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Certified coach Michael Carlini discusses his article “Why physicians with ADHD are burning out.” Michael explains how high-IQ physicians often mask their ADHD symptoms through hyper-organization, perfectionism, and hyperfocus, which allows them to succeed professionally but takes an immense internal toll. He outlines how misdiagnosis, overcompensation, and lack of accommodations contribute to severe burnout, strained relationships, and declining well-being. Michael also highlights solutions, including increasing awareness of ADHD’s diverse presentations, encouraging comprehensive assessments, and building supportive, neurodiversity-affirming environments. Listeners will take away strategies to recognize hidden ADHD in high-achieving physicians and insights on fostering resilience in the medical profession.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Michael Carlini. He’s a physician coach. Today’s KevinMD article is “Why physicians with ADHD are burning out.” Michael, welcome to the show.

Michael Carlini: Thank you, Kevin.

Kevin Pho: Let’s start by briefly sharing your story and journey, and then we can talk about your KevinMD article.

Michael Carlini: I found myself coaching physicians after I started coaching high-school-age and college students. I realized that this wasn’t the most fulfilling version of my work, and with my wife being a physician, I found myself gravitating towards working with medical professionals. Over the course of let’s say six years, things have steadily transformed into me coaching physicians full-time.

Kevin Pho: What are some of the most common issues that physicians come to you with?

Michael Carlini: Most of the time, it’s really dealing with burnout. Those symptoms of burnout are feeling like there’s no sense of autonomy and control over their work and that it’s taken over their life completely. It’s impacting their sleep, their physical and mental health, and it’s also impacting their relationships. It’s so much easier for them to disappoint themselves or their partner than it is to disappoint their employer or a coworker because it just doesn’t feel safe to say, “Hey, I can’t do X or I can’t do Y.” That’s the most common challenge that people come to me with.

Kevin Pho: Your KevinMD article is “Why physicians with ADHD are burning out.” I’m interested in hearing specifically about that connection. Tell us what your article’s about for those who didn’t get a chance to read it.

Michael Carlini: The focus of the article is talking about that, yes, physicians do have ADHD. Even though they’re high-achievers with high IQs, ADHD doesn’t discriminate in terms of who it impacts; it impacts people across socioeconomic backgrounds as well as intelligence. I think that’s the first thing that I wanted to make sure I covered in that article.

The other part is talking about what is causing these physicians to burn out: they’re trying to mask their symptoms of ADHD by compensating in the best way they possibly can, which is hyper-focusing or fixating on one specific task, or presenting this hyper-perfect version of themselves to their coworkers.

What I didn’t really hit on as much and would love to hit on is that when we’re talking about burnout in medicine, I think it’s often thrown out as, “Oh, this person’s burnt out,” but we’re not actually using any real assessment tool. It’s more like, “Oh, well this all fits the description of what I believe burnout to be.” But are we going beyond that?

Kevin Pho: Specifically with physicians with ADHD, how do they typically function in the clinic or the hospital setting? You said that they may compensate for that with hyper-focus and hyper-perfectionism. What exactly would that look like?

Michael Carlini: That’s a great question. Well, it’s obviously going to depend on specialty. I would say of my clients that are in the emergency medicine sphere, it’s like, “OK, I’m all gas during my shift and my ADHD isn’t really showing up.” But when I’m off shift, life is incredibly hard. “How do I get myself to do the laundry? How do I get myself to exercise or cook or pretty much do anything that’s not work-related because there’s no urgency within that environment?”

Then with my other clients, let’s just say family physicians or a hepatologist, for example, they’re really hyper-organized, thinking, “OK, well this is my patient list for tomorrow. I need to review all of that so that I have a plan for everything.” But that’s taking a lot of time and a lot of effort, and it’s stealing it away from their personal life where they are really hoping to have more time for themselves or more time with their family. They’re doing an amazing job at work, but it comes at that cost of, “Well, what about me?” I’d say that’s a lot of what I’m seeing with the clients that I’m working with.

Kevin Pho: So, physicians with ADHD are saying that at work they may be functioning OK, but where they would suffer is outside of work, in contrast to physicians without ADHD.

Michael Carlini: Exactly. And I would say that’s not going to be universally true. I definitely have some clients that are falling behind on documentation, who really are just struggling to meet the demands of the job. In those cases, we’re really focusing on, “Well, how do we actually support you a little bit better so that you’re able to get these tasks done and be able to have a healthy life?”

Kevin Pho: What kind of tools do you use for these physicians with ADHD to help better manage some of these issues?

Michael Carlini: What I would say has been extremely helpful in the last year or two has actually been having that AI scribe software be available, whether it’s through MyChart or through some third-party software. It’s been really helpful for dealing with that working-memory-heavy task of documenting these patient visits. If you don’t have to try to recollect everything four hours after you’ve had that patient visit because it’s been recorded, that’s so much easier on your executive function, on your brain, really.

That’s one thing. The other thing is really using the tool of building a template for these visits so that you’re not having to regenerate what you need to cover and in what order. Those are some of the tools when it comes to the documentation because that’s pretty much the largest burden on all physicians at this point. Other strategies and tools are really just about ADHD-specific time management: “How do we plan and prioritize? How do we set goals?”

Kevin Pho: One of the things that you mentioned earlier is that ADHD sometimes is misdiagnosed or overlooked in high-achieving medical professionals. What kind of symptoms do physicians have that may point to a potential undiagnosed case of ADHD?

Michael Carlini: It’s a great question. I would say when anxiety is incredibly prevalent and obvious on the surface, regardless of how well someone’s functioning. I see physicians who are anxious because they need to make sure that they get all these things done and don’t have much trust in themselves or their process to actually be able to get it done. I would say that’s the most common sign of it.

What will often be the case is that these physicians will get treated for their anxiety, and their anxiety actually doesn’t respond well to it, and it doesn’t solve the challenge that they’re having. That’s what I would say is the most common example that I see in these physicians that are going undiagnosed and are at a loss of, “Well, why isn’t anything that I’m doing working? I’m working extra hard and I’m constantly anxious about messing up.” They’re just at a loss. That’s usually when people go and seek answers.

Unfortunately, what I would say is a lot of psychiatrists and therapists are not super well-trained at diagnosing people with ADHD who have high IQs and maybe didn’t have any behavioral or academic issues or professional issues.

Kevin Pho: Because they assume that if a physician finishes medical school and residency, how could they have ADHD?

Michael Carlini: Right. Exactly. Absolutely. That’s exactly almost the phrase I hear most often, and it’s probably the most frustrating.

Kevin Pho: You mentioned that you would like to see some validated tools that can diagnose ADHD in high-IQ individuals. Are those tools even available?

Michael Carlini: I would say that they’re available in the sense that if you get the right type of training or you’re getting trained by a mentor who focuses on specifically diagnosing, let’s say, autism spectrum disorder and ADHD, they’re probably going to be a lot more equipped to know what ADHD looks like in those contexts.

In terms of a more in-depth evaluation, it’s one of those things where you could go through the full psychological battery of testing. This person might perform incredibly high in some areas of this testing and then relatively mediocre in some other areas. The science basically says, “OK, well, why is there that significant drop-off by comparison to all these other areas of their testing?” That’s usually the indicator of, “OK, well this person could be diagnosed and meet the criteria for someone who has ADHD.” But if you don’t know what you’re looking at, it’s really easy to go, “OK, well it’s not that.” I would say it really is more about medical training and mentorship from people who are truly specialized in diagnosing and understanding ADHD.

Kevin Pho: So in these physicians where their ADHD is either undiagnosed or untreated, what would be a typical path if their ADHD isn’t addressed?

Michael Carlini: I’ve seen cases where someone is having difficulties within their primary romantic relationship because their partner is really struggling to understand why they said something was going to take 25 or 30 minutes, and it’s four hours later and it’s 10:00 at night. The partner thinks, “We haven’t even been able to have a discussion with each other about our days or do anything else together. What is going on? How do you not know how much time something is going to take?”

What ends up being the case is there’s that frustration and conflict that keeps on arising, and eventually, it leads to this tipping point of, “We need to do something about this. We need to look for what else might be a good explanation for this.” That is usually when people will go and seek out a diagnosis.

What will often be the case is that because they’ve had so many other mental health professionals not recognize what might be going on, people are seeking out a more specialized diagnosis. There are some great ADHD-focused centers in this country. I would say the Chesapeake ADHD Center, which is in Bethesda, Maryland; I have no connection with them, but their focus is diagnosing high-achieving women with ADHD as well as ASD. Those are the types of organizations where you go there and it’s clear that they know what they’re looking at and they know the peculiarities of how it presents in this population.

That actually leads to a more complete understanding of what might be going on. I would say that typically ends up being the path to a diagnosis and to an effective treatment. This tends to really resolve the issue. The partner can now understand what this behavior is and why it’s happening. Is it intentional? Now they can figure out how to support each other in this relationship. That really tends to transform things and lead to a lot more fulfilling outcome.

Kevin Pho: We’re talking to Michael Carlini. He’s a physician coach. Today’s KevinMD article is “Why Physicians with ADHD are Burning Out.” Michael, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Michael Carlini: Physicians with ADHD are out there, probably at the same rate as the general population with ADHD. They need support, and they are going to look a lot different from the typical cases of ADHD. When we’re talking about burnout, we need to realize that this can’t just be a catchall for the symptoms that you might be seeing in someone else. We need to dig deeper, and we need to say, “If there’s a root cause, how do we actually address that and support these people so that we’re not losing physicians to burnout?” I would say that’s pretty much my main takeaway from this article.

Kevin Pho: Michael, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Michael Carlini: Yeah, thank you.