The Money Meets Medicine Podcast

Physician Burnout: Is Financial Independence the Cure?

By Jimmy Turner, MD
Host of Money Meets Medicine

After training, I was earning half a million dollars a year, winning teaching awards in record fashion, and publishing multiple peer-reviewed, randomized control trials in my first year as an attending. I was also running a successful six-figure business. I was the host of two five-star podcasts (The Physician Philosopher and Money Meets Medicine, which I previously hosted with my friend Ryan Inman) and even authored a successful book teaching personal finance to physicians. My teaching evaluations were stellar, and I was a pretty good clinician, too.

With everything I had accomplished, I wondered why I wasn’t happier at the end of my journey. After all those long hours and sleepless nights in training to become a physician, was this really it? Without many answers, I began to self-medicate.

The Arrival Fallacy

I didn’t self-medicate with any medications or subtances. Instead, I self-medicated through my addiction to what is known as an arrival fallacy, a term coined by Tal Ben-Shahar—a Harvard-trained psychologist. Tal Ben-Shahar described the arrival fallacy phenomenon in an article in the New York Times as an “illusion that once we make it, once we attain our goal or reach our destination, we will reach lasting happiness.”

If you aren’t sure whether or not you have ever succumbed to an arrival fallacy, tell me if this sounds familiar.

Do you remember feeling that when you got to residency, things would be better than medical school, only to find that you were burned out in residency? Did you think that the burnout of residency would surely get better when you became an attending physician making a physician income? When that didn’t work, did you think that getting promoted to partner or advancing in the academic ranks might improve your situation?

That’s exactly how I felt, and when my chain of “arrivals” finally broke in a harsh and sudden way, my demons came out. I was in arrival fallacy withdrawal. My professional autonomy over my career had been stripped from me. And I certainly didn’t feel appreciated. I was burnout out.

My personal autonomy was under attack as I had little control over my time and when I got home each day. My life felt controlled by a constantly growing to-do list, and I only felt temporarily better when I accomplished more. Yet, there were never enough hours in the day to accomplish everything that I needed to get done in order for my arrival fallacy to keep me afloat. As a husband, father, physician, and entrepreneur, I had a hard time keeping up. Even when I’d have a momentary hit of dopamine from an accomplishment, it was short-lived. I was suffering from all of the symptoms of burnout.

That’s when the anxiety and depression accompanying my burnout became very real for me. As I started to go down, my primary care physician threw me a life preserver called escitalopram and therapy. This made things better for a bit, but my life outside the public eye was still a train wreck. I felt burned out and completely out of balance.

While I used many tools to work through my burnout, one of the few that was in my control was my financial journey. With each step toward financial independence, I gained more and more autonomy. While financial independence is not the cure for burnout, it is a topic worth exploring as it relates to physician burnout.

Disability Insurance for Physicians

 

Understanding Physician Burnout and Its Systemic Causes

Before we dive into the topic of physician burnout and how financial independence plays a role, let’s address the elephant in the room. The word “burnout” has come under fire recently (pun intended). The reason is that burnout, which was first coined by German psychologist Herbert Freudenberger in the 1970s, implies to some that the mental anguish and trauma that physicians experience is “caused by” the burned-out doctor.

In other words, some feel that the term burnout blames the victim. In an ever-growing culture where victim shaming and victim blaming are on par with things like racism or sexism, you can see why this narrative is problematic.

Instead, some have suggested that we use the term “moral injury,” which implies that the injury is happening to the physician instead of being self-inflicted by the physician. To the unacquainted, moral injury occurs when medical professionals have the ability, knowledge, and know-how to help a patient but are unable to do so because of systematic failures that prevent the care from happening.

Said differently, moral injury exists when doctors feel that the system is causing harm to their patients and colleagues and that they are helpless to prevent it. This phenomenon causes profound moral disorientation and emotional trauma. It is also distinctly different from burnout. For this reason, I want to state one thing unequivocally up front:

The causes of burnout and moral injury are systemic and systematic in nature. The causes happen to doctors (not because of them).

The Medical System is Broken

Physician burnout is a growing epidemic that’s been slowly eroding the healthcare system for years. It’s not just about long hours and tough cases – there are deep, systemic issues at play here. The truth is, our healthcare system is broken in a lot of ways. And those cracks in the foundation are putting an immense amount of pressure on the doctors who are trying to hold it all together.

One of the biggest factors contributing to physician burnout is the consolidation of healthcare systems. Over the past few decades, we’ve seen a trend of smaller practices being gobbled up by large, corporate entities. On the surface, this might seem like a good thing – more resources, more support, right?

But in reality, it often leads to a tangled web of bureaucracy and red tape that can be incredibly frustrating for doctors to navigate. The employed physician knows this plight well.

Suddenly, instead of being able to focus on patient care, physicians are bogged down with endless paperwork and administrative tasks. They’re at the mercy of insurance companies and hospital policies that don’t always prioritize what’s best for the patient. It’s a recipe for burnout, plain and simple. When doctors feel like they’re constantly fighting against the system just to do their jobs, it’s no wonder they start to feel exhausted and demoralized.

Identifying Symptoms of Burnout

So what does burnout actually look like? It can manifest in a lot of different ways, both physically and emotionally. Some common symptoms include:

  • Emotional exhaustion – feeling drained, depleted, and unable to recharge
  • Depersonalization – a sense of detachment or cynicism towards patients and colleagues
  • Reduced sense of personal accomplishment – feeling like your work doesn’t matter or make a difference

Money Meets Medicine, Jimmy Turner, Justin Harvey

 

These symptoms can have a profound impact on a physician’s well-being and ability to provide quality care. Burnout has been linked to higher rates of medical errors, lower patient satisfaction, and even substance abuse and suicide among doctors.

In fact, physicians have one of the highest suicide rate of any profession. Let that sink in for a moment. The very people we rely on to keep us healthy and save lives are struggling to keep themselves afloat. It’s a tragedy, and it’s one that we can’t ignore any longer.

The Individual Cause of Physician Burnout

To help understand how financial independence plays a part in physician burnout, we must first discuss the tripartite cause of burnout and how personal finance fits into the picture. Without buying into the false dichotomy of moral injury versus burnout above, it is important to consider the individual manifestations of burnout, and what the opposite of this – what I call becoming a self-determined physician – looks like.

If physician burnout has three pillars (emotional exhaustion, depersonalization, and reduced sense of accomplishment) the picture of what it looks like to thrive has a counter-balancing picture, which I call a “Self-Determined Physician” – fashioned after Richard Ryan and Edward Deci’s work on self-determination.

Here is how I envision the ABC’s (autonomy, belonging, and competence) of a self-determined physician from my book, Determined: How Burned-Out Doctors Can Thrive in a Broken Medical System.

Self Determined Physician vs Burnout

The Path to Financial Independence for Physicians

From the picture above, you may surmise that financial independence is not going to solve all three problems (lack of autonomy, sense of belonging, and confidence). That said, personal finance does fit squarely into the peg of helping to create personal and professional autonomy by allowing physicians to practice medicine on their terms. Eventually, with financial independence, it allows doctors to practice because they want to and not because they have to due to financial obligation.

Suddenly, doctors are not beholden to a particular employer or tied to a certain location. They have the freedom to make decisions based on what aligns with their values and goals, rather than just what pays the bills. This can be incredibly empowering for doctors who have felt stuck or stifled in their current positions. It allows them to practice medicine on their own terms, in a way that feels authentic and meaningful to them.

The Impact of Financial Independence on Job Control

Financial independence doesn’t just create personal autonomy.

It also gives physicians more leverage when it comes to negotiating their working conditions (i.e. their professional autonomy). When you’re not relying on a paycheck to keep the lights on, you have a lot more bargaining power. This can be especially important when it comes to pushing back against unreasonable demands from insurance companies or hospital administrators.

Disability Insurance for Physicians

 

Doctors who are financially secure can advocate for their patients and their profession without fear of losing their livelihoods. Of course, achieving financial independence is no small feat, especially given the high levels of student loan debt that many physicians are saddled with. But it’s not impossible, and there are steps that doctors can take to start building wealth and creating more options for themselves.

Financial independence is not a panacea for burnout, but it can provide a sense of control and autonomy that is sorely lacking in today’s healthcare environment.

By taking charge of their finances and working towards financial freedom, physicians can start to reclaim some of the power and agency that has been stripped away by a broken system. It’s not a complete solution, but it’s a step in the right direction.

Financial Flexibility as a Tool Against Burnout

Financial independence isn’t just about having the ability to walk away from a job that’s no longer serving you. It’s also about having the flexibility to make changes and advocate for what you believe in, without fear of financial repercussions. When physicians have a strong financial foundation, they’re more likely to speak up about issues that are impacting their well-being and the quality of care they’re able to provide.

This could mean advocating for better staffing ratios, more reasonable work hours, or improved communication and collaboration among healthcare teams. It could also mean pushing back against policies or practices that prioritize profits over patient care. We all know medicine is broken, and it isn’t going to fix itself. Having the financial security to take these stands is crucial, because let’s face it – rocking the boat can come with risks.

Physicians who are living paycheck to paycheck may be hesitant to speak out, for fear of losing their jobs or damaging their career prospects. But when you have a financial safety net, you have the freedom to do what’s right, even if it’s not easy. You can be a voice for change, without worrying about how you’ll pay your mortgage or put food on the table.

Beyond Work: Finding Value and Belonging

Financial independence can also have a profound impact on physicians’ lives outside of work. When you’re not constantly stressed about money or tied to a job that’s crushing your soul, you have more time and energy to devote to the things that truly matter to you.

This could mean spending more quality time with family and friends, pursuing hobbies and passions, or volunteering in your community. It could also mean having the resources to travel, learn new skills, or give back in meaningful ways. All of these things can contribute to a greater sense of purpose and fulfillment, which is essential for combating burnout. When you feel like your life has meaning and value beyond your work, it’s easier to weather the challenges and frustrations that come with being a physician.

In a world where so much of our identity and self-worth is tied to our careers, it is important to redefine success and find fulfillment on our own terms. It’s a powerful tool for combating burnout and building a life that truly aligns with our values and priorities.

Systemic Solutions vs. Individual Solutions

While financial independence can be a valuable tool for individual physicians, it’s important to recognize that it’s not a complete solution to the problem of burnout. The reality is that the healthcare system itself is broken, and no amount of personal resilience or financial savvy can fix that on its own.

The Limitations of Individual Efforts

Don’t get me wrong – I’m a big believer in the power of individual action. I’ve seen firsthand how making changes in your own life can have a ripple effect and inspire others to do the same. But when it comes to something as complex and deeply rooted as physician burnout, individual efforts can only go so far.

We can’t expect doctors to simply “tough it out” or “pull themselves up by their bootstraps” when the system they’re working within is fundamentally flawed. Sure, achieving financial independence can provide some relief and create more options for individual physicians. But it doesn’t address the underlying issues that are causing burnout in the first place – things like excessive workloads, lack of autonomy, and a culture that prioritizes productivity over well-being.

At the end of the day, financial independence is just one piece of the puzzle when it comes to combating physician burnout. It’s a valuable tool, but it’s not a panacea. To truly address this issue, we need to come together as a society and demand better for our healthcare workers and our patients. We need to create a system that values compassion, collaboration, and well-being, not just productivity and profits. It’s a daunting task, but it’s one that we can’t afford to ignore any longer. The future of our healthcare system – and the lives of those who dedicate themselves to it – depend on it.

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