If you have found yourself feeling prolonged exhaustion, growing indifference or cynicism and even regret over pursuing a career in medicine, you may be suffering from the all-too-common phenomenon known as burnout. Unfortunately, you’re in good company. But, the question remains: How to avoid physician burnout?

The American Medical Association’s most recent Organizational Biopsy, which surveyed more than 12,000 physicians, found that 48.2% of responders reported at least one symptom of burnout in 2023.  

What is physician burnout and how to avoid physician burnout?

“Technically by definition, burnout is a psychological syndrome that develops secondary to work-related stress and is characterized by emotional exhaustion, depersonalization and a reduced sense of personal accomplishment,” says Paducah, Kentucky-based otolaryngologist Shawn C. Jones, MD, citing the Maslach Burnout Inventory developed by researcher Christina Maslach and her colleagues.  

The actual experience of burnout may leave you so exhausted, however, that you have trouble identifying these exact symptoms. In fact, you may feel nothing at all.

“I woke up one morning and realized I wasn’t ‘feeling’ anything,” says Jones, who chronicled his own burnout in his book, Finding Heart in Art: A Surgeon’s Renaissance Approach to Healing Modern Medical Burnout. “I was experiencing alexithymia and was completely unable to identify or feel anything in the way of happiness or sadness, anger or calm. I felt no connection to anything—myself, my family, my associates, my patients. I felt completely disconnected from the world around me.”

Another way to understand Maslach’s burnout description is as a complete depletion of your physical, emotional and spiritual energy accounts, says Dike Drummond, MD, a family medicine physician turned physician coach based in Tacoma, Washington. Physicians, he says, are particularly vulnerable to burnout because they’re trained to keep going even after their energy is depleted. 

“What happens when the Energizer Bunny’s battery runs down? He stops. When did any doctor ever stop?” asks Drummond, founder and CEO of TheHappyMD.com and author of Stop Physician Burnout: What to Do When Working Harder Isn’t Working. 

That bone-deep exhaustion often leads to the depersonalization or cynicism and sense of inefficacy that Maslach described. “When you get to that exhausted state, you start to protect yourself from your organization, from patients, even from your colleagues, and that shows up as cynicism,” says California-based family medicine physician and healthcare consultant Paul DeChant, MD, author of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine. “And then the sense of inefficacy feels like, ‘I’m working so hard, and it doesn’t feel like things are changing at all. Is this really worth it?’”

This sense of inefficacy may even manifest as regret over ever pursuing a career in medicine and occasionally may lead to walking away from the medical profession altogether. 

“Every time I went into work, it felt like somebody was choking me…a real, powerful, physical sensation,” says Drummond of his own burnout, which he experienced after 10 years in practice. “So I took a one-month sabbatical, shaved my head, did a bunch of yoga, didn’t do anything medical and hoped it would go away when I came back, but it recurred the instant I walked back into the office. [So] I went back into the CEO’s office, and I signed my resignation…which I don’t recommend as a transition strategy.”

Drummond has gone on to work with more than 40,000 physicians and 200 organizations on burnout prevention. 

What causes physician burnout? 

To understand burnout, it’s important to recognize what isn’t causing it: you.

“The prevalence of burnout in physicians speaks much more about the current state of healthcare and the conditions under which doctors practice than it does about the physicians themselves,” says Jones. 

Maslach’s research identified six key drivers of burnout. “The first driver is work overload,” says DeChant. “That’s not a big stretch. We could all figure that if I work too hard, I’m going to get exhausted. [But] there are these five other drivers that most people don’t consider, and those include a lack of control; …insufficient reward, recognition or appreciation; breakdown of community and connection; absence of fairness and lastly, values conflicts.” 

DeChant reiterates that these are management problems, not provider problems. He would know—after 25 years in practice, he became CEO of the Sutter Gould Medical Foundation and eventually went on to his current role as co-founder and principal of Organizational Wellbeing Solutions, a consultancy that helps healthcare organizations create healthier workplaces. “Those five drivers actually have everything to do with how that organization is managed,” he says.

As for the causes of his own burnout earlier in his career, DeChant cites an accumulation of responsibilities that had nothing to do with caring for patients—a kind of death by a thousand administrative duties. 

Interestingly, even before physicians become attendings, many have already been primed to burn out. “We get trained how to burn out in residency,” says Drummond. “It’s a survival contest.” 

Thankfully, however, there are strategies that physicians and organizations can use to balance the burn. 

What physicians can do about burnout

When it comes to combating burnout, the ideas of strategy and balance are key. 

If you’ve noticed the telltale symptoms in yourself, an important step in recovery is simply calling burnout what it is and seeking help. 

“The first step would simply be to accept what has happened and acknowledge where you are,” says Jones. “I believe that you would be best served by speaking to a professional: a mentor, a coach or a counselor/therapist, etc.” He also recommends taking care of yourself physically, mentally and emotionally through nutrition, exercise, mindfulness and personal connections and then asking what needs to change about the way you’re working. 

In that same vein, Drummond recommends crafting what he calls the “ideal job description” to begin working toward. 

“I want to know, in an ideal world, what kind of patients would you be seeing? For what kind of things? For what kind of hours? And what kind of pay? On what kind of team? And what kind of organization, where in the world?” says Drummond, who advises physicians to write down their description and date it.  

He then advises physicians to create a Venn diagram so they can visualize the overlap between their current job and their ideal one—and then to make a second list. “This one’s called your ‘Master Plan,’” he says. “Sit down and think of everything you would change about this practice to make it more ideal.”

Next, he says, it’s time for baby steps. “All you have to do is pick one of the things off of the Master Plan and do that different thing,” says Drummond. “And because you’re taking a new action, you’ll get a new result that is highly likely to lead you to a higher satisfaction score. Baby steps are best—little tiny things that you can do that’ll make a little tiny difference in how you feel.” 

What employers must do about physician burnout

The bulk of what’s required to combat the burnout epidemic, however, falls at the feet of healthcare higher-ups. 

After his own experience of burnout, DeChant was given the opportunity to improve physician wellbeing from the top down when he became CEO of Sutter Gould. “I had a real opportunity to make a difference,” he says, “so we launched a transformation for this 300-physician, $300-million-revenue group with a theme of returning joy to patient care.” 

The transformation required finding alignment between what took place in local offices and the success of the organization as a whole. “Every health system has a dashboard—metrics of patient satisfaction, access, safety, quality, financial stewardship, experience for the patients, for the doctors and for the staff,” says DeChant. “[We focused on] finding ways to directly connect the activities that took place in the office, essentially process metrics that people had control over locally to what we were pursuing at the dashboard level and helping people learn how to make those changes and drive improvements in each location.” 

Five years later, Consumer Reports recognized his organization as the top performer among 170 medical groups in California, and internal physician satisfaction had risen to the 87th percentile. 

“It demonstrated the power of leading in a different way,” says DeChant. “[We worked] to really empower people to be able to take control in their local offices and make a difference.”

Jones, too, has parlayed his personal burnout into a role that allows him to change the culture of medicine. Now the medical director of provider wellness for Baptist Health Medical Group, Jones works to address burnout and promote professional fulfillment on an organizational level. This has included implementing a medical assistant optimization program, integrating Kentucky’s prescription reporting system into Epic, introducing Ambient AI into office visits, improving EHR training and efficiency, implementing yearly surveys and more.  

“When we do this work that actually makes things more efficient, we also reduce burnout,” says DeChant.  

Recognizing and responding to colleagues’ burnout

Another likelihood in a still-broken system is that you will at some point notice the signs of burnout in a colleague. 

“It’s actually much easier to recognize in a colleague than it is in yourself,” says Drummond. “What you’ll see if you’re watching [is that] their affect changes. …Their energy level changes. And what ends up happening is that they’re just dragging themselves from patient to patient, just doing anything they can to get to the end of the day.”

At each burnout training, Drummond gives attendees a protocol for reaching out to a suspected sufferer of burnout. It begins by asking to speak to them somewhere private.  

“You can’t be in a Plexiglas nurses’ station. …You’ve gotta go into a broom closet or something,” says Drummond. “Literally put your hand on your head and mime that you’re taking a hat off and say to Chuck, ‘Well, Chuck, first of all, I’m taking my doctor hat off now. It’s just you and me, heart to heart. I’ve been watching you, and I’m concerned. How are you doing?’”

Drummond says to expect intense denial at first. Many burned-out physicians will say they’re fine and may even act belligerent. When this happens, he recommends being persistent and following up every two weeks. “You did not make a mistake,” says Drummond. “Because what signal did you send him? ‘I’m awake. I’m noticing. I’m wondering. I’m a shoulder to lean on. I’ve got your back.’” 

How to avoid physician burnout and the job search

Of course, what’s even better than recognizing and recovering from burnout is preventing it from the get-go. If you’re in the midst of the job search, an awareness of burnout and its causes can help you choose a healthy employer.  

This is another situation in which Drummond recommends referring to your Ideal Job Description, which will help you identify which types of roles and environments would recharge you and which would drain you. When considering an opportunity, he advises physicians to again evaluate the overlap in the Venn diagram between that job and your ideal. “If it’s not 70%, walk away,” he says.

Residents are familiar with the process of med school and residency applications. “In that case, it was only just ‘Pick me, pick me, pick me,’” says Drummond. “[Don’t] take that same mentality into job search. It’s not about them wanting you. It’s about whether or not you want this opportunity.” 

Speak to other physicians and shadow them if possible. Ask about their workload—whether they really take their vacation, recent turnover and even their own burnout. 

The future of the field

Despite the prevalence of burnout, the tides may be starting to shift. In fact, though nearly half of physicians reported burnout symptoms to the AMA in 2023, that number was down nearly 5% since 2022 and nearly 15% since 2021. 

“I see more organizations paying attention to it—not just offering resilience support, but actually starting to address the key factors, the inefficiency in the office and working at tangible ways to fix that,” says DeChant. “There’s some that are excellent at it, some that aren’t even started on the journey. But the gradual movement of it is really beginning to change things.” 

Additionally, as DeChant, Drummond and Jones all demonstrate, there is life on the other side of burnout, and for all three, it has included getting to improve the well-being of other physicians. 

“We have to begin to foster a culture where healing our healers is a priority not an afterthought,” says Jones. “We need physicians who are wellness champions throughout the delivery system to care for patients as well as each other and [to] hold the systems accountable for meaningful change in that regard.” 

If you’re recognizing burnout in yourself, remember that this may be the turning point in your story as a physician, not the end of it. 

“At any point in time, any of us has the ability to pick up the pen and write the next chapter of our lives,” says Drummond. “If this job is what’s getting you down, I encourage you to immediately make the mindset shift into thinking, ‘This job is just a bridge for me. It’s not where I’m going to stay. This is a bridge to a better place, and I’m going to work on figuring out what that better place is.’” •