Are you burned out and ready for a new job?

Roger Kapoor: ©Roger Kapoor

Burnout has been the scourge of physicians for many years. Long hours, a heavy administrative load, increasing patient demands, and poorly designed EHRs have all contributed to the problem. But the question remains: Are there any answers? And how do you tell the difference between burnout and normal job-related stress that comes with a high pressure job where lives are on the line?

Medical Economics spoke with Roger Kapoor, M.D., author of “Working Happy: How to survive burnout and find your work/life synergy in the healthcare industry,” about the state of burnout and solutions for physicians.

(Editor’s note: The transcript has been edited for length and clarity.)

Medical Economics: What are the biggest causes of burnout for physicians today?

Roger Kapoor: It's either your workplace and or yourself. The workplace causes are very obvious. Maybe you're working for private equity, where you feel money is valued over mission. Maybe you're finding that you're being compensated to do things to people instead of doing things for people. Maybe you're depressed, but you're scared to talk about it because it has to be disclosed on certain license renewal forms. Maybe you're dealing with burdensome and repetitive administrative tasks like prior authorizations or feeling a lack of control over your work environment, or maybe you're spending more time staring at a computer screen instead of your patients. One thing, though I'm purposely not mentioning is maybe you're working long hours because, surprisingly, burnout is actually unrelated to whether the work is hard or if somebody spends long hours at work. One of the interesting things about people who love their work is that they often work harder and longer at their jobs than people who are disengaged. Nevertheless, the list of workplace related causes for burnout obviously are long.

The second bucket of burnout, which is often overlooked, is our own lifestyle choices, our own attitudes. It's easy, of course, to just focus solely on the external factors, but the truth is, the way we manage our personal lives, it plays a crucial role, and can either mitigate or exacerbate burnout. For example, simple mistakes like depriving yourself of adequate sleep or chasing the elusive goal of work-life balance--that can actually contribute to burnout. And these behaviors not only heighten stress, but they can also diminish your ability to thrive, both professionally and personally, ultimately degrading your overall quality of life.

Medical Economics: How do you differentiate what is truly burnout and what is just normal work stress?

Kapoor: In general, there are three key signs that you might be dealing with burnout. Number one is what's called emotional exhaustion. You're feeling drained--this is going beyond being tired after a long day. It's a little deeper. It's this ongoing sense of fatigue that doesn't go away with rest, and now your body is in a constant state of stress. The second is what's called depersonalization--growing distant or even cynical about your job. And this is when you start to feel detached from your work. You might, for example, catch yourself thinking, “I don't care anymore,” or you're feeling like your job is meaningless. It's that take-this-job-and-shove-it mentality.And the third point is personal ineffectiveness. It's feeling less effective at work, and this could take the form of somebody starting to doubt their own abilities, or you feel like you're not making a difference anymore, and that negative self-assessment that affects your confidence, it affects your job performance.

Not all stress is bad stress. If you think of a bodybuilder, good stress, when it's managed properly with adequate rest and recovery, it builds strength. But let's say the load is too heavy, or maybe the length of time you're going to hold that weight up gets a little prolonged. It can become damaging, like a muscle tear that occurs when the strain is too great. That bad stress, when it's chronic, it manifests as burnout, leading to potentially devastating consequences for both the provider and the patient, and just as that bodybuilder needs proper recovery time to grow stronger, health care providers need space. They need resources to manage the immense pressures they face on a daily basis. And of course, there are some tools, like the Maslach Burnout Inventory that can help assess burnout and recognize these symptoms early, but definitely finding it quickly is probably the best way to prevent burnout from taking over your professional and personal life and really taking root.

Medical Economics: Does feeling burned out mean you have to look for a different job?

Kapoor: That's a that's a tough question, because there's really no clear cut answer. I think it really comes down to some type of honest soul searching about where you are in life and what you truly want. It's not something you can figure out overnight, but it is crucial to think about if you're feeling unfulfilled or if you're feeling out of sync with your current career. My advice is, if you're in a job that doesn't align with your sense of purpose, it's probably time to start thinking about making a change, and that naturally leads to the next question: How do I figure out what my purpose actually is? And one concept that I think might help is called ikigai, a Japanese term from Okinawa. It's essentially finding your life's purpose. Discovering your ikigai involves basically asking yourself four simple questions: what do you love to do--and that's really reflecting your passion; what makes you feel alive, what makes you get up in the morning? What are you good at--you're doing a self-assessment of your skills, your talents, what are you excelling at naturally? Number three is, what can you get rewarded for? Because that's going to ground your purpose and practicality. What can you do that will either allow you to get paid or get you a sense of accomplishment? And then the last question in this tool is, what does the world need? And that's about finding a way to contribute meaningfully to the world around you.

When you find the intersection of those four things, you have found your ikigai, your reason for being. If you find your ikigai, it might require some effort, might require some exploration, but I think it's worth it when you're living in alignment with your purpose, and work no longer feels like a burden or a drag. It feels like a more natural expression of who you are.

Many of us, we want the apple, but we're not always willing to put in the effort to fully understand what it takes to nurture that seed. We focus on things like wealth, social status, possessions and other things--in other words, the apples, but we're going to overlook the importance of pursuing our passion, cultivating our competency, generating goals with clarity, that's the seed. So the idea here is, if you focus on the seed, the rest will take care of itself.

You could take the flip of this as well. You know, imagine you're in a job. You don't know what your ikigai is, but you know that you're not supposed to be where you're at. You have this nagging feeling, this inner voice that tells you do something different, do something more. I would refer to that as an unsatisfied affinity you're not fully aligned with your work, and a great example of that is Vera Wang. Before she became a household name in the fashion industry, many people are unaware, she made several career changes. She started in Vogue, she moved on to Ralph Lauren, and she didn't find her true calling until a little later, and when she did, you know, the rest is history. She used the opportunities that she had before she found her true purpose to sharpen her skills. She used those opportunities to broaden her expertise while she was patiently waiting for her true passion to be uncovered. So my advice is, if you're feeling stuck, if you're feeling frustrated with where you're at and you think you're in the wrong place at the wrong time, you might actually be exactly where you're supposed to be, and you just don't realize it yet. You know before you start chasing after the next job, before you start looking for the next title, take a moment and fully immerse yourself. Instead of getting frustrated or bitter, focus on getting the most out of your current situation, enhancing your competency. Think about this as kind of like you're blooming where you're planted. And that approach really takes some honest self-reflection. We all have areas we need to work on. None of us are perfect, regardless of where we are in life, and you need to start working on those areas right now. Think of your competency, your skills, your passions, as seeds that you need to fully nurture, because if you focus on developing them truly becoming at the top of your game in your current role, you're going to be ready for your breakthrough, and that means you don't let your ambition overshadow the importance of developing your inner competency.

Medical Economics: Some doctors feel that if they need to leave a position, that it's a betrayal to their patients or even their fellow physicians who might be left in a job situation that might end up being more work for them. Is that the right mindset to take when looking at a position that maybe isn't right for you?

Kapoor: Well, I think it's important to recognize that for doctors feeling like leaving a job is a betrayal, I would say that is completely natural, because this comes from a strong sense of duty toward our patients and colleagues. And think about it for people who go into medicine: It is largely due and seen as a purpose-driven decision. This is purpose-driven work. There's a deep commitment that can make the idea of moving on feel like some act of disloyalty, but it's crucial to shift that perspective, because the reality is burnout actually often stems from the fact that physicians, who are frankly accustomed to putting everyone else first, they struggle to prioritize their own well-being. During medical school, during residency, doctors are trained to take on more and more responsibilities and eagerly say yes to every opportunity and maintain their professionalism despite mounting pressures. We learn about diseases, we learn about organs of the body, all these therapeutic options, but we don't learn much about how to maintain our own well-being during the daily pressures in the medical field. So that ingrained habit of overextending oneself, it's definitely admirable. It makes the people that you work with incredibly humbling experience to work with them, but it can lead to significant personal and professional tolls as your career advances, because in the long run, your patients and colleagues, they actually benefit more when you're in a role where you're truly engaged, you're truly energized, and you're able to provide top-notch care. So leaving a job doesn't have to be seen as some form of betrayal. It actually should be viewed as an act of responsibility if you approach it the right way, being honest, being open, maintaining good relationships. You and your team can work together to find a role, either at the same employer or a different one that better fits your values and interests, because that'll help you gain more satisfaction in your own work, but it will also set the stage for, I believe, better outcomes for your patients and likely a smoother transition for your colleagues.

Medical Economics: If I'm a physician and I'm feeling burned out at work, what should I do? Is there a sequence of events I should follow?

Kapoor: I think there are probably several steps that a physician can take if you find yourself in that position. So first thing I would say is listen to the advice of Warren Buffett. He said you really should take a job that even if you were independently wealthy, that would be the job you would take. So what he's saying is that your fulfillment should not hinge on what's happening around you, but rather on what's happening within you.

We often think of burnout as a result of being overworked, but it can just as easily come from a feeling of being underworked or unfulfilled, whether you're doing too much or you're too doing too little. If your work doesn't bring you joy, it can lead to burnout. Now in any profession, obviously, take health care as an example. It's easy to point out to our work and say that's a source of burnout, if only this were fixed, it would be so much easier. While there may be some truth to that, we have to remind ourselves that earlier generations of professionals in most careers, especially in health care, they didn't have it any easier than we have it now. Every generation faces its own set of challenges, just like we face our own set of challenges through every phase of life. Think about it. As toddlers, almost anything can set us off. As teenagers, we feel like the adult world is our enemy. We're overwhelmed by these hormonal changes, and if we take a moment to reflect on our teenage years, we had some pretty serious stressors that we all had to deal with as we move through life. Some people suffer from being single, finding a spouse, finding their soulmate. They now suffer from being married in middle age. We desire more money. We lament over when is it going to happen to me? When am I going to have my breakthrough? But give us more, we'll start complaining about taxes. We get older. We wish we were younger. When we're younger, we wish we were older.

What I'm trying to get at is that every phase of life, it’s got its challenges. So my question back is, when are we going to be happy? And by we, I mean us as a profession, in this case, health care. But honestly, for whatever profession you're in, are we only going to be happy when everything around us is actually the way we want it to be? Because if that's the answer, we're setting ourselves up for a lifetime of struggle and, frankly, burnout. The second tip I give you is to prioritize sleep, and this is something that, frankly, doctors are not good at because they have the rigors of the professional career. But it's also an ingrained habit for medical training, where sleep is really thought of as a nice-to-have, not a must-have. But this is so important, especially today, where the lines between work and personal life become increasingly blurred due to digital technology. And there's a constant connectivity, a pressure to always be on, and it makes it more challenging to get the rest we need. That accumulates the negative impacts on your work performance, your mental health, your overall well-being. When your sleep is at its best, you are at your best. There was a real notable study in JAMA. It examined 100 doctors, and it found that one in three had a positive screen for sleep disturbance, and those that had the sleep disturbance had higher rates of burnout. They reported less professional fulfillment, and they were more likely to make medical errors.

Medical Economics: For doctors who have a staff they manage, or they own their practice, how can they make sure they're not burning out their staff, whether it's other physicians orsupport staff?

Kapoor: The first thing is people in positions of authority like that need to be real honest. Your employees are probably not going to come to you and say, “Hey, you're burning me out.” If they do, I'd say the situation is pretty dire. A lot of employees, they often can't recognize that they're in a toxic environment when they're in one, which is why sometimes it takes a friend to kind of hit you over the head or the shoulder and say, “Hey, you kind of changed a little bit.” So when it comes time to preventing burnout, you need to be really proactive and consciously avoid behaviors that could exacerbate or contribute to that phenomenon. It's a multifaceted approach, but a few consistent themes that that I've come across is, number one, I would make it a habit to recognize others. Aknowledge your team's efforts boost morale. They sustain enthusiasm. On the flip side, micromanagement is a surefire way to drain energy and creativity. Steve Jobs put it really wisely when he said, “It doesn't make sense to hire smart people and then tell them what to do. We hire smart people so they can tell us what to do.” When you're micromanaging employees, they perceive it sometimes as a lack of trust. Giving them autonomy not only fosters creativity, but it gets them more invested in the outcome. Another common issue is how we give people feedback. Teams deserve clear constructive feedback and a mutual understanding of expectations. Ambiguity here can lead to an immense amount of anxiety and burnout. Tough conversations should also include 360-degree feedback on whether the employees have enough resources and support to meet the goals that are being set. One of the worst things you can do is set unreasonable expectations just because they look good on paper. Goals need to be really rooted and realistic and challenging yet achievable to build that long-term success, rather than trying to put together a short term house of cards. Lastly, you've heard the saying hire slow, fire fast. I think there's a lot of wisdom in that. Take a deliberate approach, that when you're hiring to build really strong and cohesive teams, look beyond just mere intelligence. What I would prefer people do is focus on insight, as opposed to intelligence, such as situational and behavioral awareness, forward thinking mentalities, problem-solving attitudes, intelligence and insight. On the flip side, when it's necessary, I would act decisively. This doesn't mean you go around saying you're fired; it means regularly providing feedback, offering support if somebody is underperforming, initiating performance improvement plans, demonstrating empathy to your employees, monitoring progress closely. One mistake I see is a lot is recycling employees--just moving them around instead of letting them go when that decision has to be made. That's a great way to cultivate a toxic environment.

In short, if you're feeling even a bit burned out as a leader, there's a pretty good chance your employees are feeling it even more.