Encroaching flames

Other factors that can contribute to burnout include:

Work stressors — Most physicians in private practice are working in volume-based environments, running a daily hamster wheel of patient encounters to meet revenue demands. Wible, who set up an atypical solo practice after suffering serious burnout in 2005, knows how dehumanizing this scenario can be. She recalls a colleague’s sadly amusing response to a patient who was miffed at having to remind the doctor why she was there for a follow-up visit: “Honey, I’ve seen 2,000 patients since I saw you last. I can’t remember your name.”

Physical exhaustion — “When they give all day long, they get drained,” Pfifferling says. “I was just talking to a cardiovascular surgeon who’d just done four surgeries that day — two emergency and two scheduled. He’s very concerned about the life on that table. When he gets home, he’s bone-tired, and he may be on call that night.”

Attending hospital physicians are particularly at risk for this. Since 2003, residents are legally prohibited from working more than 80 hours per week. Yet a survey released by Academic Medicine in December 2006 shows the unintended consequence of this restriction: half of attending physicians are now logging more hours because residents must clock out when they hit the 80-hour limit. “The attending doctor is stretched like a rubber band, ready to break,” says Pfifferling.

Asymmetrical work relationships — Because medicine is fraught with risk, most physicians give their patients their full effort. But like a car slowly leaking oil, your intellectual, emotional, and physical engine will eventually seize, and you will have no more to give, unless you are occasionally replenished.

Information and cognitive overload — An unrelenting flood of new clinical and practice management information inundates you every single day. Overwhelming, to be sure. Physicians are “supposed to synthesize all this, and keep up with whatever’s considered cutting edge at that time,” says Pfifferling. “In the smallest specialties there are 20 journals. How do you keep up?”

Litigation stress — The average malpractice suit takes three to nine years to resolve. And although the chances of a plaintiff winning the suit is about half that of all other tort cases, the awards are 16 times higher, averaging about half a million. Notably, 25 percent of all U.S. doctors get sued annually; 65 percent will face some sort of malpractice lawsuit during their careers. Fear of malpractice partially determined Haley’s decision to bail out of obstetrics altogether; he now focuses only on gynecology.

Financial pressure — Physicians “are the only organization that cannot by law collectively meet, bargain, and represent ourselves to protect our rapidly declining reimbursements,” Haley laments in a recent letter to Physicians Practice editors. “Insurance companies have known this for years, and have continually used it against us with little means of any recourse on our part. … [Physicians] never thought there would be such a concern about our financial futures as it has become.”

The feminine unique

Do women and men experience burnout differently? Wible thinks so. And studies suggest she may be right. Wible maintains that the path for a woman physician differs from that of a man because, generally speaking, women react to the world in fundamentally different ways. “Men are really good at turning [practicing] into a game,” she says. “How many patients did you see today?”

But women “like to hang out with their patients more. Call it touchy-feely or whatever you want, but it’s looked down on in the medical culture,” she says.

“Minimizing Error, Maximizing Outcomes,” a three-year study sponsored by the National Institute of Child Health and Human Development, shows that female doctors tend to have patient panels that contain more complex cases, and many more publicly insured or uninsured patients than male physicians. Also, female doctors want to spend more time with their patients. They often find themselves at odds with the values of the practice in which they work.

“Working in a high-volume atmosphere takes its toll on women more than men,” says Wible. “It makes it hard to balance their home and work. Women reach the empathy burnout stage. They have one foot on either side of the door. They’re trying to live with their instincts, and it doesn’t work.”

Burnout fallout

How do you know when you’re burning out? You might “act out” by becoming abrasive with staff and patients or by demonstrating aggressive anger and rudeness. Or maybe you “act in” with depression, pessimism, and brooding.