When things began to go awry for Kernan Manion, the Massachusetts physician wasn't sure exactly what was happening to him. All he knew was that his hospital job as the primary counselor for people with new spinal-cord injuries was getting to be too much.

Sure, he liked what he was doing and felt he was providing a valuable service. But at the same time, Manion was feeling worn down emotionally, wiped out physically, and progressively more irritable and distant from his colleagues.

Then his father had a stroke, along with a sudden diagnosis of bipolar disorder; Manion was called upon to assist in his care. And on top of that, the hospital where Manion worked was being sold to a for-profit chain. Layoffs were inevitable.

Manion's breaking point came soon after that, in the middle of a team meeting with a patient. When the other doctors and the patient turned to Manion for his input, he was completely choked up.
"The intensity of the work had gotten to me," says Manion. "I was baked, fried, crisp — and the personal matters were just making things worse."

Manion stepped out of the room to try and regain his composure. In the hall, he wondered if he should quit hospital life in favor of spending more hours with patients in his small private practice. Another part of him toyed with leaving his practice altogether to become a chef, one of his long-held dreams.

Instead, after some soul searching and time with a career coach, Manion decided to stay in the field but shift his focus to helping other doctors who were going through what he had: an acute case of physician burnout.

And since then he has been busy. While Manion's situation may have been particularly severe, studies show that increasing numbers of doctors — up to 40 percent of physicians and 70 percent of residents — are feeling burned out and dissatisfied with their professional life these days. Corresponding with that are much higher rates of alcoholism, drug addiction, and suicide among physicians.

A growing risk

"No question about it — physicians are at greater risk for burnout now than they've ever been in history," says Wayne Sotile, clinical psychologist and co-author of The Resilient Physician: Effective Emotional Management for Doctors and Their Medical Organizations.

Sotile says the primary culprit is the "high demand and low control" environment doctors face in many practice settings these days. Doctors struggle to squeeze more patients into their day to make up for reduced reimbursement, in between calls to payers to justify the services they've provided. There's more and more paperwork, including stacks of literature to keep up with as technology marches forth at break-neck speed. There's also an increasingly demanding patient population, who attempt to direct their care according to what they've seen on TV or read on the Internet. Frustration with the process is epidemic.

"Physicians generally will say one of the reasons they went into medicine was to help people, and part of that is having a relationship with the patients," says Manion, who now runs Work/Life Design Associates, a Wilmington, N.C.-based coaching firm for people in healthcare. "When you diminish the patient encounter and have to speed through, both the patient and the physician feel robbed."

The result? "Burnout robs [physicians] of positive resources such as humor, enthusiasm, empathy, appreciation and being present," says John-Henry Pfifferling, director of the Center for Professional Well-Being in Durham, N.C., and author of Techniques for Coping with Stress and Change. "Burned-out doctors catch themselves, in increasingly common moments, being curt, uncaring - or even hating their patients."

Anatomy of the problem

One of the keys to avoiding burnout is knowing the warning signs. The first phase, explains Manion, is "wear down," which is marked by emotional exhaustion and a feeling of being drained and beaten down by the system. At this point, doctors become irritable and impatient with their colleagues and patients. They tend to isolate themselves and feel a diminished sense of accomplishment. Work is no longer fulfilling.

If nothing's done to remedy the situation, full burnout will soon follow. This is when a physician is so stressed, he or she walks around angry, feeling inept, chaotic, panicked, and depressed.
For instance, says Manion, "As a burned-out doctor, if Blue Cross only pays me two-thirds of what I bill, I will have an internal dialogue going on, either consciously or unconsciously. I might think: 'Those inconsiderate SOBs — what right do they have?' Or, 'Not another patient with this insurance.' Next, you learn your malpractice rates are getting raised and another internal dialogue starts: 'Where will I get the money? Every patient is a potential litigator.' Soon the internal dialogues turn into screams."