The Opposite of Burnout

What Keeps Doctors Happy and Productive

Everybody in medicine is talking about burnout. We all have our favorite hypotheses about what could be to blame: tight schedules, too much computer time, tough administrators, know-it-all politicians, RVU’s (Relative Value Units), difficult patients.  Doctors seek to understand causes so that we can find cures. It’s the diagnose-and-treat paradigm.

This essay is not a referenced journal article.  I’m here to tell you what I have seen keep doctors happy and productive in my 14 years as a hospitalist - including me.

1. Acknowledge Your Value: You were born with gifts and you cost a fortune to make. Fail to give ample consideration to your own satisfaction and you could end up leaving medicine forever. Studies show up to 400 physicians die of suicide every year, a number that could be underreported and much higher. I have practiced long enough to see doctors die by suicide. I have had medical friends end up in drug and alcohol rehab. These are not theoretical or statistical events to me. These are phone calls I have gotten in the dead of night. Your feelings and relationship with your work are important, in fact, they are more important than many other competing demands. You deserve to be happy at work.
2. Don’t Try to Do Too Much: Satisfaction comes from mastery. Mastery requires focus. Pick a thing or two in your professional life that really matters to you and do that. Abandon bad projects early. Quit things that are no longer in line with your primary focus. You are going to have to say “no.” I have seen doctors who are great at patient care, research and administration and say “yes” to every next thing. They are few among the happy doctors I have known.
3. Separate Home from Work: My dad used to tell me he’d never seen a gravestone that said “I wish I had spent another day at the office.” Emails do not self-destruct—they will be available for you in the morning. Have someone teach you how to use your Out of Office email assistant.  You do not have to do everything. Work is a liquid and will fill the volume of any form it is poured in to. Carefully shape the hours of the day you wish to work and put your work only into those hours.
4. Prioritize the Care of the Sick: Plaques and awards don’t love you. Your publications will never say “thank you.” Most doctors are hard-wired to thrive on gratitude Caring for the sick should be your top priority; it has the capacity to fulfill and reward that sense of duty more than any award can.
5. Build Rewarding Patient Interactions: Enjoying the time you spend with patients is no accident. The best doctors will structure visits to be a fair exchange of knowledge and skill for honesty and appreciation. They build their visits to be mutually beneficial and end warmly.  They are honest about their limitations and don’t make promises they can’t keep. They bring hope and good cheer even when there is nothing else to offer. They are clear about the effort involved in the practice of medicine and welcome appreciation of the care received. They aren’t adversarial but present themselves as an ally fighting at the patient’s side against the disease.
6. Discuss Failures: You’ll get better with practice but you’ll never be perfect. You will make mistakes and sometimes, despite being both correct and well-intentioned, patients will die. These are spiritual burdens that must be shared with a trustworthy colleague lest they crush you under their weight. Find someone compassionate and forgiving but also honest and willing to help you avoid pitfalls in the future. The flip side may be even more valuable—become a person to whom other doctors come to when torn up with guilt. You’ll learn an important part of being a professional. And importantly, you will learn to forgive yourself.
7. Prioritize Friendships: It seems unrealistic on top of a big clinical practice and a young family to carve out time for friends, but you are putting yourself in harm’s way without them. Romantic partners cannot be your only support. You need a balance of friends inside and outside medicine to give you support and perspective to handle the inevitable interpersonal conflicts and spiritual dilemmas. And you need to create time and space to meet with them. Also, if you believed #6 above, you are going to need #7.
8. Be Driven by Mission:  Why did you become a doctor? What do you think a good doctor should do? How should they go about doing it? Deciding your reasons and purpose before you begin (and editing them as you go along) will make you nearly invincible to trivialities. I have chosen to take care of patients at a hospital that provides care for all and deliver high quality care. This simple mantra has gotten me through many difficult times in my professional career. I spend time with people who share my mission. There will always be people who complain about everything. Avoid them.

Doctors are not happy because they have “good patients.” Happy doctors understand the problems of illness and offer solutions to them. When you offer solutions to the conditions of sick, scared, hurting and uncertain, you will be appreciated and therein find satisfaction and reward in your work. While much of medicine is solitary stuff, many of the tricks to a happy career are found in building a community of other caregivers. Finding a rewarding path in a busy and challenging career requires the input of trusted colleagues to supply needed objectivity, balance and support.