Physician Burnout - too much of a good thing?

Posted by Dike Drummond MD

good-stress-physician-burnoutPhysician Burnout and "Good Stress"

At every live training, I ask the group, "How would you describe the difference between stress and physician burnout?" Someone always musters a really hopeful look and chimes in with ...

"Well, stress can be good sometimes, right?"

The short answer is, "Yes".

Its what they are hoping I will say - as if those three letters will make everything better. As if that answer will make burnout go away, so we don't have to talk about it today. Talking about it would make it impossible to ignore. That is uncomfortable when you finally realize you are walking the cliff edge (see below).

That "Yes" begs another question:

If there is such a thing as "good stress", then what goes wrong when stress gets tipped over into physician burnout?

Let's examine the answer to that question in today's blog post.

  • Let me show you a graph that shows the bell shaped curve mapping the relationship between stress and performance
  • I will also show you the cliff edge most doctors are walking that explains the high prevalence of physician burnout
  • And why you always have to be on the lookout for your last straw

Stress and Performance

Give a human a task without a deadline or any other form of stress/pressure to perform and they will check out, dawdle and get bored. The project will sit in a pile on their desk. You have to push - apply a certain quantum of stress - to get them to move.

On the other hand ... 

Give a human a haystack of complex tasks, sprinkled generously with meaningless busywork, supply them with dull and ineffective tools and impossible deadlines (feel familiar?) and they collapse in a heap.

Where is the Goldilocks here ... the sweet spot of "good stress"?

The Stress vs. Performance Curve


In this graph, Goldilocks is the grey zone. 

You know this "just right" level of stress if you have ever tried to get your 6 year old to clean their room.

You have to get their attention and give them some kind of kid-level incentive to help them focus on the task. If you get mad when they stay rooted to the video game, go over the top - yell and scream and throw things (not recommended) they run away crying and the room is still a mess. 

So ... yes there is "good stress". It is just that physicians rarely inhabit that good stress zone. 

The last time you were in that "not enough stress" situation was in the month before graduation from your senior year of High School or on day seven of your last two week vacation. 

(NOTE: I encourage you to stop for just a moment and reflect on how long it has been since your last two week vacation. If it is over 18 months, I encourage you to get out your calendar, look as far out as you have to, and put a two week break on your calendar now. Then pay for the tickets - it is the only way to guarantee you will take the break)

Your practice has PLENTY of pressure to perform - both on quality and quantity scales

Here's the problem ...

Many physicians are walking the cliff edge on the high side of this curve. Here's the way I see it with my physician burnout coaching clients.

On anything but the most mellow of days, a solid 30-40% of physicians are in the yellow and red zone for at least a couple of hours in their practice. This is not good stress. You are flirting with overwhelm.




Here is a familiar rating scale that will make this easier.

Take a look below and pick the face that best represents your most difficult day in the week just past. You can see where the yellow and red stress levels sit from a different perspective.




The Downward Spiral

The downward spiral of physician burnout begins when you spend too many days in the yellow and red stress zones. Unless you are very skilled at recharging in your time off, your Energetic Bank Accounts become drained. You are running on fumes, just hanging on from day to day.

You are walking the edge of the cliff

All it takes is one more teaspoon of meaningless EMR box checking at work (ICD-10 anyone?)

Or something to come up at home that blocks your ability to recover - sick child, money issues, relationship conflict, etc, etc

You come face to face with the last straw

And off the cliff you go

Step away from the cliff and you won't have to worry about the straw

Notice your energy levelsHow can you pull up out of the downward spiral and get back to the Goldilocks scenario? The steps are simple.

1) Notice your energy levels

Notice the frequency of yellow and red stress days at work.

Notice your physical, emotional and spiritual energy levels. Don't judge. Just notice.

If you are tapped out and below empty, recovery can only start when you admit it and commit to change.

Don't continue to fall victim to your workaholic, superhero programming and just keep soldiering on. Einstein used that behavior as the foundation for his insanity definition.

2) Make small changes at work to deal with the things you know stress you out

Get crystal clear on your Ideal Job Description. Use your team. Ask for their help. Find some wiggle room in your schedule. Use Batch Processing and the BID huddle.

3) Learn how to build life balance despite a busy practice

The Schedule HACK is your friend and the Boundary Ritual is essential


No matter what,
little-voice-in-your-head-physician-burnoutDon't let your head trash tell you making these changes is a sign of weakness

Don't let that little voice tell you if you were stronger or worked harder or had more of the right stuff ... this wouldn't be happening. That is just the head trash of your programming. You learned to think that under the stress of your training.

In reality, you are human. Yep. Deep down under the layers of that white coat and the letters after your name sits the same flesh and blood as your patients.

You have finite limits. When it comes to caring, empathy and helping others, "You can't give what you aint got".

  • You can take care of yourself and your family and be a good doctor
  • You can ask for changes in your practice to make your work day less draining
  • You can decide how you want to balance your life and say, "No" to protect those boundaries

All of this is possible, even if you have never done any of them before.

Maybe now is the time to get started


SBP-Final-CoverImage_opt200W-1If you want the support of the first step-by-step field manual for any doctor to prevent physician burnout and build a more ideal practice ...

CLICK HERE to learn more and get your personal copy of "Stop Physician Burnout - what to do when working harder isn't working"


Tags: Physician Burnout