3 Reasons Some Doctors Burn Out & Others Don’t (Plus Why Financial Freedom May Be the Answer)

Burn out for doctors is a major issue. There is a doctor shortage in the United States. But it seems that more and more doctors are leaving the field of medicine due to moral injury and burn out.

This is obviously a very complex issue so I am not pretending that we can solve it in this one post. However, I’ve been thinking more and more about this question: Why do some doctors burn out and others don’t? Similarly, why did I experience burnout in the past but I’m not right now?

Again, not simple questions to answer but still worth exploring.

The key ingredient for doctors who don’t burn out

In his popular book, Outliers, Malcolm Gladwell talks about the concept of meaningful work.

And meaningful work is work that one finds satisfaction engaging in. Yes, it is still work and it’s not always enjoyable (in fact it often is not). But one finds fulfillment by engaging in it. The example he uses in the book is that of Jewish garment makers in New York City in the early twentieth century.

Anyway, Gladwell lays out 3 requirements for work to be meaningful:

1. Autonomy
2. Complexity
3. A relationship between effort and success

I argue that doctors who do not burn out find these three components in their clinical work. And doctors who do burn out do not.

In my mind, the (main) secret ingredient for doctors to avoid, solve, or improve burnout is to engage in meaningful work.

What is not the answer for doctors who burn out

Resilience.

That is not the answer. However, it is often bandied about as the answer. The more resilient you are as a physician, the more you mitigate burnout. Not true. And, quite honestly, a bit insulting.

Because that explanation puts the onus and burden squarely and solely on us as physicians for being responsible for the burnout epidemic.

And yes, a strong mindset does play a role in burnout mitigation (more on this later), but it is not sufficient in and of itself.

And I can tell you in a very personal way that resilience is not the answer to burnout. Because that was pretty much the sole strategy that I used before I actually…you guessed it…burned out!

Back to meaningful work for physicians

Ok, we laid out the three requirements for meaningful work, defined a work in which one finds fulfillment and satisfaction, earlier. They are:

1. Autonomy
2. Complexity
3. A relationship between effort and success

Let’s look at these three factors through the lens of medicine.

First, complexity

I think we can pretty easily set this one aside. Medicine is complex. There is sufficient complexity in any specialty, any clinical practice to meet the definition of meaningful work.

I have not yet heard of a doctor feeling burned out from clinical medicine due to a lack of complexity.

So, most physicians will be able to check this box.

Second, autonomy

Here’s where things get a bit more dicey.

There is a huge, wide spectrum of autonomy within clinical medicine. Both within specialties and among different specialties. And especially depending on the employment setting.

Autonomy, within medicine, is the ability to practice in the manner that you feel is best for the patient, without interference or interruption. Of course, some oversight will always be present, be that from a partner, administrator, or regulatory board. That is necessary to ensure safe practice. However, for the large majority of well-trained physicians, this oversight should never impede them as they practice safe and effective medicine.

Clinical practice without autonomy however can be exhausting and insanely frustrating. Being managed in how you practice, in your ability to help patients with constant interruptions in the form of administrative oversight or unruly paperwork is often cited as a main reason for doctors experiencing burn out.

Autonomy therefore becomes a crucial variable in this equation.

And lastly, a relationship between effort and success

We need to be able to see that by working hard, we will be rewarded for this effort. This is basic psychology back to Skinner’s rats. But it becomes even more important as the complexity of what we do increases. And, as mentioned earlier, doctors do complex work.

If we feel that our efforts are not met fairly with success, then we become disillusioned to what we are doing. The sacrifices, personally and professionally, don’t seem worth it. We begin to see patients as widgets we need to get through in a day’s work at the assembly line.

On the flip side, if our efforts are rewarded with success, it all feels worth it. And success is defined personally. For me, success means happy patients, professional respect, and monetary compensation.

This version of success will be familiar to most doctors. However, the problem is that compensation for doctors is generally dropping across the board. Thankfully there are ways to increase your compensation clinically and non-clinically.

But, any way you slice it, the connection between hard work and success for doctors is thinner than it has ever been in the past.

Putting these three factors together

Too many doctors are missing the autonomy and relationship between effort and success to meet the standards of meaningful work.

This is bad. But it gets worse…

Because the complexity of the clinical medicine persists despite the lack of autonomy and work-success relationship.

That’s why someone in a non-medical field may not experience burn out (at all or as intensely) as physicians. They may lack autonomy and the work-success relationship too. But they also lack complexity. And as a result, they can tolerate going through the motions of their work.

But not doctors. Going through the motions means poor patient outcomes. Those are some serious stakes.

And that is why a lack of meaningful work for doctors spells burn out.

Indulge me in a thought experiment

Let’s say you are a burned out doctor right now. (And if you aren’t in real life, pretend you are.)

Think of all the aspects of your job or circumstance that contribute to this burnout. Write them down. And now categorize them into one of three columns. Which of the three factors of meaningful work do they violate:

• Complexity,
• Autonomy, and
• A relationship between hard work and success

For instance, when I burned out, I realized a huge component was a lack of financial well-being.

I worked so hard to become a doctor, but now that I was about to graduate training, I was disillusioned. I had given up my 20’s to train in medicine with the promise that things would be fine after. But they weren’t. I was >$500k in debt. My expenses were racking up more than I could cover with my (now rising) income. This was not what I imagined.

And you can file that as a violation of the relationship between hard work and success

I worked hard under the premise that things would magically just be perfect when I finally became an attending physician. That I would experience my version of success.

Not so. That didn’t just happen.

I would have to work on it. And so I did. I started my financial comeback story.

And once my financial well-being improved and I re-established the relationship between hard work and success, an amazing thing happened.

My overall well-being sky rocketed, I re-discovered my love of medicine, and I became a better doctor!

And this is my thesis…

Look at the list you have created. The aspects of your current clinical work that violate your autonomy, complexity, and/or relationship between hard work and success.

Now imagine those violations being erased.

Imagine gaining back your autonomy and relationship between work and success (and complexity if needed although less likely).

How would you feel?

Would you re-gain your love of medicine? Would you become a better doctor?

My guess is that most of you would!

Now what can we do about it?

Thankfully, a lot!

I am a firm believer in our own individual power as well as the power of doctors to collaborate and help each other.

First, we need to grow and cultivate a personal mindset of growth and abundance. We can optimize our situation to regain any of the aspects of meaningful work that we are lacking.

And next, we need to create a plan to actually reclaim our meaningful work.

The good thing is that you already have a roadmap. You have a categorized list of the things that are impeding your work from being meaningful. So create an action plan to improve each of those factors. This will not be easy. It may require other sacrifices or uncomfortable talks with partners or administrators. But it will be worth it.

And if that leads no where, it may require changing jobs. Or changing practice type, from an employed to a private practice job or vice versa.

This is a big change of course, but you now have the advantage of understanding what makes work meaningful for you. So you can look for the right opportunity this time!

But financial freedom is the ultimate trump card

Let’s say you can’t adjust any of the factors that are impeding meaningful work.

(Now, this is never actually the case. There are always things we can do. If this is how you feel in real life, I argue that it is a limiting belief. Let me know and we can try to work on things together!)

But for the sake of this new thought experiment, let’s pretend that’s the case.

Now, pretend that you are financially free.

Welp, there you go! Problem solved.

You now have absolute free rein to do anything and everything you want/need to do to make your work meaningful.

• Need to drop down your clinical hours? Done!
• Don’t want to put up with some arbitrary administrative tasks? Done!
• Want to change jobs but have the flexibility to wait until the perfect opportunity comes around? Done!

You now have the absolute ability to work only on your own terms. And, if you just are done with clinical medicine, that is fine too!

Burn out is complex

And I am not pretending it is simple. But I think it does make sense to try and break the issues down to some concrete, actionable factors that we can optimize.

If you are experiencing burn out, take a few minutes and write down what the root factors are. See where they fit into the 3 components of meaningful work – complexity, autonomy and a relationship between hard work and success. Then, think about how you can improve all of them.

For some, these will be minor tweaks. For others, it may be major changes. And for some, accelerating towards financial freedom may be the best answer. You can do this by better utilizing your clinical income to save and invest or even branching out into physician side gigs like these.

In any case, there is always an answer!

Here are some other posts to help along the way:

• 6 Steps for Physicians to Attain Financial Freedom, Decrease Burnout, and Become a Better Doctor! 
• I Found My Perfect Physician Job in 6 Steps!
• Physician Finances: the Race vs. the Finish Line

And if you are looking for a one-stop actionable guide to get on the path to financial freedom, check out my best-selling book, Money Matters in Medicine!

What do you think? Why do some doctors burn out and others don’t? Is meaningful work the secret? Is your work meaningful? Let me know in the comments below!