As I have embarked on a new adventure as a physician, I'm beginning to understand just how burnt out I had become in general pediatrics. Now that I am focused on integrative and functional approaches to patient health, I have found myself more engaged and focused than I have been in years. I have pleasantly discovered that I enjoy spending the time analyzing my patients' nutritional status and complex genomics to create a personalized plan of action for them.
So, the question to ask yourself is: Are you bored with your practice life?
After a while, any profession will have a good deal of repetitive situations. After all, that's what gives someone expertise in their field. The first warning sign of burn out is when you no longer feel challenged by the patients you see. I always loved the days when I saw new presentations of medical conditions or when I had to say "I don't know…"Those situations pushed my intellectual curiosity and gave me the courage to dig deeper.
I think that is why in my career, I have moved through a series of areas in which I became knowledgeable ranging from breast feeding specialization to pediatric obesity to business operations. Each of these started with being frustrated at not knowing what to do with specific situations, but probably arose from being bored with the "same old, same old" and the need for new challenges.
But boredom alone is not responsible for burnout. I think being trapped in a practice (because you own it) and having extreme financial burdens, from personal debt to responsibility for your employees' income also plays a big role.
Owning and running a practice requires a physician to remain in one place. Once you become an owner, you no longer have the mental freedom to dream about joining Doctors Without Borders or simply relocating to another location that has better weather. It's terribly difficult to just walk away and start over. When you start thinking of your practice as a ball and chain, you must consider whether burnout is setting in for real.
So, what can you do? Lots!
Only you can decide if boredom is a factor. If it is, find a new area of practice in which to become educated. You don't have to know exactly what, just start somewhere and see where it leads. Last year, I was not sure what I wanted to do "when I grow up," but I started learning more about functional medicine, became more knowledgeable in nutrition and microbiome specifics as well as started to earn accreditation in medical management. In the process, I have discovered new areas of fascination as well as realized that I need to drop some of the paths which I had started. One of my favorite quotes is from the artist Chuck Close:
"The advice I like to give young artists, or really anybody who'll listen to me, is not to wait around for inspiration. Inspiration is for amateurs; the rest of us just show up and get to work. If you wait around for the clouds to part and a bolt of lightning to strike you in the brain, you are not going to make an awful lot of work. All the best ideas come out of the process; they come out of the work itself. Things occur to you."
As for feeling trapped, allow yourself to think outside the traditional box. Write down all your responsibilities, especially all those beyond direct patient care. Carefully analyze which of these you can delegate to others or even outsource. You don't have to micromanage every piece of your practice! As a primary-care practitioner, I refer to other specialists when it is out of my knowledge or experience base. You should consider doing this for the business side of your practice.
Another thing to carefully assess is whether you have too many staff members, which always pressured me with the need to keep everyone employed. You don't have to let people go, but consider whether you really need to replace employees that leave.
Lastly, do you need a sabbatical? A sabbatical is NOT just a vacation. It is a rest or respite from work often ranging from two months to one year. If you cannot take this lump sum of time, consider using some vacation time to get started on your personal journey then schedule time every week for continuing your exploration. Sabbatical comes from the word Sabbath, which quite literally means "ceasing"; it is the one day out of the week in which no work is done. This becomes your private day and you must hold this day as sacred for yourself to explore something other than finishing your office notes or working on schedules/budgets/human resources!
I didn't think that I needed one but that is exactly what happened, due mainly to some medical issues. I am now grateful for the time away from the daily grind of a practice. It gave me time and space to consider what is important for me in my future. I also learned precisely what I missed from my previous practice life as well as what I most certainly didn't miss!
Start to recognize the signs of burnout and take steps now to avoid having a crisis in your own life. It will extend your years of practice as well as increase your joy in the extreme privilege of being able to impact the health and lives of your patients.