For the first 12 years as a physician assistant, I thought provider burnout only happened to wusses, those better suited to working in health insurance or doctoring at a summer camp.  Sure, I felt overwhelmed at times, but I planned to soldier on in clinical practice, happily serving my patients until retirement.

That was before.   Before dreading Sunday nights, feeling heaviness in my gut, a tightness in my neck, and bouts of insomnia at 3 a.m.   My migraines ramped up to several per week, but I was convinced the problem was physical, not mental.  My husband was the one with depression, I was the freight train, plowing ahead, always on course, my metal exterior protecting me from the weather I traveled through.

And yet, out of nowhere, I  began looking forward to jury duty and my kids’ well checks or frankly, even a minor accident if it meant time away from work.  On weekends, my temper would flare as I’d frantically over-prepare with hours of laundry, cooking, and cleaning in an attempt to control something.

“What the heck is wrong with me?” played on repeat in my head.  Nothing had drastically changed in my life. I’d been at the same dermatology job for six years.  My doctor was quirky, maybe even cuckoo, but she’d been that way since I started.  Our staff of 12 had experienced massive turnover in my first four years, but things had settled down.  I now realize my burnout had been brewing for years. I’d grown frustrated with the medical assistants, with my role as the unofficial office manager (she never re-hired one after #7 was fired), and with my doctor’s frequent overseas travel and the expectation that I’d manage crises while she was gone.

Feeling trapped and indebted to my doctor for hiring and training me in the coveted field of dermatology, I stayed and powered through.  I was also loyal to my patients, but the biggest ankle shackle was my non-compete contract.  If I quit, I couldn’t work in dermatology for two years within a 20-mile radius of the practice.  My love of dermatology and fear of the unknown kept me tethered there for another year.

I finally started seeing a therapist after my internist and neurologist hinted anxiety was the problem.  The therapist validated my feelings but helped me see a larger view of the situation and empowered me to take control of my life.  She framed burnout as a wakeup call to make positive changes, including overcoming my victim mentality.

Soon thereafter, I found my current job with another dermatology practice in town.  I skirted around my non-compete by working at a satellite clinic an hour from home for two years.  I felt amazing.  I was the driver again.

My new office is astoundingly efficient.  The employees are the cream of the crop, and my supervising physician is the nicest guy ever. That’s why it shocked me when I got slapped by a wave of burnout again last year.

It happened after I’d transitioned from working part-time at our slower-paced satellite office to full time at our huge main office.  My schedule was now a blank canvas for new patients, rashes, and urgent work-ins.  I was already feeling overwhelmed when two of the PAs announced they were pregnant.

Being short two PAs during our busiest months meant we all had to see more patients, which we willingly did.  Our schedules, however, got busier and busier each week.   Soon, it wasn’t unusual to see 50+ patients a day.  Even with two competent MAs, the pace felt impossible to maintain. Throw in my kids’ summer camp schedules and a husband who was working full-time and getting his PhD, and the recipe for burnout was, in hindsight, inevitable.

Once again, my physical symptoms ramped up.  Short fuse at home, migraines, not sleeping, overcompensating by being a control freak and micromanager.  And, once again, I ignored the clues.

This time, a routine meeting with our financial consultant jolted me awake. The consultant turned to me and casually said, “OK, I ran your numbers, and if you retire in 20 years, you should be pretty set ….” The words, “Twenty years” kept playing over and over in my head.  Twenty. Years. Twenty. Years.  My heart started thumping, my eyes teared up, and my husband shot me a worried glance.  I waited until we were in the elevator before I started bawling. “I can’t work like this for another 20 years!  I won’t last another six months!” Until that moment, I hadn’t even realized I was experiencing burnout again.

I had an honest and tearful talk with my office manager and told him the pace was killing my desire for patient care.  I confessed I’d gone from providing A+ care to B- care, and I didn’t even give a hoot.  I was recklessly flying through my notes to get the heck outta there and didn’t have time or energy to research conditions and treatments like I’d always done.  I barely had time to go to the bathroom or eat lunch.

To his credit, he listened.  He took my concerns seriously and began making changes.   It turns out I wasn’t the only provider feeling burned out.  Having the courage to speak up helped us all have a healthier work-life and prompted regular check-ins with our supervising physician.

Burnout isn’t always due to a crazy boss or a toxic environment.  Even with a great job and amazing coworkers, it can happen, but it’s harder to admit when everything looks perfect on paper.  I thought I “should” be happy and convinced myself something was wrong with me.  I felt guilt and shame for not being able to hang with a busy schedule when everyone else managed OK.  The money factor also complicated things; the more patients I saw, the more I got paid.

It takes courage, honesty, and a hard look at your role in the situation to overcome burnout.   Wusses are the ones who refuse to admit burnout and allow it to destroy their relationships, their career, and their own mental health.

Hope Cook is a physician assistant and can be reached at HopethePA.

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