It is time we talk about a critical, yet often overlooked, factor contributing to physician burnout: attention-deficit/hyperactivity disorder (ADHD), particularly in those with high IQs and a history of academic and professional success.

Many physicians, often driven and intellectually gifted, develop sophisticated coping mechanisms that mask their ADHD symptoms for years, even decades. Their high IQ can, paradoxically, compensate for executive function deficits, allowing them to excel in demanding environments like medical school and residency. They might appear organized, focused, and high-achieving on the surface, but this often comes at a tremendous internal cost.

The masking effect and misdiagnosis:

For physicians with ADHD, masking is more than just quickly changing the subject to hide a tangent; it is a complex, often subconscious, system of overcompensation. This can manifest in several ways:

• Extreme organizational systems: A neurotypical person might use a planner. A physician with ADHD might have multiple color-coded calendars, countless alarms, and an almost obsessive reliance on to-do lists just to manage their time and avoid the chaos their mind naturally produces.
• Hyperfocus: While their ability to hyperfocus can be a huge asset during a complex surgery, it is also a form of masking. They may become so engrossed in one task that they neglect others, only to catch up with a surge of adrenaline-fueled work later. This intense focus can look like dedication, but internally, it is a desperate effort to get the job done.
• The “perfectionist” facade: To counteract a fear of making careless mistakes—a common ADHD symptom—a physician might develop perfectionistic tendencies. They may double-check every order and re-read every chart, working late into the night to ensure everything is flawless. This appears to be a sign of a great doctor, but for the person with ADHD, it is a draining mental burden.

Peer-reviewed research highlights that individuals with both ADHD and a high IQ are more likely to mask their symptoms, delaying diagnosis or leading to misdiagnosis. Instead of ADHD, their struggles with organization, time management, and emotional regulation might be attributed to anxiety or depression, leading to ineffective treatment.

The road to burnout:

This constant masking and overcompensation create an unsustainable level of mental and emotional exertion. Physicians with ADHD are often working twice as hard to achieve what their neurotypical peers manage with less effort. This relentless struggle to keep up, coupled with the inherent demands of the medical profession, leads to profound and often debilitating burnout.

Studies indicate that individuals with ADHD are more susceptible to burnout due to the constant drain of managing symptoms and the heightened physical, mental, and emotional exhaustion it entails. For physicians, the stakes are even higher, as undiagnosed ADHD can impact their ability to regulate stress, prioritize tasks, and maintain focus in a high-pressure environment, ultimately affecting their well-being and potentially patient care. More often than not, without proper accommodations, physicians often sacrifice their physical health and neglect their relationships. Over time, many married physicians with ADHD, without adequate support, end up facing divorce due to the lack of contributions to the relationship and household responsibilities.

The call to action:

We need to foster a more nuanced understanding of ADHD, recognizing that it presents differently in high-achieving adults. It is crucial for health care systems and individual clinicians to:

• Increase awareness: Educate themselves on the diverse presentations of adult ADHD, especially in high-IQ individuals.
• Encourage comprehensive assessment: Look beyond surface-level success and consider ADHD as a potential underlying factor in physician burnout, anxiety, and depression.
• Provide accessible support: Create environments where physicians feel safe to seek evaluation and receive appropriate, neurodiversity-affirming support and treatment.

By providing support for physicians with ADHD, we can not only improve the well-being of our dedicated physicians but also strengthen the health care system as a whole.

Michael Carlini is the founder of Carlini Coaching LLC, which has been empowering medical professionals with ADHD for over six years. As an associate certified coach (ACC), he focuses on helping clients transform challenges into strengths by tailoring strategies to the unique demands of medical careers. By creating systems that foster clarity, balance, and sustainable success, Michael combines deep knowledge of both the medical field and ADHD to deliver results with empathy and expertise. Through one-on-one coaching, workshops, and public speaking, he inspires clients to thrive both personally and professionally. His mission is to help medical professionals confidently navigate their careers while reclaiming time for what matters most. Learn more on his website or connect with him on LinkedIn.