I was a poster child for physician burnout. After working as a family physician for 25 years, I left medicine in late 2021 because I felt I had nothing left to give patients. I had wanted to be a doctor since I broke my leg when I was 7 years old. I still remember sitting in the emergency department's orthopedics room, looking at all the stuff on the wall and thinking, “I want to know how to use all this.” My entire educational and professional career had been geared toward becoming and then being a physician. As I walked out of my office in late 2021, I remember feeling empty. I wasn't happy to be leaving. I wasn't sad. I was just numb.

My burnout experience was not unique and highlights many of the issues practicing physicians face today. A recent article noted that more than 60% of physicians surveyed two years into the COVID-19 pandemic reported at least one symptom of burnout.¹ While I was fortunate to find a way back to primary care, too many of our colleagues leave permanently and patients suffer due to decreased access.

BURNOUT'S MANY CAUSES

Why physicians burn out is a complex process with multiple contributing causes. For me, the combination of documentation demands, value-based payment pressures, pandemic factors, and personal stressors left me feeling emotionally disconnected and often angry at patients for wanting my help.

When I became a medical director for population health in 2017, I enthusiastically supported the promise that value-based reimbursement offered. Why pay for more care when you can pay for better care? However, I quickly saw how participation can become a numbers game, with some health systems preferentially reporting on quality metrics where they already do well. In poorly designed programs, quality may not necessarily improve, and at-risk populations may be worse off as dollars shift “away from patients, providers, and communities with fewer resources and toward those with more.”²

Being a typical physician perfectionist and overachiever, I wanted my system to perform well, and I felt singularly responsible for our success. So I started focusing more and more on care gaps during patient visits. It seems hard to believe in retrospect, but I found myself increasingly frustrated when patients wanted to talk about their complaints as I attempted to pivot the conversation to address unrelated quality metrics so I could check boxes.

As I struggled to balance my patients' needs with my system's needs, the COVID-19 pandemic was in full swing. People were demanding unproven treatments, and once a vaccine became available, everyone was suddenly an expert in immunology. More than one visit ended with an argument about the merits of mRNA vaccines.

Around the same time, I became a caregiver for my father who was suffering from metastatic prostate cancer and progressive dementia. I would like to say that I handled my adult caregiver role with empathy and compassion, but by the end I was pretty worn out.