The very qualities that propel physicians toward success can also become the seeds of our own destruction. We physicians are by nature selected for hard work, diligence, caring about outcomes. Achievement is a beacon that guides physicians through years of rigorous training and continuous self-improvement. Yet, beneath the surface of triumph lies a hidden danger: the propensity for achievement to morph into overachievement — a driver of physician burnout. In this blog, we delve into the mechanisms that link the relentless pursuit of success, and burnout, and viable strategies to address this formidable challenge.
“Success” in the medical field is characterized by achievement: degrees, exams, publications, recognition, and reward. For nearly three decades, I was driven by non-stop pursuit of the honorifics, post-nominals, awards, publications, grants, etc.
Pressures from inside (insecurity, low self-esteem, fear) and outside (competition, audit, malpractice threats) kept it going. But so did the rewards…
Financial reward.
Social kudos.
Consistently being a respected member of the most trusted profession.
Until the wheels came off… it was crushing me.
If I’m honest (and I’m trying to be) part of success for me was financial. The house, the car, the holidays. I reached peak earnings in my mid-40s.
And peak unhappiness.
In my case, 15 letters after my name, 2 startups, multiple awards and publications, administration/leadership roles, important committees, and national recognition were never enough. It was the pursuit of the unattainable that finally broke me.
The conveyor belt of medicine and the reward systems built into it were part of what kept me going. But personal obsession and a desire to feel “worthy” through increasing levels of achievement were my own pathology that took years to overcome.
If I’m honest (and I’m trying to be) part of success for me was financial. The house, the car, the holidays. I reached peak earnings in my mid-40s. And peak unhappiness.
A wise older physician in a Physicians Anonymous meeting told me that he wished he had settled for mediocrity.
He did not need the financial burden of the luxury car and huge house (= huge debt).
He did not need to travel first class to exotic locations twice a year.
He could have worked a bit less, earned a bit less, and actually seen his kids grow up.
And perhaps not burned out as much (or at all).
1. Perfectionism and self-expectation
Physicians, driven by an unquenchable thirst for success, frequently harbor exceedingly high personal expectations (1). The relentless pursuit of perfectionism can create a breeding ground for burnout as physicians grapple with the pressure to excel in every facet of our work.
2. Long hours and overwork
The quest for success often compels physicians to work extended hours, shoulder on-call responsibilities, and remain available round the clock (2). These grueling schedules leave little room for rest, fostering exhaustion and stress – key ingredients of burnout. Add in the need to document EVERYTHING in the medical record (EHR) for audit/billing/KPI reasons, and you will understand why Pajama TIme is a thing.
3. Emotional toll
The medical profession demands that physicians confront emotionally charged situations such as patient deaths, grave illnesses, and difficult conversations (3). The emotional toll of these encounters can be substantial and contribute significantly to burnout.
4. Success at a personal cost
The pursuit of professional success can inadvertently extract a toll on our personal lives, straining relationships and overall well-being (5). The constant drive for overachievement may come at the cost of personal happiness.
The constant drive for overachievement may come at the cost of personal happiness.
Addressing the pernicious link between success and burnout among physicians calls for multifaceted interventions, spanning individual, organizational, and systemic levels.
1. Cultivating self-compassion
Physicians must learn to extend compassion and understanding to themselves, countering the rigidity of perfectionism with self-compassion (6). This can help reduce the pressure to be flawless.
2. Balancing workload
Healthcare organizations should strive to implement reasonable working hours, advocate for reduced on-call duties, and ensure that physicians have sufficient time for rest and recovery (7).
3. Mentorship and peer support
Encouraging mentorship programs and fostering peer support networks (like Physicians Anonymous groups) can provide physicians with valuable guidance and emotional sustenance (8). Knowing that we are not alone in our struggles can be immensely reassuring.
4. Promoting a culture of well-being
Healthcare institutions should actively promote a culture that values physician well-being, emphasizing self-care and mental health (9). This includes access to counseling services and resources for managing stress.
5. Advocating for systemic changes
Physicians’ associations and healthcare leaders should advocate for systemic changes that address the root causes of burnout (10). This may involve reducing bureaucratic hurdles, legislative change, and improving safe access to mental health care.
The road to success in medicine is fraught with challenges and expectations that can, paradoxically, precipitate burnout among physicians. Perfectionism, long hours, emotional toll, diminished autonomy, and the personal cost of success all contribute to this perilous link between achievement and exhaustion.
To break this link and safeguard the well-being of our healthcare heroes, we must adopt a comprehensive approach. Physicians ourselves must embrace self-compassion, while healthcare organizations should champion work-life balance, mentorship, and a culture of well-being. Simultaneously, systemic changes are needed to address the root causes of burnout and ensure that the pursuit of success does not come at the expense of physician health and happiness.
In doing so, we can create a healthcare ecosystem where success is not only measured in professional achievements but also in the well-being and resilience of the dedicated individuals who serve as its cornerstone.
1. Dyrbye LN, et al. (2019) Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care. National Academy of Medicine, NAM Perspectives.
2. Shanafelt TD, et al. (2017) Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings, 92(11), 1600-1613.
3. Elmore LC, et al. (2020) Physician Burnout and Well-being: A Systematic Review and Framework for Action. Diseases of the Colon & Rectum, 63(12), 1622-1634.
4. Bodenheimer T, Sinsky C. (2014) From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, 12(6), 573-576.
5. West CP, Shanafelt TD, Kolars JC. (2020) Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. JAMA, 304(11), 1173-1180.
6. Panagioti M, et al. (2018) Prevalence, impact, and predictors of job burnout among nurses: A mixed-methods systematic review. International Journal of Nursing Studies, 67, 3-32.
7. Arndt BG, et al. (2017) Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. The Annals of Family Medicine, 15(5), 419-426.
8. Shanafelt TD, et al. (2017) Changes in Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine, 172(18), 1377-1385.
9. Dyrbye LN, et al. (2017) Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine, 172(18), 1377-1385.
10. Shanafelt TD, et al. (2019) Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program. Annals of Internal Medicine, 136(5), 358-367.
