Burned Out? An Expert Explains How to Know and What to Do About It

John C. Hayes; Peter S. Moskowitz, MD


November 29, 2012

In This Article

Editor's Note:
Physician burnout has been with us for a long time, but it seems to be getting more attention as the pace of change and the pressures in practice increase. Peter S. Moskowitz, MD, a pediatric radiologist at Stanford University, has followed this problem for more than 14 years as the principal of the Center for Professional and Personal Renewal (www.cppr.com). Today he describes himself as a career and life coach for physicians, but much of his work involves helping physicians deal with burnout. A workshop on the topic that he presented at last year's Radiological Society of North America (RSNA) meeting sold out, as has another that he will present at this year's meeting. Both have drawn attendees from the United States and internationally.

Medscape asked Dr. Moskowitz to describe the conditions that lead to physician and radiologist burnout, how to spot it, and how to deal with it.


Medscape: What are the signs and symptoms of burnout, both from a general physician's standpoint and a radiologist's standpoint?

Dr. Moskowitz: I think the original description of burnout came about 30 years ago from Maslach, a psychologist who first began describing professional burnout as a series of sequential stages.[1] It's essentially a spectrum of symptoms that begin as relatively mild and progress over time to become incapacitating.

The primary problem is the excessive ambition of a professional -- the desire to prove oneself -- and that can get out of control in both benign and adverse working situations. These people find themselves having a harder time fitting into an organization, or that the expectations of the organization don't fit well with their personal values.

Peter S. Moskowitz, MD

As a result, the professional works harder and harder to try to stay ahead and prove himself or herself and look good. Eventually, that leads to neglect of their personal, physical and emotional needs. If that continues, their internal values start to shift, and they withdraw and isolate more from other people. They then become depersonalized and exhausted emotionally.

It's a self-fulfilling prophecy: The more they work, the less they are connected with others and the more depersonalized they become. This leads to a sense of dissatisfaction with work and with their performance. As that continues, the withdrawal gets worse, and it spills over into private lives. They become detached and less connected with family and lose interest in hobbies and other things.

The desire to self-medicate eventually arises, in an effort to feel better about themselves. The professional may try various things to elevate their mood, such as alcohol, drugs, gambling, and other behaviors that we would ordinarily consider nonproductive. At the far end of the spectrum, you get physical symptoms, depression, anxiety, physical exhaustion, and the inability to function.

That's a long answer, but I think it's important to realize that it takes a while for the symptoms to progress. It often is unrecognized by the professional himself or herself, and it's usually coworkers and family members who recognize a change in behavior and attitude. Once physical symptoms develop, it becomes apparent to the professional himself or herself.