Why physician burnout is really a money problem

The math I’d never done

A few years ago I took a hard fall on our annual family ski trip and landed on my wrist. It wasn’t broken. It wasn’t even a bad injury by any medical standard, just a sprain. But sitting there holding my arm and waiting for the throbbing to settle, a single thought pushed everything else out of my head.

I’m a periodontist. I treat patients with my hands. If this wrist doesn’t work, nothing else in my financial life works either.

The pain faded in a couple of weeks. That thought never did.

On paper, I was doing everything right. I’d finished residency with around $300,000 in student loans and attacked them until they were gone Dave Ramsey style. I had a healthy income, growing practice, and a family I could provide for. By every standard we’re taught, I’d made it.

But that day on the mountain forced me to do a piece of math nobody had ever asked me to do. I was self-employed, with no partners. If I wasn’t in the operatory, production stopped. If production stopped, income stopped. One income stream, flowing through two hands, supporting an entire family.

I hadn’t built wealth. I’d built dependence on my own ability to keep working, and I’d confused the two for my entire career.

The strangest part is what it took to expose that. Not a lawsuit, not a market crash, not a health crisis. A minor sprain from a recreational fall. It took almost nothing to reveal everything.

Why nobody teaches us this

I don’t think my situation was unusual. I think it’s the default. Dental school taught me everything about how to use my hands. Residency taught me more. Continuing education keeps teaching me still. Somewhere along the way, I absorbed the assumption underneath all of it: keep the hands skilled and busy, and the finances will take care of themselves.

Nobody teaches what happens when the hands stop. Nobody even raises the question.

Yes, I had disability insurance, and every clinician should. But somewhere along the way I realized coverage is a parachute, not a plan. It softens a catastrophe. It doesn’t build a life. And it does nothing for the slower versions of the same problem: the shoulder that ages, the burnout that builds, the reimbursements that shrink while overhead climbs. Every one of those is a variation of the same vulnerability, an entire financial life resting on continued clinical output.

We spend a decade or more learning to manage our patients’ risk. Almost none of us are taught to manage our own.

What I did about it

I started reading everything I could find about how wealthy families actually structure their money, and one distinction kept surfacing. It sounds almost too simple, but it changed how I saw every dollar. Assets put money in your pocket while liabilities take money out. Most high-income professionals, myself included at the time, own plenty of the second and almost none of the first.

So I started buying assets. Slowly, and imperfectly, while practicing full time. For me, that meant passive real estate investments, starting as a limited partner in syndications where experienced operators handle the daily work and investors share in the income. Over the years, those investments began producing something I’d never had before: income that shows up whether or not I’m treating patients.

I want to be careful here, because the details matter less than the principle. Real estate happened to fit my interests and my schedule. For another physician it might be something else entirely. The vehicle isn’t the point. The point is the question I’d never been taught to ask: if my hands stopped tomorrow, what income would continue?

For most of my career, my answer was zero. Changing that answer became the most important financial project of my life.

The honest limits

I won’t pretend any of this was quick. It took years, not months. It required capital I had to save first, patience I had to develop, and a willingness to learn an entirely new field from scratch, with mistakes along the way.

And I still practice part-time. I still enjoy the clinical work as nothing about building outside income diminished that. The difference is that I now practice because I choose to, and I can’t fully describe what that one word, choose, does for how you walk into the office each morning.

The part of burnout we don’t talk about

There’s been a lot written lately, on this site and elsewhere, about physician burnout, and much of it is excellent. But I’d add one variable to the conversation.

Burnout isn’t always exhaustion. Sometimes it’s the quiet knowledge that you can’t stop. A physician who can’t slow down, because everything collapses financially the moment they do, isn’t free at any income level. That trapped feeling doesn’t show up on a wellness survey, but I believe it sits underneath more clinical careers than we admit.

The most powerful thing I ever did for my own stress wasn’t a wellness program or a schedule change. It was gradually lowering the amount of clinical income my life required.

The lesson from the mountain

Dental school taught me everything about how to use my hands. It never taught me what to do the day they might stop. I had to learn that lesson sitting in the snow in Colorado, holding an injured wrist and running numbers in my head that I should have run a decade earlier.

My hope is that you learn it here instead.

This essay is cited in the KevinMD record on physician burnout.

Jeff Anzalone is a periodontist.