Physician Burnout - What to do When the Thrill is Gone

Posted by Dike Drummond MD

physician-burnout-the-thrill-is-gone_opt150W.jpgRemember back to your first clinical rotations in medical school ... how exciting it was to finally be face to face with live patients. Bedside conversations, recognizing skin lesions and the signs of CHF. What a thrill it all was. Remember?

How much does the word THRILL apply to your feelings about your practice ... now?

In the last month, how often did you say to yourself in a quiet moment, "wow, that was really cool" about a patient, a diagnosis, a procedure, a conversation with a family member or member of your staff? I sincerely hope you run out of fingers to count them all up.

However, if that is not true for you - if the thrill is gone or you can feel it slipping away - what can be done about it? Can you get the thrill back?

In this article let me show you

  • how a chunk of your original sense of excitement and wonder disappeared
  • why this often happens to doctors between the ages of 40 and 50 - at around the 30,000 patient visit threshold
  • three ways to get your thrill back

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Forrest Gump's Box of Chocolates

physician-burnout-thrill-is-gone-forrest-gump-box-of-chocolates_opt240W.jpgThat is exactly what your practice is like at the start ... right?  Everything is fresh and new. You never know what you're gonna get behind the next door. Things you have only read about until now are right in front of you in the form of a living, breathing person giving you a history that you just figured out. Your detective work exposes the presence of an illness you have only imagined seeing until now. 

  • Diphyllobothrium Latum
  • Syphilis of the tonsil
  • The bizarre symptoms of a central cervical cord contusion
  • Leg cellulitis from a rams horn toenail curving in a full circle to penetrate the skin of the arch of the same foot
  • HIV in an infant
  • An acute MI presenting as nagging upper back pain

These are just a few examples from my practice. I know you have your own. Each is a thrill as we see the pages of a text book or the bullet points of a differential diagnosis come to life before our very eyes.

Not only that ... the privilege of being a doctor is beyond compare. You can ask anyone pretty much anything and they will give you an honest answer. Amazing. 

This is THE THRILL.  At first - each encounter and each procedure is a revelation. We have never done anything like this before. Wow, wow, wow.

Over time you develop deep experience in treating the vast majority of the symptoms that walk into your exam room. If you do procedures, you do hundreds, maybe thousands of them.

This experience and the sense of control it brings is comforting at first. You begin to master your craft. This sense of familiarity and OK-I-know-what-to-do-in-this-situation here is very comforting -- at first. This dance of experiences weaving through your weekly practice -- the sense of wonder and feelings of mastery --  is able to hold off the drudgery of EMR overload and InBox whack-a-mole and help you maintain your thrill and a connection with your purpose.

The 30,000 visit threshold

In my experience as a family practice doctor, there is a threshold for many of us at about the 30,000 patient visit mark. You are no longer wet behind the ears. You have seen and done a lot. People say you are in the prime of your career. This is when mastery is more common than wonder and you see less and less of the things you have never seen before.

The box of chocolates fades into an infrequent experience and you miss it.

The volume of patients and the tedium of the same old same old can wear you down. This form of physician burnout can take your sense of mastery and turn it into boredom and a longing to see a case of something - anything - you have never seen before.

You are longing for a growing edge and more purpose in your practice

This threshold happens at about the age of 40 for many of us.  At this point your practice is often completely dominated by the daily grind.  This is when I often hear physicians say, "I'm not sure how much longer I can keep going like this."

How do you get the thrill back?

First, recognize that your need for something new, something fresh, a growing edge ... is a core human desire. Losing the thrill at this point is NORMAL. There is nothing wrong with you.

If you don't experience the fresh, new and exciting in your practice week regularly - you wither. Things can be draining and stressful and disappointing. Your energy suffers and physician burnout can creep in and finish off your career if you aren't careful.

If this feels familiar, there are three common ways to bring back the thrill

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1) Find a new growing edge AT WORK

Since you spend 50 or more hours a week at work, you might first try to find a new growing edge at work. I have seen two main versions of this:

a) Find a new clinical interest you can explore

Who are your favorite patients?
What are your favorite diagnoses to treat or procedures to perform?
How can you do more of these things?

It is possible to create a mini-referral practice doing what you love to do just by letting people know about your preference and expertise?  You can begin to promote your special interest to your partners and local colleagues and request referrals.

This is a growing edge you select and grow on purpose. In some cases physicians will choose a cash service and develop a new source of income at the same time. Botox, fillers and other minor cosmetic procedures are examples of this.

b) Find a new non-clinical interest

The most frequent variation here is when a clinician assumes a part time leadership role in the organization. In most growing groups, physician leadership positions open up from time to time. I have found many doctors take these positions hoping to get their thrill back via the new and unfamiliar duties of leadership. 

Physician leadership is very different from clinical practice. Physician leadership is a new box of chocolates for sure, just remember to be on the alert to physician leadership's dirty little secrets.


2) Find a new growing edge away from work

The thrill of new experiences and adventures is something you can find outside of your career as well. What is on your bucket list? This is the best place to start. Your medical career might have been the source of your growing edge for the last 20 years, but that does not mean it has to be that way forever.

Your bucket list - the list of things you absolutely must do before you die - is chock full of fresh, new, purpose-filled experiences just waiting to happen. What's on your list?

  • Triathlons
  • Photography
  • Travel
  • Volunteer work

What's on your bucket list right now? Here are some ways to start living it to re-establish the thrill that is missing from your practice in a new location outside your hospital or clinic.


3) Consider the Terrarium Practice

A terrarium is a self contained environment - usually in a 10 gallon aquarium with a lid. You don't have to add anything. It takes care of itself. 

physician-burnout-coaching-terrarium-practice_opt300W.jpgA Terrarium Practice is when you put the lid on your time and energy commitments at work and look for fulfillment and passion elsewhere. Just a quick reality check - your clinical practice of medicine is the most income dense activity available. It is the way you can make the most amount of money in the least amount of time ... even if the thrill is gone at this point. 

Here's how the terrarium works:

  • Figure out how much money you need to make in a month
  • Figure out how many patients you have to see, hours you need to work, procedures you need to complete to make that much money
  • Work just that much and no more
  • Do your best with your patients, staff and documentation while you are at work - demonstrate your mastery and practice your craft to the best of your ability in the hours you dedicate to work
  • And no more

Put a lid on it and terrarium your practice.

Then grab your bucket list and get started.

And you can always work both sides of the equation - something fresh and new at work and something fresh and new in your larger life.



How do you keep the thrill in your life and practice at this point?


Tags: Physician Burnout