Dr. Able Speaks on Physician Burnout

The first time I heard about burnout, I was a senior internal medicine resident and we were required to attend a lecture about resilience/wellness at 7am. I was post-call and had been up all-night caring for ICU patients. From what I remember, we were instructed about the benefits of meditation, yoga and provided with free counseling service information. I could not comprehend when this would fit into my hectic schedule. After the information was presented, we were then required to fill out a survey for the associated quality improvement project. I’m certain my feedback was vicious. I felt that this presentation was the opposite of wellness for the rotation that I was on. It was a bad look. I did not think much more about wellness until much later. I was focused on my path to fellowship.

In my first year after finishing GI fellowship, I went to a conference with a few of my closest residency friends. We are all in different subspecialties following being Internal Medicine residents together at the University of Kansas. One of my former attendings created something completely different- a conference for women physicians focusing on wellness. While there, I had the opportunity to share ideas and learn from those who were at the end of their careers and quite a few physicians that had stepped away from clinical medicine mostly due to burnout. 



For the last decade, training programs have been talking about burnout. It’s imperative to appreciate that burnout can lead to anxiety, depression, substance and alcohol abuse, decreased quality of care for patients (errors), and physicians leaving medicine or worse, dying by suicide. I was determined to build better habits, work on efficiency and take a keen interest in my own mental health and wellness. I heard about how therapy should be part of every physician’s armamentarium. I learned about physician coaches. The benefit of coaching has even been published in JAMA in 2019 and 2022 with the benefits of reducing burnout, imposter syndrome and increasing self-compassion. (1, 2) In 2021, Cleveland Clinic saved $133 million in physician retention due to an internal coaching program they implemented. Some of the presenters shared that they were coaching other physicians on efficiency (ie no more charting at home!) It changed my perspective. It was unlike any other conference I had attended before. 

“Our inability to say no, our avoidance and our hiding, often lead us to feelings of immense failure, inauthenticity, and burnout.”

– Sasha Shillcutt, MD

Since starting in private practice Gastroenterology, I’ve made a choice to receive much of my continuing medical education (CME) from conferences that focus on wellness and leadership. I’ve chosen to fill my cup first. What I have learned has made me a better doctor, partner and parent. When we care for ourselves, we stay in practice longer and provide the best care possible for our patients. Medicine is a calling, but it’s also a job. We cannot continually sacrifice ourselves and leave nothing for our families and friends. I’ve learned that I cannot continue to pour into cups that don’t pour into mine.

Many of my colleagues know that I strive to be authentic. Depending on when you catch me in the hall on rounds, I will give you the truth about my day. Transparency with regards to the difficulties we encounter while practicing clinical medicine is something that unites us. Spending time with my colleagues in the physician’s lunchroom and listening to the stories of the day, as well as the challenges, can be a bright spot. This is my way of receiving energy as I’m an extroverted introvert. Sometimes this socialization even saves me a few phone calls because we can coordinate care in complex cases. Often, I seek advice from my more senior colleagues and practice partners. Venting to one another is also quite therapeutic. 

In the past 5 years, it has become more challenging to get coverage for my patient’s much needed medications. Medicine is now governed by insurance authorizations, protocols and administrators. Our autonomy as clinicians can feel like it is being constantly undermined. I have found myself being less eloquent when I write letters to insurance companies about why my critically ill IBD patients need guideline-directed therapy. I will often tell my rotating KCU medical students (OMS3, 4s) that the moment I stop being a passionate advocate for my patients is the day I should announce my retirement.