Why I Left Medicine: A Burnt-Out Doctor’s Decision To Quit

By Diane Shannon
Guest Contributor

When I introduce myself as a physician who left clinical practice, non-physicians ask me why I left. They’re generally intrigued that someone who sacrificed many years and many dollars for medical training would then change her mind. But physicians, almost universally, never ask me why I left. Instead, they ask me how. They call and email me with logistical questions, wanting to learn the secret of how I managed the transition out of clinical medicine (read “escape”).

Earlier this month I attended a conference on physician well-being at the Massachusetts Medical Society where I heard an alarming statistic: the suicide rate among women physicians is more than two times that of women in the general population.

Diane Shannon, plagued by constant worry about patients, and fear of medical errors, gave up her career as a physician. (Courtesy)

Dr. Diane Shannon — plagued by constant worry about her patients and fear of medical errors — walked away from a career as a physician. (Courtesy)

It may be dramatic and self-serving to frame my career change as a way to avoid suicide, but I can attest that medicine was not conducive to my health. As an internist, working in adult outpatient clinics around Boston, I had trouble leaving my work at work. I’d go for a run and spend the entire 30 minutes wondering if I’d ordered the right diagnostic test. I suffered from chronic early morning wakening, even on my weekends off. I startled easily. I found it impossible to relax. I worried constantly that I’d make a mistake, like ordering the wrong dosage of a medication, or that a system flaw, like an abnormal lab report getting overlooked, would harm a patient. I no longer remembered the joy I’d felt when I first began medical school, and I couldn’t imagine surviving life as a doctor.

I no longer believe it was weakness or selfishness that led me to abandon clinical practice. I believe it was self-preservation. I knew I didn’t have the stamina and single-mindedness to try to provide high-quality, compassionate care within the existing environment. Perhaps, due to temperament or timing, I was less immune than others to the stresses of practicing medicine in a health care system that often seemed blind to humanness, both mine and my patients’.

That’s not to say that I don’t miss practicing medicine. I do. I miss engaging in meaningful interactions and being of service, reassuring an elderly woman that we could make her emphysema easier to endure, bearing witness to a cancer patient’s grace in the face of death, supporting a college student facing an unexpected pregnancy. I miss spending my days in deeply meaningful work. But given my choices at the time, I have no regrets.

I recently interviewed Mark Linzer, M.D., who researches physician burnout, and learned that the underlying causes are fairly predictable. Linzer and his research team found that four factors are associated with higher rates of burnout: time pressure, degree of control regarding work, work pace and level of chaos, and values alignment between the physician and administration. I experienced all four, but I think the greatest source of stress for me was the high level of chaos. I didn’t trust that patients would consistently receive the care they needed. Orders were sometimes incorrect, illegible (in the days before electronic medical records), or overlooked once written. An intravenous catheter left in too long led to widespread infection. Care providers forgot to wash their hands and spread serious infections from one patient to the next. EKGs and x-rays were misread. I’m someone who tends to imagine the worst. In the maelstrom of a chaotic work environment, I was worn down by worry.

Tactics to prevent medical errors have advanced since I practiced medicine. Checklists now remind care providers to replace intravenous catheters. Hand sanitizing gels and handwashing reminders are commonplace in hospitals and clinics now. Electronic ordering systems prevent handwriting errors and signal care providers about drug interactions and duplicate orders. It’s possible that with these improvements my greatest source of stress is now less of an issue, but physician burnout remains a widespread problem.

A 2012 study found that almost half of the practicing physicians surveyed had one or more symptoms of burnout. An online poll in the same year of more than 24,000 physicians found that only 54 percent would choose medicine again as a career, compared with 69 percent in 2011. From personal experience, I know the importance of creating a system in which physicians can fulfill their potential and connect with patients. I believe that until we see physicians as humans, prioritize their well-being, and create systems in which they can provide safe and compassionate care, we cannot expect them to heal others.

Hospital leaders are beginning to understand this equation. At the MMS conference, a panel of hospital executives spoke about the additional pressures on physicians within the current economic climate. I found it encouraging that the hospital leaders saw physician burnout as a serious problem and that many of the changes they were using to combat burnout were relatively simple. At one medical center, leaders attend patient rounds on a regular basis to better understand the physicians’ experience at the frontlines of care. They hold retreats to listen to physician complaints—then follow up on identified issues. Another leader sends thank you notes to physicians each time the hospital receives a complimentary letter from a patient. At another hospital, leaders decided to allow physicians to have more say about their daily schedule at the outpatient clinics. These were not costly interventions, and according to the executives, they seem to be helping.

Some of the solutions to physician burnout may be relatively simple and inexpensive — administration taking the time to understand physicians’ work experience and the barriers they encounter daily. Others are complex and resource-intensive, such as revamping the reimbursement system to measure and reward high quality compassionate care rather than the volume of procedures, tests, and physician visits.

Whether simple or complex, none of the solutions will be easy to execute, especially in the midst of the seismic changes taken place with health reform. But I believe that it’s possible to create a health system that supports physicians in their quest to provide high-quality, safe, compassionate care. I don’t think we can fix the U.S. health care system by expecting superhuman performance from humans under super-sized stress. We will only succeed if we instill safety and compassion for patients and providers in every aspect of care. If I suppress my humanness to survive in an environment that requires such a sacrifice, how will I be able to see yours?

Many groups across the nation are working on ways to infuse more humanity into health care. One example, the Schwartz Center for Compassionate Healthcare, founded by a health care attorney diagnosed with advanced lung cancer at age 40, helps health care organizations set up meetings where care providers can speak openly about the feelings of distress triggered by their daily work. If I’d had a safe place like “Schwartz Center Rounds” to express my emotions — fear, overwhelm, anger, guilt –perhaps I would have developed the resilience I needed to continue practicing medicine.

Given that I recently celebrated my fiftieth birthday and am happily ensconced in a writing career, it is unlikely that I will return to clinical practice. Sometimes this realization saddens me, but I no longer feel that leaving was weak or selfish.

Instead I believe that because I’ve survived in the trenches and now have a bit of perspective, I can help advocate for changes that will allow other physicians to practice medicine in a way that is life-giving to themselves and the patients they are privileged to serve — the way I had hoped to practice when I first donned my white coat.

Diane W. Shannon, M.D., MPH, is a freelance writer who focuses on performance improvement in health care. She lives in Chestnut Hill.

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  • MD.Lovejoy

    Hi – Yes I am a Doc. Yes I love being a DOC. What tears me up and keeps me awake – what is it? HERE IS WHAT IT IS – It is OPEN season on Docs.. yes no rules people. If you want something or you had a bad day or you are just a person with bad motives, you can take out your angst on your doctor -
    Any professional needs to be PROTECTED AND SHEILDED – ANY public service PROFESSIONAL – . We are skilled, highly trained – I trained at one of the top programs – years of study and experience that I carry with me – not ego – this is a value that cant be replaced. Protect it. To be a doctor -it is not a job, it is and always will be a profession
    We strive to use what we know- the art of medicine requires connecting with patients – we do it well when we have staff and managers and nurses who work with us as a team. When we are out there like the lone ranger with no sidekick – alone- we are attacked. More now than ever when the public is fearful and insecure with the state of things in general.
    My friends out there – my fraternity of fellow docs – do you feel that now as I do – that now any person with any kind of issue can feel free to spit, fling poo, curse my mother, insult my heritage, frighten me, hit me, or worse call their lawyer.. and really – who the heck is out there with me?? yeah, nobody – thats how I feel – in spite of the web ads for the feel good fuzzy groups – nobody gets it except you

    my fellow docs.. do you find yourself being locked into being impersonal and pretending everything is OK when it is not- are you afraid if you fuss you will be singled out and hurt also? – you are my fellow abused child – you pretend you dont see me suffer as much as you suffer.but I know you see it – I see it happen to you. .. sometimes I hear it in your voice when you call me for a consult – you feel bad for me – and I pretend I dont hear it because I might cry -
    and the Lone Ranger doesnt cry.

  • Nats Rogers

    For myself, I find that the joy of helping patients is being eroded by patient’s treatment of doctors. As a female doctor I made a lot of sacrifices, working late, researching treatments, battling insurances consumed (and continue to do so) my time. Now as an oncologist, I find most patients do not care or appreciate…one patient criticized me on a survey because the phone In the clinic ran unanswered by my nurse (who is always off chatting with friends in other clinics BTW)… Another because the nurse claimed I had never told her about a medication (I did)… Meanwhile the same patient does not talk about how I gave her treatment when no one else would which led to real benefit with treatment of her pain…or that I explained to her and her many family members what was going. I think medicine and being a doctor is now a popularity contest…and that impacts the pressures placed on you by administration and payors….I see patients now differently…charting a visit is an exercise in legal documentation…

  • Gal220

    I had left my med practice years back for personal reasons, topmost of which was family. I had joy, peace & contentment ministering & spending more time w/them. My peace had been altered however by the constant “whys” & “hows” by people, friends especially & those from church. I could read between the lines ..”how could you waste God’s special gift? “..I felt i had done a dis-service to God & the community.. This drove me to seek God’s Word & His ways. I read the Bible over & over again..During this time, i had been impressed that true healing comes only from God & by faith alone..His healing is free, pure, simple & permanent..Healthcare is a way of the world. It is expensive, complicated, adulterated & not definite or permanent. Science is a changing thing..Coffee used to be a health-offender..now it it is recommended, even encouraged. Statins were approved by many before..now many think they are bad..Our God, our creator & giver of life is the only constant in this world. He alone is the true healer. Jesus said” i came that you might have life & have it to the full.. The Bible says He not only died for our sins but for all our infirmities .” By His stripes we are healed..” All we have to do is ask.. Thank you Diane and to all who shared their insights..God bless you always!

  • Kity

    First of all, forgive my english.
    I am studying medicine. I’m on my fifth year. I know that I haven’t experienced the work environment yet, but I definitely don’t like what I’m studying. It’s just too stressful for me, I feel like I’m leaving my dreams back and I’m just leading to a zombie way of life, with no joy for work or for what I am going to do. Sadly, there’s no turning back for me. I’m studying with a scholarship, and I can’t quit now. My parent’s couldn’t pay me the college if I would decide to start to study another career.
    All I know is that I made the wrong decision, and I wouldn’t choose medicine if I had the chance again.
    What can I do now? I think I just will finish my career, and just try to start a new life. of course, is too many years of sacrifice and time, and youth “lost” between texts, books and exams. But we can’t go back, just try to fix things from what we have now.
    I’m super glad that I’m not the only one in this.

  • charlesjneilsonmd

    Having started practice way back in 1977, I experienced the end of the Golden Age of Medicine, when physicians controlled practically every part of the medical profession then. There was a sense of the highest order of responsibility and ethical expectations…..all emanating from the physicians themselves. But the process has led to physicians having lost their self-governing and self-imposed control over the profession while a wide array of non-physicians now perform all of this. Hospital administrators have risen to powerful (and high paying) sources of control over physicians. Government regulators (EPA, CLIA, Medicare/Medicaid, etc), Joint Commision on Hospitals, Board Specialty organizations, Insurance companies, and others are all spewing forth an ungodly amount of “requirements” imposed upon physicians, that are designed to control the practice of medicine. Some requirements, like electronic health records, are supposed to increase efficiency, improve patient satisfaction, and the like, while really existing as a mandate for our government to extract personal health information. There is hardly an EHR that does improve healthcare, while the majority of physicians’ workplace circumstances have become steady chaos, tense time constraints, and even less time spent with patients. The fact that the people who use these systems in direct patient care, namely physicians and nurses, have no say in the selection of EHR makes the workplace a lot like Rumpelstiltskin, “spinning straw into gold”, with all involved no longer enjoying comraderie. Everyone is minding their own process of feeding “the beast” in their own cubicle.

    Medicine has become a profession whereby all of these non-physicians are now in total control of the physician (and nurses) and there is no longer a way for physicians to have a say in their workplace conditions. Government has instituted innumerable incriminations to control physicians. Imagine being fined $50,000 for not being allowed to charge for a comprehensive ICU admission history and physical more than once over 18 months just because the government is trying to save money. The government does not care if you do it…..they just do not want you to charge for doing it. And being removed from Medicare/Medicaid privileges will cause loss of hospital privileges, so these threats can be career-ending. Being told to take annual exams and courses on the various lab testing that is done in one’s office is very costly and time-consuming, but the issue is why is it necessary when these are tests that each physician learned in medical school and in residency? Why should I take an annual parasitology course, costing up to $900, in order to quality to check for pinworms, Giardia, malaria, hookworms, etc. There are many different organizations that profit off of the backs of physicians as well as government regulatory agencies whose existence is based on questionable “violations” such as not checking gram stain solution controls in the lab every 6 weeks. Maintenance of Certification is an ongoing process that makes big money for the Board Specialty organizations and is really no different than each State’s annual CME requirements, but is a costly additional time consuming requirement. Physicians do not even want the responsibility of determining the qualifications of hospital privileges for applicants as they just throw in Board Certification as a requirement and check malpractice history or drug license problems, and voila, easy decision. Physicians have had their self-scrutiny, self-governing, and their own input into all aspects of their medical workplace taken away. It is no wonder that physicians would want to get out of this current crucible of burnout that once was actually enjoyable.

  • Kay Nelson

    How do I get out.

  • FedUpMD

    The reasons I got fed up:
    1) Corporate healthcare swallows nearly all local practices in this region
    2)If you work independently, you need to contract with the hospital systems for hospitalists and specialists to take care of your in-patients
    3) When I worked for the last corporation, there was a nurse-manager who deigned to do any patient-care(she was now in ‘administration’) but totally drove a whip and controlled the doctors’ schedules
    4) the NPs I’ve seen had a huge chip on their shoulders about physicians–reminded me of reading about the 1960s’ angry feminists and all men being ‘male chauvinist pigs’
    5) Other colleagues and I left for a marginally better healthcare system because we knew our previous hospital was phasing many of us out. Mid-levels are cheaper. For now.
    I read a BBC article that in the UK they allow for private practices. The Amercian corporate healthcare leaders don’t want that in the US. They have taken steps to make private practice unfeasible.
    What choice does that leave many of us? Leave medicine or go to Australia?

    If we want to leave, how do we do it?

  • Agness Kaku

    Something I’ve wondered about: What currently prevents a physician from setting up a reasonably-priced private practice in, say, their own neighborhood? Is it insurance matter, admitting privileges, or is it just not viable as a way to make a livelihood?

  • HairyGuy

    the BIGGEST problem with medicine is that you have no work-life balance. you have only one life. you aren’t coming back to earth. make sure you live your life daily too. no one is promised tomorrow. i can’t fathom how someone works his or her life away and then in old age (starting in your 40s), nothing can be enjoyed. bones hurt, sexual organs fail, new diseases crop up, metabolism slows down. it doesn’t matter what you do for a living or what you saved up. the best years of your life are behind you and if you didn’t enjoy them, there’s not much ahead outside of pill bottles, adult diapers, and competing to look young again against the new batch 20 something year olds…

  • Shyam

    I fail to understand why the hospitals do not hire more physicians, and give them lesser hours. I worked at a hospital for one year after residency as a hospitalist (night shift), and realised there was no justice to patients. Such time constraints, meeting targets, notes within 30 min of admmission, teaching residents, “soft admissions” and billing (thats another topic by itself). It definitely takes a toll on one’s health, and most of the time, the hospital administration doesn’t give a damn about it
    From what I hear from UK doctors, their system is much better. Hospitalists burn out quicker than other

  • KalipsoRed

    As a nurse working along side physicians, I often wondered why so many of them put up with the pressures that they do. When I first started nursing I felt very much like yourr article states. I was over run by chaos, had little in the way of assisstance provided to me by the hospital’s staffing models, constant worry that I going to miss something, and anger at my self for not being able to ‘do it all.’ I felt trapped by the debt I encoured and dredded with tears and sleepless nights my next shift. This may not be the most kosher thing to admit but to relieve this pressure I finally came to the conclusion that I would go to work and do my best, if I ended up getting my license taken away for something then so be it. That I would follow policy and procedure on my terms, which was often slower than management was happy about, and at hand off time I was giving report and LEAVING no matter what (well with little exception). And that s how I have survived the last 6 years along with becoming poorer because I can not tolerate full time. I love the sense of pride I have when I actually get to help someone and take good care of them, but I still regularly search for a way out of medicine, because I cannot imagine doing this for another 6 years.

  • Sheen Rillo

    thank you very much for writing and sharing this. i am going through this right now and I dont know how to tell my parents and everyone around me who have been very supportive of my studies all these years that I no longer want to be a doctor. i am in my clerkship and am about to graduate this year.

  • http://www.drmarisfaithstop.com/ Dr Mari

    I’m glad to see another physician make the right choice of pursuing greater health and wholeness. I’ve remained in clinical medicine but see patients part-time and have a fulfilling life as an author and speaker “on the side.” Although I struggle to juggle my many responsibilities at times, I have much more joy in medicine now and find that writing and speaking has made me a better doctor. I had to learn to think outside the box and made the necessary changes and sacrifices to pursue my lifelong dream of writing. I feel a greater sense of purpose and fulfillment and love to share this with my colleagues. Whether we choose to leave clinical medicine or stay, we can all experience greater joy by pursuing our purpose and nurturing wholeness and health in our own lives. Then we can also serve as better examples for those we serve.

  • JerseyMD

    I read this article looking for guidance. It is very hard to find other physicians willing to discuss their personal disillusion with practicing medicine. Even harder to find physicians who have left practice and share the path to that goal. I went into medicine because that was my life goal and now I realize it is something that is making me physically and emotionally sick. How to leave? After all the training and debt incurred, you feel as if you have no other skill and therefore no choice but to stay a physician. Reading your article I see it is possible.

  • unhappydoc

    as a current resident, soon to enter fellowship i often find myself searching threads such as “leaving medicine” or “getting out of medicine”. isn’t that sad? gone are the days of entering medicine with manageable debt (unless your family is wealthy), and tailoring your practice to fit your level of energy. personal overhead is too high, and hospitals are (after all) business which will wring physicians dry in order to make profits. personally speaking, my experience in healthcare has been terrible. i was a ‘slightly’ non-traditional student in that i had held a few ‘normal’ jobs prior to entering medicine (and during medical school, in a failed attempt to reduce my loan debt), and feel that the current climate in the workplace is just atrocious compared to my previous jobs which were tolerable and wonderful; unfortunately i thought i had a meaningful goal to work towards (or so i thought, youthful ignorance). i would completely agree that those ‘four factors’ are (a few) legitimate parameters, all of which i am uniformly dissatisfied with. i feel rushed (read: have to make too many important decisions in too little time, with increasing amounts of useless obligatory note writing which no one reads). our labs are becoming increasingly understaffed, leading to terrible issues when workers are absent. i have very little work-life balance. i do realize that i am in residency, however not having time to exercise daily or eat healthy as a young adult with no children is just unacceptable to me. my personal life has fallen into shambles. if i weren’t a beaten plow horse saddled with enormous debt, i jump the fence for greener pastures in a heartbeat, but unfortunately reality beckons (maybe once i am completely burnout/used up someone will sell me to a glue factory [if i am lucky]).

  • BurntOutPharmD

    I understand this all too well as a pharmacist. I graduated from school just a few years ago and I am burnt out all ready! I’m not even 30 yet! My job no longer brings me the satisfaction it used too. I’m a completely different person now. I used to be full of energy and a health nut, but any more I feel like I’ve given up. I’m exhausted, depressed and have given up caring. At our hospital we are already bare bones (severely understaffed), work crazy schedules (work all three shifts in a week), keep adding on responsibilities (half of which I fake doing because they are a waste of time). People often say you make a lot of money what can you be sad about? Money doesn’t buy happiness! If anything it’s only made me worse. I’m at the point where I’m really considering leaving the profession to take care myself and get healthy. Especially with where the profession is going! I’m a very intelligent & capable individual. I know I can make it in whatever I choose once my body and mind is healthy!

  • Krysten34

    Dear Diane,

    I left medicine as well but I am in the latest stages of the healing process.
    - Your article is so wonderful and empowering I only wish that it would become available to those who are in the initial stages of this devastating decision. They often feel alone and disempowered not knowing that there are so many out there who understand their plight.
    - Doctors, teachers and nurses, vet professionaks alike since the personal attributes and work environmennts of many of us are so similar…

    ” I no longer remembered the joy I’d felt when I first began medical school.” “In a health care system that often seemed blind to humanness, both mine and my patients.”
    - For me medicine was a way of achieving meaning, in the line of Maslow and Marx. I enjoyed in particular the partnership and support between all health providers and patients as well.Although most of my personal interactions and experiences were excellent (supportive , forgiving workmates) it was the 5%- psychopathic managers, bullies among colleagues that affected me to a concerning degree.

    “It may be dramatic and self-serving to frame my career change as a way to avoid suicide. The suicide rate among women physicians is more than two times that of women in the general population.”
    - Not dramatic at all. Although I am indeed among the people that you are referring to :vulnerable to the stresses inherent to the profession, since I do have a history of biological depression. The ‘straw that broke the cammel’s back’ was my last depressive episode. I became concerned about my negative thinking and about the attitude at that time of the 5%. I realised that I needed to get out in order to survive.

    I have no regrets in fact I currently feel that this was among the better decisions that I ever made. The money is not that good but my current work is as meaningful as it can be. I am also working on improving my e language skills, something I should have done a long time ago but lacked the drive , given that I ‘ve been in a constant survival mode for so many years.

    Thank you once again for this wonderful and kind article. PLEASE make it more available as it would make a difference for those who are temporarily distressed or are even contemplating suicidr.

    • Jesse Sanchez

      Do you have an engineering degree? If so I have some non-clinical, lucrative career options in San Antonio Texas. My email is jsanchez@brconline.com

  • Krysten34

    Dear Diane,

    I left medicine as well but I am in the latest stages of the healing process.
    - Your article is so wonderful and empowering I only wish that it would become available to those who are in the initial stages of this devastating decision. They often feel alone and disempowered not knowing that there are so many out there who understand their plight.
    - Doctors, teachers and nurses, vet professionals alike since the personal attributes and work environmennts of many of us are so similar…

    ” I no longer remembered the joy I’d felt when I first began medical school.” “In a health care system that often seemed blind to humanness, both mine and my patients.”
    - For me medicine was a way of achieving meaning, in the line of Maslow and Marx. I enjoyed in particular the partnership and support between doctors, patients and other health providers as well.Although most of my personal interactions and experiences were excellent (supportive , forgiving workmates) it was the 5%- psychopathic managers, bullies among colleagues that affected me to a concerning degree.

    “It may be dramatic and self-serving to frame my career change as a way to avoid suicide. The suicide rate among women physicians is more than two times that of women in the general population.”
    - Not dramatic at all. Although I am indeed among the people that you are referring to :vulnerable to the stresses inherent to the profession, since I do gave a history of biological depression. The ‘straw that broke the cammel’s back’ was my last depressive episode. I became concerned about my negative thinking and about the attitude at that time of the 5%. I realised that I needed to get out in order to survive.

    I have no regrets in fact now I feel that this was among the better decisiins that I ever nade. Although the money is not as good good, my current work is as meaningful as it can be. I am also working on improving my language skills, something which I should have done a long time ago but lacked the drive , given that I ‘ve been in a constant survival mode for so many years.

    Thank you once again for this wonderful and kind article. PLEASE make it more available as I am sure that it would make a difference for those who are feeling temporarily distressed or even contemplating suicide,

  • Guest

    Dear Diane,

    I left medicine as well but I am in the latest stages of the healing process.
    - Your article is so wonderful and empowering I only wish that it would become available to those who are in the initial stages of this devastating decision. They often feel alone and disempowered not knowing that there are so many out there who understand their plight.
    - Doctors and teachers, nurses and vet professionals alike since the personal attributes and work environmennts of many of us are so similar…

    ” I no longer remembered the joy I’d felt when I first began medical school.” “In a health care system that often seemed blind to humanness, both mine and my patients.”
    - For me medicine was a way of achieving meaning, in the line of Maslow and Marx. I enjoyed in particular the partnership and support between doctors, patients and other health providers as well.Although most of my personal interactions and experiences were excellent (supportive , forgiving workmates) it was the 5%- psychopathic managers, bullies among colleagues that affected me to a concerning degree.

    “It may be dramatic and self-serving to frame my career change as a way to avoid suicide. The suicide rate among women physicians is more than two times that of women in the general population.”
    - Not dramatic at all. Although I am indeed among the people that you are referring to :vulnerable to the stresses inherent to the profession, since I do gave a history of biological depression. The ‘straw that broke the cammel’s back’ was my last depressive episode. I became concerned about my negative thinking and about the attitude at that time of the 5%. I realised that I needed to get out in order to survive.

    I have no regrets in fact now I feel that this was among the better decisiins that I ever nade. Although the money is not as good good, my current work is as meaningful as it can be. I am also working on improving my language skills, something which I should have done a long time ago but lacked the drive , given that I ‘ve been in a constant survival mode for so many years.

    Thank you once again for this wonderful and kind article.

  • Guest

    Dear Diae,

    I left medicine as well but I am in the latest stages of the healing process.
    - Your article is so wonderful and empowering I only wish that it would become available to those who are in the initial stages of this devastating decision. They often feel alone and disempowered not knowing that there are so many out there who understand their plight.
    - Doctors, teachers , nurses and vet professionals alike since the personal attributes and work environmennts of many of us are so similar…

    ” I no longer remembered the joy I’d felt when I first began medical school.” “In a health care system that often seemed blind to humanness, both mine and my patients.”
    - For me medicine was a way of achieving meaning, in the line of Maslow and Marx. I enjoyed in particular the partnership and support between doctors, patients and other health providers as well.Although most of my personal interactions and experiences were excellent (supportive , forgiving workmates) it was the 5%- psychopathic managers, bullies among colleagues that affected me to a concerning degree.

    “It may be dramatic and self-serving to frame my career change as a way to avoid suicide. The suicide rate among women physicians is more than two times that of women in the general population.”
    - Not dramatic at all. Although I am indeed among the people that you are referring to :vulnerable to the stresses inherent to the profession, since I do gave a history of biological depression. The ‘straw that broke the cammel’s back’ was my last depressive episode. I became concerned about my negative thinking and about the attitude at that time of the 5%. I realised that I needed to get out in order to survive.

    I have no regrets in fact now I feel that this was among the better decisiins that I ever nade. Although the money is not as good good, my current work is as meaningful as it can be. I am also working on improving my language skills, something which I should have done a long time ago but lacked the drive , given that I ‘ve been in a constant survival mode for so many years.

    Thank you once again for this wonderful and selfless article.

  • ggghhh

    gyyh

  • Empwrdlf

    Dear Dianne,

    I left medicine as well but I am in the latest stages of the healing process.
    - Your article is so wonderful and empowering I only wish that it would become available to those who are in the initial stages of this devastating decision. They often feel alone and disempowered not knowing that there are so many out there who understand their plight.
    - Doctors and teachers alike since the personal attributes and work environmennts of many of us are so similar…

    ” I no longer remembered the joy I’d felt when I first began medical school.” “In a health care system that often seemed blind to humanness, both mine and my patients.”
    - For me medicine was a way of achieving meaning, in the line of Maslow and Marx. I enjoyed in particular the partnership and support between doctors, patients and other health providers as well.Although most of my personal interactions and experiences were excellent (supportive , forgiving workmates) it was the 5%- psychopathic managers, bullies among colleagues that affected me to a concerning degree.

    “It may be dramatic and self-serving to frame my career change as a way to avoid suicide. The suicide rate among women physicians is more than two times that of women in the general population.”
    - Not dramatic at all. Although I am indeed among the people that you are referring to :vulnerable to the stresses inherent to the profession, since I do gave a history of biological depression. The ‘straw that broke the cammel’s back’ was my last depressive episode. I became concerned about my negative thinking and about the attitude at that time of the 5%. I realised that I needed to get out in order to survive.

    I have no regrets in fact now I feel that this was among the better decisiins that I ever nade. Although the money is not as good good, my current work is as meaningful as it can be. I am also working on improving my language skills, something which I should have done a long time ago but lacked the drive , given that I ‘ve been in a constant survival mode for so many years.

    Thank you once again for this wonderful and selfless article.Please share it further, as I fell that it would make a difference among those who are distressed or even contemplating suicide.

  • http://www.NaturopathicKnights.com/ Naturopathic Knights.com

    Having worked as a PA for 13 years in the field of allopathic medicine, how could anyone not get burned out? No one ever gets truly cured. A lot of people get better in terms of having their symptoms removed or palliated, but at what cost? There’s side effects of drugs, and you begin pushing these dis-eased stated down different pathways. Simply put, you can’t cure chronic illness with pharmaceutical drugs. It defies that natural laws of health. Why would not get worn down by patients never coming off drugs?

    I jumped ship after 13 years because I got tired of the system. My last stop was a short job at the VA which is probably the worse medical institution I’ve ever been part of. And I’ve been around. The level of care was deplorable. As with every other clinic, it’s just more medications to suppress symptoms. More tests looking for the ‘diagnosis’, etc. What good does it to study disease and not health? The current model will always fail because it fails to address the causes which far precede the changes that are finally picked up by the tests ran. At this point, the patient is far down the river and the restoration of health is more difficult, however, it can be done and is being done. In order to experience cure, you have to remove yourself from this paradigm and enter a different one. Unfortunately, people are too conditioned to rely on this form of medicine. And they will always be let down, because the natural laws of health say so.

    The only thing I can is that I left being a PA and entered Naturopathic Medical School for one reason only, to learn how to take care of my own health, and to cure myself of illness if and when the time comes. Therefore, it is purely for my own good. If it didn’t work, I would not have stayed the course. I will also say that one day I look forward to helping people, but if you can’t take care of yourself, then the rest is no good. People need to stop relying on a system that cannot and will not work for the treatment of acute non-emergent and chronic illnesses.

  • Beatriz Arango

    Soy médica patóloga, trabajo en Manizales, Colombia. Me gustó mucho tu punto de vista, he sentido todo lo que relatas y no he tenido el valor de dejar mi profesión aunque por dentro grito todo el tiempo que ya no quiero tener mas presiones. Seré capaz de decir ya no más?
    Un abrazo, Beatriz.

  • Cheryl

    Wan wah wah! Shame on you! Life got a little tuff so you quit? You and your , “everyone gets atrophy” generation… I am so tired of hearing you and your cohorts complaining about your ” condition”. Why don’t you pull up your big girl panties and do something to fix it instead of taking the easy road. Patients… And nurses… Need good physicians to get us through this current healthcare environment… Apparently you never had the stuff or you wouldn’t have walked out on us.. Again… Shame on you for taking the easy road!!!!

    • MoreThanADoc

      I think committing suicide is a little more than “life got tough”. It’s mind boggling to see, what I expect is another health care provider, post such a heartless comment. Shame that the system hasn’t weeded out someone like you yet. But then again, I’m sure you’re all smiles to the doctors you work with, yet under the frame of anonymity, you are very tough.

    • HairyGuy

      you can’t fix something that starts out broken. 80 hour workweeks are normalcy in the medical field. add to that, frivolous lawsuits as well as errors out of your hands as cited in the article and that will drive you insane, literally. this isn’t about whining. the entire industry is really badly messed up. when i look back at not choosing medicine 10 years ago, i now smile and say i made the right choice. i knew that i would never have a bit of work life balance in that field. instead i would be chasing the next doc. or hotshot jones who lives near me in wealth accumulation. it’s a toxic lifestyle.

  • docapol

    Hmmm…might not be a good doctor to begin with… if she were, her patients might not have let her leave her practice..i know of good ones who tried..

    • hedzzup

      To would be or neophyte practitioners…
      If you don’t enjoy interacting and treating patients, medicine is not for you… It takes a lifetime of sacrifice to devote yourself to the practice of medicine, it’s a thankless job. Make no mistake, if you’re after the money you’re better off doing other things. It’s a vocation not a career…

      JALNJR, MD
      ORL-HNS

      • HairyGuy

        and the ones who benefit off this are big pharma along with insurance companies. at one point in life, everyone has the right to enjoy his or her life without feeling “guilty” and unthanked.

  • Altostrata

    It seems to be the integrative MDs are writing their own tickets. Very high demand and a lot of independence.

  • CaitlinMD

    I read this article with a sense of relief that I’m not the only one that feels this way. Out in my first years of practice, I find myself worrying about my patients all the time. I’m constantly stressed and wondering if I’m providing the best care for my patients, and it’s consuming my life. To make matters worse, I feel I’m constantly scrutinized by my more experienced colleagues. I think there’s another big issue that lurks here contributing to physician burn-out: the medical culture that has taught us for so long it’s not acceptable to be anything less than perfect and not provided the emotional tools to deal when something goes awry. I too am thinking of quitting medicine for good, after years of training, of course, it’s not without a guilty conscience. Thank you for this very insightful article.

    • HairyGuy

      work life balance is the first and foremost issue that should be addressed. i laugh when people proudly claim to work 90 or so hours in a week. uh yeah, but only like 40-50 of those were productive to the max. the rest were just busy body hours you were there for. mistakes increase with hours worked. if you have a happy and non-stressed person who is practicing a difficult task such as medicine, the results are likelier to be better. every time i see someone who works too much in any field, i run the other way. i notice people making mistakes in auto shops, animators for cartoons, security details at various jobs, etc. if you do too much, you will make errors, period. you can’t escape that facet of the human mind. we can hack out an 80 hour workweek once or twice a year but to make that into a lifestyle is fooling yourself. you can’t cheat your body. it always catches up with you.

  • Tullymd

    Medicine had been a public service. Dedication included time commitments and emotional energy at the expense of family and a balanced life. Not ideal but for a good cause. Now medicine has been transformed into a business. Value system is diametrically opposed to kind compassionate empathetic care. Fifteen minutes per patient with much of that time doing documenting. Doctor fixing his ( her ) gaze on computer screen in lieu of patient. It has become a task oriented profession which is factory like and dehumanizing. We have been turned into documentation specialists for the purpose of maximizing reimbursement. Instead of the computer serving us, we serve the computer. And we all know that we spend twice as much on health care as other countries with worse results. The system is corrupt and inefficient. Corporate America has hijacked a once noble profession.
    Recommend reading Otis Brawley’s book The Harm We Do. He is chief medical officer of the American Cancer Society. Also The Metamorphosis by Kafka…. the transformation of a lovely little boy into a hideous beetle. That says it all.

  • BC MD.

    Thank you for writing this thoughtful article. As an emergency physician, working long hours of shift work, I very much appreciate your article. Kudos for having the strength to do what was right for you – it takes a tremendous amount of courage. Having sifted through some of the comments below – there is one thing I’d like to comment on myself.

    I see the thread of persistent Doctor-Nurse division, and it saddens me. I am a physician who gives my all, every day at work, usually staying several hours late, without benefits, sick days, lunch breaks, pensions or vacation time. I have a huge debt to pay off from medical school. I have family pressures, personal pressures, and could actually be at work 24/7 if I said yes to every request of my time. I believe in what we do, defend my colleagues when needed, but also realize that not all doctors are created equal. Some are amazing, caring and keep on top of every new advance in their field and are constantly available and helpful. However, some physicians are rude and dismissive to patients, families and nursing colleagues, fail to round regularly on patients and provide inadequate care. My partner is an emergency RN who also gives his all at work, stays late when needed and keeps on top of recent advances and is committed to continuing education. Most of our nursing colleagues are the same and tremendously dedicated. However, there are some nurses who sleep for 3 hours on night shifts, hide beds in our hospital to avoid getting another patient even without having a full assignment, abuse sick leave when the weather is nice, do leave in the middle of a code because their shift is ‘over’, are verbally abusive to families, other nurses, and physicians, and don’t do anything to improve their medical knowledge.

    Bottom line – this is a human issue, not a doctor-nurse issue. Most of us are there to care for people and give everything we have, sometimes at the expense of our own health, as the author of the above article has described. Let’s take care of ourselves and our colleagues in our teams, regardless of our titles. Let’s respect our individual roles in caring for patients and learn from each other because we need each other to do this job. I cant do my job well without a stellar nursing colleague, and my nursing colleagues need me to do my job well. My nursing colleagues have caught some of my mistakes, and I have caught some of theirs.

    If we work on this, and put our pride aside, we will all benefit, our patients will benefit. We can decrease our burnout rate and have a hell of a lot more fun doing an amazing job that makes a difference in people’s lives.

    • Young Kim

      Hey, yours was a very well written note. Well done! Written with detailed passion.

    • Jesse Sanchez

      Do you have an engineering degree? If so I have some lucrative non-clinical career options for you in San Antonio Texas. My email is jsanchez@brconline.com.

  • Emily

    It’s good when being ‘burnt out’ is recognized for what it is. I feel there is a high chance of burn out when working with people. It is good to change work if needed as the empathy and what brought us there can feel lost. I recently went to a seminar about burn out and am saving to take a decent size vacation after I leave my current full time work within the next few months. As a therapist, I need that empathy at its best. It’s hard to fake it for too long.

  • Evan Thames

    I dropped out of a six-year, accelerated BS/MD program because I feared medicine wasn’t a good fit for me. It wasn’t that I couldn’t handle the workloads; I cruised through the undergraduate portion with a 3.8 GPA taking 20 hours a semester, plus summers. I just came to the realization that being a clinician was not for me. The more exposure to the clinical environment I got, the more disenchanted I became. I could not get excited about the daily grind of hands-on interaction with patients. Policy and macro-level health care administration is far more interesting to me, and one certainly doesn’t need an MD to thrive in that field.

  • Chris

    I gathered from the piece that Diane’s reason for transitioning out of clinical practice was due to her heightened anxiety leading to stress: fear of ordering the wrong medication or prescribing the wrong dosage etc. While this is not the worst fear to have (keeps you focused), what did she expect going into clinical practice is the first place? I’m only a lowly pre-med, but i’m not naive to think that the profession doesn’t have its inherent stressors. Frankly, I think students should work for a while before going to medical school, to have some perspective, instead of going right after college That is separate debate, however. Diane also presents cherry picked data to add to her thesis: That female doctors have a higher rate of suicide that the general women. That is far fetched, even if that is a published article. There are lots of doctors who enjoy going what they do, and their frustrations are primarily at the level of bureaucracy, paper work, and volume rather than actually providing care. There was ways to mitigate stress that doesn’t involve something draconian. If she wanted to see fewer patients, she could go part-time or concierge, for example.

    • Kate

      First, I think the “innate anxiety” stems from those very real issues you mention surrounding physician burnout. It is not easy to make sure that every appropriate test/imaging/referral is made in a 15 minute session with a patient, not surprisingly, it’s errors and miscommunication from these time-crunched visits that often led to malpractice suits. I’m sure most doctors during the course of their careers experience these feelings, I certainly do. That’s not to say I don’t like my job or my patients, just that sometimes the burden of work seems to overshadow everything else. To be quite frank, as a medical student I rarely experienced intense anxiety or apathy regarding patients, as ultimate responsibility doesn’t lie with you. Additionally, I think it would be a disservice to upcoming physicians to NOT discuss the emotional toll medicine takes, it’s something nobody teaches you in training but a very real part of daily medical practice.

  • Katie

    Thanks for that Diane: it never fails to amaze me how there is no support available whatsoever for Doctors in my country: neither Doctors or Nurses (whether in training or consultancy posts) have any entitlement to free / subsidised health care & even if they did, no time to attend appointments, or are never encouraged to seek help. Incredible stuff: we have had several recent suicides amongst Doctors: esp trainees & GPs…the pressures are growing in the face of government cutbacks, plus the ever increasing patient demands & general lack of respect for the medical profession is also on the rise…..challenging times….action is urgently required

  • Kendrick Mentee

    You precisely argued my long held perception about healthcare delivery, particularly in a fast pace society like the US. All through I have held the belief that for most part the system was no more representative of compassionate medium for humanity but solely bent on serving the bottom line….the economics needs of owners despite the presence of qualified and well meaning practitioners.

  • DD Cross

    NIce work.

  • DD Cross

    Nice work.

  • Martha Lemos

    Don’t become a veterinarian – we are 4 times more likely than the general population to kill ourselves.

  • K991

    Reading these threads I guess the most important message is how much nurses and vet techs disparage doctors and veterinarians.

  • anondoctor

    Unfortunately I am part of the female physician suicide statistic you cite. At the time when I attempted suicide at age 47, I was working long hours as a hospitalist in a new position where I felt very alone, unsupported, and very stressed. I had worked in one hospital for over a decade and hoped the work would be less stressful and more fulfilling at a new hospital. When I realized it was no better, I lost hope and just spiraled downward.
    I was lucky to survive my attempt; I was in the ICU on a ventilator for 4 days. I have now gone to primary care but find it difficult and pressured as well. Trying to see patients in 15 minutes is impossible to do well. I worry that I am missing things and feel I am not able to provide the level of care I was trained to provide. I really don’t want to leave clinical medicine so I have simply cut back to part time. When I first started out as a physician, I intended to work well into my old age (that’s how much I loved it) but sadly I no longer feel this way.

    • Young Kim

      I think you should take care of yourself first. If you don’t nobody can be helped in my opinion… Two doctor friends of mine who left practice (one is a librarian and paints oil canvases and the other is a taxicab driver and writer), are so incredibly happy and cheerful. You must of course swallow your pride an embrace humility, but it can be so uplifting to look forwards to a day without crushing stress.

    • FLDoc

      Dear anondoctor, it touches me to hear that you were at a point in your life where you felt so hopeless. I’m glad to hear you survived and went part time. I think more of us should entertain the option of working part time. I think being high-acheivers, we as physicians are hardest on ourselves and fail to realize no one can push us into a situation unless we are willing to tolerate it. We always have a choice. Part time is an excellent way to maintain a healthy balance in our lives. And when it comes to medicine, sometimes less is more. I find that when I come back from a vacation, I love what I do much more than before I left. We often feel like we’ve failed or feel guilty for working part time, taking vacation, or working less in anyway. What I’ve realized after feeling burnt out several times over the last 7yrs as an anesthesiologist that covers trauma is that whether I am at the hospital or not, there will be a way that things get done. The system will survive without you. You cannot survive without you, and so you have to take care of yourself. It’s not selfish, or weak. It’s just being smart, so kudos to you for going part time.

  • Human Values in Healthcare

    Diane, thank you for your thoughtful article. We particularly resonated with your comments about “We will only succeed if we instill safety and compassion for patients and providers in every aspect of care. If I suppress my humanness to survive in an environment that requires such a sacrifice, how will I be able to see yours?” We’ve lost our humanness and human connections in today’s healthcare system; yet, relationships & caring are fundamental to practicing compassionate, ethical
    and safe care.

    We have established an international collaborative effort to restore human values to healthcare around the world. This effort has resulted in the International
    Charter for Human Values in Healthcare. The Charter’s mission is to restore the
    universal core values that should be present in every healthcare interaction. We are working to restore caring, respect, dignity and other values that have been diminished in the current system—for patients and physicians, and other healthcare professionals. We invite you to join us in this work: charterforhealthcarevalues (dot) org

  • littlefaith

    Just like I have always loved teaching, but I
    know I burn out when I’m in a school setting. I can’t stop seeing all
    the horrors of the institution, and the wreckage it is making of the
    students. It is too bad that doctors like this one don’t
    find ways to practice medicine in a more controlled, personalized
    setting, maybe do house calls. Given the choice I prefer to be a
    private tutor, to give myself and my students maximum flexibility and
    freedom to learn without the pressure that leads to burn out. I hope
    that doctors experiencing burn out will find a way to give themselves
    and their patients maximum flexibility and freedom to heal without all
    the stress.

    • littlefaith

      Guess what I’m saying is… kick the establishment. Go out on your own or band with other doctors who can help you make a good environment for treating patients with the kind of care and respect they deserve, while respecting your own needs. I was a patient at a naturopathic medicine practice where three women banded together to create their dream clinic, where they offered their services without dealing directly with medical billing, so their entire support staff was a single receptionist at the front desk. They had no giant administration sitting on their heads, taking a cut of the fees. And their fees were all stated up front, so you could decide which services were important enough for you to pay for. They ended up being fairly affordable to me, and their services were still paid through insurance, even though I sent in the form myself after each visit for reimbursement, and they would spend an hour just getting to know me and about what other life issues might be contributing to my health problems at each visit. I loved it. I really felt like they understood me as an individual and had enough time to think deeply about what the best treatment would be for me. Every time I went to see them, I felt like I was among friends.

  • John James

    What a lovely piece of writing on life as a burned out clinician. Medicine is incredibly complex and if I were a physician I’d constantly worry that I had made an error. I once had a physician tell me that he was taught in medical school that sooner or later you are going to kill somebody – learn to get over it. I don’t think I could do that.
    I lead a technical group involved in human spaceflight. We deal with complex problems that reach into uncharted scientific and technical areas. I encourage the experts in my group to get a second opinion from one of their colleagues if they are not confident in their judgment. Perhaps physicians should swallow their pride more often and ask a colleague for a second opinion.
    I am sorry that our medical care system fails so many patients and physicians…and nurses. Healing is going to take strong medicine.

  • Jeff Kane

    Hats off to you, Dr. Shannon! I, too, left standard medicine–almost forty years ago. Maybe I’m a hypersensitive diva, but the direction healthcare was heading was both obvious and ominous. I’ve made my living since by writing, teaching, and facilitating cancer support groups–which, incidentally, comes close to what I originally went into medicine for. The docs I know who have left have uniformly stayed connected in some way, and are becoming increasingly influential. I want to believe Dr. Shannon and her counterparts are treating the system itself.

    Jeff Kane MD
    BedsideManifesto.com

  • Judy Fost

    I spent time to read the whole article and appreciate your take on improving physician’s work quality. However, the beginning of the article esp. the third paragraph comes across as dramatic and assumptive. Yours is a very personal problem but the way you quote the female suicidal rate around your own experience brings doubt to the quality and ability of female physicians to readers’ mind. Balancing life and work is very stressful for a female physician in general but constantly worrying about your own decisions and leaving practice or committing suicide because of it are not the same.

  • Emy

    burnout , I could relate to that. I pray everyday that I finish my ran. Cause of burnout? lost of freedom ( too many regulations, leading to too many paper work and less human interactions diminishing the joy of practice of medicine but we, doctors prevail for the sake of our patients, we comply for the sake of our patient, but take away the respect for Physicians? then , there will regrets for not producing the smartest , kindest , the most enduring human profession, The Physician, The Doctor.

  • GetOverUrSelf

    Love all you folks who say – “Yes! I can relate to this, thats why I quit”; “now I am a self preserver, an advocate & mentor leader for correcting the system, sharing my experience to gain sympathy from like individuals”

    News Flash for all you self absorbed type A personalities…..let go of the control & its ok to say – I screwed up by taking the wrong career; not learning to trust & balance my life – But no! No 237 comments & all pointing fingers, on everyone but them selves – Unbelievable!
    “Become the change you want to see in the world” not by quitting the system & your colleagues but collectively finding a way from within!

  • John

    I’m a physician specifically Peds PGY3 on sabbatical and what the author wrote rang true for me when I made that decision to step back. I was debating leaving medicine all together too, but that idea made me miserable as I love seeing patients. It was during this desperation that I realized I don’t need to practice the way I was being instructed (30+ patients per day, increased probability of making an error, poor patient satisfaction). So I’m switching to family medicine (I love peds but I want to offer more and it will be better for the population I wish to serve [a small mountain community]) and if I get the courage to finally do a YouTube v-log, I’ll talk about all this. Until then, I’ll be in Summit County, Co working as a ski instructor while I am looking for a family medicine residency.

    John Coolahan, M.D.

  • Suzanne Biddiscombe

    While I commend the recognition that you were not living from a place of “joy” due to stress Diane the reality is that “stress” is now manageable for physicians and their patients through meridian “tapping” modalities such as EFT, FasterEFT, VRT and other processes. The research is there. The science is there demonstrating and reflecting the relationship between the mind/body and how these techniques and processes release stress and its deleterious impact in daily life. I have worked with physicians who naturally did not want to speak about their “stress” and yet were looking for a manageable way to release the stress and live more fluidly and flexibly in the present whether they were at work or with their loved ones. We are living in a Meridian tapping techniques effectively release “anxiety” and “stress” without medications so one does not have to sacrifice what one loves to do because stress has stolen their joy.

  • Richard Willner

    Over the last 13 years running the Center for Peer Review Justice and consulting with and being part of a team that defends physicians and surgeons from Sham Peer Review and the abuse of the State Medical Boards, the WORST time in a doctor’s life is during these bleak times.

    We maintain a Hotline during the normal waking hours. We encourage those docs in crisis to call us.

    In January of 2012, 3 woman surgeons called us before and during a potential irreversible act. Thank God, we were able to solve these problems.

    At CPRJ, we say that “Doctors Are Our Patients”, and we mean it. We mean it.

  • http://www.medicalschoolhq.net/ Ryan Gray, MD

    Great Article.

    I just did an interview with Dr. Dike Drummond who is an expert in physician burnout. You can hear that at http://medicalschoolhq.net/47.

  • GS

    I am a physician and dont agree with what she is saying much because I dont think all doctors go home and suffer anxiety for every little detail related to our daily routine. I certainly dont go home and wonder whether I gave the right dose or did the right thing or even worse whether the “system” will make a mistake. For sure if I did that I would b miserable too. I think her problem is either a personality trait that was not managed correctly or she has an actual psychiatric problem which was not managed properly such as an anxiety disorder. Burn out and at times feeling tired or overwhelmed is understandable but what she experienced is a different problem. You can not take your work home as a physician and certainly not everybody does that. I make a thoughtful decision knowing that I did my absolute best and continue with my life without regret or anxiety.

    • GetOverUrSelf

      I 100% agree with your assessment….
      If your 4 year old says:
      Child – “life is so hard, I don’t like school, I hate my friends, can I quit”
      You – “no u have to keep going”
      Child – few years down, mum I still hate everything & feel the same what I felt!
      You – Ok honey “lets self preserve” QUIT school!

      I hope you won’t say that to your child, perhaps the 1st time around you will brainstorm what is it that the child can do to find a balance w/o feeling overwhelmed; you may even set up a system to reassess what has worked & what can further be done….
      Well then…..why set a different standard for yourself!

      But if you really just left your child to keep bottling his/her anxiety, delusional about the consequences—> Mental fatigue, BURN OUT ‘syndrome’ & wishing things would ‘magically’ resolve themselves
      .then I am glad u left medicine!

    • townie1952

      I also agree with you 100%.
      Today too many people are spending too much time analyzing everything in their lives and it leaves them paralyzed. Worrying about making mistakes will not prevent mistakes. Humans make mistakes. Second guessing yourself hours or days later is also non-productive.
      I’m not in medicine, but can definitely sympathize with the overwhelming bureaucracy that has wrapped itself around the profession. If doctors sixty years ago had known what the health insurance “money men” were going to do to their practice…….

  • Ameet Bakhai

    There are those who heal people and there are those who heal system. I applaud that you will be doing the latter.
    As always it’s the people who can support people.
    Great friendship with others or with yourself allows us to overcome all the odds and retain perspective.
    Detachment allows us to move to the next moment without the attachment to the prior moment holding us back.
    These are things not yet taught in medical school.
    Really enjoyed reading your sharing. Thank you and enjoy your work and life.

  • MDCapsule

    Wow, great article! I recently left clinical practice here in Boston to start a company called MDCapsule that focuses and advocates for a strong doctor-patient relationship through the use of technology. Doctors as a group need to be more vocal and there needs to be many more physician leaders advocating to bring compassion and “humanness” back into medicine.

  • RomyO Corre

    Lisa Rankin, M.D. is a believer and practices what she believe in…”Be the change you want to see in the world.”

    • HairyGuy

      um nope. she just left what she couldn’t change. she isn’t the change she wants to see ’cause it ain’t happenin’ buddy. the reality is medicine is driven by greed (which is fine to a point) as well as purposely holding back seats for doctors to control the high levels of either income or whatever else. this means more hours per doctor/resident worked because there are simply less docs/residents to go around.

  • Jp Cedo

    Take good care of your Doctors, as well as other health care professionals. Give to them the respect and what is due to them. Getting burned is true. Do not tell them what to do.

  • Gil Asoy, MD

    Part of the stress is due to the potential litigation problem faced for any “sins” in patient care – whether this be a sin of omission or a sin of commission. The public sees this as either physician incompetence or negligence thus the the high pressure environment. Professional athletes, who are paid in the millions, makes mistakes and is the culprit for their losing the game, even the league championship ! But they are easily forgiven. Should the same perspective be applied to physicians ? We are only humans . . . and , I believe, we never had any intention to harm our patients.

  • Mall-issues

    She just wasn’t probably very good at it to be questioning how her practice was and be bothered by the decisions she made as one…good for her patients.

  • Anna

    What a nice straight from the soul article…. Im about 10 years younger than you are and practicing for about 7 years now… I know all about burnout which is exactly why I had set up my own little practice away from the bureaucracies and politics of hospitals and clinics… I know that I will burnout in a heartbeat and hence, Ive done everything possible to prevent it from happening as at the end of the day , I still love what I do… Why? because I think that Im still able to help despite it all… Yes it is a very difficult role we have … I sometimes will come home and husband and teenage daughter calling ” Mom come on lets watch a movie here downstairs” Then, I would shout out while preparing a quick snack.. exhausted mentally, physically and emotionally… ” Wait, mom healed so many patients… but now its me that needs healing… ” And its true … doctors for the most part are “wounded healers.”
    I know what heals me and I continue to learn as I live and pursue and persist in this life: Humor, Exercise, Nature, Sleep, Massage, Prayers , My kids, My husband…

    And its not just MDs that carry this stress, its everybody in the healthcare industry that take care of ” lives”
    It just the way it is… We don’t take care of commodities.. – its a breathing, talking person or animal – hence the stress is always attached to our jobs.. But with a lot of weapons ( education, strong will, optimism, humor, expertise) we thrive and survive… Good day to all!

  • Hendogail

    As an ER doc, I feel like physicians nolonger get any respect. I choose to retire early rather than get pushed around anymore. I felt like various forces had a grasp on my hand and usurped my authority. My patient orders were replaced with protocols; my Rx were altered ever increasingly by pharmacists; our medical records were restricted to computer programs geared to bean counters and the insurance industry rather than physician/ patient needs; I’m considered frequently replaceable by physician extenders. In effect all these other folks are using my signature to do what they want. So I put down my pen and left. The lack of civility in patients (yelling, vulgarity, violence and entittlement) was an added push out the door.
    While i did love the old practice of medicine, there is a wonderful life out here!!!!

  • Leedia Catello Macomber

    So sorry that medicine has been so hard on clinical practitioners!

  • ExhaustedMD

    After thirteen years of family practice, I burned out to the point of not being able to work for awhile. It took a family intervention with my husband, parents and brother (he is an ID doc) to become “un-brainwashed” and realize my quality of life was horrible. I gave all of myself to my patients. In my large, multi-office practice (of which I was a full buy-in partner) I was required to see 30-35 patients (minimum) daily. I refused to stop giving my patients the time, compassion and respect that each of them deserves. My partners were unwilling to discuss a fair compensation for working part-time. As my colleagues crammed in more and more patients, I could no longer tell people that these were the doctors I would send my family member to for medical care.
    Of note, my very bright college freshman daughter and high school senior son have absolutely NO plans of pursuing medicine.
    Truly, what a relief to hear others’ experience and realize I am not alone.

  • DWMD

    I would caution all budding doctors that if you aren’t comfortable with uncertainty, you should not go into medicine. I agree with the sources of stress that Dr. Shannon lists but many of her examples relate to the uncertainty in medicine.

    • Robin

      What med schools are actively seeking candidates who aren’t comfortable with uncertainty? Seems like tape scores are all that count.

  • JEM

    A problem that the author does not address is that there are too-few physicians, a state of affairs that results from the numerus clausus governing medical-school admissions. Many highly qualified applicants fail to gain places in medical school. If there were more doctors, each would be saddled with less work, no?

  • meyati

    Oh an EHR can be screwed up too. When my physician was doing the red tape to send me to a hospital for a dog bite infection, he told the nurse to enter a specific antibiotic, but the discharging doctor needed to decide on the dosage, as the discharging doctor would be doing the assessment. The discharging physician decided that my PCP already had prescribed the antibiotic. I argued with 2 doctors. It was a 3 day holiday. I got a shot in the rear and horse pills. That was May 8, 2013. I’m on another dose of antibiotics. Everybody kept telling me that I had a virus. I have a new PCP that’s treating the infection. My head feels like it’s been in an oven, roasting since May. Oh, I was at the ER 15 minutes after I was bitten. I don’t need to say any more.

    I think that my name should be changed to bad luck.

  • margaret

    I love this. I left being an NP for the same reasons, and hope also to help to advocate for more human centered medicine for both providers and patients. Your article is kind of my mantra about health/medical care.

  • Nicole Chen

    Thank you for this incredibly thoughtful article! It feels especially critical to address and prevent burnout at early stages of one’s career as a doctor, and for what it’s worth, the Internal Medicine department at Johns Hopkins is making some great inroads there. I work at a design and innovation consultancy that’s been helping them address resident wellness – you can see more here: http://daylightdesign.com/project/john-hopkins-resident-wellness/

    Would love to hear your thoughts about our initiative!

  • Amanda

    Thanks for writing this, I found it helpful and inspirational.

  • C

    This definitely speaks to me. I am a nurse practitioner, only in my fourth year of work as an NP and my 7th year of nursing, and made the decision recently to leave a large organization to pursue group private practice. At 27 I was already burnt out. Hoping I can make it work in an environment that is in my control and much less pressure – it’s going well so far. I don’t know that I could have continued in this career had I waited much longer.

  • acn0211

    Right at the outset, I commend Dr. Diane W. Shannon, M.D., MPH, for her courage and her inner strength. After having invested so much of her life, it would have taken her tremendous inner questioning to make the decision that she has arrived at. Even greater is her conviction that she has done the right thing and has no guilt in the her decision. Considering the situation she rightly realized that her life is much valuable and she would be able to contribute to society, in other ways than being a practicing physician. Yes, life is most important.
    Having observed medical education, rotation and residency processes in USA and in some other countries, somehow, what we have in America appears to be artificially made physically, mentally and emotionally very challenging. For a patient to be attended to, by a medical professional, who has been at work for over 10 hours at a stretch is unsettling. Why does the medical profession have to ignore the very rest requirements, that they themselves prescribe for other professions? An alert and well rested doctor is more likely to make the right decisions and fewer errors. Errors a doctor makes could affect the life of the patient.
    Dr. Diane W. Shannon, M.D., MPH did the right thing!

  • JMZ

    All this whining! Sounds like the Republican Party! There is little to nothing scientifically proven as effective in Alternative medicine. It is all anecdoctal. It isn’t necessarily the harm it does to people, as the billions of $$ it steals from patients who are paying for a placebo. It’s clear everyone has some sort of stress in their daily life and many handle it better than others, with and without drugs of one sort or another. The “good” Dr. Shannon had many alternatives available to her when practicing medicine, but she did not recognize them or utilize them. Today frequently seems better than yesterday, but is it really? Bad hand writing…….that’s her fault not medicines’. I use to cancel orders by other docs whose writing was horrible and might lead to a mistake, and that was over 30 years ago. We had checklists for duties, but she did not use that. Check lists are not new. We washed our hands, something encouraged since the time of Pasteur. If you didn’t, then that’s not the fault of medicine…it’s yours. If you “burnout”, that’s OK. If you cannot get the help you need, then go onto something else. Each person’s burnout will be different and no one answer will work for every case or profession.

  • http://www.crashutah.com/ John

    I was partially saddened that you didn’t cover how you got out of medical practice. I was hoping you’d share the advice you’d give to those doctors calling to ask you how to get out.

  • Maria

    Wow, I admire your courage. I would love to talk to you or meet you one day. I am an internist, solo practice with 2 small girls, and definitely burn out with my practice. I wish I had the choice to quit like you did

  • michala

    Thank you for this article. My husband is a doctor and is burnt out and unable to relax anymore. I showed him your article and he said he could relate. I think it is time to find him a new career!

  • Necator

    Hey, i am 2nd year resident… You know what I really am? a secretary! day after day I sacrifice family engagements, personal growth, to fill out ICD and CPT codes so that the crap we do to patients can be properly billed. My thoughts on how the patients should be managed are not even listened to… I work 100+ hour weeks (by the way, I am “encouraged” to lie on those questionnaires about work hours) – and I don’t learn anything, and don’t contribute anything to patient care. I am head over heels in debt – which is why I cannot quit… this is the definition of indentured servitude.

  • joe Joe joe

    Back in the 50′s when the economy was actually booming a man could make a great living doing a number of different jobs….while the wife stayed at home….but slowly congress has inflated the dollar, illegal crossing the border have bled every govt progam, and the economy has brought us to having to be on our a game for what ever we go after….not only is it hard to get a good job now…there are many other things driving us over the edge……this country has put us on the edge. If it’s not up to par there will be a lawsuit? Jesus you can’t even breathe now days without offending someone. Stress ……stress……stresssssssss……it’s the american way. Lets drive up a student loan that takes me 20 years to payback….and I hope I get a job within 5 years of graduation….stress…….stress……what about my backgound check? OMG stresss …..stresss everything is stresss……..women don’t know what they want when they are 16, by 25 they do….by 35 they wonder if they made the right chioce, by 40 they are divorced and not going to date anyone but a prince….then they can’t make up their minds and drive everyone crazy.

    • Young Kim

      So true. Our country is on a course to self destruction if we do not change course. I think the top 1% sold out the rest of the country decades ago. All in the name of productivity and more money for the richest of the rich.

  • Carolina Trabuco

    I can relate to you Dr. Shannon 100%! I left medicine for the same exact reasons… I am just finishing my masters in my second career and I do not miss my daily routine as a physician. I miss the patients, yes I do.
    Thank you for your insight!

  • My Urology Doc

    If professional practices are not aligned properly, burnout is inevitable. Thankfully, I currently love my role as urologist. However, I have my work life and personal life structured the way that works best for me, not someone else. Unfortunatelt, as more and more docs become employees, and continue to answer to administration, insurance companies, and the federal government, the problem with “burn out” is only going to get worse.

  • Almas

    Albert Einstein ones said “Its not that I am so smart, its just that I stay with the problem longer”. I am going to play devils advocate here, the story above sheds light of system failure on many levels: lets start with the average age & life expereince of students that are chosen to be doctors. Most just fresh out of university w/some “volunteer”, lab, research experience, is that enough, do most med students really know what they are getting into?
    Diane shares her expereince as a physician, the “anxiety & degree of power” or less off it around situations she could not control, causing “intense worry”. Well, no system is perfect & yes, thats the goal to work towards, however expecting everything to allign as it is compartmentalized in ones mind is in fact a recipe for disaster. Why do we as physicians think that we should always be in control? Why is there a dichotomy in expecting everyone to trust us with our judgements however unable to revert it back to others. Its fundamental for medical students, residents to known them selves first before pursuing this profession. By that I mean asking questions like: do I as an individual have had difficulty trusting others? do I function well in chaos or work well alone?
    We are so dedicated as a society to blame the system, government, not enough resources, not enough support, its the doctor’s fault or its the nurses that don’t follow hand hygiene; well to all those folks, have you ever witnessed practicing in a developing nation or a rural community in a developed country, with limited resources. People are CONTENT, does not mean that they don’t strive to be better but they look for “what is” & not for what they think “should be”. There is an innate knowing in doing your best when working with others & then allowing the universe to take control, I guess thats a skill that medical school will NOT teach you. Why do we list all reasons that may or do not work, why can’t we perhaps believe in that ONE reason that will. I am not judging anyone here & I am happy for Diane that she discovered clinical medicine was not for her and hope she has found her peace!
    Cheers

  • Almas

    Albert Einstein ones said “Its not that I am so smart, its just that I stay with the problem longer”. I am going to play devils advocate here, the story above sheds light of system failure on many levels: lets start with the average age & life expereince of students that are chosen to be doctors. Most in 3rd year or post bach w/some “volunteer”, lab, research experience, is that enough, do most med students really know what they are getting into?
    Diane shares her expereince as a physician, the “anxiety & degree of power” or less off it around situations she could not control, causing “intense worry”. Well, no system is perfect & yes, thats the goal to work towards, however expecting everything to allign as it is compartmentalized in ones mind is in fact a recipe for disaster. Why do we as physicians think that we should always be in control? Why is there a dichotomy in expecting everyone to trust us with our judgements however unable to revert it back to others. Its fundamental for medical students, residents to known them selves first before pursuing this profession. By that I mean asking questions like: do I as an individual have had difficulty trusting others? do I function well in chaos or work well alone?
    We are so dedicated as a society to blame the system, government, not enough resources, not enough support, its the doctor’s fault or its the nurses that don’t follow hand hygiene; well to all those folks, have you ever witnessed practicing in a developing nation or a rural community in a developed country, with limited resources. People are CONTENT, does not mean that they don’t strive to be better but they look for “what is” & not for what they think “should be”. There is an innate knowing of doing your best in working with others & then allowing the universe to take charge, I guess thats a skill that medical school will NOT teach you. Why do we list all reasons that may not work, why can’t we perhaps believe in that ONE reason that it will. I am not judging anyone here & I am happy for Diane that she discovered clinical medicine was not for her and hope she has found her peace!
    Cheers

  • Believe

    Albert Einstein ones said “Its not that I am so smart, its just that I stay with the problem longer”. I am going to play devils advocate here, the story above sheds light of system failure on many levels: lets start with the average age & life expereince of students that are chosen to be doctors. Most in 3rd year or post bach w/some “volunteer”, lab, research experience, is that enough, do most med students really know what they are getting into?
    Diane shares her expereince as a physician, the “anxiety & degree of power” or less off it around situations she could not control, causing “intense worry”. Well, no system is perfect & yes, thats the goal to work towards, however expecting everything to allign as it is compartmentalized in ones mind is in fact a recipe for disaster. Why do we as physicians think that we should always be in control? Why is there a dichotomy in expecting everyone to trust us with our judgements however unable to revert it back to others. Its fundamental for medical students, residents to known them selves first before pursuing this profession. By that I mean asking questions like: do I as an individual have had difficulty trusting others? do I function well in chaos or work well alone?
    We are so dedicated as a society to blame the system, government, not enough resources, not enough support, its the doctor’s fault or its the nurses that don’t follow hand hygiene; well to all those folks, have you ever witnessed practicing in a developing nation or a rural community in a developed country, with limited resources. People are CONTENT, does not mean that they don’t strive to be better but they look for “what is” & not for what they think “should be”. There is an innate knowing of doing your best in working with others & then allowing the universe to take charge, I guess thats a skill that medical school will NOT teach you. Why do we list all reasons that may not work, why can’t we perhaps believe in that ONE reason that it will. I am not judging anyone here & I am happy for Diane that she discovered clinical medicine was not for her and hope she has found her peace!
    Cheers

  • Diane Carter

    I was an anesthetist for 15 years and when I quit-also to save my sanity- I received no kind of support for the decision. I was told that I was selfish for not wanting to continue devoting my life to saving others, told that basically I was a bad person or some kind of nut for my decision. Only after several years out of the field did I meet a pysician who said that I shouldn’t feel guilty for leaving…I’d done enough to save the world and it was time to take care of myself.

    • Believe

      Wonder why “taking care of myself” has to be a task to conquer on a to do list vs a simultaneous ongoing process of our Being!

  • jrhmd

    I can certainly empathize. I was a family practice physician who owned a solo practice and practiced for a total of 13 years. I am now on (private) disability for anxiety and depression and don’t ever expect to return to practice. I did nearly lose my life due to the stress. There is no possible way to meet all the expectations of your patients, the insurance companies, your family, and run a profitable business. We aren’t making widgets. The same principles the bean counters apply to other businesses don’t apply to the human interactions that are critical to primary care medicine. Attorneys write all the arcane contracts requiring filing deadlines and standards of care, yet they get to charge for phone calls and take weeks to return those. Our patients pitch a fit if they don’t get an answer within a hour or two and blast us on online review sites if they don’t get what they want, even if it is not in their best interest medically. With all the recent uproar over Obamacare, healthcare will never be fixed until the healers are healed and we are once again appreciated and valued for our services.

    • Young Kim

      A very good friend of mine also had the same story as yours and became a taxicab driver. He loves it! Works every day and loves telling stories about hearing stories. You are definitely not alone.

  • nia

    I agree with the part of her saying we expect superhuman activities from human sized physicians. BUT!! I strongly believe every physician should take a stand for themselves rather than only blaming the system. System comes from us afterall.. Our colleagues judge us when we say ” I need a vacation or I need to get out of hospital early or I am sick”.. We have to stand for each other and ourselves. Also with all due respect to the physician who wrote this article, clinical medicine is not for everyone like reserach is not for everyone. We all come with our own skill set but we fail to recognize them and run after “What’s cool and sounds more respectful”.. All specialities and all jobs have a specific need. Doctors need to be easy on themselves first.

  • r1108

    Nice article and a very important topic. Our entire medical, science, business, education system needs to reassess itself and figure out how to create some balance. High pressure, low reward is even being pushed into K-12 with high-stakes testing and hours of nightly homework required just to matriculate. Where is a life in any of this? The doctor that steps away from practicing medicine shows both wisdom and courage. I won’t say hero. That word is far over used, but this person did exhibit the ability to make a tough choice based on quality of life, and future life. Not an easy decision, but well thought out. Good for her.

  • Kathleen Fitzwilliam

    Thank you for this honest commentary on the compassion fatigue many in health care face. As an LCSW I face many of the same concerns you describe. Thank you for modeling so courageously the self care that many professionals feel is unreachable.

  • Bacon3001

    Burnouy begins in Residency. 16 hour days 6 days per week for less than minimum wage per hour is utterly cruel.

    • Robin

      My husband made more money per hour as a high school life guard than he did as a 1st year resident.

  • TJtruthandjustice

    Burnout is not exclusive to medicine. Most people are stressed out from their work. Most can’t afford the luxury of quitting.

    • Bacon3001

      Most people dont have a half million dollars of school debt and 80 hour work weeks.

  • Bacon3001

    To the person/people who keep telling physicians to “study” Homeopathy – seriously, stop. Anyone with the mathematical skills of a third grader and a high-school level chemistry knowledge would tell you just how bogus Homeopathy is.

    Homeopathy is NOT “natural”. Far from it. Homeopathy takes “toxins” (IE – substances like arsenic) that CAUSE disease, then dilutes them to 10^20 or beyond and essentially sells you a vial of pure water. The purest water you’ve ever seen.

    Of course there are no side effects. It’s pure water. There are also no effects – aside from the placebo effect

    • TJtruthandjustice

      Scientists are sure how SSRI’s work and the most recent research indicates that they are no better than a placebo – yet they generate tens of billions of dollars a year in revenue. What’s the difference? SSRI’s require a prescription, and hence a doctor’s signature, and hence a doctor’s bill, and homeopathic remedies do not. Let’s not kid ourselves: money and profit are key factors in medical decision-making.

      • Bacon3001

        Do provide the link to this peer reviewed double blind study

        • TJtruthandjustice

          The effectiveness of SSRIs is almost certainly due to the placebo effect, which is A) powerful and B) an action that conventional medicine disregards completely and in fact considers a nuisance.

          http://www.madinamerica.com/2012/02/60-minutes-the-ssris-and-the-dirty-little-secret-2/

          • Bacon3001

            That’s not a study nor peer reviewed. And need I mention that 60 minutes is no more a valid source of scientific information than any other link you could post?

          • TJtruthandjustice

            You obviously didn’t read the article very carefully or at all. There are links included in the article as well as references to peer-reviewed studies.

  • hlstep

    I wish she had tried to unpack possible reasons why this might have a higher impact on women than men. Maybe the fourth, alignment between administration/physician values? Do hospital administrations tend to be composed primarily of elite, possibly older men who may unconsciously put more pressure on women doctors? Or perhaps male physicians also have twice the suicide rate of the general public, she just doesn’t mention that? Worth considering.

  • drdave

    I have been a practicing veterinarian for 30 years. In that time I have watched as the suicide rate in my profession rose to four times the national average. While the situation in my profession has problems similar to the human field, we have some problems that may be unique to my field. One, many pet owners now view their pets as children rather than animals. Our profession has fostered this view with our emphasis on the human-animal bond. Two, many pet owners believe that a vet can diagnose an animal’s condition merely by looking at it without performing any diagnostic workup. Three, if things go badly, the pet owner can then drag the vet’s name through the mud by writing a negative online review, refuse to pay the bill, or engage in litigation. Or in my case issue death threats. I have had eleven death threats against me in the last three years. Four, pet owners demand Mayo Clinic technology at Wal-Mart prices. That is not going to work. Five, vet colleges are teaching students wonderful technology that cannot be used in private practice either because the equipment is too expensive or the public will not pay what the test is worth. I have experienced burnout myself but got past it by promoting myself to administration of the business and not practicing actual medicine anymore. Need I mention how pet owners like to play Dr. Google now. Depression, overuse of alcohol, and suicide are big problems in my profession yet to discuss them is taboo. We need to get past that and we need to educate the public to get real, as Dr. Phil says. I worried about every case just like you did, I woke up in the middle of the night, I paced the floors, I have been there. At least in human medicine the problem is beginning to be addressed. My profession is running a little behind, in my opinion.

    • Krysten34

      In my opinion, the burnout in the medical profession is related to some degree to harassment by regulatory bodies(some psychopathic managers or superiors who are also bullies). Whereas in veterinerinerian medicine, harassment can come from uninformed patients. And death is unavoidable, but having to witness it in such loyal and helpless creatures… Which might explain the higher suicide rates in your profession.

  • Heather

    Thank you Diane for this timely article. I have felt just as you have, interruptions in sleep and constant worry. A few weeks ago I did hit rock bottom and didn’t think I could survive any more. Reading your article gave me hope as well as a good counselor who was very understanding.

  • gail lowenstein md

    I am a western-trained female physician (age 57) who handled the burn-out issue by studying functional medicine and becoming board-certified in holistic medicine. I now incorporate holistic healing with western medicine and have a concierge practice of home visits only. I do not accept any insurance. Job satisfaction is excellent – I specialize in illnesses that are difficult to diagnose and treat, and really make a difference. I supplement my income with part-time work as hospice medical director and insurance work. I went through so much to become a doctor to give it up, so I found a way that works for me.

  • A.A.

    Brilliant article. However, as a person in the medical field who is seriously depressed and constantly looking for “unconventional” ways out, you haven’t answered the question: HOW?

  • http://www.flickr.com/photos/theamarand/ Amarand Agasi

    Enjoyed reading this article. As a computer engineer who works on-call, we’ve often joked about “well, hey, at least it’s just a computer broken, not like we’re doctors where if you make a mistake, it can be the difference between life and death.” I get the stress of the long hours, and a little bit of the worry (I care about customers and systems being down or degraded), but I know that my worry would grow exponentially if there were human lives at stake. I know there’s not an easily solution to all of this, but as a patient, I know I’d like to have compassionate, well-reimbursed, healthy and happy doctors taking care of me. I just wonder what the best way to get back to that point is? I know that, for me, the “control” (or lack thereof) would be an issue for me. Allowing doctors the freedom to perform medicine in a creative, artful way seems like the best way to keep doctors happy, and having reasonable controls against mistakes would help too. But I also seeing fewer mistakes occurring in a less hectic environment. Late nights, random people running around barking orders, the stress of constantly dealing with human problems and pain – that sounds like an easy recipe for mistake making and burnout. Here’s hoping things get better, and thanks for writing about this important topic in an easy to understand way.

  • DarrenFonzseau

    Thank you so much after 15 years at the bed side in hospitals, I can for sure say that it is all about the money and not the humans any more. What do we do to change the divided in this country?

  • RhoniL

    What will you do now? I see it as well, as I am an R.N. Case Manager at a hospital. We are also suffering burnout with pressure on us to put pressure on everyone else to turn over patients faster. Health care has turned into a pressure cooker. I could not remain full time, so for the past 2 years have been half time and plan on retiring next year. Life should not be like this, I know. My daughter’s physician just started a plan, charging her patients $50/month with inexpensive diagnostics. I don’t know how that will work with the ACA, but we’ll see.

  • Brian

    At least you are (or were) compensated for your trouble. Millions of nurses and laboratorians have the same issues at a fraction of your pay. I’ve been a Med Tech for over 25 years and learned how to have faith in my peers and system without wasting the time and resources used in my education by walking away. Sorry about the lack of sympathy here but it was very clear where the bus was going when I bought my ticket.

  • ES Bruce

    Thank you, Dr. Shannon. I would far rather know a physician has pulled themselves out of the practice of medicine than deal with one who is so burned out they can’t feel anything any longer let alone compassion for the sick or injured patient they are treating. I rarely go to doctors because, for the most part, I take good care of myself and I rarely become sick. My numbers look good and I have a great attitude about life. However, the times I’ve had to go to a physician for an ailment or an issue the particular physicians I have chosen have done nothing to re-establish my trust in the medical profession as a whole. I’m the patient that will remind the burned out physician or physician’s assistant who is still practicing medicine that she/he is treating a living, breathing human being. We are partners in treating my medical ailment, not parent to child. I realize a medical student spends countless hours at studying and a bundle of money to go to school, that experience and cost I do not question. It takes a very, very intelligent individual to pursue the career field. However, you (as in a collective ‘you’) are human and can potentially make a mistake that could be devastating to the individual you are treating, hence the reason I educate myself as a patient expecting to be heard as much as the physician is when I go to one.

  • http://www.zdoggmd.com ZDoggMD

    Excellent piece doc, and congratulations for doing something that takes immense courage! As an internist practicing hospital medicine for the last 10 years, burnout was a constant menace…so much so that I ultimately threw my hands up and surrendered. But surrender is not giving up—it’s giving in to who we really are and reconnecting with that person: http://www.zdoggmd.com/tedmed/

    Thanks again Dr. Shannon, yours is a voice that we ignore at our peril!

  • Rhonda

    I really admire the doctor for getting out of medicine. I don’t know how she extricated herself from a career that took so much money, time, sweat, stress, loans to achieve. I feel if many MDs want to change careers, they feel stuck due to the above situation. The population at large does not know what it takes to become a doctor. The sacrifices one has to make while they are young, the endless hours of study, the loans that would make someone cringe that would take most of their life time to pay back. And that’s before they even start practicing. What they have to endure as MDs makes me anxious just thinking about it.
    My daughter was just starting her 3rd year of medical school and doing well in it. Her life seemed beautiful and fine. She showed no signs of depression or stress. She killed herself 4-11-13. She said she had been depressed all her life in her suicide note. She hid it from everyone an never got help. I don’t know if it was the stresses of med school that made it worse or not, but I can’t imagine the stress that she would have continued to have to go through. However, she never seemed stressed out or burnt out, but she hid a horrible deep depression that killed her, so she could have hidden the stress as well.

    I admire this doctor for telling it like it is. After my daughter died I have done much research. One thing I have found is that an average of 400 doctors in the US kill themselves each year. Something is wrong somewhere.

    • Believe

      Dear Rhonda
      Thanks for sharing…..stay well!

    • Young Kim

      I am so sorry and saddened to hear about your daughter!

  • Diane Shannon

    I appreciate all the comments on my post and am touched by the stories
    of others who have suffered from burnout. The issue is a crucial one to
    address because burnout exacts a huge price–on individual physicians
    and their families, and on patients. It seems a pretty simple concept
    that care providers need to be healthy and well-supported to provide
    ideal care. How much better could our health care be (more
    compassionate, better health outcomes, more cost-effective) if we
    focused some attention on the well-being of care providers? I think the
    investment would more than pay for itself and be a clear win-win for
    everyone involved.

    • Young Kim

      Thanks for writing this article! It was so well written and written “with heart”. I am very active socially and speak to many of my friends from high school and college on social media and at reunions. Most all of them that did medicine and nursing complain a great deal and the main topic of conversation is about how to leave medicine. Those that did seem a lot happier, whether they did something creative like writing or oil painting, or something related like health care public policy or health care computer programming, or something completely different like taxicab driver or librarian (all were real examples of people I was close to). All that left medicine had the following in common they gained…equanimity, peace, and happiness.

  • zingdoozer

    I’m a doctor who finds working in a system designed NOT to work almost despairing. The goal is to have people on medications for the rest of their lives. No one with diabetes or hypertension gets better, at least not once they start the drugs.

    I had a diabetic scare (dad on insulin, mum on OHA’s) and dropped my weight by 20 lbs and my sugars by 40 points in three months. If I got on the meds, I’d be up sh*t creek in a few years.
    Even in psychiatry where I work. Not a single doctor (bar one) I’ve worked with has used any psychological or talking therapies with a patient. They give them drugs, and see the next patient. 1970′s therapies like CBT that don’t work (how many of us doctor’s use it – if it worked, we’d be using it on ourselves too) – we’ve sent dozens of patients to psychology in the last few months. Not one of them has been helped. They’re all in the same situation.

    Doctors are great people who care, so are nurses. Shame they are instruments of such an impotent system that is designed to worsen the very thing it purports to cure.

    But thats the nature of reality. Economic system worsens it. Educational system is worse with every passing decade. The health care system has more people churning through the mill with epidemiology reaching epidemic proportions (:) ).

    No control over anything doctors do. Over and over again the system tells you that as a doctor, no matter what you do – you simply aren’t good enough. Paperwork, decreased patient contact, lack of resources and manpower, stress and chaos.

    This article speaks about stress and chaos as her primary reason for quitting. Those issues are there in every job – the issues are far far more concerning that just stress/chaos.

    And like the rest of what’s happening in the world, I see things getting worse before getting better, if ever.

    • Young Kim

      Yes, when I got anxiety and depression from my banking job in my twenties, my family doctor who was also double boarded in psychiatry just smiled and gave me Clonazepam and then Ambien for better sleep. Both nearly killed me… My anxiety got much worse, my sleep more fragmented, and I got hopelessly addicted. My insomnia was SO bad afterward as the tolerance to the meds built up. After a slow taper, I am off the meds and doing much better after I left my banking job and work as a social worker which I love. It was all about a change in lifestyle. I felt my doctor was trying to do what he was trained to do, but that was just pushing medication on me so much so I nearly died. Instead, he should have just asked me why I hated my job (true source of anxiety and sleep trouble), and advised me to quit and find something new. I was finally helped by counseling from a monk at my Catholic Church (thanks Brother Joseph) who was the one who advised me to find other more gratifying work.

  • Allen

    Let’s not forget that the medical industry is inherently corrupt to its very core.

  • Ben Tibbetts

    This is a remarkable article. It is reasonable, compassionate and honest. As a graduate student, the remarks about burnout–both in the article and in the comments below–hit home for me. It’s sad and ironic that this unhealthy part of our culture would seem to particularly affect those people who are most responsible for the health of others.

  • Maria

    Thank you. As a brand new attending I needed to read this right now. Thank you for publishing. Just like getting girls into science has to start in junior high or younger, the atmosphere preventing physician burnout needs to be in place back in medical school. It’s different from workhour restrictions… It’s an attitude change.

  • Johnny Daniels

    Further proof that men are the only ones capable of handling real stress.

    • rosross

      Oh dear! And the fact that men die younger and generally have poorer health? Is that handling real stress or just being frightened to face the truth and so resorting to denial?

    • Young Kim

      Lol.

  • rosross

    I suspect the biggest stress factor is that Allopathic doctors so rarely cure anyone. At best, for most patients there is chronic ill health and ongoing medication, procedures, medical meddling and medical monitoring and little hope of health in sight.
    Anyone with half a brain, and one assumes doctors have some intelligence, can see the destructive and at times deadly effects of drugs on patients, and even of procedures and surgery.

    Modern medicine is in the main an experiment – the biggest experiment yet perpetrated on humanity and as doctors would be aware, not only is disease not diminishing but serious diseases like cancer are increasing at fast rates, particularly in children; heart disease is increasing; diabetes is ridiculously and dangerously common now and they are just a few among many which have most people unwell for most of their lives. It is probably worse in the US which is the most heavily vaccinated (creating more illness) and heavily medicated society on the planet but the simple reality is that modern or Allopathic medicine rarely heals, often injures and frequently kills.

    Which is why Iatrogenic, doctor or medical induced, is the third biggest killer after heart disease and cancer. And doctors know it. Well, the informed, intelligent caring ones do and they are the ones who burn out.

    • Young Kim

      Agreed. As I wrote earlier, the two times I went to a doctor were negative experiences. The first was when I felt anxiety and insomnia from a stressful job in banking. My doctor just gave me meds for the SYMPTOMS instead of probing and suggesting I change careers (which my Catholic Church monk helped convince me to do). The meds made my anxiety and insomnia MUCH WORSE. After tapering off the meds, I changed careers and now I have zero anxiety and my sleep is just fine…without ANY drugs or doctor visits.

      The second time was for mild hypertension for which I was given anti-hypertensive drugs when my blood pressure was not so bad to begin with (140/95). I thought taking such meds was sort of ridiculous so I stopped the pills and I just decided to go to the gym and start swimming at the YMCA. Then, my blood pressure dropped to 110/75 and stayed there… and I obviously did not need any more medication and doctor visits.

      I felt both times the doctors were trying their best but were following a bad model. They just wanted so much to push medication. They were not even interested in hearing my psychosocial history. It was just about, “What if any meds are you allergic to?” and “Take these pills, it will solve your problems very easily and quickly”. and “Don’t forget to call me next month for an appointment for a refill”.

  • Dee

    As Teddy Kennedy once told his son Patrick there are many ways to serve one’s country. And certainly sitting behind a desk or seeing a different patient every 15 mins in a medical practice is no picnic as this young doctor found. Hence some-times the wisest & necessary thing is to leave such a job with so many stressors.

    I think the best thing Howard Dean did (the former Governor of Vermont ) was leaving his private practice behind and jumping into state and national politics.

    Today, his is helping progressive democrats run for office. In the process, I believe he will probably do more to serve the Health and Well Being of this country than all his yrs in private practice. See URL http://www.democracyforamerica.com/about

  • rb

    I wish there were more docs into natural cures with diet, exercise, avoiding food toxins and environmental toxins, etc. When I think of mds I relate them to annoying salespeople and I stay away.

    • rosross

      Modern medicine is a profit based system where patients come last. If doctors were not paid as well as they are many would leave. If medicine were not seen as a well paid prestige profession many would never take it up in the first place.

      Allopathic medicine has some valuable skills – those sourced in its materialistic and mechanistic mindset – which come into their own in surgery, reconstructive and repair and crisis/emergency situations. Beyond that modern medicine is generally a failure and an utter failure in terms of creating more health. More people today than ever before suffer chronic illness. Hospitals get bigger, the system gets more expensive, rates of cancer have skyrocketed – one in ten in 1900 and one in two today – particularly in children; diabetes at astronomical proportions; more not less disease in general; more allergies, asthma, behavioural and learning difficulties in children – the list is long.

      Society today is sicker than it has ever been and at a time when modern medicine meddles more than it ever has before. It doesn’t take much to put two and two together.

      And the sickest developed society is the US where medical meddling is the greatest. Americans are subjected to more vaccinations than anyone else – often compulsory; Americans are the most heavily medicated people on the planet and consume most of the world’s pharmaceuticals including 80% of the world’s painkillers; Americans are the most medically tested, monitored and medically meddled with people on the planet and the least healthy with the worst longevity.

      The simple reality is that modern medicine, Allopathy, has utterly failed its brief to make people healthy. But that is hardly surprising when the foundation of science/medicine is that human beings are machines, bags of chemicals or materalistic entitites and that they are to be approached and repaired or restored as one would a machine.

      And with profit driven medicine doctors have lost their skills. Most cannot diagnose. They rely on tests. They are no more than secretaries ordering and reading test results and pharmacists dispensing drugs – none of which is about healing. No wonder they burn out.

      • Young Kim

        I actually agree. When I was first having anxiety and insomnia in my life, instead of lifestyle changes a doctor put me on benzodiazepines and sleep aids like Klonopin and Ambien. it only made my anxiety and sleep problems worse and almost made me permanently disabled. And hopelessly addicted! Now, I just made minor lifestyle changes and I am as healthy as a teenager!

  • PamelaWibleMD

    I, too, quit “assembly-line” medicine 10 years ago. I had decided to return to a waitressing job (so I could have time to be NICE to people again). Then I became depressed and suicidal as I so desperately wanted to be the physician that I had always dreamed of being. Rather than end my life, I asked for help. Not from a psychiatrist or a friend. I asked my entire town for help. I called a town hall meeting where I shared my pain publicly. I stood up and bared my soul to the very patients who once stood naked before me. And I invited them to design an ideal clinic. I promised to do whatever they wanted as long as it was (basically) legal. I collected 100 pages of testimony, adopted 90% of their suggestions, and we opened one month later. My community saved my career–and my life. And they’ve inspired other physicians and communities to create ideal clinics too. Learn more here: http://www.idealmedicalcare.org

    • rosross

      Study Homeopathy if you want to heal. Utilise the best of Allopathy but only as a last resort. Include all traditional medicine including Traditional medicine, herbal, energy medicine and you will be able to heal more people.

      • Bacon3001

        I studied homeopathy. That’s why I know diluting substances to concentrations below one atom per Galaxy is bull crap.

        • rosross

          Then study quantum physics as well and really study Homeopathy and you might know what you are talking about.

    • Young Kim

      This interesting. Many doctor friends went to driving a taxicab or stuff they did BEFORE medical school. Some say it was a regression, but if it makes them happy it is a progression. It is great that you found a way to return with your mental health intact!

  • dri

    Therapy sometimes helps….

  • tafa

    I work as a Occupational Therapist and cannot agree with you more; there is a culture of chaos even with the addition of electronic documentation.With the continuing shortage of nurses which results in inadequate care and unnecessary mistakes patients are suffering. I am non medical but constantly see the outcome of an overly stressed medical system and its impact on those struggling to maintain their sense of humanity. I also am thankful that I chose the path I am on instead of a medicine be it nurse, physician P.A. etc., as a therapist very few of my decisions are life and death, I f I had chosen medicine I am confident the end result would be the same as yours.The constant worry of mistakenly doing harm is exhausting.I too hope for change because the people who feel as you do are the very people we need in medicine,compassionate,thoughtful, humane. Being able to share that gift needs to be the norm not the exception.

  • Muhammad

    Agree with Judy 100%. The system is all in all what leads to the unbearable amount of stress and issues in the healthcare field. Malpractice lawsuits are rampant, hospitals need a much higher bed turnover to sustain profits, primary care physicians are essentially forced to blast through patient after patient without taking a proper history because they need to wheel them out with a prescription ASAP in order to get the next patient in, and plenty of ER rooms are saturated with very preventable issues or drug addicts.
    The healthcare system itself is crumbling around us; the only saving grace is the higher priority being placed on preventative health, and that has a long way to go not even being a priority of the government. No, instead, lets implement universal healthcare for a country of 330 million with an incredibly in debt government and see how that goes…

  • Priya carden

    I graduated medical school in 2002 and like most other medical school graduates shared all the eagerness and compassion to start my medical career. Only 10 years after medical school, I felt the burnout. It seems to me that every physician does in some way and finds or doesn’t find a coping mechanism. I’m fortunate in that dr. Pamela Wible is based out of my town, Eugene, Oregon. She holds an amazing retreat for physicians to “recover and refresh” while also encouraging the “ideal medical clinic” model. I urge any physicians who would be interested in continuing to practice medicine in a healthier and sustainable way to contact her for more info.

    • PamelaWibleMD

      Hi Priya! Funny to find you here. :)

      We need more inspiring mentors in medicine. Too often when doctors get together it feels like a “pity party.” I don’t think we put this much time and energy into our training to flee a profession that we essentially love. The field of medicine is a deep spiritual calling for those who pursue it. We are doing ourselves and our patients a disservice if we give up our dreams of being the healers we were born to be.

      Off the soapbox and going to visit my sweetie pie. Nighty night. . .

      :) Pamela

  • Ann Reichsman

    I am a Family Physician working in a Community Health Center where I have worked for 32 years. We have been able to create a safer space for mission driven physicians, nurse practitioners and midwives. It isn’t perfect, burnout is an ever present risk, but we have managed to nurture many who have had long careers with us.

  • Tex Doc

    Due respect, this is not a problem limited to health care professionals. I see this more as a “perfectionist” problem. I accept that no matter how hard I try I cannot be perfect. It’s a given. No one is perfect. I’ve learned to weigh how much burden I can carry and try my best to limit myself to that level of worry/stress/energy…and try to stay on the good side of my limit. Some weeks months I go over my limit. Some weeks I stay below…the key is deciding what the limits are and plan accordingly. I try to weigh the pro’s and con’s of income vs work level, stress vs vacation time, work vs play. The key is to find a balance that makes a person happy and fulfilled without sacrificing personal quality of life. That’s my 2 cents.

  • vlsia pechlivanoglou

    i am not a doctor i am a regular person ,with expiriance on health care on the other side.i do have the same problem or worries as a doctor because they trying to take care of me on this conditions.i worried maby the wrong medicine or wrong dossage or they do not have fellings anymore.i have people in my family that are doctors and i worry for them and the health.i hope and pray that what i just read (that there are doing somthing and know the problem and trying to corrected) is true.thank you

  • RoCon

    Wow! I’m a burned out critical care physician fresh out of fellowship at the age of 30. I take my work home with me all the time and giving bad news to families daily is wearing on my soul. I’m the only female in a male dominated critical care group. Most of them don’t care like I do and I think that’s the key difference between the sexes. I can’t put up a wall!!! Currently I’m refreshing my IT programming skills to potentially “escape” clinical medicine. Amen sister! you said it all!

  • ajokey

    Volunteer as a EMT/Medic :-)

  • LL

    I work in healthcare as a therapist. Something that isn’t really discussed among rehab professionals is burn-out. I really appreciated reading this article because i think on some level each person in healthcare faces the stressors you mentioned. I think the stress medical professionals and caregivers face day to day can be simply overwhelming.
    As a therapist, I face the similar pressures, time pressures or productivity standards, chaos in the work environment with therapists trying to gain access with too few computers to document, degree of control regarding work (corporate telling therapists how to document everything and dictating extremely high productivity standards) all contributing to a brutal work pace and dis alignment between the corporate structure and patient care. Quality of patient care becomes secondary and quantity is what is valued.
    Dr. Shannon, thank you for your candid article. It was a brave choice for you to transition and write about your experience. Not everyone may understand, but I believe those that are in the trenches in medical care comprehend why you made your choice.
    One day I expect to leave my profession. I can’t sustain the level of productivity standards that are expected and provide the kind of care that I want for my patients.
    I hope that I will be able to transition and advocate for therapists the way you have chosen to advocate for physicians.

  • SWRDR

    Medical marijuana try it.

  • JL

    I’m a young surgeon (37) and I’m also looking in getting out of medicine soon.

    • rosross

      Before you do, study Homeopathy. It will be the medicine of the future and it does heal and does no harm. Surgery is actually one area of Allopathic medicine where there are invaluable skills but there is also a lot of unnecessary and ineffective surgery as well. I have read of more than one surgeon though who uses Homeopathic remedies to treat trauma and to aid healing.

      • Bacon3001

        You’re right. Diluting things to the point of nonexistence had no side effects. It also has no effects. Watch James Randi on YouTube sometime.

        • rosross

          James Randi is a magician. By citing him you display your prejudice and ignorance. Honestly, a magician and you consider that credible?

    • Young Kim

      As I wrote before, two doctor friends of mine who left medicine seem so incredibly happy pursing their “artistic side”. They are both doing stuff in the arts while having a stress free “day job”. One is painting oil canvasses while working as a librarian and the other is a writer while driving a taxi part time. Of course, you can stay in the health care area as more than a few friends went into public policy, hospital administration, and one returned to teach high school physics.

  • Daniela

    No offense, but try real estate for one week -work for free tirelessly around the clock -and eventually when you close a deal, you get pennies…(after all of the splits and taxes -we have to pay double social) -at least you get paid for your work (and well!) and have respect from others. I wish I could be something as important as a doctor…I have a masters degree and left corporate America after having a child a few years ago and then got into this -talk about burnout…with no pay…not a good situation. If you are getting paid, think about burn out in a different way…

    • LookingGlass

      True, but how many people run the risk of dying if you screw up? Do people run rampant infections if you pick the wrong antibiotic? What if you forget to run a specific test or blood level? I’ve no doubt that what you do is stressful, however monetary issues run across the board and until you screw up and make a mistake and forget to order something and know you’re responsible, it doesn’t occupy the same category.

  • Tracy

    Thank you for this. I thought I was going crazy and was a failure. But this certainly provide some profound insight.

  • StressedOutMD

    You are describing my life. Although I work in a system that has used an electronic medical record for years (the VA), all 4 of the factors that cause physician burnout are alive and well. Lack of control and chaos are my top 2. If I ever mention my level of stress and frustration to non-physicians, they always say “So look for another job”. I’m just not convinced that primary care in any other system is any less stressful and after many years at the VA, at least I know my enemy. We are the bottom of the barrel, and any attempts at making working in the trenches seem noble is just a lot of talk.

    My daughter just started medical school – my warning to her: don’t go into primary care. As for me, I’m counting the days until I can retire and work in a bookstore.

    • Young Kim

      hehe. Two older friends who are doctors did this. One works at the Morton Grove Public Library in Illinois and is happy as can be and paints oil canvases. The other is a taxicab driver and seems so happy now, always cracking jokes about the drunks he picks up at the bars! There is hope!

  • Hal Wallis, MD, FACOG

    I retired from Ob Gyn at age 53 and am now teaching science to college students. All you need to describe me is to insert my name into the many who have responded to this article. Perfectionism is a two way sword. As physicians we are trained, nay, admonished to always be right. no one ever taught us how to live with our mistakes in a healthy way. hopefully we can find a path for the many young and eager new doctors who come from training with the same compassion and care that we all felt as we began private practice. It is also a selfish desire, these are the ones that will care for me in my old age, and I pray that we in the medical community can find a way to nurture them in a more constructive way. Thank you Diane

  • boston doc

    You may want to check out this report published by RAND last week: http://www.rand.org/pubs/research_reports/RR439.html. Sounds like some of your experiences are good examples of what they found.

  • http://doyle-scienceteach.blogspot.com/ Michael Doyle

    Here’s what I wrote a year ago to answer folks who wondered why I left medicine to teach:

    http://doyle-scienceteach.blogspot.com/2012/08/why-i-left-medicine-to-teach.html

  • Guest

    Here’s what I wrote a few years ago when folks kept asking me why I left medicine to teach:

    http://doyle-scienceteach.blogspot.com/2012/08/why-i-left-medicine-to-teach.html

    • Dwight Eisenhausyermother

      Way to self-promote.

  • New physician

    Is expanding residency and increasing the overall numbers of practicing physicians the answer to this? I am currently an allopathic student applying to residency for the 2014 year. I am in incredible debt- every second there is another ‘non for profit’ charging an outrageous fee or wedging their place into requirements for the match and processing scores etc. I love medicine, and I love working. I was in healthcare long before medical school. Now on the precipice of my career as a physician and I see a thing for what it is.

    We lose wonderful physicians like the one above and administrators with no medical education are too daft to even care. Replacing her with a PA or NP is NOT the answer.

    We must do something to affect great change

  • Victoria

    I too feel your pain as an advanced practice nurse. I am looking onto starting my own practice that focuses on what we as providers want to give and what the patient expects to receive. Time, care, compassion and healing. Instead of trying to get everyone to change I have decided to start the change and when others see the benefit maybe they will change too. Have you ever thought about doing that?

  • Cathy Hinga

    I’m glad to be just a scientist but I want to point out that there is no way I could have started a writing career at age 50 because I didn’t have the money to do such a thing.

  • qvc

    you are a coward. you took a gift – something most of us can only dream of – and threw it away. good job.

    • LByrne

      If you don’t have something meaningful or positive to say, why don’t you keep it to yourself.

      This doctor cared for her patients. She worked within a flawed system that most health care providers will tell you it is extremely difficult to provide care for patients in a meaningful, client-centered fashion. She made the choice to move on and advocate for improvements for doctors in this broken medical system. Ultimately, choosing something that is highly gratifying and meaningful to her and promote quality of life for all.

      How can you be so judgemental? If you want to be something in this life, work for it. Be persistent. Because for most people if you are persistent you can do most anything.

    • RCG

      I trained with Dr Shannon and have known her for over two decades. She is definitely not a coward. In her current role, she is an educator and cares for groups of people, as compared to individuals.

  • Geenius_at_Wrok

    Linzer and his research team found that four factors
    are associated with higher rates of burnout: time pressure, degree of
    control regarding work, work pace and level of chaos, and values
    alignment between the physician and administration.

    You just described the life of a public school teacher.

    • http://doyle-scienceteach.blogspot.com/ Michael Doyle

      I was a doc, I am now a public school teacher.
      Trust me, there’s no comparison.

  • http://doyle-scienceteach.blogspot.com/ Michael Doyle

    I left medicine. I was good at it.
    You cannot accept that kind of responsibility without autonomy–when autonomy was stripped from us, I left.

    I miss big chunks of it, but I’m not sure I’d make it to 60 if I stayed.

    • Young Kim

      You are totally not alone. Of my friends who went to medical school, it seems most of them have just one topic in mind when we get together, and that is of leaving medicine. Many talk about a second career in the arts, like painting, sculpting, and writing.

  • DrSSteph

    Thanks for writing this. I have often contemplated leaving because I get super burned out. Not sure that it’s right for me now, but this is encouraging for the time that may come.

  • woman doc

    I feel for this doctor. I am also a woman doctor in primary care. I began suffering from severe anxiety triggered by the birth of my own child, a type of postpartum depression but it was more anxiety, and then the career made me unable to let the anxiety fade. I ended up on a little touch of medication and I finally have my life back. I am grateful for my own primary care doctor for knowing me well and understanding this job. I hope she is able to find peace.

  • Rebecca R. RN

    It is a common feeling in the healthcare professions, I am a nurse and have had similar feelings, ruminating on the care I had given, decisions made. I often told my family that when you have 6 patients, that is 10 minutes per patient per hour to care for them in any way needed, document, and speak with and reassure family members. You can imagine why so many patients and families become disgruntled with their care. I remember developing anxiety/panic symptoms each day on my way to work just knowing that the work load would be intense. I have spent the last several years imagining myself in a new profession but never left nursing because on the positive side, it is interesting, dynamic, and truly wonderful when there is enough time to do what we are trained to do. MD’s and nurses need to be able to take TIME with patients so they can develop realistic expectations for their health and well being. And to encourage patients to do lots of research on their own health concerns so they can help guide their own path.
    The difficulties and heartache of healthcare can only be internalized for so long before you either become cold and uncaring or broken and beaten. I hope for some large scale solution in the hospital/ clinical setting.

  • Anon Y. Mous

    I have watched, over the years, two of my favorite physicians burn out–a My Brigham/Mass Gen PCP and my physiatrist. Both were smart, energetic, funny, caring people. Now, they are shells of what they used to be.

    The first physician I watched burn out was my physiatrist (who diagnosed me with a rare condition and sent me to a top out-of-town colleague who reworked up the case and confirmed the rare diagnosis). He was young, very smart, caring and loved a challenge. He had a smart mouth, cultivated on the streets of New York City. Over the years, I watched him loose interest in his profession. I didn’t like it when I had to leave him, for I remembered when he was a really great doc and I was hoping that he would get his mojo back. He was a shell of what he used to be–to the point that on physician review sites, patients said that the doctor they met was not the doctor described in the early reviews.

    I’m very sad at what happened to my PCP. She was smart but sometimes too rule bound. I started seeing her when she was just out of her residency at the Brigham, moved with her to MGH and then back to the Brigham when she became a director of a residency program there. When she became an administrative physician, she became more hide bound. She became angry at me for canceling an appointment with a specialist who did not have the expertise I needed (the specialist’s office manager was very apologetic–she said that I should have been assigned to someone else). She became angry when I refused certain screening tests because they were known to be too risky for someone with my rare medical condition. (She should have been relieved that I picked up her boo-boo–no harm, no foul, instead she gave me ATTITUDE). She was not happy when I discontinued PT at the hospital’s outpatient clinic (PT did not have the physical strength needed to properly treat me and I knew it) and I selected someone else (it took him 2 sessions to fix the problem). Frankly, she shouldn’t be training younger doctors. I would like to see a Brigham PCP, but I don’t want to see her or any of her direct reports. I don’t want to interact with her, nor do I want her to have any influence over the medical decisions or advise a PCP would give me. Personally, I think she needs to quit her job, take five years and be a mommy to her babies, then come back to medicine as a PCP in a non-hospital/non-academic setting–that’s if she returns to medicine. The problem is–she’s drowning in debt–she can’t get off the hamster wheel.

    Something is really wrong with the profession–especially in primary care. The best and the brightest are burning out. They’re continuing to practice, even when they know their heart isn’t in the job and the stress is eating them alive. I know that my PCP is drowning in debt (Harvard undergraduate, Harvard Medical School) and she can’t afford to get off the hamster wheel and take care of herself.

  • Keri Allen

    I think physicians have painted themselves into a corner. I think doctors have fostered an attitude where the physician is very divorced from any emotional aspects of patient lives. And I believe many doctors like this buffer and actively promote it. I’m not happy with my health care being whittled down to how many procedures can we, as doctors, make you have before we’ll give you a prescription and then see you back (for another copay) every month for the foreseeable future. I don’t have the time or money for that, but I can’t find a doctor anymore who doesn’t play that game. As a result, I don’t take my medication consistently, mostly bacause of money. I’m tired of being required to get a bloodtest every dang time I go to the doctor, too. I have insurance and still can’t afford what passes as medical care these days. I have two serious, chronic health conditions, and the choices my doctor makes actually finds me less healthy.

  • dcsdjs

    I was struck by how similar your experience was as a physician, in particular, the 4 sources of stress you identified as leading to your burnout, to the experience I had in a long career in IT, before taking early retirement to help relieve all of the stress leading to my spiked hypertension and weight gain leading to other illness. I believe that these stresses (time pressure, degree of control regarding work, work pace and level of chaos, and values alignment between the physician [the employee] and administration) exist in most professions.

  • georgehall1

    Our entire model for modern medical treatment needs to change. For one thing it is too expensive to be sustainable and too much emphasis is put on a McDonalds instant quick cure as opposed to living a healthy lifestyle..
    They system is unhealthy so it is little wonder those in the profession are straining.

  • Robert Bowman

    The case can be made that clinicians are not prepared, selected, or trained specific to the day after day health care encounters in an area such as primary care.

    Until we have preparation, all years of training, accreditation, training funds, and practice revenue support all specific to primary care visit result, we will have fewer primary care visits per graduate – and worsening deficits

    Physicians who are most empathetic and most aware of the steady deteriorations going on where most Americans need care may be at highest risk. I was getting pretty fried after 15 years of watching eastern Omaha slide into deeper decline as the state ignored education, child development, health care, and other needs. With the decline in access, taxi services were getting paid more per patient encounter than our clinics were to ship patients to sites where services were available. Awareness can be a curse but even worse is the lack of awareness on the part of our leadership with regard to what is going on at the front lines of child development, early education, public health, health access, and public safety.

  • MD

    This is not an uncommon story.
    Curious why the author chose to leave medicine altogether?
    There are many opportunities for a well trained internist to remain gainfully employed using their expertise, yet not required to do the type of clinical work described by the author.
    I left direct patient care 4 years ago and still contribute to the field.

  • Truthspew

    You make some very interesting points in this article. The whole medical system is sort of a mess right now but with a little leadership it could be much improved. But alas, I think more of you will be replaced by expert systems like IBM’s Watson and robotics. The computers have a bit more precision to them, but they lack the humanity.

    So I think there’s still a huge space for humans in the mix. and I hope that it’s less stressful for them.

  • Kay

    Thank you Dr. Shannon for sharing your story. Although I am not a physician, I am a retired RN who worked for 30 years primarily In a hospital setting including many years in a neonatal ICU. I can attest to the fact that burnout is a serious problem among nurses also. I also would bring the work home with me and worry about possible mistakes I might have made. Nurses are responsible for the care of their patients for twelve long hours. Many times I would have two or three critically Ill patients, most with ventilators, IV drips, multiple medications and treatments. I worried that I would miss some critical change in my patient’s condition, forget to give a medication, make a medication error, etc. These were life and death issues. The list was endless and neverending. It was hard to go home after a long shift and not dwell on the day’s events and not to worry about my patients. I did burn out eventually, left the hospital setting and worked in phone triage. Thankfully I never made a major mistake perhaps because I was a conscientious worrier.

  • getoutside

    The direction that we are moving in healthcare is supposed to be towards collaboration and teamwork among multiple professionals (doctors working WITH nursing, PAs, NPs, social workers, pharmacy, PT, OT, mental health, etc) to provide good care. If this works, then it will help alleviate the pressure on the individual healthcare provider to make all decisions, and feel the total burden of patient health. There are some major roadblocks, however, and please pardon some of the generalizations I’m going to make here, I think that they are still valid points. The competitive and arrogant model of medical school has to change. Medical students are trained to be highly competitive and duke it out in a very hierarchical system of abuse in which older residents, etc, lord it over anyone younger than them or newer in their training. As you rise in experience, you get to make the new intern below you look like an idiot because you went through it too. It’s like, systematic medical school hazing that never ends. If you did not experience this, then you are probably among the lucky few! This combined with the fact that most people start medical school without any prior patient care work experience leads to graduates with the stereotypical “God complex” that is rampant. People who have had to “know it all” and compete to the death in order to survive, people who have always had the “I’m the doctor” mentality, and have never known what it’s like to be the nurse’s aid, the paramedic, the lab tech. People who have had to compete for residency spots, and jobs. I think it is hard for people who have been trained this way to join the movement of collaborating and respecting other medical professions, a la, Patient Centered Medical Home, in which you, the doctor, don’t necessarily call all the shots anymore. So, we have to change how medical schools train people. We need more classes in which medical students learn alongside PA, NP, and pharmacy (etc) students. We need more collaboration in clinical training. We need students to start working together before they are out in practice so that once in practice, they already work together, know and understand each others’ roles and training, and listen to each other. I also think that medical students should have required patient care experience before starting medical school, so that two things happen: they know what it’s like in the trenches of aids, techs, and other extremely important, but often less respected positions, so that they respect those professionals once they are the doctor, and second, so that they can make a more informed decision as to whether the highly stressful patient care environment is truly the right fit for them. This is the case for PAs, who already typically have years of patient care experience in a variety of professions before attending PA school. I am a PA, and I can’t even tell you how many medical students have been CLUELESS about my training and scope of practice, and that I have an important role to play in healthcare. They think that only people who have gone through the hell of medical school should be qualified to make medical decisions, but the national data on PA and NP practice shows that midlevel practitioners provide quality, competent healthcare, and are an important part of our healthcare future. As a PA, I am trained to be a team member, not the head honcho. It is my job to collaborate, and ask when I’m not sure about something. If doctors were more open to this kind of collaboration and team-based care, I think that the stress that this author totally understandably felt would be decreased. We cannot be healthcare islands, we have to work together. This is how I plan to survive family practice! As an important part of a TEAM. I hope that medical schools will change so that people can go through medical school, and not come out so exhausted, strung out, jaded, arrogant, and suspicious of other healthcare professionals, and therefore prone to take all the pressure on themselves! (and for those of you who aren’t, thank you. You are probably the favorite doctor of your MAs, midlevels, staff and patients.)

    • Jah Pastafari

      Alot of generalizations. As a medical school professor in the US for 15 years, I can tell you that the students who come in are generally timid and work in groups. Med school is humbling for the students. They work in groups and they have multiple team assignments. Havent seen much of the God complex. I agree that PAs and others like nurses should also be able to prescribe. Being a doctor really isnt that hard. They dont really do research which takes all the brains.
      As for the article, alot of what the author says equally applies to the guys pouring concrete for a living. Burnout is everywhere in a society that overworks and fails to encourage or reward vacation and free time. Im sure they are happier in Europe.

      • ES

        Your statement that “being a doctor really isnt that hard” is another generalization and so is the fact that the “research which takes all the brains”. As a medical school professor you should know that it takes not only brains but also stamina and dedication to study the material, match into residency, graduate from residency to attending-hood. Oh by the way, physicians also do research within and outside of residency including bench-work and clinical.

      • Nancy Hall

        I’ve been a master’s level psychotherapist for 35 years, working primarily in psychiatric facilities. Most have followed a medical treatment model, in which the psychiatrist directs the activity of the rest of the staff. I’ve encountered some psychiatrists who can work with a team and others who cannot. It may be the latter to whom getoutside refers. I haven’t seen much evidence that a pure medical model is especially effective, especially in psychiatry which is based as much on the quality of human interaction as it is on the use of medication. It also seems, to me, that a team approach may be less stressful on the individual members of the team, including the physician.

    • SY

      IDK, I guess I was lucky… most upper level residents were very nice to me, and great role models whom i admire to this day. I tried to be the same to my underlings, and valued my teaching role as an upper level resident myself. While I witnessed a select few individuals approach patients with the “I’m the Doctor” attitude (this included some attendings, usually male, more so than residents, though occasionally residents as well), the vast majority of residents and attendings I trained with were very compassionate, team oriented, patient centered individuals.

  • Sylvia Shannon

    As a nurse for 34 yrs. it was difficult to leave nursing, but I found my time was spent in front of a computer and passing meds—not giving the care and support to the patients (or their families) that needed it. I left work feeling like I had not done a good job, not met the patients’ needs and realized this was not why I became a nurse. About ten years before I retired, I began to educate myself in alternative therapies, nutrition and natural remedies and found real joy in sharing my knowledge with people who were discouraged that pills only made them worse, doctors wouldn’t listen to them and only wanted to pick up the prescription pad or order more tests that they couldn’t afford. I had become a volunteer at a free clinic and was able to suggest natural treatment for their problems such as using honey to heal a wound that antibiotic didn’t work on, or white vinegar to cure foot fungus when the prescription was too expensive to fill or just didn’t work. If people were discouraged or depressed, I had time to sit with them and listen to their concerns or fears and pray with them. I will never go back to work and feel sad for the multitude of doctors and nurses who are frustrated and defeated by the present system. I am outside that system and delighted to use my skills and knowledge whenever the opportunity arises and just enjoy people!!

    • cchuff

      Kudos to you for having the courage to forge a new path. I believe more every day that we need to return to the old ways and I study a little every day just for my own benefit. I fear that in the coming days that knowledgeable is going is going to be valuable.

    • Krysten34

      Your story is so empowering… Thank you for sharing it

  • Tophat

    I would like to hear from some military doctors. Years ago one of my good friends was a Navy flight surgeon who was enjoying his career. He told of classmates who spent more than his salary on premiums for medical insurance. He felt that his orders were carried out properly and he was not bothered by bean-counting administrators.

  • Gregory M. Buchold

    I was an MD/PhD student. Being someone who can easily see the ultimate progression of a process, I got burned out much sooner. When I told folks around me that I had panic attacks and couldn’t sleep due to nightmares of clinical errors, I was told this was just what training is about and I should get some meds to control it. I thought that’s exactly what’s wrong with the medical system in general, how we give patients pills when they need lifestyle changes. I was convinced I would have a heart attack if I stayed and might have since I was diagnosed with a now ablated arrythmia. I considered several career options but ultimately chose to leave the program and continue in research instead. While I have regretted the job security loss, I haven’t questioned my decision not to practice medicine. I hope to use my medical knowledge in other settings.

  • Richard Alan Russell

    It is the system. Lets be real. Doctors can’t just help patients.

  • Mrs. Buteau

    I completely agree with Judy. It saddens me the field.has lost a highly compassionate member of the team. I wonder though, that there may come a day when physicians can practice healing without the undue stress of beauracracy. If members of a preatigious group could practice under their own rules.

    I realize insurance and regulatory bodies are there for a reason, but they now dictate care. When practicing medicine became big business, you all became assembly line workers. I see this in the pharma industry (albiet always has been big business).

  • SL

    Dr. Shannon, I applaud your decision to do what is right for yourself. I take great issue with the title of this article as I feel that the terms “burnt out” and “quit” imply failure. You have not failed. You have ignited a new spark in your life. Congratulations on your courageous choice to pursue a new direction. May your new fire burn bright!

    • AS

      I certainly agree. Congratulations doctor for taking a new step. I did this as well in my medical (psychiatry) career, I guess for different conscious reasons – to concentrate on my family as my husband too, is a physician. This is a difficult pill to take for such a stubborn independent person like me. But burn out is all to real for the both of us, not only for myself. I have to look after our health. So, I did it. I understand you, when you might have felt weak, selfish. I had those feelings come and go. At the same time, it’s odd, because I do not have any regrets because I have achieved in my own world now, yet I know how it is to miss the medical world. It was a conscious decision but as determined as I am, I have endeavoured to be the best of my happier self. I am still in the fringe of medicine as I also write about what I know and have been trained on. I am now also studying psychology. This newfound learning gives me hope that I can still function to assist people in their lives. I had to muster courage and take in a lot of humility to go back to studying again. But I discover, this time is a great time in psychology, so it keeps me interested and challenged. The science now includes positive psychology – where empirical evidence now finally focusses on human potential instead of disorder. The kind of ‘medicine’ I was really into, after all. I intend to still be in the helping profession, but on my own terms. These terms are about taking care of myself, my family, my patients. There is life after medicine – a wonderful one, I dare say. It’s ok to feel at times that we are weak and selfish and must admit, we miss the profession we love. Our deliberate decision though will still make us strong and ready in giving the best of ourselves again, in any form. It’s the thing we were trained on and it will never go away. It’s what really matters. All the best Dr Shannon.

  • Julie Quinn-Huffman

    Have you heard of Dr. Pamela Wible? She left medicine years ago, then ended up starting her own ‘ideal clinic’ in Eugene, Oregon. I recently read her book entitled “Pet Goats and Pap Smears.” I heartily reccomend it to Dr. Shannon and anyone in the medical field who yearns to practice medicine the way they dreamed of before medical school.

  • Don Cowan

    Dr Shannon….It sounds as though you were the exact kind of doctor that we need….Caring and compassionate. It’s too bad that you couldn’t find the cutoff between your job and your private life. I wish you the best.

  • Boston2353

    I wonder if we would have as many doctors burning out if we placed emphasis on having experience in the field before entry into medical school. This is starting to be more of a “thing”, but so many of the medical students I see are so young and green that they haven’t a clue about the profession they’re entering beyond perhaps a few years as candy stripers or researchers. Other professions, such as PAs and NPs, place a much larger emphasis on working in healthcare before applying. This would seem to weed out people who can’t handle the pressure in favor of clear-eyed, level-headed graduates who know what they’re getting into and want to be there regardless.

    • getoutside

      I agree! I think this is a really important point- we are putting students through hell to make it through med school before they can really be sure that they are cut out for the demands of full time healthcare jobs. All my classmates in PA school had years of patient care experience, and knew exactly what they were getting themselves into. Instead of being burned out by the time we graduated like 4th year residents, we were excited and ready to go.

    • Medstudentintexas

      I don’t feel this is a viable solution. We are facing a major shortage of physicians over the next several decades. Further restricting the supply will only increase the burden on those people still in the system. As a medical student, I can already say that I feel extremely stressed by the exceptional demands placed on us, but my school does a lot to try to emphasize wellness within the student body with free access to counseling services. That won’t be the case for me when I am a practicing physician.

    • Robin

      Its a nice thought to ask future physicians to have some real world experience before they enter the marathon to become practicing physician, but the Medical School/Residency/Felowship process takes at least 9 years, and as noted in earlier comments, leads many to be “advanced maternal age mothers.” Such delayed expectations are a source of the burnout-especially when the payoff grand job is not that different than training was, but adding to the length of time required is absurd if anyone wants a life outside medicine ever.

      • AT

        Completely agree. Interesting idea but somewhat unrealistic. Most docs are already well into their 30s by the time they finish training. It’s difficult enough starting your career so late compounded by a mountain of debt (especially for lower-paid specialties).

  • Ginnie

    Thank you so much for bringing to light the occupational hazards we face as healthcare workers. The vast majority of us went into the healing arts, be it medicine or nursing or allied health fields, to make a difference in the world and alleviate suffering, but the stress that comes with it is often intense and has long been overlooked. It is heartening to see the beginnings of positive change, and that we’re able to have this conversation. Huge step in the right direction!

  • Phil Nichols

    For my FB friends in healthcare, take the time to read this. I would like to hear you thoughts on the good doctor’s article

  • J. M. Flint

    Wellness is a part of medicine that is almost totally under served. Your masters in public health should be an entree into that area.

    I love the analogy of most clinical medicine being like parking an ambulance at the bottom of a cliff where people fall off and not at the top of the cliff to warn them away.

    Prevention is a hard sell to people addicted to bad food and a sedentary lifestyle perhaps your creativity as a writer could be a break-through. See:

    http://nutritionfacts.org/

    Dr. Michael Greger M.D. is using his expertise to great effect. Contact him personally if his type of work interests you. I am sure that he would be happy to talk about your experience in clinical practice.

    -a 78 year old health nut

  • Amber Martingale

    Altjhough I just skimmed, this was an interesting article.

  • Gorey Thonkleson

    She’s pretty hot, so I’m sure she’ll do fine.

  • Katie Barnes

    Thanks for the story. I’m a veterinarian who left private practice due to burnout, but the reasons were slightly different because the pressures on us are slightly different, but nonetheless, it is hard to face leaving something you worked so hard to achieve, especially without blaming yourself. Ultimately you have to remember that doctors (whether our patients are people are animals) are humans, we deserve respect from ourselves and our patients, and the decision to leave, should we make it, is not a weak one.

  • Mark Hutchins

    Dr. Shannon said, “administration taking the time to understand physicians’ work experience and the barriers they encounter”. The real problem here is that she was always working “for the boss” who in her case was the “administration” and she was trying to please them, but in fact the person(s) she needs to be accountable too are her “patients”. We as physicians, should consider ourselves service providers and educators of “our patients”. It is an aberrant notion for a patients physician to be accountable to an outside MBA who must “go on patient rounds” to “understand” the practice of medicine.

    • AT

      Much of medicine is moving toward an employee-physician model in which docs are salaried by a hospital or large health group. Economic realities are quickly making independent practice a thing of the past. With this comes a profound loss of autonomy which adds to the stress of being a physician. The terms of your practice are no longer your own. You are now part of a system that dictates how you’re going to practice medicine. You are then evaluated on production and other metrics at the whims of non-medical administrators. I perceive this is rather soul-crushing for many docs. No longer are you an autonomous expert, but rather a cog in the machine practicing cookbook medicine without any power to change the system.

      So yes, I do agree with the author. Since administrators now make many of the important decisions that affect patient care, it’s important they understand the process to the best level possible.

      • Mark Hutchins

        Agreed, much of “medical care” is becoming “institutionalized”. But, that does not necessarily mean it must be. As a physician, you can elect to “make less money” and have “less job security” and be your own, CEO and have the autonomy that provides both physician and patient satisfaction. It is not a “9-5″ endeavor, it is essentially a “life”. But, since no one made me elect this life, that is the path i have chosen and I’d do it again in a heartbeat, no profession could ever be as rewarding in my view. (there are maybe things to do to make more money, granted).

  • Alicia

    Wow – you just told my story. I’m 50 now, stopped practicing medicine 10 yrs. ago, tried to return 4 yrs. ago , then quit again. Severe anxiety, insomnia, panic, worry that I would make a mistake or someone else would, completely debilitated with chronic pain which I now know was a result of the fear and anxiety. The time pressures did not allow me to interact with my patients in a way that was best for them. The constant recording of data, test, forms. I felt like I spent most of everyday just trying to prevent lawsuits instead of focusing on patients. I spent more time looking at computers than patients. I also experienced some traumas in training that I’m not sure I ever worked through. So, now, I’m done. I’ve escaped. I no longer have pain. I’m happy. I sleep like a log now. I am me again. I haven’t been able to get back to any form of work yet, but volunteer alot. Developed a fear of work itself which I am working through now. Thanks for sharing your story.

    • Guest

      I hear you–I worked with my therapist on residency traumas for years. It’s never too late to recover from the past. –Michelle, MD

    • Young Kim

      A few members of my family had the same story as yours. Many of them burned out and then quit practicing medicine for the sake of their health. Much kudos to you for looking out for your own sanity and health!

  • cyb pauli

    It’s totally messed up that a normal, really empathetic doctor got kicked out of medicine! She’s the kind of doctor we need!

  • Concerned

    I agree- I am a therapist and have dabbled in researching why western medicine functions the way it does. Upon learning that the “father of western medicine’s residency” training programs was a cocaine addict, it became less of a surprise why things have spiraled out of rationality.

    • SY

      YEP. The entire residency training model was established by Dr. William Halsted, one of the Big Four founding professors of Johns Hopkins Hospital, and a cocaine addict throughout his professional life.

    • alexafleckensteinmd

      Concerned, A really interesting thought you contribute!

      I first thought you refered to Osler as the father of residency programs – he sometimes is credited for it. But it seems to meant Halstead. He certainly was addicted to cocaine and morphine – both legal substances at the time. Halstead also invented the radical mastectomy …

      Alexa Fleckenstein M.D., physician, author.

    • Krysten34

      Haha…I love your sarcasm…I wish I could create a website with all these witty comments that can heal and inform. No offense intended(as I believe that you are among the enlightened therapists) but I can make similar comments about the psychoanalytic tradition that guides some aspects of residency training. Those people are driven by power keen to show patients the right path(aka theirs) while pointing to patients what they are doing ‘wrong (and occasionally shame-inducing). With no regard for the social aspects . And feelings if shame and disempowerment can l make one demoralized.

  • Jack

    I would like to add that nowadays it’s the physicians who aren’t washing their hands when they go in to see a patient. And it’s a source of stress for nurses!

    • cheryl

      I’m constantly reminding MDs to wash their hands and it’s usually the same ones I’ve told the week before. Yet when “serious infections spread from one patient to the next” it’s still the RNs that get blamed. It’s contributing to my impending burnout.

      • NurseJackie

        I am also a nurse. And as I agree that hand washing is a very valid concern, I believe this thread is not the place to be bashing physicians and their practice as so many nurses find themselves doing. I can guarantee there are many other disciplines other than physicians (including, at times, maybe even yourselves) who are not 100% compliant with hand washing. My point is that we need to be working a little more like a team. I absolutely love and highly respect the docs I work with on a daily basis as they highly respect me. I support them; they support me. I value their opinion; they value mine. If I need to approach them about something, I do so privately and respectfully and they appreciate that and are generally receptive to it. I would expect the same from the rest of my fellow medical team.
        We need to be fiercely protecting our teammates; not belittling them.

        • profoundbandit

          Nurse Jackie here is a breath of fresh air. She’s the exact kind of person I want to work with on my team. So many nurses these days are focused on bashing doctors, that they forget it’s a team in that healthcare environment.

        • Kirsten

          While I agree this is not a place to “bash” doctors, the doctor who wrote this article seemed to have a big problem with many things that are very nurse related. Such as saying she didn’t trust that patients would consistently get the care they needed and then went on to discuss items such as leaving an IV catheter in too long and overlooking written orders etc (all nursing functions). As far as the hand washing goes I have watched physicians round on several patients in a row, never once washing their hands in between or cleaning off their stethoscopes. I have been a nurse for 20 years and have a great relationship with the physicians I work with, I still believe in calling a spade a spade…

          • KKGALWAYDOC

            so u watched physicians round on several patients i a row without washing thier hands and YOU ALLOWED IT. why? so u can come here and say it?…you re indeed the most foolish and professionally stupid for it!..my 2 cents!

          • kirsten68

            Wow name calling, usually resorted to by people who have no argument. Last time I checked it is not a nurses place to ALLOW physicians to do anything. I remind physicians to wash their hands, I can’t exactly force them to do it. I think the assumption that nurses have time to run behind physicians and force them to wash their hands says more about YOUR professional stupitidy than mine.

          • KKGALWAYDOC

            What?…i have no argument?.. i have just said only a stupid/foolish nurse will “watch” a doctor move from one patient to another without the use of any form of hand cleaning/washing and the only thing s/he could do about it is come on a public forum to announce it. ….. it’s either you re just plain stupid and so do not understand the reasons for cleaning the hands or u don’t understand the fundamental meaning of being a team player or your re maybe you wee only lying to make a point. Now how is that for an argument? . Flaw that!
            FYI you assume too much… i did not assume that your job is to run after physicians reminding them about hand washing. Neither did anybody assume that a long staying IV line is supposed to be flagged by the nurse ONLY. Why are you bringing drama to yourself?…or is it a guilty conscience at play here?. These were genuine concerns of the writer during her years as a doctor and they are real. Or are u trying to say the things she alluded to are far fetched?
            Stop this doctor bashing and get a life.

    • Ed

      On a recent day-surgery, all but one pre-operation visitors ignored the “mandatory hand sanitize” notice. Surgeon, anesthetist & administrator brushed past it. Only the theater nurse complied.

      • KKGALWAYDOC

        ….no Eddie boy, that’s a medal for compliance!

    • Dennis

      A couple years ago, I was rounding and the hand sanitizer dispenser outside my patient’s room was empty. I found another one, but did let the charge nurse know one was empty. Big mistake. She let me know in no uncertain terms that she had more important things to deal with than empty dispensers.

  • Waltwannabe

    I’m in Capital Equipment Sales. I’d trade the stress of being a doctor over what people in my field face any day. You should start out every day where 90% of the people that YOU have to reach out to, to do your job, immediately reject you. Doctors have people waiting for weeks to get a chance to come in and let you work on them. That sounds like a good problem to have to me.

    • getoutside

      I’m sure you mean well, but it’s really unfair to conclude that someone else’s job is less stressful than yours when you have never been in their shoes. Patients can be very manipulative, abusive and dishonest, so yes, they wait for us to see them but that doesn’t mean they are kind! Finally, the decisions I make multiple times a day could cause harm, even when I make the best decision possible. The stress of knowing that people have placed their lives in my hands can be extremely overwhelming.

    • Justmyhumbleopinion

      Walt-I sympathize your stress level, but can a mistake at work accidentally take a life? I think not. Stress is stress. Obviously your priority in sales is to have a market. So yes, the rejection is stressful, but so are the examples in this article and getoutside’s comment. It’s all relative.

      • sayitlikeitis

        Yes, there is a lot of stress in the job. There are a lot of jobs with ridiculous amounts of stress. There are a lot of jobs other than being a physician that require decision-making or performance where mistakes may have a critical impact on the life of others – even potentially “accidentally taking a life.” A lot of the problem with physician burnout is the holier-than-thou attitude physicians take and then cannot deliver on. They set themselves up for this stress, and then want a pity-party when they can’t handle it. Let’s face it, most physicians went to med school because of the status it would provide for them. If they were truly committed to patient care, then they would make the same choice regardless of the status of the physician. Now physicians want the status afforded them by means of their privileged position from spending years studying, but don’t want to have to make any of the sacrifices. They want easy hours, kind patients, and patients to be concerned with their well-being. When physicians get all the concessions they seek so their lives will be easier, how much should they be paid and how much elevated status do they deserve?

    • Geenius_at_Wrok

      No offense, brother, but maybe what you’re struggling with is the fact that your job isn’t all that meaningful. I mean, yes, businesses have to sell their products, but is anyone’s quality of life substantially reduced if you don’t succeed, or substantially improved if you do? Is your job really worth all of yourself that you put into it?

  • cory gadwood

    As a veterinarian…the career with the highest rate of suicide, a compassionate, hardworking individual, and someone who been appalled at the poor overall quality of human medicine (and with numerous m.d.’s in my immediate family), I can totally relate. Its sad that it tends to be the most compassionate docs that people benefit most from, are the ones who burn out quickest.

    • dali

      as a vet tech, it is tiring for me to listen ad nauseum to the veterinarians at our practice and how hard they have worked for so little etc etc etc etc. They leave before the techs every night and routinely put us in harm’s way. They get to sit down. And they have the egos to blame us (just as this “catheter-left-in-too-long” doctor does) for everything that goes wrong. No control over work load? Chaos? Welcome to our world. And if we work for an unethical vet that doesn’t prescribe pain meds for major surgery, we have to recover those patients in agony. Please spare me from all you have “suffered”.

      You don’t look anywhere near fifty in this photo and you certainly don’t look burned out.

      • Therapist

        As a mental health professional who actively engages in personal, intensive self-healing, I have realized none of us have the right to judge another’s suffering. All suffering is relative, and minimizing the impact of what is difficult or traumatic for someone is extremely damaging and invalidating, furthering the shame/guilt cycle that is often already present. No matter what someone’s profession may be, stress is stress and unfortunately our society as a whole does not reinforce self care. On the contrary we are often praised for the sacrifices we make for others and in the process lose ourselves. How wonderful that this physician followed her intuition and heart and proceeded along a path in life that led her to health and peace. This is why she does not look burned out in the photo. Of course it is often tough for many of us to leave a job/profession in which we feel stuck as that often means sacrificing security/stability, potentially making it impossible to support ourselves and families financially. However, being in environments in which we feel under-valued and under-appreciated (as seems to be the case for many people who have posted here) can drain our spirits of the passion we may have felt for our jobs and the capacity to love ourselves and others.

        • Curt

          Thank you for this comment. We all have crosses to bear, and yet we somehow seem to find value in dismissing the problems of others rather than giving the understanding that we would like from others for ourselves.

      • Dvm

        As a veterinarian, I think you need to find a new place to work. If we are sitting down, it is to return the 20 phone calls sitting on our desk. To research the latest treatment of the disease we have diagnosed. To write up the numerous charts we haven’t gotten to. To organize a treatment plan for our hospitalized patients. And if you administer the wrong drug, or leave an iv cath in too long, it is our license on the line. If you were my tech, you would be fired for a piss poor judgmental attitude. If the vets in your clinic are truly that bad, find a new place to work. I assure you, your attitude is not improving working conditions or your patient care one bit.

  • jefe68

    This speaks to the main issue, that our entire health care system is broken.
    The ACA will not fix this. Our so called elected officials are not interested in doing what is best for the nation. They just kick the can down to road and put band-aids on the gaping wound we call health care in this country. It really is pathetic.

  • ahumanbeing

    Ihave had horrific experiences from heartless medical professionals…They REALLY NEED TO KEEP THE HUMANITY IN THE TRAINING! OTHERWISE, THEY GET AWAY WITH MURDER. I DON’T BLAME THOSE WHO SEE IT HAPPENING AND WANT TO COMMIT SUICIDE…THE SYSTEM IS BROKEN!

    • also a human being, MD

      Physicians typically aren’t trying to murder people. In fact, we try every day, very hard, to do the opposite. It is our livelihood, and our time away from our children. It is our identity. Please do not sweep up all physicians with your capital letters.

      • Jah Pastafari

        Yeah, but docs should actually quit teaming up with big pharma to push poison and they should stop practicing side effect medicine. Wellness > pills in many cases.

    • Jah Pastafari

      All of my docs are pretty good and respectful but I have knowledge of science and medicine. Maybe we should teach more science in school? Wow, a concept.

  • Lynn K

    Congrats to you!! If I could find a way out and afford my student loans I would leave too!

    • CatDO

      Thank you Drs. Drummond and Shannon for your story/comments. I read this while nursing our 3+ week old son – my first. I’m so happy, and am blessed that his birth came just months after I finished my family medicine residency, and that I was able to work per diem ER shifts until I went into labor, and am now taking 4 months off with him before starting my first job as an attending. Though a wonderful situation, it is interesting that I postponed child bearing until I was “advanced maternal age” – something I see most other female physicians doing as well, if they decide to have children at all (I think this would make an interesting study).
      I recognize all of the “survival skills” Dr. Drummond mentioned in myself. I am thankful however, that I entered medicine after 6 years in the (non-medical) workforce and have a BA in philosophy. I promised myself when I started that I would only do this so long as I enjoyed it. Life is too short to postpone time with family and friends or whatever else brings us meaning and joy. Its a privilege to serve, but never at the expense of our own humanity. I’m hoping now though, that I haven’t self sabotaged – I’ll be starting a full spectrum FM position soon – the only one in my residency class to choose to do inpatient, OB and clinic full time. I love the breadth of full spectrum medicine, and many rural communities need doctors such as us, but we are a dying breed – I just hope I don’t discover why. I’m hoping my experience with integrative medicine, osteopathy and plenty of hands-on patient care will constantly remind me of what’s important while at work, and I have this wonderful new son to remind me to let it all go as soon as I leave the clinic or turn off my pager. Wish me luck! Thank you for all of your advice – we need it!

  • alexafleckensteinmd

    After retirement, I started to think how lucky I have been that never anything bad happened to my patients, and that I survived the malpractice system. It scares me more now than it did when I was working. Perhaps I had never time to worry??

    Like you, I made a second career of writing – a happy choice. What saddens me that polls show that physicians don’t recommend medicine as a career to their children. Administration interferes with diagnoses and treatment, and it is no fun anymore.

    I loved every second I worked as a doctor (working in the new field – not yet officially recognized – of integrative medicine, and that might have made all the difference). But it gives me pause that I don’t want my children to go into medicine. The healing profession makes their doctors sick. Something is wrong with the system.

    Alexa Fleckenstein M.D., physician, author.

    • Anon Y. Mous

      I’m sad that you are entering ‘integrative medicine’. Unfortunately, that discipline is dominated by ‘New Age’ nut cases, such as Dr Andrew Weil, Dr Deepak Chopra, Dr Mehmet Oz and Dr Christine Northrup. These people willfully disregard basic science and promote questionable medical practices such as accupuncture, homeopathy, Reiki, etc. Stick with science based medicine, not woo-woo.

      • Biomed

        Wait?? What? Stick with science based medicine? Can you clear that up for me? Is it the one that gavel us thalidomide or the one that gave out Vioxx? How about the one that skews research data? You should really try and understand what you are saying instead of vagrantly displaying ignorance in such dogmatic fashion. Have you not any idea of the psychosocial implications in medicine? Sometimes patients just need to be heard or need a simple lifestyle change. Keep sticking to medicine, you and whoever likes your comments. This is why healthcare in America is not the best. I don’t understand how you confide in science so much when it’s humans that are conducting it for you. Not science itself.

        • Artoo45

          Science is the worst method for understanding the world, except for all the others. And you would have us rely on . . . what? Anecdotes? A friend of a girlfriend’s mother took some stuff and she was cured. Cured I tell you!

          Most docs do listen. Most docs do recommend lifestyle changes and better diets. Science is self correcting. Mistakes are made. People die. Nothing is 100% safe. Mortality is nowhere near what it is the third world or the pre-scientific past. Full disclosure: I am a former alt-med employee and new age nutcase. I got better.

          • Biomed

            So sad that my profession in science has become religion. However, religion is the reason I don’t go to church Mr. Churchill. Naturally, I am flattered how much people defend science and medicine and even show obedient patriotism towards this once flourishing nation. Unfortunately, you’re blind. If I had anything positive to say about alternative medicine, I would have. But I don’t, do I? Nevertheless, working in medicine and biomedical research for many years, I CAN say something can I? But I won’t, because its nothing positive really. And believe me the science behind it is beautiful!!!! But the way the general population, like yourself, misconstrues it is beyond depressing. Believe what you will. Physician population in the US is unhappy. Not just with the government, but the crazy demands and expectations the people have. I’ve seen many go into internal medicine, just to realize they are curing anyone really, just prolonging a diseased or chronic state, keeping the gene alive and passing it down to more generations. Don’t be surprised if the next generation of physicians look to practice outside the US. No, I am lying, a lot of students already are. lol. In medical school they basically teach us to be little anti social recluses, I don’t see how I would miss the US when my job is mostly indoors. How many countries have a higher income per capita above the US? lets go!!!! hahaha. This is the last post I make. Say what you want. i chose these comments to pick on because of their level of ignorance. But my education did cost above $200,000, consequently any more wisdom that I impart must be billed to your home address.

          • rosross

            Most developed countries have higher per capita income than the US and all have lower rates of crime, working poor, poverty, semi-literacy and vastly better rates of health and longevity.

          • Artoo45

            Your pearl-clutching dramatics aside, I’m sure the denizens of your new country will welcome you with open arms.

        • Nancy Hall

          Science is what tells us whether a theory is valid or not. Despite some of the problems with the business of biomedical research, the scientific method remains the only approach that can point the way to real treatments and cure. It has saved, and will continue to save, many more lives than the TV docs, who function more as entertainers than as healers. This anti-science movement, whether focused on climate change or evolution or medicine, is a manifestation of ignorance and superstition. It’s more evidence that the dumbing down of America continues. .

          • Biomed

            This is sad. I am happy that our medical community is adamant to correct this type of thinking. You sit here and talk about cures and all this non sensical ideas. You sound like the TV docs selling wonders as well. What is the point that we attempt to cure lung cancer if smoking nicotine is still abused socially? Before the levels of smoking became prevalent, lung cancer wasn’t on the map. Whats the point of HIV going from a deadly diseases to a chronic state with a life expectancy greater than the average human if you still have unprotected sex? Yes, we’ve eradicated Small pox, but don’t get your hopes up as well. You think pharma will save you? ha. Eat all the McDonalds you want, Statins will destroy you way before a burger will. I am amazed by society and this type of thinking regarding assumptions. I guess every one who questions science is a nut or trying to be a famous TV doc? So, if we tell patients to just drink water, then surely we doctors have made a deal under table with aquafina correct? Let me end this sarcasm. The only ignorance being displayed here is you. Science today, and I beg you to call and ask any med school, is indicating that doctors should start looking beyond the “science” and focus more on the humanistic aspect of medicine. Don’t believe me? Call any med school, get a hold of a student. Ask them how much is the psychosocial aspect being emphasized in their training? Today. I guarantee it is a huge deal. Most med students hate it, because they and we wanted to just learn the science. But science is now indicating how important it is to look at other aspect of the patient. So before you speak and try to defend something that you don’t understand, please read up and educate yourself, because morons on Facebook pick this stuff up and they share it and then stupidity gets spread like a raging virus and like infected T-cells with HIV, it becomes dormant, but the stupidity still remains, there, hidden. And you can make all the assumptions you want, with all the fallacy you like, but not all those who question science are seeking TV fame, and all those who seek to prove science is always right, is unfortunately not a real scientist. See, when I worked in the lab, and when it was taught properly, it was stated this way. “Science doesn’t try to prove itself right, science just shows what it is.” But if I were gullible like you, and believed science the first time around, I guess I would also feel offended if I was told science and I were wrong the first time around. And the worst part about dumbing down America is not change, it’s the actual stagnant state of mind we have. Anti-science movement? You say America is being dumbed down, but when they become smart and start questioning all the poisons we are giving them, you call that dumbing down? wow. No wonder docs are being fed up. Whatever. The cool thing about being a scientist is that sometimes we can help people and at the same time watch people destroy themselves so arrogantly but we have the choice to decide and not take part of it, like this nice doctor lady who quit. Do what you will. I hope you wake up soon. I am sure your intentions are good, but I would warn you not to pick a side in such a biased manner. I am not anti science and although I have been active in science and medicine for many years, I would also caution you and ask you to take heed.

          • Gund

            One bitter non-physician!

          • SY

            That is EXACTLY the reason why i didn’t go into heme/onc. From doing 2 months of inpatient heme/onc during residency, I knew this field would make me burn out very quickly for this very reason. I chose endocrine… though being a workaholic and perfectionist without an “off” switch i’m still feeling a bit burned out. However, in endocrine, most diseases can be ameliorated/cured in some way or another, so that’s been quite encouraging even when feeling burnt out. I am now in fellowship, but am not sure if i will choose a clinical job once i’m done. Certainly not a 100% one. I have a few friends who are doing that right now–it’s like a machine, nonstop, 20 patients a day. How can you possibly be a compassionate thoughtful physician seeing 20 patients a day???? I never envisioned myself practicing by reflexive responses, and that basically is what the expectation is. So I am going to try to shape my career in a way that I can practice the way that I want to — spending more time with patients, thinking about their problems in an individualized way, thinking outside the box. If that’s not possible in the current system, well then I am with the author… I’ll go do something non-clinical, advocate, help people in a different way.

          • Nancy Hall

            Your response to my comment is bizarre. Science is nothing more or less than a process of formulating and then testing theories. The results of the tests are not absolute, but they may offer useful information while showing the way toward more theories and more tests. This is true even if the results show that the original theory was wrong. The point is that science is a process through which ideas are put to the test. The result is an increase or refinement of our knowledge of a particular phenomenon.To reject science is to reject knowledge. You claim to be a scientist, but your response to me is riddled with assumptions about me and my beliefs that you could not possibly have inferred from my comment. You claim to be a scientist, but you don’t think like one.

          • rosross

            Science may well tell, based on its own paradigm, what is valid but it is utterly incapable of answering questions which are not based on the material and mechanistic. Therein lies its problem and limitation.
            Human beings are not machines and neither are they bags of chemicals.
            If the scientific method was the only way to real treatment and cure then there would not be more disease in society than ever before; more chronic illness and more iatrogenic – doctor or medical induced deaths.

        • Joanne

          Thank you, Biomed, for your response to Mous Anon above. Holistic Integrative Medicine has its place here. And actually, reiki, massage, healthy eating, balanced lifestyle, acupuncture, Ayurveda, etc, are all based in science. It’s a matter of what does the patient/client need? And then, having a knowledgeable practitioner/doctor assess and administer appropriately. It could be a valium or an aspirin or an acupuncture needle or a breathing technique. I come from a family of doctors and nurses. When I had my rock climbing head injury, I had X-rays, cat scan, 7 stitches, for gashes and a concussion. I was grateful for the care I was given in the emergency room. Yet, it was the gentle hands of a cranial-sacral practitioner who balanced me out of the intense headaches and loss of equilibrium. I needed both emergency and integrative medicine to restore my health.

      • Bryan

        Anon, please make an attempt to not be so dismissive of thousands of years of healthcare for which you don’t fully understand. Integrative medicine is the portal through which, Allopathic medicine will finally get to scientifically weigh in on the efficacy of these ancient therapies.

        • SY

          Absolutely. herbal and traditional medicine has millenia of empirically observed effects. Empirically derived results are certainly not as robust as randomized controlled trials of today, but by ignoring that entire discipline of medicine, i think we may be missing out on many good treatments/cures that our ancestors knew about. Furthermore, certain herbs are ubiquitous and may be more afforable to the poor uninsured (they just go out and pick the herbs themselves!).

          While I am not suggesting freely integrating TCM or TKM or european herbology into allopathic medical practice just yet, I do think the biomedical research world would do well to embark on studying ancient medical practices, to get some/all of those more validated. I dont think these disciplines should be ignored or equated with wrong.

          Additionally a large percentage of current allopathic medical practice is empiric and non-validated as well. Does that mean we should stop doing those things?

          I personally am curious to read about traditional and herbal medical practices and see what it’s all about. Yes, the mortality rate was higher in those times — however back then they did not know anatomy, molecular biology, microbiology, or intricate pathophysiologic mechanisms when approaching disease.

          • phaedrusxy

            Big Pharma has no interest in natural therapies, as they can’t be patented. That’s the main reason that traditional medical practices have so far mostly been ignored by the “modern” medical world: they’re not profitable. Despite that, more and more “alternative” therapies are making their way into Western culture, and thankfully not all medical schools are adverse to these practices.

      • alexafleckensteinmd

        Anon Y.Mous, I am sad that you lump together all kinds of practices, and reject them summarily as “New Age” and “Integrative Medicine”.

        I happen to have been a math teacher before I became a doctor, and try to base my practice on science. Fresh food, movement, hydrotherapy, herbs and a balanced lifestyle (like getting enough sleep and more hugs) have all solid science behind them.

        Acupuncture is effective against pain and after a stroke. On the other hand, I agree with you that homeopathy has no solid science behind it – therefore I don’t practice it. But, overall, homeopaths probably do less harm than allopathic medicine – 100,000 people die each year of medication side effects, and 30,000 die of mistakes in hospital – their sugar pills don’t kill anybody. Having said that, I rely heavily on conventional diagnoses, and think not to do so borders on quackery. Certainly, homeopathic practitioners hit its limits when they claim it can heal AIDS – as is happening in Africa; I think that is a crime. – And reiki, your last example? To get so much attention, and to learn concentration, and being the moment is surely not harmful for a patient.

        And lastly, Anon Y.Mous: Your arguments would weigh more, if you would not hide behind anonymity. But thank you for your thought-provoking ideas!

        Alexa Fleckenstein M.D., physician, author.

        • justsayin

          Sugar pills kill when there is an actual cure out there in science world. My mom was told to have a bath (hot and cold) as a cure for appendicitis

          • rosross

            If there were cures offered by science then societies in the developed world, the US more than anyone, would not be facing massively higher rates of disease, particularly chronic disease. Neither would iatrogenic, doctor or medical induced by the third biggest killer.

            Homeopathy is not about sugar and your comment demonstrates ignorance if not prejudice. Homeopathic remedies do not kill – they cannot kill. And what a hot bath for appendicitis has to do with Homeopathy is beyond me and most.

          • alexafleckensteinmd

            justsayin, That’s exactly what I mean when I talk about how important a good, conventional diagnosis is. Many chronic diseases, because they are lifestyle-created, respond beautifully to lifestyle changes. Many acute disease might develop into a catastrophe when not addressed promptly and properly. – I hope your mother survived that horrible misdiagnosis, justsayin!

            Alexa Fleckenstein M.D., physician, author.

        • rosross

          You are wrong to say Homeopathy has no solid science behind it when what you mean is the current scientific paradigm of materialist and mechanistic cannot yet understand how Homeopathy might work. And Homeopathy does work and has worked for more than two centuries.

          Advances in quantum physics, a field which developed because classical physics was so locked into the materialistic and mechanistic that it simply could not be used to answer many of the questions which needed to be asked, is moving in directions which allow greater understanding of how Homeopathy works. Ditto for cellular biology.

          However, in the meantime, most people in the world including many MD’s don’t care that science can’t understand how Homeopathy works, they know it works and so they make use of it.

          Perhaps a little more research into Homeopathy in general and the treatment of Aids in Africa might stand you in good stead. Prejudice does rather limit intelligent enquiry. One of the reasons why Homeopathy is growing faster in the Third World than the First is that not only does it work, it is cheap, it does no harm, the remedies are more resilient than conventional drugs and, it works.

          • Michala

            Thank you for this article. My husband is a doctor and is burnt out and unable to relax anymore. After reading your article, I think it is time to find him a new career!

      • rosross

        You mean the science-based medicine which now has Iatrogenic – doctor or medical induced – as the third biggest killer after heart disease and cancer? That science-based medicine?

        The science-based medicine which rarely cures and creates chronic illness with people medicated or managed for life? That science-based medicine?

        As to Homeopathy, it is the fastest growing medical methodology in the world for the simple reasons:

        it works
        it is cheap
        It does no harm

        • alexafleckensteinmd

          rosross, In my mind, homeopathy works in three ways:

          1. The practitioner avoids costly procedures and harmful pills.

          2. The practitioner gives ample understanding, listening and empathy to his patient (placebo effect – which is real, as proven in many studies. And it is huge!)

          3. The practitioner drops helpful lifestyle hints, and the patient picks them up happily because he/she feels understood.

          On the other hand, there is no shred of proof that homeopathy works better than placebo and the avoidance of damaging drugs – and the gentle workings of the innate healing system in every body that kicks into gear for most lifestyle-related diseases when we follow a healthier path.

          Whenever homeopathy is used on potentially lethal (and even contagious) diseases like AIDS, homeopathy is dangerous and criminal.

          Alexa Fleckenstein M.D., physician, author.

    • cchuff

      I for one, would like to see more doctors practice integrative medicine. There are those among us who believe in the mind/body connection and that illness is a symptom of an underlying nature that is all to often masked with prescriptions that lead to the need for more prescriptions. I believe we are going to see more and more people turning to integrative medicine as opposed to allopathic care especially in the light of Obamacare. We will all be much better off to stay healthy and learn how our bodies recognize stress and cause illness instead of looking for a magic pill.

  • Judy Foreman

    You are, of course, precisely the kind of doctor we all need – thoughtful, responsible, compassionate. I believe it is the system, not you, that has made your once-promising career untenable, at least at the moment. the plus side, for all of us, and I hope for you, too, is that your writing and compassionate understanding of the problem may help improve the system for all of us, including doctors. I applaud your strength.

  • Raji Menon

    Diane, Thanks for sharing your experiences so candidly. I am a general surgeon, who experiences severe burnout many years ago. With a change of scene and a short break from surgery, I felt ready to give it a try again, and found out how much I really loved it. With all the lessons learned, I now work at my own pace, and have put in many safeguards to see that it doesn’t happen again.
    I also trained as a Life Coach, to help my colleagues in the profession avoid burnout, and deal with the stresses in a timely fashion.
    There are many things that we cannot really change, about the nature of our work – the fast pace, the differences in priorities between physicians and administration being perhaps the biggest.
    The best thing we can do is find ways to handle the stress better.
    My personal feeling is that most people who take up this profession do so for the satisfaction it can bring. Most of them are caring individuals, who really are capable of making a difference in the lives of their patients. As such, I would like to see that these well trained professionals and their skills are not lost to the profession.
    The most caring people are perhaps at the greatest risk for burnout as well. If every one of those who burn out decide to quit medicine, it would indeed be a huge loss to the entire system, but most of all to the poor patients who deserve the support of these individuals.
    I would like to see more people access coaching and other support early on in their careers, and avoid burnout altogether.
    Thanks,
    Raji Menon
    http://kindlelife.wordpress.com

    • Mark Hutchins

      Well said, best wishes.

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for your story Diane … I burned out of my primary care practice 14 years ago and have gone on to become an executive coach to overstressed and burned out physicians. In my experience with hundreds of physician coaching clients .. the four sources of stress you mention are certainly valid
    - time pressure
    - degree of control regarding work
    - work pace and level of chaos
    - and values alignment between the physician and administration

    And it is the conditioning of our medical education that sets the table for burnout to strike in our 40′s and 50′s. We learn a set of survival skills I will list here
    - Workaholic
    - Superhero
    - Emotion Free
    - Lone Ranger

    - Perfectionist
    These are great to survive a night on call or a tough week. The challenge is no one showed us the off switch and we start to live our whole lives this way. Then there are the two prime directives we internalize
    1) The patient comes first
    2) NEVER show weakness

    These make it extremely difficult to acknowledge and meet our own self care needs or ask for help when we are in trouble – especially men.

    There are literally hundreds of tools docs and organizations can use to lower stress and prevent burnout. It starts with Caring though. Does your organization care about your quality of life? Most do not. I believe that the organizations that begin to build physician friendly workplaces with thrive in the years ahead.

    IMHO the disruptive innovation healthcare desperately needs is the creative destruction of burnout

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • CatDO

      Thank you Drs. Drummond and Shannon for your story/comments. I read this while nursing our 3+ week old son – my first. I’m so happy, and am blessed that his birth came just months after I finished my family medicine residency, and that I was able to work per diem ER shifts until I went into labor, and am now taking 4 months off with him before starting my first job as an attending. Though a wonderful situation, it is interesting that I postponed child bearing until I was “advanced maternal age” – something I see most other female physicians doing as well, if they decide to have children at all (I think this would make an interesting study).

      I recognize all of the “survival skills” Dr. Drummond mentioned in myself. I am thankful however, that I entered medicine after 6 years in the (non-medical) workforce and have a BA in philosophy. I promised myself when I started that I would only do this so long as I enjoyed it. Life is too short to postpone time with family and friends or whatever else brings us meaning and joy. Its a privilege to serve, but never at the expense of our own humanity. I’m hoping now though, that I haven’t self sabotaged – I’ll be starting a full spectrum FM position soon – the only one in my residency class to choose to do inpatient, OB and clinic full time. I love the breadth of full spectrum medicine, and many rural communities need doctors such as us, but we are a dying breed – I just hope I don’t discover why. I’m hoping my experience with integrative medicine, osteopathy and plenty of hands-on patient care will constantly remind me of what’s important while at work, and I have this wonderful new son to remind me to let it all go as soon as I leave the clinic or turn off my pager. Wish me luck! Thank you for all of your advice – we need it!

      • msphb

        the best of luck to you!

    • Geenius_at_Wrok

      You also just described the life of a public school teacher.

      • greenteaj

        That was my first thought as well…

      • Sarah

        I often think about the many ways doctors’ and teachers’ lives are similar, and here’s one more. In a particularly hard year myself, I am thinking often of quitting because this lifestyle just isn’t healthy for me or my family.

      • ThurzdayNext

        Eerie how many of us teachers read this and thought the same thing. Am posting to all I know.

      • Mel B

        I’m a pediatrician, and several of my friends are teachers. I absolutely agree that the demands and stresses are much the same. While I agree with policy makers that there is room for improvement in quality in both medicine and education, I sometimes feel like we’re given an impossible task of fixing it ourselves. Without access to healthy foods, without the time or knowledge of how to cook those foods, without safe areas for exercise, without parents knowing to read to their children and helping kids learn to get enough sleep, trying to educate about vaccines in just 15-20min, when people spend hours pouring over inaccurate articles on the internet —- we can’t fix these societal issues just in the exam room and in the classroom.

      • Laura

        Yep. I work in an elementary school and it is much the same, especially in special education. Teachers are judged based on student achievement, which seems reasonable but sometimes isn’t. There are so many confounding variables to take into account. It’s hard to help a child achieve in school when his/her family recently moved into their car or lost a parent. Teachers have kids for six hours a day and are expected to provide twenty-four hours worth of support and education. It’s simply not possible. And in special ed, some parents make demands that are outrageous. They don’t want to admit that their children are disabled, so they expect the schools to “fix” them. I believe that our children deserve the best in every respect. But I,we, can’t do it all.

      • zz

        yeap. same burn out. But a doctor makes three times more than a public school teacher.

        • sdd

          Not all physicians make 3x more than a public school teacher – that is a great misperception. Some of us doing primary care actually make less than many public school teachers, not only when you compare dollars per hour, (many teachers have all holidays and summer months off as well as spring and winter breaks – physicians do not have that), but also when you look at total salaries. Several experienced teachers in Ohio make 100k/9mo, more than I make as primary care doctor (100k/12 mo.) My days are often 12 hour days, and there is call. I do agree that teachers deserve the money they make, but just to educate, many primary care doctors actually do not bring home those mega salaries.

          • Necator

            ha ha ha, and how much do we have in terms of school debt??!!

          • Geenius_at_Wrok

            Judging from your comments, you’ve burned out already. I hope you withdraw from the profession very soon, for the sake of your patients.

        • linda

          Teachers in Northern CA with M.A. in Special Ed make round $86K, tops. Eight weeks off in summer is a plus, but is sometimes shorter. Meetings, continuing ed, workshops, IEPs… teachers are grossly underpaid. Most are still on campus much later than dismissal time, and have adjunct duties after school as well. I know docs making more per month than teachers can earn in a year, although they are specialists/surgeons, and not newbies.

      • http://www.thehappymd.com/ Dike Drummond MD

        Actually burnout and these kinds of programming and stresses apply to any profession where you learned something equivalent to “the patient comes first” in your training. The more difficult the training and the subsequent job … the more than mandate is driven home.

        It puts someone else’s needs before yours and automatically sets up a higher risk for burnout. There are a number of professions this applies to

        Teachers, counselors, therapists, anyone who works with disabled or disadvantaged in any way
        Doctors
        Law Enforcement
        Military
        and many more I apologize for not mentioning here in this brief comment.

        If you learned to put someone else’s needs before yours in training … realize right now that only applies when you are on the job. The rest of the time is for you, your needs, your family and your life. It has to be that way or you will never have anything to give when you return to work. Burnout is the result.

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • Kirsten

          I find it shocking that an MD would write this list of professions where the patient comes first and not include nurses in his short list…. Our hospital motto is “Patient first” (and yes you can assume that means nurse last)

          • Necator

            I work in NYC, and most nurses here are unionized. They work amazing cush hours, and even when the patient is crashing, if her shift ends at 3, she’ll leave at 3! As an MD, I have no limits on my workload, or my work hours. And I make as much as the nurse. And I have much more in terms of legal responsibility and financial debt.

          • Kirsten

            I work in FL a right to work state so no union and if you make as much as I make you need to find a new job. I don’t know the laws in NYC but in FL leaving a patient who is crashing no matter when your shift ends is abandonment. I work in OB one of the most litigious fields of medicine at one of the top 5 busiest hospitals in the nation with an 85% medicaid population. I have just as much if not more legal responsibility for the labor and delivery of my patient (while the physician is at home asleep). Medicine is tough no matter what and nursing is just as stressful as teaching, counseling, and therapy the top three the physician names. I was commenting that I found it interesting that nursing didn’t even make the short list.

          • http://www.thehappymd.com/ Dike Drummond MD

            Superb observation Necator … I have several clients who are docs working where the Nurse Practitioners are unionized and the same thing happens at 5PM. Docs working until 11PM finishing charts at home is not uncommon.

            Dike
            Dike Drummond MD
            http://www.thehappymd.com

          • KS Nurse

            I’m a nurse who works in a clinic in Western KS and believe me when 5pm rolls around NURSES DO NOT LEAVE!!! The Docs do if not BEFORE 5pm!!! Many times our work load is such that we don’t leave until 6 or 7pm and a couple of nurses even work past that! We are not unionized. Admin EXPECTS us to stay while the docs are free to go.

            Yes I know the Docs work on-call……sometimes. In our clinic, which is attached to our Hospital, they hire ER traveling Docs -who cover the On-Call as well. So most of our providers never do any on-call work.
            Nurses do a ton of work and to not place them high on the burn-out list surprises me.
            I’ve been in nursing for 10 yrs now and I’m beginning to seek other options. With the way things are going w/Obamacare, I may not have a job in a few years anyway!

          • RN CNS

            Kirsten,

            Thanks for saying what I was thinking! I am also an RN MSN, prepared as a Clinical Nurse Specialist. I spent many years in critical care before leaving to work in medical sales. I’ve only recently entertained returning for a Post Master’s NP.

            Lisa

          • http://www.thehappymd.com/ Dike Drummond MD

            Of course you do Kirsten … it is an obvious oversight on my part and I did apologize in advance in the post knowing I would overlook someone … and they would be “shocked”. Please note I was responding to a teacher at the moment. Of course nurses have that programming and of course they suffer from the same flavors and depths of burnout as doctors.
            I hope your motto does not include the post script “nurse last” …

            Dike
            Dike Drummond MD
            http://www.thehappymd.com

          • veritas78

            Dike, while I’ve no argument with your comments, you seem more interested in advertising your “coaching” practice. Either that, or you’re incorrigibly infatuated with your brilliance.

          • Tullymd

            Narcissism is endemic in our society and is intrinsically anti empathetic.

        • kcgirl56

          I am an RN with 35 years experience. I work in a high stress setting in a hospital. I am a resource to my coworkers and respected by the physicians I work with. I give my all every day and also worry that I forgot to do something, missed something, made a mistake. And I am burned out. I hear physicians daily talk about wanting to retire or leave medicine. Can’t imagine any of this improving with the changes coming to our healthcare system.

        • tmana

          It is something that is socialized into ALL females from childhood, as we are expected to put our families (parents, then husbands and children) first. I would not be surprised that many men are socialized this way as well (be the breadwinner, make sure your kids have everything they need to succeed, etc.). The difference is that in the professions you listed, one is responsible for a group much larger than the average extended nuclear family (grandparents through grandchildren).

      • Necator

        yeah right… how many consecutive 100-hour weeks have you worked? don’t even …

      • Joe

        pffff there’s no comparison. Sorry. Teachers are not diagnosing and treating disease. Teaching math and science should be simple. The problem with teachers is you think you own other peoples kids. Parents can raise their own kids

        • Geenius_at_Wrok

          It should be, shouldn’t it?

      • Ali

        Of course there is stress with any profession. But it’s painfully simple-minded to compare the profession of teacher to doctor…and I’ve been both. The enormous differences in years of schooling and amount of student loans aside, there’s the none-too-trivial matter of being held responsible for the life (or death) of each patient.

  • Allison

    As an undergraduate science student, I see many of my peers burning themselves out NOW just to get into medical school. And the same goes for high school students trying to get into college. The culture of burning ourselves out, while it must be especially intense in the medical field, has been instilled in us since we were old enough to start extracurricular’s. I’m happy to see a former doctor put the “This isn’t healthy” stamp on it—maybe it’ll spark some change at other levels.

    • Caroline Bernstein

      Exactly– same here. I just graduated with my BA and started grad school– but I am horribly burned out at this point and need a break. In our culture, it seems we have to over-exert ourselves to be successful, but by the time we find success– we can’t enjoy it and burn out. This issue of burnout spans so many career fields it seems– and yet, in this economy– seems we have to be willing to burn out to possibly find success. The whole system is messed up.

      • Shauna

        I can relate to this. I am a physician now, but towards the end of college the pace was wearing me out. I ended up deciding to take a year off after college to try to get some experience before pursuing medical school. My one year turned into three years working as a CNA and phlebotomist. It took a nurse to kick me in the rear and get me back on track, but I don’t regret those three years off at all. Once I started medical school I was ready to put in the hours of study, eager to learn – something I hadn’t felt in years. I may have been older when I finally finished it all, but that’s okay with me.

        • crimfan

          I bet it made you a better physician, too, because you have some experience being in the system but not at the level of “Doctor.”

  • kfl

    Dianne, thanks so much for sharing your experience in the medical world. I have in mind my wonderful doctor of over 15 years in the Worcester area. Many times I have experienced the tension and stress while visiting the clinic as her patient. But, it never occurred to me that she was at risk of suicide. I wish you all the best in your new path. kfl

    • Johnny Ringo

      wish u luck