The Four Horsemen of the Physician Burnout Apocalypse

  • /Reviewed by: Amy Rontal, MD
  • Physician Burnout is a constant, prevalent, looming threat over doctors everywhere. The question is why? Yes, the nature of our work is difficult, stressful and draining… and there is much more here than just the stress of the clinical practice of medicine.

    In my work with hundreds of over stressed physicians I have isolated one of the major invisible causes of burnout – the pervasive mental conditioning of our training process. Call it our “brainwashing” if you will. In this article I will show you four “flavors” of this conditioning – how and why they develop and how they contribute to the physician burnout epidemic.

    The Brainwashing of Medical Education

    Yes, indeed, we are most certainly brainwashed by our medical education. There is a set of attitudes and behaviors that are expected of us while in training that become subconscious and automatic by the time we are board certified. To most doctors these behavior patterns are invisible and unrecognized. You will see in a second why they virtually guarantee physician burnout in your 40’s and 50’s if they continue to sit in your blind spot.

    The Four Horsemen of the Physician Burnout Apocalypse

    Here they are in all their glory. See if they feel familiar to you…

    • Workaholic
    • Superhero
    • Perfectionist
    • Lone Ranger

    Before they became subconscious conditioning, we learned each of these as distinct and very useful skill sets. Let’s face it—there were hundreds of times in your medical education the skills of a workaholic or perfectionist came in handy. In fact, you could not have become a physician without them.

    In an ideal world, you would have been taught to use them the way a carpenter uses the tools on his belt. You pull out a hammer when it is the best tool for the job at hand. You use it to drive in that nail, and then you slide it back into the loop on your tool belt where it belongs. When you are done with your tool, you go ahead and put it away.

    When you are done with work, you take your tool belt off and put it away until your next day on the job.

    Those are healthy boundaries.

    Early in our training, we hone and practice these skill sets constantly. We become experts in their use, even as pre-meds. We need them just to survive the training process of medical school and then residency.

    Here is one of the differences between a doctor and a carpenter: no one ever showed you how to let go of your tools and put them away. We have no tool belt we can simply unclip and hang on a hook when we get home.

    Very early in our education, we actually become our tools.

    We literally become workaholic superhero perfectionist Lone Rangers. Without knowing how to turn them off and put them away, we start to live our whole lives this way.

    People outside of medicine look at doctors and think, that’s just the way doctors are. What they are really seeing is this deep, comprehensive, and subconscious conditioning. This is one of the prices we pay to survive the education process. It sets us up for burnout down the road.

    Recognizing Your Programming

    • You can recognize your workaholic programming when your only solution to any problem is to work harder, and you get angry at people who don’t work as hard as you.
    • You can recognize the superhero when you feel you should save everyone or get very upset when you can’t.
    • You can recognize the perfectionist when you agonize over details that are not clinically relevant or chastise patients and your staff – even your family – for minor imperfections.
    • You can recognize the Lone Ranger when you are stuck in the maze of doing everything yourself, despite having a team around you.

    How deeply are we brainwashed?

    Basic training in the military is 8 weeks. In that time they can condition an 18 year old to take a bullet on command. Medical education is a minimum of 7 years. Take a second to count up how long it took you from your first day in medical school to your first day in private practice. Do you think that in all those years you were just a little bit conditioned? I believe there is no more thorough conditioning program on the planet than becoming a practicing doctor.

    If your only tool is a hammer, everything looks like a nail.

    That is the problem. Not everything in a doctor’s world is a nail … especially after you graduate to private practice and the rest of your life. Burnout results when these four become “overused strengths”.

    Being a workaholic superhero perfectionist Lone Ranger is an absolute requirement to make it through a 72 hour shift in your residency and it is NOT a great way to

    • Be in a loving relationship
    • Raise your kids
    • Get your own needs met
    • Or live your life

    I help my clients see this conditioning when it appears as automatic behavior that is driving their physician burnout … when they are using this set of hammers to drive things that are NOT nails.

    For most of us these four horsemen and their automatic behaviors are deeply subconscious. Remember that you spent a minimum of 7 years installing them in your psyche – deliberately, consciously, through thousands of hours of dedicated study and on the job training. No wonder they poke there heads into all areas of your life – and not always in a good way. AND this is not the only risk factor for physician burnout.

    Next Steps:

    Here’s a simple way to expose your own brainwashing and lower your physician burnout risk.

    Whenever you find an area of your practice or life that is NOT WORKING the way you would like … I have found a 95% probability that one of the horsemen is at least partly to blame.

    When you notice a major problem at work or at home … stop … ask yourself: “How am I perhaps acting like a workaholic superhero perfectionist Lone Ranger here?”

    Power Tip:

    If you really want to get some feedback on your programming, tell your significant other about this issue and ask them how they think your programming might be playing a role. They will have some fresh input for you I am certain.

    When you notice one of the four horsemen as the source of your automatic behavior in this area …

    Ask: “If I was to STOP behaving like a workaholic superhero perfectionist Lone Ranger here … what might I do differently to get more of what I really want?” Again, your significant other is a great source of input here.

    In the end, all of us must recognize and rise above our programming to build the practice and life we dream of. Remember Einstein’s insanity definition? “Doing the same thing over and over and expecting a different result”. That’s crazy, right? I want you to know that doctors sit in this insanity trap all the time. It is a major cause of physician burnout.

    Being stuck in your workaholic programming is one of the major reasons people come to me for coaching. They work harder and harder doing the same things they have always done, quietly praying they will get a different result this time – while their energy level slowly spirals downward.

    Now you know about the four horsemen. Your eyes are wide open. I sincerely hope you recognize when they are driving your behavior and notice the other choices available to you. It takes new actions to get new results. Everything can change from this point forward.

    PLEASE LEAVE A COMMENT. What is your “favorite” horseman and how would it lower your stress levels to let it go?

    Dike Drummond MD is a family physician, executive coach, trainer and consultant specializing burnout prevention and treatment services for physicians. Find over 117 separate ways to prevent burnout at his website, The Happy MD. This article was originally posted here.