Physician burnout image courtesy Pexels
By Gail Gazelle MD, MCC
Physician burnout coach, speaker, and author Dr. Gail Gazelle has coached over 500 physicians, written extensively about, and, been featured on numerous media outlets on the topic of physician burnout. She is considered a pioneer in this area.
In this ultimate guide, we’ll cover everything you need to know about physician burnout: symptoms, stats, causes, prevention, specialty and most importantly, how to cure physician burnout.
You’re A Modern-day Physician
You earned your dream career – after a decade + of training, countless exams, sleepless nights, hundreds of thousands of dollars of debt, and more.
You faced all of this while your peers were earning large signing bonuses, purchasing their first (and even second) homes, and rising the ranks in corporate America.
When you look around you see other doctors seemingly free from doctor burnout, that seems to “have it all together,” effortlessly breezing through their practice while your life feels like anything but.
In A Single Day You See Dozens of Patients
There never seem to be enough hours for everything you’re tasked with.
You take on the emotional burdens of your patients and in many cases wear plenty of hats besides being a stressed-out doctor. When you aren’t sprinting from patient to patient, you’re dealing with the EMR, insurance companies, or bureaucratic/administrative junk within your hospital or practice.
Your woes probably don’t end there – because life is hard. You may have kids or aging parents that contribute to your stress. You may have a marriage that could use some work. Between all of these demands and people, you rarely have time for the most important person in your life – yourself.
So, Where Does All of This Take Us?
For many physicians, the above adds up to the perfect recipe for burnout. And if you’re a burned-out physician reading this, you’re nodding your head. Physician burnout is the exhausting, soul-crushing state where you never feel good enough or like you’re doing enough, you’re tired, you’re not present, and you might be wondering if you picked the right career.
Have no fear – you’re in the right place. We’ve helped hundreds (approaching thousands) of physicians overcome burnout and get their lives back. I’m Dr. Gazelle, a former burned-out palliative care doctor turned executive coach for physicians.
Over the past decade, I’ve coached hundreds of physicians, taught mindfulness, and employed and mentored several other physician coaches. I also wrote Mindful MD. 6 Ways Mindfulness Restores, what I consider the “Burnout Bible” which comes out in the spring of 2023.
In This Guide
I’m going to give you everything I’ve learned over the past decade + of helping physicians fight burnout.
We’re going to cover:
- What is physician burnout
- How to recognize the signs of physician burnout before it’s too late
- What medical school didn’t teach you and why it’s directly causing your burnout
- Why 50% of physicians are burned out (and why it’s nothing be ashamed of)
- The leading causes of physician burnout and how to address each one
- How to prevent physician burnout and how to cure it once it’s started
- How to remove EMR stress and get your charting done in record time
- Plus – how coaching can help physicians through burnout
Table of Contents
SYMPTOMS
Introduction To Physician Burnout
Jump to a section
What Is Physician Burnout
Physician burnout is the state of emotional and physical exhaustion that so many physicians find themselves in. Burned out doctors often feel helpless and/or “stuck,” and have trouble maintaining motivation.
This lack of motivation centers around low energy (physical and emotional exhaustion), detachment and depersonalization (impaired ability and will to connect with patients and colleagues,) and a loss of sense of purpose and personal achievement behind your work (no longer feeling like you are making a difference).
Physicians that consistently do not get enough rest (which is almost all physicians!) are prime targets for healthcare burnout. When energy stores erode, we begin to experience detachment and a lack of inner autonomy and achievement, and here begins the vicious cycle that sets us towards physician burnout.
50% of physicians are burned out (we’ll touch on burnout stats in a moment) and the symptoms of physician burnout are not pretty (we’ll also go over burnout symptoms shortly).
But for now, the key thing to understand is the three core tenants (read: triad) of the physician burnout definition: Physical and emotional exhaustion, detachment, cynicism, and depersonalization, and a lack of sense of personal accomplishment.
AKA Doctor Burnout and Medical Burnout
Is burnout only experienced by physicians in the medical landscape? Absolutely not. Medical burnout affects almost all healthcare sectors. Our modern healthcare system is in a fairly dysfunctional state and all practitioners bear the burdens. More patients in less time, more bureaucracy, and less autonomy and humanity all set the stage for burnout. However, as doctors we are especially susceptible for a number of reasons.
Firstly, physicians are the bottleneck of the system. Patients can only move through the system as fast as we can see them – meaning we can feel like the reason things are held up.
Secondly, as physicians we are especially hard on ourselves. We’re used to being perfect, and having all the right answers, habits we learned in our medical training when anything less than 100% was a failure. We often beat ourselves up for our shortcomings as physicians and people, which can set us up for burnout. We also bear the pressure of being the leader of the healthcare team.
Lastly, there are unique stressors that only physicians face. Long hours, high patient volumes, administrative tasks and the EMR, risk of malpractice suits, and the emotional toll of dealing with pain, trauma, and death face-to-face are all forces that we feel with increased intensity. Let’s face it: while we work in teams, we are the ones that bear ultimate responsibility for patient outcome. All of this contributes to stressed out doctors and burnout out doctors as well.
Physician Burnout Statistics
Jump to a section
Physician Burnout Rates – Just how many doctors are burned out?
Here are some physician burnout stats: In the U.S. there is a physician burnout rate of 50% with 63% of physicians reporting at least one manifestation of burnout in 2022. Physician suicides are more than double the rate of the general population, and depression and anxiety are both more prevalent among physicians.
The average physician graduates with over $200,000 in educational debt – which likely contributes to high physician burnout rates.
According to physician burnout research, we work on average 53 hours per week, which is likely underreported, compared to a U.S. population average of 34. And over 4 of those hours daily are spent charting – it’s no surprise there are so many burned-out doctors!
If Half of Physicians are Burned Out, why does it feel like I’m the only one?
Half of your colleagues are experiencing physician burnout. So why can it seem like you’re the only one?
This mistake is a classic example of the availability heuristic. We see our own lives (and flaws) in high def 1080p every single day. We’re exposed to the workings of our mind, the somewhat screwed up thoughts we have about ourselves, the mistakes we make as physicians and as people, and the messiness and imperfections of our lives. Not to mention the fact that we learn to have very high standards for ourselves, so we can apply a harsh magnifying glass to our own lives.
We compare this to the 144p view we have of other doctor’s shiny, polished exteriors. All we can see is the side of themselves that they choose to show the world – which (of course) looks better than our messy interiors. This is a fundamental cause of imposter syndrome and of all the sense of shame that comes with physician burnout.
Physician burnout can feel embarrassing. As physicians, we’re used to aiming for perfection, having all the answers, and getting things right. So when our careers and lives are in burnout, we can feel a deep sense of shame and unworthiness. The first key step to getting over physician burnout is recognizing that you aren’t alone, and that there’s nothing wrong with you for being burned out.
1. Provider Burnout, National Library of Medicine; Pandemic Pushes U.S. Doctor Burnout to All-Time High, AMA
2. Physicians Experience Highest Suicide Rate of Any Profession, Medscape
3. Physician Education Debt and the Cost to Attend Medical School, AAMC
4. Average Physician Workweek, Staffcare.com; Average Hours Worked, BLS
5. Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record. Joukes E, Abu-Hanna A, Cornet R, de Keizer NF. Appl Clin Inform. 2018.
Physicians Burnout Stats Infographic
The following infographic of physician burnout stats in the United states will help you understand what the physician burnout rate looks like in this country alone.
Burned Out Physician Studies
The Mayo Clinic completes a regular physician burnout study and, with a decade of data, we can see that physician burnout is at an all-time high. 63% of physicians reported an incident of burnout in 2021, compared to 44% in 2017 and 46% in 2011. Meanwhile, emotional exhaustion and depersonalization scores were also higher than 2017 and 2011, as were incidence rates of depression.
The rate of physicians satisfied with their Work-Life Balance was just 30%, compared to 46% in 2020 pre-pandemic.
There is more burned out physician research that reports frightening numbers:
The 2022 Medscape Physician Burnout and Depression report reported a similar figure of 47% of physicians burned out.
These studies reveal alarming results – that physician burnout is getting worse.
Physician Burnout Symptoms
Jump to a section
Symptoms of Physician Burnout
Earlier we talked about the three main symptoms of physician burnout: Emotional/physical exhaustion, cynicism and depersonalization, and a loss of sense of purpose and accomplishment. Let’s take a look at what each of these actually looks like:
Physical and Emotional Exhaustion aka Physician Fatigue:
- Lack of quality sleep
- Fatigue/physician fatigue
- Feeling drained and unable to cope with the demands of work
- Changes in mood
- Being irritable, stressed, and cranky
- Not experiencing joy at work or at home
- Increased risk of medical errors
Physician Depersonalization:
- Feeling detached or indifferent with patients and coworkers.
- Cynical or negative towards the healthcare system – a sense of “why bother.
- Not looking forward to work/lack of interest in work.
- Feeling “eh” about your career and life.
- Loss of interest in activities outside of work.
- Procrastinating on charts or other challenging aspects of work.
Lack of Sense of Personal Accomplishment:
- Experiencing self-doubt or feelings of incompetence
- Feeling inferior to colleagues or other doctors
- Feeling like an “imposter” or being unworthy of what you have accomplished
- Unable to see the good that you are doing
- Wondering if medicine is the right career for you
As you can see, physician burnout is a miserable state to be in, and it’s a huge problem that more than half of our nation’s healers are experiencing these symptoms every day.
6. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2020. Shanafelt TD, et al. Mayo Clin Proc. 2022.
7. 2022 Medscape Physician Burnout and Depression Report, Medscape
Physician Burnout Causes
Jump to a section
What Causes Physician Burnout?
There are several factors that can cause physician burnout. While some of these are inherent to the modern practice of medicine, many we can address and work through to maintain this difficult, albeit fulfilling and critically important career.
The Top Reasons For Physician Burnout:
- Long hours
Many physicians, especially those in training, work extremely long hours, often in excess of 70 hours per week. The Mayo Clinic burnout study referenced above reported 60% of physicians work more than 50 hours a week, a stark contrast to the average American workweek of 34 hours, according to the Bureau of Labor Statistics.
Simply put, physicians are expected to work excessively – which is exhausting, and also leaves less time for sustaining activities like time with loved ones, exercise, rest, and time for hobbies and personal pursuits.
- High patient volume
Dealing with high volume of patients can lead to a high level of stress, which can contribute to burnout.
Especially post-COVID, and as healthcare becomes more and more of a business, we are expected to see more patients in less time. Our brain has little time to reset between our 17th and 18th patients of the day, and when we get home at the end of the day we find it difficult to turn off our busy mind.
- Administrative burdens
In addition to our workload with patients, we have to spend hours dealing with administrative junk, on the phone with insurance companies haggling on behalf of our patients, or trying to catch up with charting and the inbox long past when we should be home for the day.
- Lack of support
Within this broken healthcare system there is little support for it’s practitioners. Many of our leaders didn’t receive adequate training on how to support and lead, or they’re also bogged down by the bureaucracies and inefficiencies of the system. As a physician, you can often feel like you’re isolated and completely unsupported in your work.
- Workplace drama
Conflict within the workplace and petty politics make it harder for us to show up and focus on our patients.
- Life outside of work
Many of us have aging parents, children, important relationships to manage and maintain, marriages, and stressors outside of work. More likely than not, there are imperfections in each of these. These normal parts of life do cause additional stress, which can be the straw that breaks the camel’s back. Additionally, these imperfections can be especially stressful for perfectionistic physicians (most of us!)
- Emotional toll
Dealing with illness and death and bearing the fear of making a mistake on a daily basis can take a significant emotional toll on us. We take on the emotional burdens of our patients, and when combined with the rest of these factors, it can be a recipe for burnout.
- Chronic stress
We work in high pressure environments – our work is often quite literally life or death. The body can only take so much cortisol and eventually we can be overwhelmed by unregulated stress day in and day out. Fear of malpractice suit or legal repercussion for a mistake can add to this stress.
- Things get stale
Even Tom got bored of chasing Jerry. After years and years in a specialty, it can begin to feel like Groundhog day.
- The COVID-19 pandemic
The pandemic has increased the workload and stress of everyone in healthcare and while thankfully it has brought the burnout epidemic to light, it has also contributed to burnout.
Physician Burnout By Specialty
Jump to a section
Which Physicians Are Most Burned Out
As to be expected, the percentage of physicians burned out varies widely by specialty. According to a 2022 Medscape study on physician burnout, incidence ranged from 60% for Emergency Medicine doctors, to just 26% for Public Health and Preventative Medicine specialists.
The top 5 specialties with the highest physician burnout rate were:
- Emergency Medicine (60%)
- Critical Care (56%)
- OBGYN (53%)
- Infectious Disease (51%)
- Family Medicine (51%)
The bottom 5 specialties for physician burnout were:
- Orthopedics (37%)
- Oncology (36%)
- Pathology (35%)
- Dermatology (33%
- Public Health and Preventative Medicine (26%)
The fact that even in the specialty where burnout is the least prevalent, more than a quarter of doctors are burned out speaks to how big of a problem this is.
Burnout By Specialty Chart
Here you can see which physicians are most burned out, visually.
Burnout Prevention
Jump to a section
Prevention Of Burnout In Physicians
There is a slew of burnout prevention strategies that physicians can take to stop burnout before it happens. Burnout prevention is, of course, the most important preemptive step that individuals and hospitals can take – it’s easier to stop burnout before it arises than to treat it once it’s present.
Here are some burnout prevention strategies you can utilize to stop burnout before it happens:
- Put your most important patient first
It is absolutely imperative that we prioritize ourselves and work as hard as we can to pour from a cup that is full. We can’t consistently show up for our patients and our loved ones until we consistently show up for ourselves.
The leading symptom of physician burnout is physical and emotional exhaustion, and tackling this symptom head-on and prioritizing self-care, and maintaining a life outside of work is the only way to get our energy back.
For the physicians that I coach, we call this “mindful selfishness.” This may sound pedantic but as physicians, we need to practice taking care of our most important patient: ourselves.
The most important preventative measures you can take are getting enough rest, and sustaining a social and personal life outside of work. Additionally, exercising and eating healthily, and intentionally prioritizing activities that sustain you are key. For me, the two things that really sustain me are time in nature and playing pickleball. (I have definitely caught the pickleball bug!).
- Be mindful
Managing your own mind and stress responses is one of the most powerful tools we have in preventing burnout. The human mind produces upwards of 20,000 thoughts per day, a crazy number! Many are helpful but by noticing what your mind is up to, you begin to see just how many are completely unhelpful.
With mindfulness, we can pay attention to the often negative and out-of-proportion thoughts that our mind generates, and we can build our ability to be less attached to the fears, worries, and preoccupations our mind generates. This helps us attack burnout where the rubber meets the road.
While there is a great deal in healthcare that we can’t control, we can control how we respond. It is this autonomy that all the dysfunction in healthcare cannot take from us. It is this that is behind the fact that over a dozen well-conducted studies reveal the power mindfulness has to reduce burnout.
I’m thrilled to announce my new book, Mindful MD, which launches in the spring of 2023. Perhaps we can have a link to the new book page too!
- Move from inner bully to inner ally:
Two of the core symptoms of burnout relate to detachment and a lack of personal achievement. When we’re burned out, we stop being able to see the good that we are doing. In order to prevent burnout, we have to intentionally focus and remind ourselves of how meaningful our work as physicians is.
The brain has a powerful negativity bias meant to keep us alive, and this is exacerbated by the aforementioned medical mindset. So it is easy to feel like your work is meaningless. As healers, this couldn’t be further from the truth.
However, our brains and the powerful negativity bias are great at replaying in 1080p any misstep we’ve ever made, and are reluctant to show us our own highlight reel. We can get around this by intentionally reminding ourselves of the good we are doing and the positive impact we have, at work and at home.
- Learn to overcome charting stress
The EMR is one of the biggest contributors to workplace stress and burnout, and I’ve written a free guide to stress-free charting that you can download here.
Physicians and other healthcare workers can overcome charting stress by accepting that the EMR is a part of the job that is here to stay. I say this as the annoyance and frustration we experience about charting actually play a big part in the charting inefficiency I’ve successfully coached dozens of physicians on. All that emotion makes it more difficult to get our charts done! So we need to mindfully let go of the emotional charge and we also have to let go of a sense of perfectionism or that our note somehow proves our worth.
Another helpful strategy is reminding yourself that your note is just a note, and also that you don’t need to get an A+ for every note you write. While this may sound silly, I have seen these strategies be game-changers for many overburdened physicians.
- Do your part to create a positive work environment
We all know that workplace drama and politics can sap our energy and make our workplace somewhere we dread going to. Contributing to strong relationships with colleagues and coworkers, and working to build a positive culture despite whatever our organization may lack can be a powerful antidote to burnout.
- You can ask yourself
What can I do today to contribute to the positive culture I want to work in?
How can I help those I work with have a better day?
Focusing on positive actions you can take contributes to a needed sense of agency and autonomy and helps us feel good about ourselves and our work.
- Seek support
Seeking support often flies in the face of the medical mindset reinforced in our training which teaches us to never appear weak or ask for help. Ironically, when we can be open about our shortcomings and what we’re struggling with, it helps break the sense of isolation inherent in being burnout out. Push yourself to speak to colleagues, friends, or a coach about the challenges you are facing and seek help when you need it.
The US Physician Support Line is an important resource (888) 409-0141. This confidential, free phone line is staffed by volunteer psychiatrists who help physicians and trainees navigate stress, burnout, and desperation.
Preventing Burnout In Healthcare
While may causes of healthcare burnout are inherent to our broken healthcare system, at risk of recommending “change everything” I will outline some changes that healthcare systems can make to better support clinicians through burnout.
1 - Providing support and resources
As a lack of perceived support is a leading cause of burnout, healthcare systems can offer resources such as coaching to help physicians cope with the demands of their jobs.
2 - Reducing administrative burdens
Organizations can streamline administrative processes and paperwork, and/or hire scribes and more medical assistants to reduce the amount of time physicians spend on below-grade tasks.
3 - Creating a culture of teamwork and collaboration
It takes a village to raise a child and to run a hospital or practice. Leadership can foster a culture of teamwork and collaboration among physicians, nurses, and other healthcare professionals to promote a sense of shared responsibility and support.
4 - Promoting work-life balance
Organizations can encourage physicians and other healthcare professionals to maintain a healthy work-life balance by setting realistic expectations and providing flexible scheduling options.
5 - Improving communication
Improve communication within the healthcare system to promote transparency and build trust among physicians, nurses, and other healthcare professionals.
6 - Recognizing and rewarding good work
For physicians who feel underappreciated and that their work is not making an impact, organizations have the ability to completely reshape a sense of personal accomplishment. Leadership can recognize and reward physicians and other healthcare professionals for their hard work and dedication to improve job satisfaction and motivation.
7 - Encouraging leadership development
Amongst the many things that medical school does not teach us is how to be an effective leader. By investing in physicians and equipping us with the tools we need to lead, we can overcome burnout as we rise in our organizations.
8 - Implementing a burnout screening program
Regularly screen and track burnout rates among physicians and provide additional resources for those most at risk.
Providing coaching for your physicians, something that there is increasing data to support as a means of decreasing physician burnout.
Physician Burnout Treatment
Jump to a section
How To Deal With Physician Burnout
In the above section, we covered how to prevent burnout. Treatment for physician burnout once its onset is similar, but requires a slightly different protocol. Understand that there is no “one-size fits all” solution to physician burnout, but a multifactorial approach combined with consistent effort will help put burnout in the rear-view mirror.
A large part of dealing with burnout in your life is understanding what is at stake. You’ve already invested decades of your life becoming a doctor, and hundreds of thousands of dollars.
This is your career, and this is your life. You are the one person responsible for its success and you are currently in a position where either your career is in jeopardy, or you’re trudging through but you’re unhappy, exhausted, unfulfilled, and burned out.
Either way, this can feel like a very bad position to be in after everything that you’ve invested. And likely not what you anticipated at the beginning of your medical journey.
So That’s A Big Piece Of What Is At Stake Here
Your career, and your life. On top of all of that, because burnout spills over and has tremendous ripple effects, what’s also at stake is:
- Your time and presence with your children, spouse, aging parents, and loved ones
- Your ability to be present with your patients
- Your relationships and quality of care that you provide to your patients
- Your calm when you go to sleep, when you look in the mirror, and when you are alone with your thoughts
- Your relationship with yourself
There is a LOT at stake when it comes to getting over burnout. And you definitely can and you will – I’ve coached hundreds of doctors through it and I know with 100% certainty that if you can do what it takes to become a doctor, and you put your mind to it, you can also find real satisfaction and happiness. You can overcome physician burnout.
Next, make a commitment to getting out of physician burnout. It may seem like you’re in a mile-deep hole. But recognize that you can get out of burnout and actually enjoy the career and life you’ve worked so hard for.
Lastly, identify the causes of burnout that are impacting you. The three main symptoms of burnout – fatigue, depersonalization, and a lack of esteem when it comes to your work – are three areas to tackle when it comes to overcoming burnout. Make a plan of action to move past these causes, be “mindfully selfish,” and prioritize your most important patient until you have your career and life back.
For many physicians, working with an experienced, physician coach who gets it and has helped many other physicians out of burnout is one of the most effective ways forward.
How To Cure Burnout
This title is a bit of a misnomer – physician burnout is a “chronic condition.” That is, it requires continued attention to stay out of burnout – you can’t just take a pill and forget about it. However, by developing mindful habits and integrating the strategies outlined above, you can create a sustainable life and career as a physician that will leave you happy, fulfilled, and largely burnout free.
The key here is integrating the habits and mindfulness tools that are most effective and maintaining them as part of your life – not just when burnout pops up.
Physician Burnout Coaching
Why You Should Consider Physician Burnout Coaching
If all of the above sounds like a lot, that’s because it is. Undoing the patterns that set you up for burnout in the first place is no small task, and isn’t a project that is easy to DIY. Having an outside perspective and advocate to help you make the changes is why physician coaching is so effective.
Working with a dedicated physician coach, who has been in your shoes and has helped other physicians through burnout, can be instrumental in regaining your life and career.
Jump to a section
About Physician Burnout Coach Dr. Gail Gazelle
Dr. Gail Gazelle is a former hospice physician who has coached over 500 physicians personally through burnout. She is faculty at Harvard Medical School, a founding member of the Harvard Institute of Coaching, a certified mindfulness teacher, and the CEO of MD Can Help, her organization dedicated to fighting healthcare burnout. Dr. Gazelle is also the author of the 2020 Everyday Resilience, and the upcoming book Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout (June 2023).
My 30 years as a physician, 20 years as Harvard Medical School faculty, 12 years as a career and leadership coach for doctors, and 25 years as a mother have all led me to the purpose I live by today.
My Mission Is Simple: I Help Physicians Live The Lives They Deserve
There is so much, internally and externally, that gets in the way of physicians enjoying the career and lives they’ve worked hard to create. I help physicians work through both the internal and external, so they can get back to living.
My coaching is founded on a number of core beliefs:
- That there has never been a more difficult time to be a physician.
- You cannot pour from an empty cup.
- Way, way too many doctors are walking around feeling stressed, burned out, and inadequate, as a physician and as a family members.
- For all the medical training that we received, we got very little training on how to manage the stresses of the profession, and how to manage our most important instrument: our mind.
- A small dose of physician mindfulness goes a long way.
What I see time and time again is that small changes have a massive impact on the quality of life of the physicians that I coach and their coworkers, patients, and loved ones. - It’s every physician’s right to live a healthy, balanced life.
- No matter how powerless they may feel, every physician can feel happy, in control of their life, and confident.
- And perhaps most importantly – I believe in you. And I’m here to help.
Gail
Physician Burnout Solutions
Six Free Physician Burnout Resources
These FREE physician burnout resources are meant to give you exactly what you need to build inner strength and weather the challenges you face.
Jump to a section
Stress Free Charting
This free resource is aimed to help you better manage your physician charting tasks so you can save time to do what’s important – enjoy your life.
The Daily Dose of Calm
A free 14-Day mini mindfulness course. In less than 10 minutes per day, you’ll learn about mindfulness and get practice meditating.
Imposter No More
Everything you need to take full credit for all your accomplishments and strengths and vanquish Imposter Syndrome from your life!
Leading In A Time of Crisis
What healthcare leaders need to know. Leadership in healthcare has never been more difficult than it is now. Get exactly what you need to cope and thrive.
From Balance To Burnout
Struggling with burnout? This brief must-read guide provides just the right practical resilience strategies you need.
Everyday Resilience
Read a free chapter and get the exact practical knowledge and strategies you need to weather whatever challenges come your way.