The 4 Main Causes of Physician Burnout

In over 1600 hours of one-on-one coaching experience with burned out physicians, here are the five causes of burnout I see commonly. Please note that even though I am describing physicians below, all members of a healthcare organization share these burnout risks— both the administration and clinical side of the business.

1. The practice of clinical medicine

   Being a physician has been and always will be a stressful job. We are dealing with hurt, sick, scared, and dying people and their families.

   Our work takes a significant amount of energy even on the best of days. Our practice is the classic high-stress combination of great responsibility and little control. This stress is inescapable as long as you are seeing patients, no matter what your specialty.

2. Your specific job

   On top of the generic stress of caring for patients above, the physician’s job has a very specific set of unique stresses. They include the hassles of your personal call rotation, your compensation formula, the personality clashes in your department, and many, many more.

   You could change jobs to escape your current stress matrix, but your next position would only provide you with a whole new stress matrix.

3. Having a life 

In an ideal world, your larger life is the place where you recharge from the energy drain at work. Two major factors can prevent this vital recharging activity.

1. We are not taught life balance skills in our medical education. In fact, our residency training teaches us just the opposite. We learn and practice ignoring our physical, emotional, and spiritual needs to unhealthy levels and then carry these negative habits out into our career.
2. Multiple situations can arise at home that eliminate the opportunity to recharge your energy account. Your life outside your practice then switches from a place of recharge and recuperation to an additional source of stress.

The causes can range widely from simple conflict with your spouse, to illness in a family member (child, spouse, parent), to financial pressures, etc.

4) The conditioning of our medical education

As premeds several important character traits become essential to graduating from medical school and residency. Over the 7 plus years of our medical education they become hard-wired into our day-to-day physician persona creating a double-edged sword. The same traits responsible for success as a physician simultaneously set us up for burnout down the road.

Here are the top five I see in my physician coaching practice.

1. Workaholic

2. Superhero

3. Perfectionist

4. Lone Ranger

5. Emotion-Free

In addition, we absorb two prime directives. One is conscious and quite visible.

“The patient comes first”

This is a natural, healthy, and necessary truth when we are with patients. However, we are never shown the off switch. If you do not build the habit of putting yourself first when you are not with patients, burnout is inevitable.

The second prime directive is never stated, deeply unconscious, and much more powerful. It goes like this:

“Never show weakness”

To show you this programming in stark relief, please try this thought experiment. Imagine you are back in your training. A faculty member walks up to you and says, “You look really tired. Is everything OK?” How would you respond—and how quickly would that response come out of your mouth? That is the essence of this deeper prime directive. This knee jerk defense makes it very difficult to help physician colleagues even when their burnout is clear to everyone on the team.

Put the five personality traits together with the two prime directives and you have the complete conditioning of a well-trained physician. Combine this with a training process that is very much like a gladiator style survival contest, and doctors become hard-wired for self-denial and burnout.