AAP Voices Blog

Burnout is Not Your Fault

I thought I was doing pretty well, married with two girls and a full-time practice. Everyone joked by the third child, you’re “practically negligent” with everything on autopilot. But my third was born with a prenatally undiagnosed hole in his heart. The cardiologist told me to watch for heart failure symptoms. The surgeon commented it “looked like he was trying to have Tetralogy of Fallot but didn’t quite get there.”

Paralyzed with fear, I couldn’t care for other people’s kids with mine in harm’s way. I went on leave, planning to stay with him until he was safe. My left arm became fixed at 90-degrees because I never put him down. Soon, my marriage ended and my path to burnout began.

I felt alone but I wasn’t. 63% of US physicians report symptoms of burnout, dramatically increasing during the pandemic but affecting over a third of physicians prior. A chronic stress response encompassing emotional exhaustion, depersonalization, and feelings of decreased personal achievement, burnout, peaks 6-10 years post-training. Combined with the stress of being a parent, I’m amazed how well most of us parent physicians manage.

My post-divorce job included frequent ER and nursery calls and feeling like an intern again.  Our babysitter slept at the house on my call nights so I wouldn’t have to take my kids into the hospital, dreading middle-of-the-night 911 pages for non-breathing newborns. Worried about everything that could go wrong, a NICU fellow’s motto played on repeat in my head: “never trust a baby.”

I felt like I missed everything with my kids and began to despise working. Resenting how work took me away from my family to take care of other people’s children, I was always counting down days until I was off. It didn’t help that my lawyer hadn’t told me my ex-husband should’ve been sharing the childcare costs. So after paying for child care, mortgage and bills, I also couldn’t make ends meet.

One evening, I actually made it to my daughter’s dance recital. I introduced myself to another mom. She said “Oh yes, we figured out who you are. You’re the one who came in, tested my daughter for strep and treated her without ever telling us who you were.”

It was one of those moments where you stop to reconsider your life choices. Appalled with myself, I also knew I’d been functioning at the highest level I could manage. That’s it. I’ve tried and failed at being a doctor. All that was left to do was quit and open a coffee shop.

Then another pediatrician who wanted to work closer to home and didn’t mind after hours call swapped jobs with me. Reading to my kids at bedtime brought me joy. Sleeping through the night left me rested. My new schedule even allowed me to walk my son to elementary school.

Rested me was so much more present for patients and able to take care of myself. Pausing for a moment of mindfulness before I walked into an exam room, allowed me to actively listen and the resentment evaporated. Relearning synchronous self-care was surprisingly refreshing. When I was hungry, I ate. When I felt anxious, I validated my own experience and paused for five big deep breaths. Welcoming my own humanness allowed me to care for myself. Making my own needs wait until all of the work was done had been implicitly programmed into my intern mode.

I began enjoying work again. Over time, my patient care transformed. I’d been functioning in overwhelming stress mode for so long, only a shell of myself entered the room when I was in this “intern mode.” As I befriended my own nervous system, I noticed how I could think laterally and problem solve more effectively with families. I felt deep gratitude that I had the privilege of being a pediatrician. I realized parents wanted help with their relationship with their child, something we usually referred out in primary care. Along with treating all the things, I began cocreating plans for relational health to support connection and understanding in order to transform frustrating behavior patterns. Instead of reflexively reacting to behaviors, we could help parents on their journey to better understand their children’s needs.

It dawned on me that we were promoting positive childhood experiences and protective factors. Connecting with parents and patients helped me fall back in love with medicine and I rarely left a room without using at least one of these relational health approaches. I’m so thankful I didn’t throw the proverbial baby out with the bath water.

We’re trained to put aside our needs for others while being simultaneously told we have to take care of ourselves before we can take care of anyone else.

Burnout is not your fault. It’s prolonged unmitigated stress.

We must unlearn “intern mode” and relearn how to synchronously care for ourselves and protect for what is essential to our wellness. I believe we can do this within the current system. Take care of yourself while you are caring for patients. It can’t be something we wait to do after hours, on vacation, or when we retire.  

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.