Your MD Career

Is Burnout a Valid Reason to Leave a Job?

Michael E. Brown, MD

Disclosures

March 24, 2021

This is the first column in a new series that addresses physicians' questions about making career decisions, dealing with challenges at work, and finding the best ways to have a satisfying career. We will feature several guest columnists in the coming months.

Do you have a career-related question that you would like to see addressed in a future column? Send it to LKane@medscape.net . (Please note that we may not be able to post all questions, and we cannot answer questions individually.)

Michael E. Brown, MD

I've heard many physicians say they're so burned out and fed up with their job that they feel like they have to leave the job in order to protect their sanity and their spirit. This problem predates the pandemic, but it is particularly worse now with many physicians working longer hours under more stressful conditions.

Sometimes leaving a job is the right thing to do, but sometimes the job may be salvageable and improvable. Physicians are doing themselves a disservice by leaving a job that has some inherent positive elements before trying to "fix" what may be fixable.

Here's an example: An ophthalmologist I know was extremely burned out. She was great at her work and the practice leaders loved her, but their expectations of what she was supposed to do and produce kept increasing. She would stay up until midnight every night completing her notes from home to rise to the challenge, which she always met. The practice leaders felt that because she easily did well, they needed to increase her targets. She finally became completely burned out. She told them she was leaving, and they were aghast. She is now looking for a job in industry.

I feel that instead of leaving, she could have made her job doable. She loved being a clinician. She could have pushed for or set boundaries that would have changed her situation. But instead, she smiled and performed well, and the powers that be had no idea how miserable and overworked she felt.

What Are the Options?

What's important when deciding to leave a job due to burnout is to know what your options are before you leave. Could you be seeing fewer patients? Volunteering less for work that's not absolutely required?

I've found that it's very common for physicians not to know how to say no to work demands. They keep taking them on because they feel that if it's too much, it's a personal failing. Then, their company is shocked when they leave.

I've seen situations in which it wasn't the practice or business putting pressure on the doctors. It's the doctors putting pressure on themselves. Many people work longer hours and beyond what is expected, and they do it because they are perfectionists, or they are more worried about the work than their superiors are.

What should you do instead? You need to let your boss or superiors know that you have too large of a workload. Are you worried that you'll get fired if you mention your hours? You don't know until you ask. In the case of the ophthalmologist, it wouldn't have hurt to ask.

In any job, how do people know how hard you're working? If you never let them know you are staying up until midnight every night, they don't know. If you are not communicating what you're doing, it's the natural tendency of people not to know. And if you're the only one doing your particular job, the only indicator your boss has about your workload is what you tell them.

It's All in How You Say It

How do you convey that you are working long hours without appearing to be a slacker, starting a fight, or ending up with hard feelings? It's all in how you say it and how you communicate.

Some doctors have asked me, "Do I speak up, or should I not speak up?" As far as I'm concerned, that is not the question at all. The question should be, "How do I say what I need to say in a way that is not accusatory and will not be offensive?"

There is a way to address this subject so you don't seem like you are complaining or rebelling. How do you do that? For example, you could say, "I see you are continuing to increase my target. I am putting in an extreme number of hours to meet this target. I feel that if the target continues to increase, perhaps this job is not a good fit. These are more hours than I'm willing to work."

The key to having this conversation successfully and remaining on good working terms is to make it a neutral discussion. Unfortunately, some people hold their emotions back long enough that they're angry at the person they're speaking to, and they are probably also angry at themselves. They've gotten themselves all worked up, and the negative and hostile emotions come through in the discussion. Pay attention to keeping the tone of your voice neutral. Also pay attention to your body language, which typically conveys more information and emotion than the words you're using.

One script that seems to work well is something like, "This doesn't seem like a long-term tenable situation. I wanted to talk to you about how to problem solve. I don't know the answer, but this situation doesn't seem like the right one to me." If you can approach the conversation with more of a problem-solving approach, it's more likely you and your boss can adopt the spirit of working together to solve the problem.  

If you are being pressured to see more patients, perhaps it is possible for you to do so, but it may require better support, elimination of some of your other duties, or higher pay. Instead of a discussion about your willingness to do more, see if you can instead have a problem-solving discussion where you discuss the different trade-offs to the options being discussed. This is also the time to communicate your boundaries for what you might accept.

Leave on a Positive Note

Regarding the decision to leave a job because of burnout, what is the right reason to leave? I don't think leaving is a tragedy. Just don't burn your bridges. Explore your options. If possibilities on the outside are better, make the leap. The key is not to do anything as a knee-jerk reaction.

It's always better to leave a job or explore other options for positive reasons rather than negative ones. Instead of running away from work, run toward what really matters to you. This is better than "I've got to get out of here."

Even if you want to "just get out of there," think about how you might take this precious time to treat yourself in a way that you previously did not have the luxury to do. This will help you use your decision to create the best reality for yourself, and you will feel better about the decision.

Why wonder for the rest of your life what else there could have been? Try something else for a year. Maybe by doing this, you'll be able to come back and approach your job with a much better perspective and a different mindset.

The wonderful thing about being a physician is that a physician is able to take a chance and see what else is out there. You can always go back to what you did before. That's just not true of most professions. One physician I know had a high-level administrative job in a very large health system. He left the job to move elsewhere because his wife wanted to live closer to family, and he got a job as an emergency department physician. He had time to volunteer in the new system in which he was working. Over time, he was recognized and moved back up to a position of even greater responsibility than the position he had in the last health system.

Another option is to keep your job but structure your life differently. One hospitalist I know worked in a hospital but used that job just for his salary. On the side, he started a company, supported a political candidate, and created his life using his time the way he wanted. Ultimately, all of his interests came together and he worked his way into a national position.

It's true that paying back loans is really a pain in the neck, and this can have an impact on your decisions. The cost of paying for private school for your kids also adds up. If you have an expensive lifestyle, you may trap yourself into a career that is not fulfilling. Recognize that there are certain things you have to have and certain things that would be nice to have. You can get a better balance that will give you a happier life.

The aspects of your life that you ignore do not take care of themselves, and when they do not go well, they can become the dominant focus of your life. I do not know if it fits in here, but I have heard that one of the most expensive things you can ever buy is a divorce.

If you can't get more time at your job, maybe you can get more free time outside your job. Instead of cleaning the house or mowing the lawn, use your money to have others help with chores and errands that could provide you with free time.

I'd rather see someone leave a job, take a deep breath, and then figure how to get back in than to stay in the job and be overwhelmingly burned out and miserable. Physicians have such a valuable skill. If you stay too long when you're burned out and unhappy, you're going to sour the whole experience. And that's a loss to you and to society.

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