Those of you that follow me know that I write and speak often on the topic of physician burnout.  About a year ago, after my grandmother passed away, my extended family and I got together for a few days.  One night, my cousin and I got to talking about my work, and he pressed me on a question that so many have asked me before, “What makes physician burnout different than that which every other profession experiences — and if physicians are so unhappy, why don’t they just quit?”

It’s a fair question, and one that I think deserves a thoughtful response.  After all, many others work long hours in stressful positions, have extensive postgraduate training, and battle work-life balance, and if I want people to think about why physician burnout is unique and matters, I have to justify it.

In order to summarize a 3-hour conversation in a short blog post, I’ll give you the Cliffs Notes version.  The one-liner answer to the question at large: it’s not easy for physicians to leave or dramatically alter their practice, particularly early in their careers, because of financial and personal reasons as well as the unique nature of the medical field.

Example 1: the young investment banker.  These are stereotypically professionals at the beginning of their careers, entering a fast-paced, stressful, and lucrative field.  They put in longer hours than resident physicians and also don’t take care of themselves, their job security can be questionable, competition for promotions is fierce, and in these circles too, there is much talk about depression and burnout.

What’s different for physicians.  When these younger bankers have had enough, many pivot their careers and transition to more lifestyle oriented positions, with well-established nest eggs they can use to invest in the market or on their next steps professionally.  At the age where many investment bankers begin to talk of exit strategies, physicians may not even be out of training.  At this point, they’ve got an average of approximately $200,000 in debt, families to support both emotionally and financially, and they haven’t yet had a six-figure salary or put a significant amount into retirement.  Most physicians don’t pay off their loans until well into their 40s.  Quitting or taking a lower paying position is not usually a financially viable option.

Example 2: the lawyer.  This professional has also invested much in terms of time and money into their education, puts in long hours, and also has to climb their way through a hierarchical system.

What’s different for physicians.  When I think of my friends who are lawyers, they span many different professional spheres (corporate and criminal law, alternative dispute resolution, NGOs, education, writing, consulting, public affairs, ethics, real estate, and politics).  The breadth of viable options readily available offers versatility when it comes to practice settings, lifestyle, and flexible work options.  To some extent, this is true in medicine as well, as medical fields vary in their intensity and different practice models exist.  As demographics in medicine and the healthcare landscape change, I believe that the field will have to evolve to increase these options.  However, currently, most practice settings preclude the ability to work from home when a child is sick, take large periods of time off or work reduced hours, or decline after hours responsibilities.  At the end of the day, most patients need to be seen in person, and night and weekend call needs to be covered.

If physicians want to branch out from clinical medicine, how many options are there out there to replace their income, acknowledging the opportunity costs of becoming a physician?  As founder of the Physician Side Gigs group, I am a big believer in the versatility of the physician skill set and the talents of physicians.  However, I acknowledge that most physicians would have a hard time replacing their clinical income entirely, and furthermore, I don’t think the aim of most physicians should be to exit clinical medicine entirely – I think most of us really love what we do. While we can all name a few successful physician authors, politicians, and public figures, these are few and far between compared with the number of lawyers.  A physician’s most marketable quality is usually intimately tied to years of highly specialized training.  As amazing as their skills are, the ability to remove an appendix or diagnose a rare genetic disorder has limited marketability in the outside world.  You could argue that more physicians should enter the business sphere, marketing their ability to treat your rash via a mobile app or offer you advice on your children’s cough, and I think this is sound advice.  In fact, it’s one of the mindsets I’m trying to encourage with Physician Side Gigs.  My hope is that we will see more physicians considering these pathways, or finding ways to make their careers mold around the ideal lifestyles they envision, instead of the other way around.

Example 3: the entrepreneur.  These individuals also work unpredictable/undesirable hours, and can never really shut work off either.  They expose themselves to risk, and rewards are not always guaranteed.  They also face the possibility of disappointing investors and customers.

What’s different for physicians. I think ultimately, what’s different in medicine is that doctors (and society) don’t see medicine as a business.  There are a select few careers where public and self-imposed expectations propagate the concept of the infallible, selfless human being, and medicine is one of them.  We accept that businesses make mistakes and as long as they rectify them, we are generally okay with it.  We may complain about the price of a new phone, but we acknowledge that running a successful business is based on supply and demand principles.  But physicians have taken an oath, to above all, put patient care first, and its one that they wear as a badge of honor, and rightfully take incredibly seriously.   They take on uninsured patients, knowing that they’ll never get paid, because it’s the right thing to do.  They stay late to talk to patient families even though they don’t get paid for it and it means missing their children’s soccer games, because it’s an essential part of the doctor-patient relationship, and ultimately, their patients are also someone’s parent, child, spouse, or friend.  They rarely quit or strike despite often unreasonable additional demands, because they love the actual practice of medicine and recognize that they can not sacrifice the health of their patients for ideological battles.   When something goes wrong, they take it personally and regardless of whether a patient sues them or not, they take steps to ensure it will never happen again.

There are, of course, additional unique factors contributing to physician burnout.  Loss of physician autonomy, declining reimbursements and the devaluation of physician time, the litigative landscape of medicine, increased paperwork and bureaucracy, and the declining ability to focus on the physician-patient relationship all have a role.  Each of these likely warrants its own post, so I’ll stop for now.

At the end of the day, most physicians dedicate their lives to medicine.  Part of this is idealism and love of what we do, and part of this is practicality.  Despite high rates of burnout, as a whole, we don’t tend to cash out.  Instead, we go all in and rarely fold.

Nisha Mehta is a radiologist and founder, Physician Side Gigs and the Physician Side Gigs Facebook group.  She can be reached at her self-titled site, Nisha Mehta, MD, and on Twitter @nishamehtamd. 

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