Making the decision to leave clinical practice was a leap off a cliff into thin air when I wasn’t sure I had a place to land. Who was I, what would I do, if I wasn’t a physician? It felt like such a loss; I loved being able to do such deeply meaningful work.
This was back in the dark ages of the late 1990s, before “burnout” was a household word. I didn’t know anyone else who was struggling, and I’d never met anyone who had left or cut back to part-time. For years, I saw leaving as an indication that I was deficient, a personal failing. I didn’t consider the societal, structural, and organizational factors that created the circumstances that made leaving the lesser of two evils.
I left because I could not see a future in which I could avoid a second bout of burnout, have a family and a personal life, and be healthy myself. The future I did see was not one I was willing to accept.
Today, women physicians are cutting back and leaving practice on a scale that is alarming and has real implications for our access to health care as a nation. Research by Lisa Rotenstein and colleagues, recently published in the Journal of General Internal Medicine, found that women physicians are significantly more likely to leave practice, across all specialties, and they are more likely to leave at a younger age.
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Do we continue to see women physicians’ attrition as a problem caused by the individual physician’s circumstances and let them figure it out on their own? Or do we appreciate the larger drivers of the problem and our collective responsibility for finding solutions?
Every week, I hear from the women physicians in my ongoing groups about the range of stressors they deal with. Many of these problems, like workload, inefficient processes, and gaps in leadership communication, affect all physicians.
Other stressors affect women more often or more acutely than their male colleagues:
- Women receive more inbox messages from patients and from staff.
- Care team members more often approach women physicians for answers to time-sensitive questions.
- Women physicians spend, on average, more time with each patient and more time talking with patients about psychosocial issues.
- Women physicians are also more likely than their male colleagues to carry a larger share of household tasks, including the cognitive load of planning for family needs and care.
Given these realities, what should we do? Here are a few ideas.
Undergo a collective mindset lobotomy. We all need to quit blaming women and start asking, “What needs to change so that staying is a viable option?” A tip for getting buy-in: Many of the changes will support the health, well-being, and retention of all health care workers, whatever their gender.
Identify the changes that would help most. Join with others in your clinic or department. Flexible hours? Emergency child care? A revision of compensation to recognize invisible work? New policies to distribute uncompensated work fairly? As a group, take these to leadership, being prepared to articulate how these will also benefit your organization.
Leaders, ask the women physicians what they are challenged by. Schedule regular performance reviews and ask about challenges and professional goals, instead of just going through performance metrics. Conduct exit interviews to learn more about the specific issues in the workplace you supervise. Be bold and start leading the change.
It took me years to accept that I was not weak or deficient. More about that in my TEDx talk. I’d been working in a flawed system, a system without guardrails to prevent burnout and allow physicians to live healthy, full lives.
In the decades since I left, we have made strides to better understand the scope, impact, costs, and drivers of physician burnout. Now let’s move on to phase 2: making the wellness and retention of all physicians a top priority at all health care organizations.
This essay is cited in the KevinMD records on physician burnout and women in medicine.
Diane W. Shannon is a physician, professional coach, author, and health care writer who helps women physicians build influential, sustainable careers without sacrificing their well-being. She can be found at dianeshannon.com.
She brings more than 20 years of expertise in physician burnout, women physician leadership, and building sustainable physician workplaces. After experiencing burnout early in her own primary care career, she dedicated her work to understanding why talented physicians struggle and what it takes for both individuals and organizations to thrive. Drawing on her experience as both a physician and award-winning health care writer, she helps women physicians expand their leadership, navigate career transitions, and avoid burnout, while partnering with health care organizations to retain physicians, develop women leaders, and strengthen workplace culture.
Dr. Shannon is coauthor of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, a TEDx speaker, and cofounder of Lead Your Way Academy. Her writing on burnout, cognitive load, and physician well-being has appeared in Massachusetts Medical Society publications, the American Medical Association’s STEPS Forward toolkit series, and on WBUR. She shares updates on LinkedIn and Instagram.
