In June 2022, Doximity shared the results of a physician burnout poll asking doctors to identify factors that would most reduce burnout. And, a couple of months later, Abraham Kim and Daniel Novinson offered their take on the results in an opinion piece. While excellent points are revealed in both the poll and subsequent article, I think something big is missing. And I’d like to address it here.
What was the #1 cause of physician burnout in the poll?
The #1 cause of physician burnout as identified by the poll was administrative burden. This was the factor identified by physicians as having the greatest potential to decrease their burnout.
In second place was “improving work-life balance” followed by “reducing clinical volume or caseload.” Coming in a distant fourth was “other.”
I think most doctors would agree that all three of these factors would reduce burnout.
A quick summary of the opinion article
Off of the results of the physician burnout poll, this opinion piece sought to analyze the results.
The authors of the article do a very nice job in defining the issue of burnout. They also take care to emphasize the systematic nature of burnout rather than placing the responsibility and onus for burnout on physicians themselves.
A Personal Look at My Journey with Physician Burnout
Next, they spend the remainder of the article examining the issue of administrative burden. Its prevalence, causes, and even potential solutions are all very nicely covered.
You can read the entire article here.
However, upon reading this, I couldn’t help but feel that a huge opportunity to address a root cause of burnout was overlooked.
So, let’s look back at this poll and article through a different lens…
Re-examining the results of the physician burnout poll
The choices in the poll for participants to choose from is not exhaustive. And that’s fine. This isn’t a phase III clinical trial; this is a raw poll of doctors.
However, if we look at the three main choices, I would argue that they are all variations on a theme.
In the work-life balance equation, you have work on one side and life on the other. That’s obvious. Improving that equation, taken on its own, is great. Despite its vagueness and generalization, it’s a sure-fire way to improve burnout. That’s one choice offered.
But the other two choices offered are just superficial ways to reduce the “work” side of the work-life balance equation.
I think we can dig a bit deeper…and here’s why…
Work-life balance is a myth
Stay with me. Because I know this is not the popular or prevailing opinion. But, take. second to reflect on your life and career. Think of a time when you felt satisfied and fulfilled in medicine. This could be in medical school, residency, fellowship or an an attending, whenever.
Did you feel you had perfect work-life balance at that time? My guess is probably not. I know that I didn’t. And I don’t feel that way right now despite being very happy and fulfilled at work and at home.
I first read about this concept in Gary Keller’s book, The One Thing, an excellent read that I recommend to anyone. But anyway, he describes that our work-life balance is always off-kilter. Sometimes it weighs more on the work side, and we sacrifice the life side – to a degree. And other times it sways to the life side and work takes a back seat.
This is the work-life “counterbalance.” You can never let it gets so far to one side that the other falls off and breaks, but a perfect balance is pretty much non-existent.
If work-life balance is a myth, then the goal shifts from attaining perfect work-life balance to learning to accept and give space for the inevitable imbalance.
Easier said than done.
But through mindset work, it can be done. I still work on this constantly. I don’t know that any of us ever get it “just right.” And that is the point I think…it is an ever ongoing challenge. But that challenge is what propels us to do great things.
And that leads to my next argument…
The solutions lie within
It would be incredible if we could wave a wand and suddenly decrease out administrative burden, reduce our caseload, and erase all of the external systematic factors contributing to physician burnout.
But, right now, the reality is that we can’t do these things in any sort of immediate fashion. (But it doesn’t always have to be like this…more on that later!)
We just can’t right now. So, what are we to do? Continuously lament that changing the systems is a slow process. And that while we should continue to work on this, it is slow-going and not going to impact our burnout anytime soon?
No! We need to work on an individual level to improve our burnout.
This includes significant mindset work, including:
- Addressing our arrival fallacies
- Learning to say “no”
- Appreciating the small wins
- Looking to the “gain” and not the “gap”
- And much more…
A great book for those looking to build a healthy mindset within the current flawed medical system, this book is a must read!
But, I believe there is a more tangible and foundational way to address the external and systematic causes of physician burnout…
Financial well-being is too powerful to ignore
I have argued this many times. But I truly believe that a nation of financially free healthcare worked can change the healthcare system for the better in ways that we cannot even begin to imagine.
Think about it…
If all doctors could work because we want to, not because we have to, we are free to practice medicine on our terms. Employers, administrators, insurance companies…they all need physicians to stay in business. If we don’t need them. Well, I would say that would certainly turn the tables…
Ok, that’s on a huge scale. But what about just on the scale of one doctor?
Financial well-being remains just as powerful.
A quick dive into semantics
And I’m being careful to use the term “financial well-being” instead of “financial freedom.”
Financial freedom is an inevitable end product of financial well-being. But financial well-being, the state that leads to financial freedom, exists throughout and all along the journey.
I make this important distinction because I experienced a huge spike in financial well-being, and an accompanying huge improvement in burnout, well before reaching financial freedom as documented in my comeback story here.
And I’m still not at financial freedom. But I do have great financial well-being.
Ok, that aside now…
How financial well-being can improve burnout for an individual doctor
Think about your current working situation as a doctor. Whatever it is. Now, list out all of the external aspects of that situation contributing to your burnout.
These certainly would include administrative tasks, like patient notes, orders, and administrative to-do’s, among other things.
Now, imagine that you were on a set path to financial freedom, experiencing peak financial well-being.
If you are anything like me, the external burnout-contributing factors become more and more like annoyances. Things that bother you but you can then shoo away like a fly.
And as a result, we are able to move past them and focus on the aspects of our job that we really like…the things that got us passionate about medicine in the first place.
Why is this?
Everything worthwhile takes sacrifice.
No now knows this better than a doctor. We give the prime of our lives to study medicine. It robs us of hours of our lives and time with friends and family. And it puts us into huge debt.
Revealing My Secret Strategy to Pay My Student Debt
But, for awhile, we are ok with this. Because we know that after sacrifice comes the worthwhile part. But then comes the problem…
We start to realize that the deal we took doesn’t seem quite fair. If you are like me, you become bitter at a certain point. Medicine took our best years and just left us with tons of debt, subservient to a system seemingly designed to impede our ability to best care for patients.
That’s not fair. And we are rightfully angry about it.
But financial well-being changes all of that
With a path to financial freedom (here are 7 steps to financial freedom), the deal starts to seem more fair. Yes, we sacrificed a great deal of our time. And yes, we went into debt.
But now we have a path out.
Suddenly, the sacrifices we made are looked at less through the lens of bitterness and more their the lens of gratitude in being able to care for our patients.
Suddenly, the system is less scary as we gain confidence (financial and otherwise) to fight for changes without fearing any lost income.
And suddenly, we can focus on what we actually love in medicine. Whatever it is that got us into medicine in the first place. Without the anxiety of living paycheck to paycheck or working beyond when we want to because we need a paycheck, our minds can focus on what matters!
Let’s bottom line this
As the Doximity poll very accurately demonstrates, physician burnout remains a big issue in medicine. One that drains healthcare of resources, both monetary and human.
And while the causes are systematic in nature, the solutions lie internally rather than externally.
In fact, looking externally can lead to a feeling of helplessness and exacerbate burnout as we give up our locus of control chasing the myth of work-life balance. Instead, through mindset work, we can focus on making space for work-life counterbalance.
But, equally important, financial well-being represents perhaps the most direct, yet overlooked, path to burnout mitigation for doctors. This is true both on a system-wide and individual level.
And why is this?
Because it puts physicians, patients and clinical medicine in the forefront, balances the perceived checkbook of sacrifices and rewards for doctors, and places the locus of control back internally.
At a foundational level, financial well-being makes doctors better doctors!
If you are looking to improve your financial well-being, here are some great resources!
- 12 Why’s and How’s of Financial Freedom for Healthcare Professionals
- How Much Is Enough Retirement Savings?
- Exploring the Time Value of Money for Physicians
- Defining the Most Important Variables in the FIRE Equation
What do you think? What are the biggest contributors to burnout? How can physicians improve burnout? If financial well-being as important as I think it is? Let me know in the comments below!