Physicians are often associated with burnout.
And there’s a reason why.
There are arguably few professions that rival the stress a physician has to endure throughout their career.
But the stress isn’t always at the hospital or the private practice. Financial matters can cause distress for physicians, but they can also be the solution.
Topics Discussed:
- The sneaky nature of burnout.
- How medical professionals are prone to burnout from college.
- Upward mobility in medical professions and how this addicts the physician to a more stressful lifestyle.
- How to not miss out on family experiences as an ambitious professional
- And much more!
Links:
Contact Finance for Physicians
Full Episode Transcript:
Daniel: What’s up guys? I am joined with my good friend, Mr. Jeff Wenger again today. Jeff, welcome to the show.
Jeff: Hey, Daniel. Good to be with you again.
Daniel: Jeff is now father of four children on top of financial planner for physicians and all the other stuff in life. Father of four children. How’s that going, Jeff?
Jeff: Well, it’s an up and down process. Last night was a screaming night, so a little sleepier than normal today, but overall we’re happy. Healthy mom, healthy baby. So it’s hard to argue with that.
Daniel: That is important. So today we’re gonna be talking about physician burnout. So we’ve seen it and Jeff and I working one on one with physician families.
We’ve seen. You know, cropping up with our clients pretty regularly, and I’m sure you guys listen and have seen some of these stats that are coming out about burnout and the trends aren’t very good. You know, there’s all kinds of expert opinions out there. Like there always is like as far as what the causes are.
You know, I’m sure you’ve heard a lot of those too. Like everything from the culture of medicine and the practice and the stressors that come with that, and probably some of that is there’s some truth in it and some of it is probably all of it is accurate in some ways, but I think what I’ve read at least, a lot of it doesn’t really cover what I would consider like the most important thing.
And that is like how your finances play into it. What’s kind of unique about your finances is that they can really like cause it, they can really amplify burnout, but they can also be the solution to it. So that’s what we’re gonna talk about today. And I’m excited to talk about it with Jeff. We’ve got a lot of firsthand experience in talking with families that are starting to kind of experience some of that.
So look forward to the conversation with my buddy Jeff.
Jeff: Yeah, you’re, right. It is something that we do get to experience, I guess it’s secondhand, is it’s kinda like secondhand smoke like.
Daniel: Yeah.
Jeff: We’re not physicians ourselves, but every day we converse with a physicians and man before we jump in, probably is a good idea just to talk real briefly, why should our physician families care about this?
Daniel: Yeah.
Jeff: When I first started working with you here at Wrenne Financial Planning, one of the very first families I worked with was somebody that just didn’t see a light at the end of the tunnel, right? And so I think that was an eye opener to me. But I also work with a lot of families that aren’t fighting any burnout at all right now, that they love what they do and never want to stop.
So why is it important to talk about physician burnout, even if you’re not feeling it right now?
Daniel: Yeah, and I think, that’s such a good question. So, money is interesting. I think the little and big money decisions all of us are making every day, it’s either gonna be pulling you towards that risk of burnout or pulling you away from it.
And that’s happening like whether we realize it or not, like all these little decisions add up and they’re either pulling you towards it or away from it. I think where it’s dangerous is when you’re not aware of which direction it’s pulling you and that’s often the case.
Also, burnout seems to have a tendency to kind of sneak up on you.
It’s just one of those things that seems to just pop up. And it’s also something that you tend to, I guess people in general, have a tendency to be in denial about it. And the stats really just on top of all that, like the stats for physicians in general, and the trends don’t, are not going in the right direction.
So if I’m a physician, I’m thinking, well this kind of thing. It’s one of those things you tend to be in denial about. It tends to sneak up on you. Like all these money decisions are really affecting how I’m gonna be able to navigate it and I have a pretty high risk of it coming up. So I think for all those reasons, I would definitely encourage all of you to have it at least on your radar and be paying attention.
Yeah, it’s really, it’s one of those things where it feels like it’s easy to grin and bear it, right.
Mm-hmm.
Jeff: It’s easy to say, “No, I got this. It’s not that bad.”
But maybe to just kind of illustrate it, can we go through a couple of scenarios of how that might play out with a couple of different people?
Daniel: Yeah. So these are hypothetical scenarios, but you know, I think it’s helpful to kind of talk through what this might look like. So we’ll start with Dr. Smith.
So, Dr. Smith is starting in training goes through medical school and like many people in medical school, she gets financed through student loans.
And as she progresses through, that balance gets bigger. And it towards the end she gets kind of the final like report on what is owed. And that starts to really kinda weigh on her. And ultimately, so she’s really interested in going like the internal medicine for residency, but along the way, like that balance builds and it starts to weigh on her.
The student loan balance, and it actually affects her, whether she kind of like recognizes it or wants to admit it, is it pulls her in the direction of specializing. She decides to specialize in cardiology. You know, cuz cardiology has a higher pay, in order to be able to dig out faster.
So through training, she goes into fellowship, she goes into residency, fellowship. And as many of you have experienced, like it’s a challenging period of life. Like it just takes a lot, like hours. It pulls you away from some of the most important things in life, like family and relationships and all the things that like allow you to really thrive and be happy.
Not that it’s you know necessarily bad. It is, you gotta learn and you gotta experience it, but like it definitely pulls you a lot. It takes a lot of you. But there’s this, the nice thing about training is that there’s this hope that you can hang onto that. It’s like there is an end date where this is done.
It’s kind of like, I think if you go through the military, it’s like they do like the hell week like the training. I think I’ve read books about that and it’s like you know, you latch onto the fact that there is this end date. So Dr. Smith is like many, she feels okay about the fact that you know maybe she’s feeling a tinge of burnout in training, but she’s got this hope that it’s gonna end soon.
So, you know she transitions into practice, starts as an attending pay goes way up. The challenge there is a lot of decisions coming really quickly. And so she kind of just is rolling with the flow at this point. And you know, as that transition occurs, she makes a lot of decisions that feel like they’re good decisions.
You know buys the house, car, educating children, you know all these things. But what’s happening is lifestyles just kind of moving up to that pay, which is super common in our culture. I think especially lifestyle grows to where there’s not really any margin. Basically she gets used to this attending salary and she feels like it’s a for good reasons to kind of make life better.
But there’s not a lot of margin. So the problem with her situation is the job. You know, at first the job seems, you know promising, but it starts to get a little stressful. Especially in the second year. So second year she hits the end of her like a lot of you know, new physicians get this guaranteed salary for a couple years and then it’s like, okay now you move to this productivity based compensation.
So around the end of that, her administrator comes to her and is like, “Hey, in order to keep this thing going at the same level of salary, the guarantee you’re at, you’re gonna have to bump your RVs up, RV use up to like this level in order to keep this thing going.” So she’s like thinking in her head like, what are you talking about?
Like, I’m already given everything I got. Like that’s nuts. But she’s also on the other hand thinking like, I’m used to this lifestyle. I’ve already made these commitments. I have to maintain it. So she’s starting to feel pulled in like multiple directions, and there’s this pressure to keep the thing going in order to sustain the lifestyle.
And so I think the break for her, like that’s super challenging. But then on top of that, you know work is continuing to kind of take a lot. But on top of that, she misses like a huge like life experience, like with her daughter graduating in kindergarten and she’s like has to miss it. Because basically work is pulling so much, and that’s kind of like her breaking point.
And you know, she really, she doesn’t have a lot of options or really none to be able to make a big shift. So obviously that’s a bad spot to be in. And it’s a challenging one cuz you don’t really, you’re not able to recognize it, and you’re like, I got myself into it. It’s a difficult spot to be in.
Jeff: Yeah, and I mean that Dr. Smith, you just described Daniel, like that’s not uncommon like that.
Daniel: Yeah.
Jeff: That’s almost the default really.
Unfortunately, if you don’t have, you know if you don’t have any thought plans what.
Daniel: And it doesn’t look bad on the, what’s interesting too is you don’t notice it as a friend.
Like if I’m friends with Dr. Smith, we get to see it cuz we’re working with people and their money. But like you don’t see it exactly as a friend cuz like nobody’s gonna want to be like, “Hey, had a dinner conversation. I am spending up to my lifestyle and I have no options and I hate my job.” Like that’s not a topic people usually would wanna bring up.
Jeff: Yeah, and it’s definitely not what you’re supposed to say if somebody asked either, right.
Daniel: Right. Yeah, definitely not.
Jeff: So, what’s an alternative scenario here? Is there another?
Daniel: Yeah, hopefully, luckily there’s an alternative path.
So Dr. Jones, we will say Dr. Jones is going down the same sort of path as Dr. Smith. So she has a similar passion for internal medicine. And in medical school, same sort of thing like taking out the loans comes out. It’s like, wow, that’s a big balance. But what’s different about Dr. Jones is she’s gotten in this routine of like really thinking about planning and what’s most important and values.
And so she’s really sticking to her passion for internal medicine. And she decides like, I’m not switching specialties because of financial reasons. So she sticks to internal medicine, goes into residency and you know starts which is challenging equally in internal medicine as Dr. Smith.
But she has continue to develop this like planning and thinking ahead routine and that helps her. So as she transitions into practice, that gives her the opportunity to be very intentional about those decisions. Cuz all these decisions happen in that transition period, into practice. It allows her to be really intentional about making those decisions as she transitions.
And really carve out like margin and allow for flexibility. So Dr. Jones, when she transitions into practice, does not allow lifestyle to creep up to the full level of salary. She builds in lots of flexibility so that in the event plans change or if she wants to save a lot or switch jobs or whatever, she’s able to.
So she’s built in, flexibility knowing that there is risk of like burnout or job not working out. And that’s what the planning’s allowed her to do is she thinks ahead and she thinks of worst case, best case type scenario. So same thing at work. Like she gets in that second year and they’re like, “Hey, you’re not producing at the love we need to RVUs, boom.
Your salary’s gonna go down unless you see more people and which is gonna require to pull her away from what’s most important, like family stuff. But the difference here, Dr. Jones, is like, “You know what? It’s been getting more stressful and I’m really not jiving with this. I’m out. Like I’m leaving and I’m gonna take a month to think about it”.
And like she sits on it and thinks about it. She’s like, basically charts out, comes up with a plan for the next move, and is able to take that time, like the time out and ultimately, finds a different place that’s a much better fit with what’s most important to her. You know, takes a new job and is completely happy with it.
So that’s a completely different scenario, obviously. And even like a lower, I mean, on the surface you might be like, well, the cardiology persons does better because they make a lot more. But this scenario, Dr. Jones is actually just sticking with the internal medicine and her pays quite a bit less.
Jeff: Yeah, so somewhat similar, somewhat many differences there too.
And I would like to circle back to a couple of questions about Dr. Smith. When you started describing Dr. Jones, it started to make me think a little bit more about these two scenarios and Dr. Smith, you said things were building up for her and just kind of almost like we talk about lifestyle creep with expenses sometimes, but just obligation creep or whatever you wanna say.
Did Dr. Smith do this intentionally? Like did she bring that on herself on purpose?
Daniel: Yeah. Like in the scenario I’m thinking of like completely not. It was very unintentional and really that’s how it normally pans out. Nobody chooses to go down that road. And really there’s not like a major turning point.
Or mistake that occurs typically. Now, sometimes there are, but in most cases it’s like not a major mistake in reality. It’s a bunch of little things that add up and it’s a lack of intentionality. Lack of planning ahead. So my favorite, Jim Rohn, if you’re to Jim Rohn.
Jeff: I have now.
Daniel: Jim Rohn is like a, I guess I would call him a business philosopher.
He’s passed away. He was, he’s written a lot of good stuff and one of his, quotes, he says like the definition of failure is a few small. Hes in judgment repeated daily, which I think is a fantastic. Way of saying like of explaining what’s happening here with Dr. Smith. It’s like a bunch of little things.
And, and the lack of planning and the lack of realizing it and that kind of add up to a major problem. It’s kinda like eating like a cookie a day, it’s like a a cookie a day. You know, one or two weeks of that is probably not a big deal but 50 years of eating like a big old cookie every single day might cause health problems.
I don’t know. And then on the flip side, Jim Rohn also had like his definition of success. It’s basically like a few small simple disciplines practice every day. So I think the point is, it’s like typically a bunch of little things that kind of add up to a big thing. And you know the good news about that is it’s like you can make shifts.
You know, like it’s not like you know you’re ruined. It’s just a matter of changing some of these disciplines.
Jeff: Yeah, those are, I really like those, those quotes there that, I mean, they’re simple, right? There’s nothing like crazy there, but still profound and really good news there too, right? There are changes we can make that lead to outsized outcomes really.
So, right. Yeah. It adds up. Like you add a bunch of little things together and you got big, big results. So hopefully, you guys listen and like that’s motivational. You can kind of make the shift and start to take the better road and start to shift those small disciplines and ultimately get on that path.
Yeah. So I think you outlined both these doctors, Dr. Smith and Dr. Jones, and we delve into a little bit what that failure almost looked like based on that definition. You know, small errors that are repeated over time, repeated daily.
Daniel: Mm-hmm.
Jeff: Started to lead to a major source of burnout. What are some of those simple disciplines that you think helped Dr. Jones? Like what did she do differently?
Daniel: Yeah, so we can, let’s break those down. So Dr. Jones, I think the first, and probably the most important thing is she really never lost sight of what was most important to her and like what she envisioned for her ideal future. That’s important because that’s.
You gotta remember that and keep it top of mind and think about it regularly as you make these little tiny decisions. I think what happens, part of what happens is with these little decisions, part of what failure is, is that these little decisions are kind of moving towards maybe not your ideal life.
And so if you have it top of mind and you have clear side of what’s most important in your vision for your ideal life, it’s gonna allow you to kind of, as these decisions come at you, you’re gonna basically consult that and take that into consideration. And ideally it’s driving those decisions, and becomes kind of the foundation of who you are and what you’re doing.
So that’s the first big thing is, and I think it’s good to write that down, you know? Yeah. Like having, having it written. I don’t know about, I’m sure Jeff, you’ve had similar experience, like when we talk to people with physician families, like one on one, a lot of times this is not always the case, but a lot of times when we start talking about cuz we need to know their values and what’s most important to help them create their financial planning.
A lot of times when we start to get into values and vision, they’re kind of, they’ll say something like, I’ve never really thought about this.
Jeff: Mm-hmm. Yeah. It’s one of those areas that it’s never urgent, right? It never, there’s never that question that comes up and says, “You have to answer me or else you can’t go on with your daily business then.”
Daniel: Did completely not required. There’s no deadline necessarily, so it’s easy to procrastinate.
Jeff: Yeah. A lot of times that is what we hear is “I’ve never really thought about that.”
Daniel: Mm-hmm. But I think it’s important, you know, to think through it and then as you work that out, write it down to allow it to be top of mind and so that you, cuz life gets busy and crazy and that’s when you’re prone to forget it, especially so work gets crazy busy taking a lot of you, that’s when you’re very prone to start to forget that stuff.
I think the other big thing Dr. Jones did. She put money in its proper place. And I think this probably ties like to the decision about not specializing. I think ideally money is not driving your decisions.
Like ideally, money is not the end goal. In an ideal world, you’re viewing money as the tool. Like really as simple as that. It’s the tool. Money in itself doesn’t really solve problems. It’s how you use it as a tool, to I live your ideal life, which we just talked about. If money’s like pulling you away from that, you got an issue.
So you gotta really look at it. I think you gotta put money in its place and if you don’t do that, the tendency or the pull is for us to kind of start to view money as this is more than just a tool.
Mm-hmm. And that’s where the problems happen.
Jeff: Right. It makes a good tool.
Yeah. Not a good master, right. As they say.
Daniel: Right, right, right, right. And then of course, Dr. Jones was practicing good financial planning which us as financial planners really you know appreciate that. But there is, I mean, financial planning or having like a plan for how you’re gonna use your money to live a better life.
I mean, that’s where it’s at. Like, it’s by far the best process for kind of like putting all this together that I know of. It’s basically, you know that game plan to kind of pull this together and allow you to start to put those day to day decisions, you know making sure you’re intentional about ’em and making sure they’re in alignment with your values and your vision and, you know, start to execute on it.
And with any good planner is gonna be regularly tweaking it. Like you kind of do like the plan and then you. Execute and then you make tweaks and revisit and then you plan. And that’s kind of the cycle with good planning. But, I mean, I think the question I would pose it’s planning, I think all these are like difficult cuz they’re not required, there’s no deadline, they’re not, You could go through life without ever doing any of these and you know, you might be okay, but I think what I would pose, the question I would think about is like, what do you think’s gonna happen if you don’t have a financial plan?
And I think that’s probably a good thought experiment. It’s like what? What is the natural pool on you when you don’t have a plan?
Jeff: Yeah. Do you want my observations?
Daniel: I don’t know. I’m curious
Jeff: It’s funny. I mean, we’re looking at these two scenarios, right? Dr. Smith and Dr. Jones.
And really when you’re not using money as a tool, but rather just following it, you turned into Dr. Smith by naturally.
Daniel: Just kind of meandering. And I think that’s when these cultural norms or, like keeping up with the Jones’s and like those kinds of temptations are you’re way more prone to those. Because the plan is kind of like keeping you in check. I mean it’s your voice of reason basically.
Jeff: Right. And even, well there’s, and I would have to go back and find the author that I was reading about this as a couple years ago, but we as people have a desire to be consistent with things that we have said we would do, and you’re talking really early on there about writing it down. Like even the act of writing something down is a tool to help, right?
You know, keep things, keep values top of mind and keep those a priority. But when you have actually voiced that to another person, the intentionality of it and the the pressure to be consistent with what you’ve already said, just skyrockets. and it, it combats that natural pull towards, not having a plan
and
Right.
Really, I mean, what happens is money comes in, money always goes somewhere, so if it doesn’t have a plan already, it gets spent.
Daniel: Yep. For 99% people
Jeff: Yes. Yeah. The other 1% it goes into a bunch of cash and doesn’t get invested.
Daniel: Right. ?
Yeah, that’s probably true. And at least in our experience.
I think the last thing Dr. Jones did was she had a, she recognized like the risk of burnout and. you know, realized it was a thing and realized it was something she would be prone to. And she intentionally kind of built that into her, decision making and her own unique financial planning. And really by doing, by building in like margin, not only for money stuff.
Like how her, how she handles money, like allowing for margin, but also time, like having margin time wise and money wise allows for flexibility to be able to navigate challenging situations like burnout. And I think it’s, so for example, when you have margin, you have less dependency for work because if you’re not spending 100% of, so if when you’re spending 100% of your paycheck, you have to work. Like you are completely job dependent, but when you have margin, you’re less job dependent. You can make shifts, you can take a lower paying job, you can kind of take some time off to think about it.
So I think it’s good. One good practice I would throw out is like tracking or measuring, trying to measure how much margin you have in your finance or even thinking about how much margin you have in your time. I’m a big, so in my current life’s, my current phase of life, like I don’t have a lot of margin.
Like it’s, I’ve said yes to a lot of things over the years and it’s kind of like I’m aware of it and I’m trying to say no to more things than I say yes to so that I can still maintain some margin. My wife and I always talk about having the weekends. It’s like we need to, it’s a very important time because that allows us to have balance and recharge batteries and that kind of thing.
Same thing with finances, like looking at your finances and saying like, “What percentage of my paycheck goes to lifestyle and what doesn’t, and what percentage is margin?” And that’s gonna allow for lots more flexibility.
Jeff: Yeah. I think you’re hitting the nail in the head with both of those finances and the time aspect of it and.
Daniel: Mm-hmm.
Jeff: The finances makes a lot of sense, right. You can imagine an emergency that, or just something that comes up and it is helpful to have extra money available. But I think I’ve seen it on the time aspect with about a half a dozen families recently that maybe, tell gimme your thoughts on this for time.
Do you think it would be helpful to have some dedicated time, like a vacation to get away and, and unplug? Because I’ve, I’ve seen this a half a dozen times this summer recently, so maybe it’s just anecdotal information but families coming back from a two week vacation to Hawaii. They’ve wanted to do, getting married and going on their honeymoon.
And you know, other situations like that just a couple of weeks away and they come back and realize they wanna make a big change.
Daniel: Yeah, I mean, it allows you to kind of think creatively and cut all the noise. It’s always. I see it in our work with residents and fellows. Like I notice it’s very difficult to think creatively and long term in that phase.
I think it’s just because when you’re working 80 plus hours a week, we’re not built to do that long term. So that takes up all your mind space, kind of your, when you give all you have to work. There’s nothing left to do other things. So you’re kind of just like, “Ah, go home and you lay down.” But you have to, when you free up that space, that’s where you can be creative and I think the best environment for being like creative Or thinking about vision and these kinds of things, like we we’re talking about, is literally doing nothing or having zero responsibility for a slot of time at least.
And that’s a lot of times where the ideas, I notice that like when I go on vacation, that’s when a lot of the ideas come. I’m like, you know, all sorts of new things and it’s key. I mean, so you gotta build that end really. And it’s interrelated too. The money and the time aways.
You have to have margin in your lifestyle, like margin in your money, so that you’re not so relying on work so that you can take time to step away. You know? It’s all interconnected.
Jeff: It’s all interconnected. It really is.
Daniel: Yeah. Well, let’s talk about some follow up action items. I think so you can. If you’re looking to kinda make progress on this sort of thing, of course, you know, the first big step we would throw out, and we’ve kind of sprinkled this in, I think having a plan or a financial plan really is the key starting point.
If you don’t have that already, cuz a good financial plan will really hit on all these things. And you know, as you work through that planning process, like thinking about you know, things like burnout risk and having margin and some of the things we’ve talked about I think is really important. Now you can do a, you can do financial planning, yourself, DIY, which is completely fine.
Everybody’s listening I’m sure is completely capable of doing that. Or you can, you know, hire a planner which kind of walks alongside with you along the way, which is what Jeff and I do in our day job. So our firm, Wrenne Financial, we’re happy to have like one on one consult to see if we might be able to help with that.
Or if you’re going the DIY route, we have a do it yourself guide that we can link to in the show notes that kind of walks you through the steps. But I think the most important thing is committing to take a step like one, and it doesn’t have to be like you created a perfect financial plan.
Because that’s actually impossible, financial planning is not, you’re not gonna do it perfect. It’s more of just like getting on the right track, and it all starts with taking one step and it doesn’t have to be a big one. It can be a small step. I think the key though is that you are taking that step. So I’m excited to hear about progress.
Feel free to reach out. Let me know how it’s going. Let me know if you’re getting hung up on any of the aspects, what’s working, what’s not working, and as always, it’s been fun talking about this with my good buddy, Jeff. Jeff, thanks for joining us.
Jeff: Oh, it’s been a pleasure. Thanks for having me, Daniel.
