Physician “burnout” is defined as loss of enthusiasm for work, feelings of cynicism, low sense of personal accomplishment.

I think the factors involved are infinitely complex. I will also hazard a guess that the issue of burnout builds on two fronts:  Stress and Age, and the nomenclature for each is radically different.

Front 1– The peak “burnout” in the age group of 36-45 comes on two groups:

Group 1.  Doctors that emerge from the long training grind to find out they’ve bitten off more than they can chew and are having trouble digesting it. Too many responsibilities, too much work load combined with the era of mortgages, spouses, kids and mounting expenses acquiring the creature comforts lacking in the austere training days.

Group 2.  Doctors that emerge from the grind to find out that their reward was a false promise and they really don’t like living with the end product. The difference between training for a career and the nuts/bolts of the career don’t match and they’re miserable locked into the saddle with no escape.

The salvation of group 1 is usually that the personality type that thrives in this environment is selected out during the gauntlet. Those that can’t hack it fall by the wayside during training, like Navy Seals in boot camp that ring the bell when they’ve had enough. I think this is an unusual burnout group.

I think group 2 is much more common and not necessarily amenable to filtering by the gauntlet. By and large, there is a big qualitative difference between trainees and attendings, and the realities of that difference are not necessarily apparent before the fact. Some seemingly high quality trainees go bust quickly in the clinch and vice versa, and as far as I can tell, it’s very difficult to discern which is which before the saddle is cinched.

I’d hazard a guess that this group is at highest risk for becoming functionally incapacitated, call it what you will, and also I might add a risk for suicide if there is no escape valve.

All complain about the following factors, but most realistic physicians understand these factors are identical to working for any major corporation in any career position.

Bureaucratic tasks, Too many hours, Compassion fatigue, Difficult employer, Difficult colleagues, The Affordable Care Act of 20008

I don’t think I have ever met a doctor that burst into tears at the thought of onerous paperwork. I do know some however that started drinking heavily at the thought of the Affordable Health Care Act of 2008. The stark reality is that all these things are the price of admission to medicine highly unlikely to cause significant lack of professional fulfillment for no other reason than they are ubiquitous to nature.

Front 2-  aging physicians are a much more convoluted and textured phenomenon- physicians who have successfully run the gauntlets to arrive at a place of relative safety only to discover seniority is a new liability. Inevitable physical limitations and the duty and obligation to make way for others climbing up the same ladder behind them. A different and much more subtle order of “burnout” from the rest.

The limitations and hassles of old age are not linear. They escalate rapidly after a variable certain age”. At 65 I was doing four night calls a month and bounced back easily. I was racing motorcycles and doing high-speed track days at 66. I thought of myself as limitless.

Then I slowly discovered my concentration on the track at 120 mph was fading and I started crashing, once twice in the same corner. I quit at age 66+ before I hurt myself or someone else. Night call quickly became difficult to maintain concentration and the day-after became more difficult to bounce back. I still had the same knowledge base but not as much concentration ability to apply it under stress.

At age 70, I have the exact same drive and passion to be the best I can as when I was at the top of my game at 36.  The only limiting factor is my physical ability to bring it all to bear as effectively and efficiently in a world of emerging young people with the same fire in their bellies. Thereby burns the age related “burnout” flame- the fear of becoming irrelevant. An absolutely terrifying, life threatening burden.

That will be the burnout issue that I think will require some creative thought on how to rectify, if it’s even possible.

Epitaph on my headstone:

“This is my generation…..

Hope I die before I get old”

Pete Townshend, 1965. (BTW, Pete is 71 this year)