Can you imagine practicing as part of a coequal “team” that includes orderlies and nurses? Where your treatment orders are relegated to suggestions? Where if you object to a lack of follow-through you’re asked why you even care?
And yet, despite all this, you’re still responsible for patient outcomes?
This is exactly where psychiatrist Jay Bauer (not his real name) found himself at a North Carolina hospital from 2000 to 2003. “The doctor has to take all the medical and legal responsibility, and he’s responsible for how everyone else performs their jobs, with no authority,” he says. “I felt like I couldn’t tell them what to do without getting into trouble. It was an awful trap.”
So awful, in fact, that he quit — but not before developing non-Hodgkin’s lymphoma and other serious health problems that have kept him from practicing to this day.
Extreme? Maybe. But hardly unheard of. John-Henry Pfifferling, who has counseled hundreds of burned-out physicians as the founder and director of the Center for Professional Well-Being, estimates that “80 percent of doctors will go through the burnout process at some point in their careers.”
But it doesn’t have to be this way. You can protect yourself. Know the facts and learn the skills before you begin to wonder if you still love being a physician.
At risk, right from the start
As a physician, you’re more likely than most to have personality traits that put you at greater risk for burning out, even as they may make you a better doctor. Among these:
Idealism — For most, the decision to become a physician is more of a calling, based on a strong desire to help people, than a career choice. “Idealism brings you to caring, and then you want to achieve all the academic accomplishments,” says Pfifferling. Unfortunately, many new doctors are unprepared for the realities of practicing medicine in the United States.
Perfectionism — As a doctor, you are inclined to be a perfectionist — for obvious reasons. Yet this tends to make you extremely self-critical. In short, good enough is just not good enough. “We keep trying to emulate an impossible role,” says Pfifferling. Gynecologist James Haley of Acworth, Ga., concurs. Having suffered through his own burnout last year, Haley says his quest for perfection is the norm among his peers. “There are few physicians I know that don’t shoot for perfection in what they do,” he says. “They expect it of themselves and so does the general public.”
Independence — Physicians tend to reject offers of support, often feeling they must project an image of strength and infallibility, says Pfifferling. “If we show any need for help, then we’re not good doctors.”
People-pleasing — An inability to say no is prevalent in physicians, particularly those in primary care. The result? You quickly become overburdened and overworked.
Work/life imbalance — The sustained pressure of practicing medicine often monopolizes a physician’s attention, leading to a skewed view of success by confusing professional and personal achievements. This results in a psychological phenomenon known as enantiadromia — a sudden, extreme transformation into an opposite state; in this case, passion becomes burnout. Swiss psychiatrist Carl Jung refers to this as “life’s contradictions” — love vs. hate or thinking vs. feeling. Failing to honor opposite aspects to being human puts a person at serious risk of imbalance.
Emotional detachment — Dealing with suffering and death is a reality of practicing medicine. Many physicians mistakenly feel they must distance themselves from their emotions and always be strong for others. This is unhealthy. “You’re not supposed to get out of medical school with your feelings intact,” says family physician Pamela Wible of Salem, Ore.
“Pedestal-itis” — Pfifferling concocted this term to describe a common physician mindset. “They get told, ‘You’re special’ from pre-med on,” he explains. This ego-stroking is necessary, as the student can draw strength from the knowledge that he’s got the chutzpah to make it through his education, but also debilitating, because requesting help becomes beyond embarrassing.
