggest things that’s different is I don’t have that rushed feeling anymore. Ya know, ya gotta get them in, ya gotta get them out, you’re running behind, stressed feeling just doesn’t happen anymore and that’s probably the biggest improvement in my life because it makes me feel joyful about what I’m doing and I think the patients pick up on that and they feel more relaxed. You can have all the technology in the world, but if you don’t have a doctor that has time to relax and listen and spend time with you then I don’t think you’re going to get a good quality visit.
PW: What do the patients think? Are you noticing different interactions with patients? The way they are receiving you or responding to you?
AC: Totally. Totally. Lots of comments like, “Wow! This is so different. Feels like I’m in a house. Doesn’t feel like I’m in a clinic.” When they call us with a question, we either pick up the phone ourselves or we call them back personally and they are kind of blown away because they don’t get that [elsewhere]. So really good feedback from patients.
PW: What about in your personal life? Has this had any side benefits being your own boss?
AC: Unbelievable side benefits. I actually love working for myself. I love the business aspect of it. Total sense of control, sense of autonomy, sense of peace. Collaboration with my colleague who is phenomenal and some other independent colleagues in town so it just feels like I should have done this 20 years ago, ya know, and that’s a good feeling.
I hope more doctors do this because I think this is the way it is meant to be. It’s much more natural. It’s why we all went to medical school I think to be able to really listen to patients and honestly if you just listen, you don’t have to have anything fancy. Just listen and you will get them figured out for the most part . . .
PW: So has your husband or kids noticed differences in you? Your family?
AC: Family and friends just notice that I’m happier and healthier and I think that’s a big bonus too because my health, my skin, I don’t feel moody anymore. I don’t cry anymore. I don’t cry anymore. I used to cry all the time just tired and fatigued and irritable. I feel at peace and rested. Sleep is huge. Sleep is huge. I can get the sleep that I need. And get the exercise that I need. And good nutrition. And we can share that with other people.
PW: Talk about your sleep before and after.
AC: Oh my gosh! Sleep before was fragmented a lot of the time and never consistent, and I was on sleeping pills for 7 years. It just wasn’t healthy and now no problem sleeping and I allow myself 7.5 to 9 hours per night, which is what I finally figured out is what I need to be healthy and productive and with that I feel like I have more energy and can give more to my patient. Another side benefit is I love medicine and I have noticed a complete turnaround in the last 10 years. Ten years ago I thought I’d never practice medicine again and I love it now and I want to do it for the next 15 or 20 years, but I want to do it in a way that is congruent with my values and what I think my patients want.
PW: And just to clarify, are you on sleeping pills now?
AC: No. Got off of them about 6 to 8 months ago. Completely.
PW: Wow!
AC: Yeah.
PW: So other health benefits? You say you feel peaceful. What was it like before and after?
AC: There was just a lot of anxiety and angst and bitterness before and now I feel at peace and calm and I see a lot more joy in day-to-day interactions. I’m just happier and then I think other people sense that and then they’re happy and calmer. before I used to feel more anxious and distraught and I think that energy bounces off and the patients pick up on that and then they get anxious.
PW: So why do you think more doctors aren’t doing this? You’ve had a big turnaround. You’ve gone from not needing medications to being able to be a real doctor and be present for your family and your kids. What do you think is holding doctors back?
AC: I think fear is holding doctors back. And status quo is holding doctors back. I think new docs and older docs alike have almost accepted that, “Oh my gosh we’ve got to be in an employed model. That’s just the way things are going” and, sadly, that has gotten worse and worse and worse. More meetings about production and bonuses and incentives and how many patients can you get through and then we’re discontent on the side of the doctors.
I would encourage people to step out, take that leap of faith if you’re ready, when you’re ready, and have peace and confidence that it will work out and—it will probably save your life—and save the lives of your patients. I hope more people do it.
PW: What would you say is the one thing that helped you get going or made this feel like it was possible for you?
AC: I think part of it is a timing thing and a personal growth. You have to go through a process of realizing that there’s an issue and it’s not good for your health. Maybe doing some introspection or counseling or writing or whatever it is for you to decide hey, I need to take charge of the direction of my life because this is not good for me or my patients. and then connecting with other people like you who are happy and have a vision and give you the confidence that you can change your life and only you can do it. Nobody else is going to do it for you.
PW: Did it help to be around a lot of other doctors doing this at the same time?
AC: It did. It definitely did. And the other thing I did is just reached out into other sectors of our society. I watched a ton of TED talks when I was going through this transition and got myself motivated and realized that you need to be creative and when you’re sleep deprived and angry and in a system that doesn’t allow you to breathe or move or think out of the box you’re not going to be creative and if you allow yourself to become healthy again and at peace, then creativity comes out and anything is possible with creativity.
PW: So to wrap up what your vision is from here into the future, like if you could have anything and this office could go the perfect direction, what would your life look like for you maybe 6 months, 2 years from now. What would this be like?
AC: So my vision is to have this place, this space, be a healing, calm, peaceful space, and I think it already is, but I hope it just grows a little bit more. I don’t want it to be crazy and chaotic, but I want it to be a place where people come and feel safe and come hang out and get their health care. They can get their massage upstairs and get their acupuncture from the gal upstairs or Kristen and get their traditional care with a focus on prevention and wellness. And do more of my walking visits which I’m starting to do which are fantastic!
PW: Tell us about that.
AC: Yes, so once I’ve established with a patient, if I feel like they are ready to take on a healthier lifestyle then instead of sitting in the clinic for 30 minutes or 40 minutes or 20 minutes, I have then bring their walking shoes or running shoes and I keep mine here, and we go 3 blocks to the trails and hit the trails and do our visit out there. It’s wonderful! They love it. I think it benefits them a lot more than just sitting in an office.
PW: Sounds awesome. So you’ll do more of those.
AC: I want to do more of those. I just want to have that balance. I want to ride my bike more to the clinic instead of driving and slow down the pace a little bit so that I have time to do that and be able to model health to our patients.
Pamela Wible, M.D., is a pioneer in the Ideal Medical Care Movement. She has helped hundreds of physicians open ideal clinics through her physician teleseminars & retreats and has been voted the 2015 Women Leader in Medicine for her contributions to medicine. Photos and video by GeVe.
How do we care for the people who care for us? As doctors, we’re immersed in pain and suffering—as a career. We cry when our patients die. We feel grief anxiety, depression—even suicidal—all occupational hazards of our profession.
A recent Medscape article on Physician Health Programs suggests that the people who are here to help us may actually be doing more harm than good. And they may even be increasing physician suicides.
Both doctors I dated during medical school died by suicide. Eight physicians killed themselves in my town alone. I’ve become a specialist in physician suicide. My cell phone has turned into a physician suicide hotline. And I have a stack of physician suicide notes that I keep at home. Here’s one of them:
Dear Some, My family, I love you. To others who have been good friends, I love you too. This is just the end of the line for my particular train. Earth wasn’t a great place for me. We’ll see what else is out there. Will miss you all. I’m sorry for what it’s worth. Love Greg.”
On June 22, 2012. Dr. Greg Miday killed himself—12 hours after being told not to follow his psychiatrist’s safety plan by the Physician Health Program that controlled his medical license. Sober for years, he relapsed just before his death. A brilliant clinician, never impaired at work, Greg drank to cope with anxiety.
Afterwards, 2 interns jumped to their deaths from New York hospitals (the same week within 3 days of each other, I believe). Greg’s mother, a psychiatrist, sent this letter to the editor of The New York Times:
An unacknowledged predicament for physicians who identify their struggle with substance abuse and/or depression is that they are often placed under the supervision of their State Medical Board’s Physicians Health Program. My son, Greg, was being monitored by such a program. He took his own life at age 29, one week before he was to enter an esteemed oncology fellowship. His final phone calls were to the Physicians Health Program notifying them of his use of alcohol while on vacation, a disclosure he had previously described as a ‘career killer.’ These programs, which often offer no psychiatric oversight, serve as both treating and policing agencies, a serious conflict of interest. Threatened loss of licensure deters vulnerable physicians from seeking help and may even trigger a suicidal crisis. Medical Boards have the duty to safeguard the public, but the assumption that mental illness equals medical incompetence is an archaic notion. Medical Boards must stop participating in the stigmatization of mental illness. We cannot afford to lose another physician to shame.
Greg Miday, M.D., and his mother, Karen Miday, M.D.
Our medical schools, hospitals, and clinics actually cause or exacerbate mental health conditions in physicians, and then they blame us and force us to release our confidential medical records. And in the end, they take our license. . .
Maybe that’s why my friend, an excellent psychiatrist, drives 200 miles out of town, pays cash, and uses a fake name to get mental health care.
And another physician friend who was deemed “too slow” [seeing patients] by her residency director, was sent to a psychiatrist who diagnosed her with mild OCD (don’t we all have mild OCD if we are thorough physicians?). Well she was actually then sent to the medical board who referred her to a Physician Health Program that mandated an AA-style substance abuse program—which makes no sense at all since she does not do substances. She doesn’t drink or smoke.
So who the hell is protecting us from being misdiagnosed, mistreated, and abused?
There are many who prey upon physicians. So who cares for doctors?
And how in the world can we give patients the care we’ve never received?
Pamela Wible, M.D., is a pioneer in the Ideal Medical Care Movement. When not treating patients, she dedicates her time to medical student and physician suicide prevention. Dr. Wible is the recipient of the 2015 Women Leader in Medicine Award. Video by GeVe. Photos courtesy of Miday family.
“Medical school is a great anti-mentorship program. You meet a lot of doctors you’d never want to become.” That’s what med students keep telling me.
Mentorless medical students?
I had no idea. Until students started shadowing me. Many also volunteer at hospice and free clinics. I asked one gal, “You must meet a lot of wonderful doctors there. Right?”
“Not really,” she said, “Doctors are on automatic pilot as they try to navigate through a staggeringly high volume of patients. It’s so disheartening. And what’s worse, everyone I speak with says, ‘That’s just the way it is. It is too expensive, difficult, and risky to go into private practice anymore. You can’t be a solo doctor in this day and age.’ After meeting you, I know there is another way.”
“You haven’t worked with solo docs?”
“No. I haven’t met anyone else who has escaped our broken system to practice medicine as it should be practiced—on a personal and human level. I was worried that I was having childish delusions of grandeur by thinking I could actually practice medicine in such a way in today’s climate. I worried I’d go through med school and residency only to find that in the end there was no refuge from our inhumane health care system. I’m here because there are no tools or mentors to help me be the doctor I’d like to be.”
Medicine is an apprenticeship profession. We learn by watching doctors around us. Sadly, many aren’t happy. Most docs I meet have been victimized for years. Many think they’ve got “burnout,” but physician burnout is really physician abuse. Hint: No amount of deep breathing, meditation, yoga, resilience training will make your crappy assembly-line job joyful. Cut your losses, get a real mentor, and move on.
So how do you find a mentor?
Look for doctors who are doing what you want to be doing and hang out with them—now! If you want to be a happy doctor treating real patients, your mentor should be a happy doctor who is treating real patients. If you take business advice from cynical doctors who are depressed—you’ll be getting career advice from depressed cynics, if that’s what you want. Warning: if they’re not happy successful doctors seeing real live patients, how can they help you become a happy REAL doctor?
The right mentors are practicing medicine the way you want to practice medicine. Beware: there are many physician gurus, authors, speakers and burnout specialists out there who are no longer practicing medicine—because they “burned out.” Would you choose a divorced marriage therapist who has never had a successful marriage? Avoid advice from people who have never done what you plan to do.
Pamela Wible, M.D., founded the Ideal Medical Care Movement. She has been awarded the 2015 Women Leader in Medicine by the American Medical Student Association for her inspiring contributions to medicine. Contact Dr. Wible. She loves to hear from med students and docs.
