This post was written by The Physician Philosopher
The burnout rates in practicing physicians and physicians in training (medical students, residents, and fellows) are simply alarming. The problem seems to be getting worse with the decreasing autonomy, unhelpful/encroaching administrators, and the ever increasing financial burden of our student loans.
While you may think that physician burnout only impacts doctors, evidence shows that it unfortunately leads to bad medical care for our patients, too. With that big of a problem, what would you think if I told you that financial independence may have the power to save our physicians?
Let’s dig in.
Defining the Problem
When the average medical student graduates from medical school, they have accumulated $190,000 in student loan debt. That gets to compound (usually with interest rates between 5-7%) over a three to seven year training paradigm. It can often turn into $200,000-$300,000 in debt by that point.
Even worse, that number above doesn’t include undergraduate debt. I have personally had residents with as much as $500,000 in student loans.
It can seem insurmountable.
Compound this on top of the long hours, lack of sleep, the loss of autonomy, and difficult life happenings outside the hospital; and you can see that a problem is brewing.
If the above wasn’t bad enough, burnout rates and suicide rates are climbing, too. Physicians have the highest rate of suicide of any profession. Dr. Pamela Wible, one of the leaders in this arena, has compiled a list of nearly 1,000 doctors who have killed themselves.
These catastrophic events impact more than just the physicians and their families, too. Medical errors occur more often in overworked and burned out physicians.
Leading Contributors to Physician Burnout
Burnout, first described in the 1970s by Herbert Freudenberg, is characterized as emotional exhaustion, depersonalization (impersonal or apathetic feelings towards others), and feeling a lack of accomplishment in your work.
Juxtapose this description with that of someone entering medical school: people who want nothing more than to help others, to be good at it, and to feel like their work is truly changing lives for the better in this world.
All the opposites of a burned out doctor. How does this transition happen? The answer is that it is complicated.
Studies have shown that the three leading causes of satisfaction at work are autonomy, competence, and support at work (aka “relatedness”).
When the opposite occurs (lack of autonomy, incompetence, and lack of support) this is a recipe for burnout and failure. There are other causes, but these three are certainly a big part of the problem.
Autonomy at Work
Autonomy means self-governance, or independence.
Many physicians currently lack autonomy. They no longer feel like the captains of their own ship. The ship is owned by bureaucrats, hospital administrators, and insurance companies.
We are expected to see more patients in less time. And when we deem a certain modality the appropriate one to diagnose or treat a patient, the insurance company must agree with us first. Otherwise, it doesn’t happen.
It’s not just insurance companies, though. Patients also have demands.
You are damned if you don’t fill that opioid prescription or give them antibiotics for their viral illness. They have certain expectations they feel must be met (even if they aren’t the one with the medical degree).
Autonomy isn’t the only problem.
Doctors often can and do feel a complete lack of support from administrators who enforce rules without ever talking to the medical professionals on the front line.
More paper work, better billing documentation, more compliance. The list goes on and on.
As an example, I’ll share a recent email interaction with you with a medical biller. Her entire message basically said that I “forgot to attest for CPR” so that we could bill for it. That night she was referencing was a rough night for me. I had a very young trauma patient die on the table.
There was nothing I could do to prevent it, but a loss of a young life is troubling no matter how it occurs.
A more appropriate email from the biller may have read “I am really sorry for the patient that you lost last night. That must have been tough. When you have some time, though, we do need to complete some documentation, including attesting for the CPR you administered.”
Nope, none of that. The point was made clearly. My job is NOT to be a human being that thinks and cares and cries.
My job is to bill for CPR. Oh, and to go take care of that next patient. We need to bill them, too. There is no time for crying or remorse in medicine. How dare I have feelings?
The utter lack of autonomy and support leads to utter dissatisfaction and burnout at work.
But is there a solution to save our doctors?
Financial Independence To The Rescue
At first glance, you might think that I am making the point that “as long as doctors earn enough money, these problems won’t bother them.” That couldn’t be further from what I am saying.
Financial Independence reliably provides some direct counter action to the causes of burnout listed above. It doesn’t fix all of the problems, but it does help with many of them.
I’ll mention three specific remedies that FI provides:
Remedy 1: A Way Out
Many physicians who get burned out do so because they feel stuck in the rat race. There is no way out. The financial burden is suffocating, and most doctors feel forced to work long hours to pay back their loans.
Financial Independence allows for increasing autonomy over our life. Maybe we cut back to 70% of an FTE (Full Time Equivalent) or even 50%. We could also retire completely, though that’s not the message I normally preach.
Maybe we use that extra time to become human beings again and realize we have other hobbies like playing an instrument, writing, dancing, brewing beer, or playing sports.
Or maybe this additional time will let us be present for the people we love. It would be nice to put our children, spouse, parents, siblings, and friends first instead of putting them on the back burner.
In fact, a bigger picture of burnout suggests that physicians often lose their self-identity in their profession. FI allows us to get back to our roots and to re-examine what makes us who we are.
That 142nd email of the day can wait til our day off.
Remedy 2: Less pressure to keep up with the Dr. Joneses
Dr. Cory S. Fawcett coined the term “Dr. Joneses.” These people are no different from any of the other Joneses that anyone else tries to “keep up with.”
Doctors are notorious for being bad with money. In part, this is because we have certain expectations placed on us by society, others in medicine, and even ourselves.
We should buy (err…finance) the right house, the right cars, and the right school for our kids.
The FI community can save us from this, because FI is part frugality and part aggressive saving.
When doctors are exposed to the frugality of the FI community, they then feel a freedom to no longer need to keep up with the Dr. Joneses.
This freedom provided by FI allows them to avoid the catastrophic financial mistakes most doctors make when they finish training (and buy all the things I listed above while trying to pay off hundreds of thousands of dollars in debt).
They realize that the right house, the right car, and the right school are the ones that help them accomplish their goals. Not what makes them look good to others (who probably don’t care about them anyway).
When they doubt themselves or want to learn more, they can turn to the vibrant and blossoming physician finance community. Here, they can find support for their ideas, which will provide some sanity.
The freedom that FI provides can release them from the shackles that bind them and their future!
Remedy 3: The Support Yourself Fund
One of the other causes of burnout I mentioned above is the ever encroaching presence of administrators. They love to tell those of us on the front line how to do our jobs even if they have never done our job (or haven’t practiced in a decade and can’t do our job anymore).
Upon achieving financial independence (or even when you get to 50-75% of your goal), this provides a certain amount of courage that simply wasn’t there when we first finished training.
When administrators tell us how we are going to do our job and we find the change to be unhelpful for our patients or us, we can simply say, “No.” We aren’t going to do it.
After saying “no” to an administrator, you’ll realize that they don’t have the power if you are nearing financial independence. You do.
Replacing a physician costs a hospital between $250,000 and $1,000,000 depending on the physician’s experience, specialty, and abilities.
Diplomacy should always be used first. But, if diplomacy fails, simply telling an administrator, “Well, if that’s what you are making me do, then I’ll go ahead and turn in my two weeks notice” will end that conversation pretty quickly.
People often call this an “F-Off” or “FU” account because you can tell the boss exactly what you think when they want you to do something that you disagree with.
I just see it as a fund that helps you to support yourself when others won’t. There is power in saying no when someone isn’t valuing you or your time.
Financial freedom never felt so good!
The FIRE movement has been good for many professions. While I don’t focus as much on the RE aspect of FIRE, I do feel that the FI aspect is crucial to the future success of medicine.
Not everyone should pursue an early retirement, but everyone should pursue financial independence.
— Camp FIRE Finance (@CampFireFinance) June 1, 2018
When the medical community learns the doctrines of FI, it provides a remedy to the lack of autonomy and support physicians receive. It also gives us the power to destroy the financial burden that plagues our doctors. FI helps free them to have time to find their self-identity, which is often lost during medical training.
So, while the rates of burnout, depression, and suicide continue to climb in the physician community, I look forward to fighting back with FIRE and an attentive ear.
I hope you’ll join me in the cause. It may just save a doctor’s life so that they can save yours someday.
Chime in below!
Do you know a burned out doctor (or are you one)? Have you ever? How did financial independence fit into their solution to the problem? Leave a comment below.