Physician's Search for Meaning and the Business of Medicine

Posted by Dike Drummond MD

The fundamental conflict and a proven process for a way forward, in three brief chapters


Chapter 1

Physician's Search for Meaning

Physicians and healthcare and the battle with death suffering Back at the Lightworker's Fork, each of us chose to ally our professional lives to the forces of light in the universe. We are engaged in a daily battle with the forces of darkness; illness, suffering, death and dying.  

We chose this life of service, of helping and healing. A life that we hoped would make a difference.

We are hard wired to create meaning out of the tragedy of the human condition.

On good days, we draw strength from our service. When healing occurs or suffering is eased we take heart, are nourished and can return to the battle with our head up and our shoulders back.

This is a heart and soul and spirit-centered drive for a doctor.

Abraham Maslow would give doctors another level in his pyramid, right above the base of physiologic needs for food, water, shelter and clothing.

physician burnout and Maslow's hierarchy search for meaning

You can find many examples of physicians who will forgo all the upper levels of the hierarchy - safety, love and belonging, esteem, self actualization - in order to make a difference, to find meaning in their work.

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When we are blocked from meaning in our practice, we suffer, wither, burnout and sometimes take our own lives - in numbers twice that of non-physicians.

This absence of meaning is actually the third symptom of burnout. Christina Maslach calls it "lack of efficacy". You will know it as the little voice in your head when it starts saying, "What's the use."

But wait, there's more ...

Not only are physicians hard-wired for meaning, we are driven to find that meaning in a very specific fashion. 

  • We are lightworkers-for-a-living. This connection with meaning must come from our job.
  • It is both a calling and a vocation.

We want our ability to make meaning, make money too. 

And all people expect an equitable exchange of value. We expect wages and benefits commensurate with our qualifications, skill and effort. 

... and even more ...

These days 73% of physicians are employees, managed by non-physician administrators, many of whom wouldn't know meaning if it jumped up on their lap and licked their face like a dog. 

You know this setup is not going to end well already.


Chapter 2

Money vs. Meaning - the Business of Medicine

Here is the core conflict.

  • Doctors are motivated by meaning.
  • Your employer is motivated by money

The life blood of an organization, whether it is designated for-profit or not-for-profit, is money. Cold hard cash flow as measured in the Profit and Loss Statement and Balance Sheet. The existence of the organization is dependent on money, lots of it. Lose enough money and the organization dies.

It has been my experience - over 12 years, 40,000 doctors and over 200 healthcare organizations - that over 90% of healthcare managers don't know what you do when you are with patients. They also don't care to know. Here's how you can tell.

When was the last time someone up the chain of command from you - a boss - shadowed you as you saw patients. For >90% of doctors that answer is NEVER.

  • They don't know what you do.
  • They can't recognize or understand meaning, especially as it shows up in a physician's practice.
  • They can't understand why you would want meaning in your job.
  • They speak a foreign language, money.

That's why when your boss wants to talk with you it is always in their language: revenue, income, RVUs and other hard metrics of performance. And how you are always losing the company money.

They don't want to hear about a difficult diagnosis, a patient saved or a meaningful death, the things that make you feel the sacrifice of becoming and being a doctor was and still is worth it. 

If you can't find enough meaning in your work, no amount of money is enough. Burnout is the only natural result. You, your family, your work team, your patients and their families all suffer. 

Reality Check:

Ask yourself, is the quid pro quo of my job adequate right now?

In exchange for my Lightworker/clinician skill set and the sheer effort I put into my practice am I receiving adequate compensation in the ways a business can provide:

      • Money and benefits
      • Staff, facilities, equipment and supplies
      • Patient volume 
      • Leadership (Mission, Vision and Values) and culture

Is this a fair exchange right now?

If the answer is no ... and there is a way to find more meaning in your practice ... would that help?

Chapter 3

A simple way forward

There is a simple way to more meaning in your practice, without changing jobs. It is so simple, most doctors don't believe it will work the first time they see it. If this comes up for you, I encourage you read this Chapter 3 a couple of times and then read what these people have said

The first step is to acknowledge Einstein's Insanity Trap and start planning to take new actions.

physician-burnout-einsteins-definition-of-insanity"Insanity is doing the same thing over and over and expecting a different result." ~ Albert Einstein

The insanity trap is a law of  nature when you are working to build a more fulfilling practice. Nothing can change until you do. Nothing will change unless and until you take different actions.

Two Tips:

  • The changes don't have to be big ones, just new actions. Baby steps are best.
  • You don't have to be burned out to benefit. All that is needed is a desire for a better practice and a willingness to try some new things.

When is the right time for some changes?

It depends on what the little voice in your head is telling you right now.

If you are hearing "I still enjoy/love seeing and taking care of my patients, but this job is painful/a bummer/a sh*t show, a drag."

Or especially, "I don't know why I became a doctor in the first place."

It is time to take your practice back before burnout takes it away. 

When the little voice of guilt or shame or Imposter Syndrome, "What if they find out" remember ...

It's not your fault.

You are on a mission for meaning in a system set up for money.

If you simply follow your job description and compensation formula and color inside the lines of this JOB, you will get your money and benefits, but the levels of satisfaction, fulfillment and meaning you want are doubtful. 

How much wiggle room do you have here though? That is what we need to test.

If you knew exactly the practice changes that would make you satisfied and fulfilled, could you build a more satisfying practice here over time?

The answer is yes, 70% of the time in our experience of coaching thousands of burned out and unhappy doctors.

3 keys are:

1) Take regular time to work ON your practice, rather than just IN it.
(reading this article is an example)

2) Figure out what you really want in your practice.
Notice how your thinking is dominated by avoiding what you don't want, what you want to run away from. My question is what would you run towards. What would your Ideal Job look like?

3) Change your actions.
Start taking baby steps in the direction of your Ideal Job.


In next week's blog post

  • I will show you a quick STATUS CHECK for you and your practice - Red-Yellow-Green
  • And the best first step to a Practice Reset



How often do you feel you can make a difference with your patients in your current practice?
Do you feel your boss/managers understand what you do in your practice day?
Have they ever shadowed you?

Tags: stop physician burnout