Stop Physician Burnout - 6 Levels of Practice-Life Integration

Posted by Dike Drummond MD

physician-practice-career-fusion-burnout-integration-mitosis-image-150Stop physician burnout - understand the six levels of integration between your life and your practice

  • You are Not Your Practice.
  • Your Practice is Not You.
  • You are in a Relationship - an intricate dance with a long and dysfunctional history.

When you recognize the nature of your relationship with your practice - and begin to actively manage it - physician burnout becomes far less likely. 

Many physicians are FUSED with their practice.

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Tragically this learned behavior puts you, your career and your family at risk.

When you are in a state of FUSION with Your Practice - your satisfaction with your practice becomes your quality of life - for you and your family.

Back when you chose to become a physician, you had dreams of an extraordinary career leading to an extraordinary life.  With 50% of doctors suffering from at least one symptom of burnout every day, you may be like so many of us - your life has become dominated by a practice that has not lived up to expectations.

You may be noticing:

It seems like all you do is work.
There is never enough time.
Rather than a sense of purpose and contribution, your main sensation is one of fatigue/exhaustion.
You never thought things would turn out like this.
Sometimes you may have thoughts of quitting, walking out, chucking it all, finding a new way to make a living.

That is what practice fusion feels like when you are in a hostile work environment.

physician-burnout-career-practice-fusion-FBHow did we get here?

To understand the origin story of this fusion phenomenon and why it is so common in physicians, we must examine the history of your relationship with your practice.


Unfortunately, this relationship started in wartime ... in a battle zone ... in the heat and fire of  your medical education.

Take a breath and remember ...

... way back when you were standing at the "Lightworker's Fork in the Road" trying to choose between going to medical school and literally anything else. You made the decision to become a physician. You decided to honor your instincts to be a helper, a healer, a Lightworker. You made this decision with some sense of choosing the extra-ordinary career and living an extra-ordinary life.

And you must admit, you had no idea what would happen next. You had no idea what it would take to get that MD/DO.

You said yes to becoming a doctor, then suddenly ... 

  • You shipped out to four years of basic training - Medical School

  • And then straight to the front lines - Residency/Fellowship

Through heat and fire and overwhelm of these experiences, you and your career (the practice of medicine) merged into one inseparable entity.

Your practice came to completely dominate your life, naturally, automatically, predictably.

In medical school and residency we prune down our hobbies, our friends, our outside interests to the bare minimum as our education/boot camp expands to occupy nearly all our waking hours.

We are programmed to believe rest, sleep, food, basic bodily functions are superfluous to our training.

Any request for humanity is seen as a sign of weakness and a potential marker that you haven't got what it takes. (don't talk to me about "grit" right now).

You and the medical education process become FUSED. Joined at the Amygdala. You are a resident ... full stop.

Then boom, just like being shot out of a cannon -- you are out, sprung, released, prepared and board certified. You squint and shield your eyes against the bright light of the sun here on the outside and try to remember where you are.

But old habits die hard. Even decades later, relationships and habits from your medical education linger on.

BEWARE, you are probably Still FUSED With Your Practice

If you are not 100% satisfied with your practice, now is the time to take a step back and look at the relationship between you - as an individual human being - and your career, the practice of medicine in your chosen specialty.

Let's make sure you are not still FUSED with your practice. Let's make sure you are not putting you and your family at risk in a dysfunctional, co-dependent relationship with your career.

"Always be building a more Ideal Practice"


Six Levels of Practice/Life Integration

1) All In
2) Terrarium
3) Bridge
4) Side Gig
5) Transition
6) Non-clinical


physician-practice-relationship-fusion-burnout-all-in-poker-chips1) ALL IN

This is the default setting installed via the immersion of medical education.

All your money, all your time, all your search for meaning/purpose are fused to your practice. You and your practice are one, just like back in med school and residency/fellowship.

If something at your practice is not optimal, it effects your whole life, including your family. If you are not able to practice with the quality and attention to detail you desire and make the difference you imagined when you chose to be a doctor - this fusion delivers a gut wrenching experience of physician burnout.

=> ALL IN can be dangerous to you, your career and your family.

=> ALL IN only works when your practice is going ideally - when the systems of care and the culture of the care team/organization are ideal.

=> ALL IN only works when the leadership of your organization is ALL IN on you and your practice too.

One of the purposes of burnout is to remind you to create some separation between you and your practice. It is here to knock you onto a path with more purpose and put you in the driver's seat of this relationship again.

Are you ALL IN with your current practice?
How is that going?

~~ Are the systems, and culture of your organization supporting you to be the best physician you can be?

~~ Is the leadership of your organization ALL IN helping you to be the best physician you can be?

~~ If you were to see your practice and you - as two separate entities in a relationship - what difference would that separation make in how you feel about your life?

~~ Do you want to continue to push ALL IN with this practice ... or is a different relationship perhaps healthier for you and your family?

~~ Would a few degrees of separation make a positive difference for you and your family?

Is your current practice a HEALTHY PLACE TO BE ALL IN?

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Let's look at 5 additional levels of career integration that provide some degrees of separation between your life and practice.

If you are not as satisfied as you would like to be with your current practice, adopting one of these integration levels - a stance that is LESS THAN ALL IN - can be a much healthier alternative for you and your family.

physician-career-terrarium-relationship-burnout-240W2) Terrarium

A terrarium is a self-contained ecosystem. It is a fish tank with a lid that does not need outside input - water, air, nutrition - to thrive.

I use this term in my coaching practice to describe the conscious act of pulling back from the ALL IN relationship with your career. Here you pull back to a separation and solid boundaries between you and your practice. You create several degrees of separation from your role as a physician and the rest of your life. 

~~ You effectively put a lid on your practice, deliberately limiting the amount of time and energy you put in and the amount of meaning and purpose you expect to get out.

~~ You go in to work and do a good job with your patients, your team, your documentation. You are a team player and an excellent clinician. 

~~ You practice your specialty to your best ability

~~ You earn the money needed to support you and your family as quickly as possible.  

~~ Then you punch the clock and go home

~~ You stop taking on additional responsibilities

~~ You clarify your Ideal Practice Description and decommit from roles and duties that do not involve direct patient care

~~ Conserve your energy, without sacrificing the quality of care you provide

~~ Re-build hobbies, relationships and outside interests so they begin to deliver more of the meaning and purpose in your life, rather than depend on your practice to carry all of this load.

Terrarium Scenarios

If you are experiencing physician burnout and questioning whether to quit this practice; the Terrarium is a safe place for you to take your time in making that decision. Pull back from ALL IN and take your time figuring out "should I stay or should I go now". 

Terrarium is occasionally a long-term practice choice. If you are comfortable in your practice and your community, Terrarium allows you to use your practice for the efficient generation of cash flow while you build a life that provides the purpose and meaning you require. On occasion a physician will use Locum Tenens positions as a long term Terrarium scenario.

physician-career-relationship-bridge-terrarium-all-in-burnout-300W3) Bridge

Bridge is a form of Terrarium practice where you have no intention of going ALL IN here in this practice.

This job is a BRIDGE to a more permanent setting where you hope to go ALL IN some time in the future.

BRIDGE Scenarios

You have decided to quit this job but not left yet.

For many physicians, the limbo of "should I go or should I stay" is a very uncomfortable situation. Sometimes it can go on for years and be a  major contributor to burnout. 

Once you make the decision you are leaving, you can shift your practice into a BRIDGE position in situ. This limits your exposure to this negative work environment while you clarify your next step.

Once you decide to leave this practice, you can also deliberately take a new position knowing that this is a BRIDGE position. You choose a new position to escape your current situation with full awareness that it is only a BRIDGE. You are not going to shoot for a potential ALL IN scenario with this job. This is often the thought process when you take a locum tenens position. 


physician-career-side-gig-relationship-practice-burnout-240W4) Side Gig

This blended practice is where you deliberately establish a side interest while you continue to practice clinical medicine.

The side interest is specifically to inject more meaning, purpose, fun, adventure, creativity into your practice by building new  experiences into the structure of your work week.

Your "side gig" can be clinical or not. There are hundreds of options and examples of side gigs:

~ One common configuration is to take on a part-time leadership role in your organization

~ You may add in a clinical side gig to your current practice 

--- botox and fillers or other cosmetic procedures 

--- you might fashion a mini-specialty area of focus in a specific disorder in your area of expertise. An example is a pediatrician who encourages ADHD referrals from the community as an area of special interest they enjoy.

~You may do something non-clinical like get certified as a yoga instructor, life coach or any other meaningful activity.

Sometimes your side gig is associated with an additional stream of income, sometimes it is not. Your purpose can be to simply allow you the freedom and freshness of an additional practice/life focus.

physician-career-burnout-transition-fusion-tipping-point-240W5) Transition

A Transition practice is a form of straddle:

You are in a transition from being ALL IN with your clinical practice to ALL IN with your Side Gig. The transition is not complete, so you straddle the two positions at this time. 

~ You have made the decision that at some point in the future you will no longer make a living practicing clinical medicine.

~ Your Side Gig is successful. You enjoy it. You are making money at it.

~ You are transitioning to using your Side Gig as your singular professional focus.

~ You are actively building your skills and experience in what was once your Side Gig, looking forward to the day when it is  your ALL IN focus.


physician-practice-exit-transition-burnout-career-240W6) Non-Clinical

You have made a complete transition to a non-clinical career. Hopefully you walked this path consciously and find it more fulfilling than seeing patients.

Remember your history with your clinical career.

If you decide to go ALL IN with your non-clinical career, beware of fusing your sense of self with your new career just like back in your original clinical practice.


BTW, my own personal journey has been:

10 years of full spectrum Family Practice and Senior Leadership Role
I flamed right out of my practice without a Terrarium phase

Urgent Care supported our family after my burnout in 2000

Sequential Side Gigs - Interactive Guided Imagery, Coaching, COO of our Training Business

Full time as CEO of since 2010




Take a look now and find where you sit on this continuum.

  • Where are you now in these six levels of integration?
  • If you are ALL IN, how is that working for you?
  • Is there a different position that would work better if you chose it consciously?
  • If you chose this new relationship with your career/practice, what difference would it make?
  • What is the first step in that transition?




How does this way of looking at your Career/Practice help ... or not?
Where are you in the six levels?



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