All this talk about burnout has me… well… burned out. Theories abound and prevalence data is flying about.  Are 54% of physicians burned out, or is it 25%? Is it because we’re worked too hard, or because the “new-trophy-for-everyone” generation is finally being hit with reality?

I can tell you from experience, burnout occurs when there are big things about your work you resent, and the rewards become overshadowed by these key persistent resentments. Working 24/7/365 isn’t the problem, its what you’re not doing because you’re working all the time that is. Its not what we’re doing, it’s what we aren’t that leads to burnout.

Duh? Well… it’s not that simple, and once again it comes back to resentment. Most of us resent what we can’t do because we work so hard, but not all resentments are the same; expectations are the second key contributing factor. If you expected to have a lot of purchasing power because of excellent compensation as a physician only to found out that you really don’t because you chose a lower paying specialty, then you may resent what you do. If you expected to be home by 6 pm most nights only to find out that to finish your charting and phone calls you have to stay until 8pm, you may resent what you do. Know your expectations and be aware of your resentments.

Burnout is best prevented, because fixing it can be hard. Both prevention and cure takes efforts on the part of the individual as well as the “system”. The microsystem (your team/clinic or pod), the mesosystem (the group practice, department or service line), and the macrosystem (hospital or network) all need to participate in the process. But without the individual taking ownership, efforts often fail.

The 4 horsemen of burnout from the HappyMD (https://www.thehappymd.com/blog/bid/290379/Physician-Burnout-The-Four-Horsemen-of-the-Physician-Burnout-Apocalypse) are around every corner and their momentum can be difficult to slow. The Workaholic, the Superhero, the Perfectionist, and the Lone Ranger are wicked creatures. All four have haunted me, possessed me and driven me into the ground (nearly literally). The system can’t exorcise them unless the individual desires it so.

But often the individual who carries the burden won’t let go of it unless others are there to take some of it away.  I survived by lowering my expectations (forget about getting home to see the kids before bed, forget about exercising or having friends, forget about doing those things that bring you joy to your work).  What I didn’t know was that constant stress kills.  My advice to anyone who is approaching burnout or is cooking at a broil: be true to yourself, your family and your patients and stop the 4 horsemen in their tracks, because once you’re toast, scraping off the burnt parts is painful, and what’s left isn’t all that appetizing.  If you’re on one of those horses or all of them, stop, drop and rock and roll on your own terms (and take your family and friends with you).