Two weeks ago, I was asked an intriguing question:
“What’s the difference between being burned out or being on the wrong path?”
I received the question from a reader after sending out a newsletter. Context was provided; her husband was a physician, and she noticed his colleagues’ lack of enjoyment in medicine. They were no longer energized by their work. “What gives?”, she wondered.
All I can proffer are the subtleties understood while living in both distinctions, in many places, across years.
Burnout is rare the first year of medical school. Why? Sacrifice was limited; the medicine crucible hadn’t come calling for your free time, hobbies, and sleep, yet. By the end of second year, the bemoaning began as the stake to enter the game rose. Third year marked the first time you saw your friends’ eyes caked with dark circle cement, hearing for the first time “I think I’m burned out”. Fourth year was a reprieve, a chance to come up for air.
Residency lurked, where the rubber met the road. There was nowhere to hide. Here, your work didn’t give you something back, you flirted with a permanently dead battery (soul). The daily demands were high, not to mention the accumulating moral injury, and on this stretch of the medicine highway, I saw cars stall and get a jump, never needing a jump again, while others went into the shop and never returned. For me, no number of waves in the history of Orange County could recharge my battery. Repeated years of not really wanting it overwhelmed my coping mechanisms and shadow callings. Vacations buoyed me briefly, but the battery depleted in short time. With no baseline charge for previous passions (mountain biking, surfing, yoga, veganism), my life outside medicine wilted like a prickly pear come September.
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The true litmus distinguishing burnout and the wrong path is… I don’t know, you just feel it. I knew I was on the wrong path but had to try every source of external power before realizing I was the charge. Other people’s praise wouldn’t do it. Accolades stopped doing the trick, too.
Life is really fucking hard. It’s hard enough when you really love what you do, and depending on what life throws at us, that still may not be enough. But, it provides us the best chance to make it through adverse circustances.
If I were stuck in the wilderness—who’s to say we’re not in this life—I’d like a renewable source of energy at my side for whatever wait around the corner.
The burnout always returned, like a Spiderman reboot, everywhere I went: medical school, residency, and board-certified practicing psychiatrist. I do know this; being on the wrong path is the surest way to get burned out. But the pervasiveness of the term (it’s a diagnosis code in ICD-10) obscures the underlying cause. If it never gets better, doesn’t change with circumstance, and seems non-responsive to enhanced coping, it smells like the wrong path. This was my path. Now I’ve located work that recharges the battery, which is pretty cool, like padding downstream instead of up waterfalls.
I once got advice from a Neurosurgery resident, some five years into his seven-year residency. He declared, more than said, “You better be doing this for you (referring to the choice of going into Neurosurg), because if you’re doing this for anything other than yourself or because your family thinks it’s cool, you will hate your life and all those you did it for.” This is not just Neurosurg wisdom.
Here’s the quote that hung in my closet as I got ready each day (now decorating the home page):
The attainment of wholeness requires one to stake one’s whole being. Nothing less will do; there can be no easier conditions, no substitutes, no compromises. – Carl Jung
That’s the reason it’s hard to endure burnout—if you’re on the wrong path—because if you’re not really committed, you can’t turn sacrifice into meaning. I did witness medical students and physicians endure adverse circumstances, traumatic patient outcomes, and grueling work conditions, without becoming resentful; those people tended to love what they did.
The right path is there for everyone and sometimes that path takes wrong turns, but getting back on the path has to start from within. If not, we’re driving around plugging gas guzzlers into Tesla chargers.
I don’t think it’s either-or. Being on the wrong path is a cause of burnout, not a mimic syndrome. I had a course correction after my first two years as an attending when I left my first job for a better one. I was burned out in the first job because I was on the wrong path. My course correction (from academics to community practice) was not as big as yours, though.
You make a good point. I also think people can dip into the wrong path, while on the right path, and still stay on course, fighting through burnout, etc. It’s hard to make those course corrections you speak of!
The ability to accomplish certain tasks, and do them really well is not an indication that you should make a career of it. This could lead you down the wrong path and explosive burnout.
No doubt, couldn’t agree more. Reminds me of a quote from Matthew McConaughey, “I am good at what I love, I do not love all that I am good at”.
Hi Ryan,
I’m trying to decide to go to medical school (where I’ve been accepted) or not when I found your video on YouTube. I’m really unsure about what to do. It would require moving away from a place I love for 7+ years and bringing my husband (who loves his job and life here) along with me. I resonated with your “fear” reason to go into medical school, but I’m not sure if it means I am making the wrong decision or if I’m just nervous for a leap of faith. I would love any advice and wisdom on how to make this decision.
Thank you in advance.
Hi Sarah, Thanks for sharing where you’re at. I think it’s important when conflicted to put words to it and acknowledge it, like you’re doing! That’s something I wish I would have done more.
Sounds like your torn like I was, but possibly for different reasons: you love the area, don’t want to move, husband loves his job. For me I was torn because I wanted to go after a dream that wasn’t medical school. I wasn’t married at the time either. I do know how much effort you’ve put into this path though, because I did it too, which means that you’ve likely got something invested in it personally. Heck you got accepted!
Where the rubber meets the road is in honesty. I can’t speak for you (sounds like there’s a chance you’d really like to be a physician), but I didn’t want to be a doctor. That made all the difference. Only thing I can recommend is dialing into what you really want to go after and make decisions from there (considering all the family factors, including your husband’s dreams). It’s always best to make decisions with clarity and everything on the table.
Not sure if that cleared up much but I’ve also learned that not many big decisions come easy.
Wishing you the best in figuring it out! I know that internal place you’re sitting in all too well 🙂
Hi Ryan,
If you could go back to the few months before starting medical school given what you know now, would you still do it?
I’ve been accepted to a really good medical school in a dream city I would like to spend my 20s in. Unfortunately, I feel like my heart isn’t really in medicine. I don’t dislike the material as well as patient care, but I also don’t really like it either.
What are some ways you recommend someone to explore their interests after graduating college? Is there a certain amount of love you need to have for a job, in order for you to take it, or is being indifferent good enough? A lot of my classmates in undergrad are similar to me in not loving their jobs, but just tolerating it because it pays well and they’re good at it. I guess passion is more important if you’re committing to medical school, however, and they were doing something else.
What makes everything more complicated is that I live with my single parent right now, and they were recently diagnosed with a terminal cancer, with several years to live. It would be such a shame for me to commit to something so demanding as medical school in a different city, not being able to spend time with my parent, working on a path/dream that I’m not totally sure I want.
Hi BT,
Appreciate you sharing your situation here. The hardest step is bringing up ambivalence to begin with 🙂
I’ve been thinking about your message over the weekend and keep coming back to your last sentence. First, I must say that my experience is certainly different than yours for a couple of reasons: 1) I was staying in the city I lived in prior for medical school 2) your mother’s diagnosis. I do understand your comments about not being on the right path well though. With that in mind, I can offer honesty inside my own experience, which is what I believe you’ve asked for.
Would I still do it, if I could go back to the months before medical school, knowing what I do now? No, I would not.
Investing 7-9 years of your life (med school + residency) during identity forming years of early adulthood is not something I would do again, knowing what I do now. Years of living in a fractured state, wanting a different life, is not something I would willfully repeat. Increased certainty does not equal happiness. That said, my answer comes from where I am now. I am only here, building a life I love, because of the path I’ve walked. Whether I went to medical school or not, I would have got myself into the same issues that medicine represented. So, that said, I wouldn’t change a thing about what’s happened as I’m grateful for what it’s given me but would choose differently if back in that same place again. Hope that makes sense.
Your next question: what are some ways you recommend someone to explore their interests after graduating college? Well, first you need to know what you’re interested in. If there’s no clarity here, just keep asking yourself big questions: “What would I love to wake up and do all day?” “What would meaningful work look like to me?” “What does my ideal work day look like?” I tried these practices for months (if not years), before real clarity arrived, so I believe in asking the questions just for the sake of asking the questions. They eventually led me to bigger choices and into what I do now. It took about a year for anything concrete to arrive, but it was so worth it! I read books in the areas I enjoy (the outdoors, entrepreneurship, real estate) which helped me till the soil for ideas to sprout. Sorry if no specific advice arrived here, I’m realizing that the exploration of interests took many small steps for bigger ideas to be realized!
And your last question: Is there a certain amount of love you need to have for a job, in order for you to take it, or is being indifferent good enough? Life is really hard no matter which path you take. Forgoing medical school and moving to the mountains would have been an incredibly difficult life decision for me. Not doing that, not following my dream, while studying for board exams and doing clinical rotations was also incredibly difficult. I’ve found in life that having heart in your decisions allows for meaning to come from the suffering a little easier. Any path will be hard. I try to remind myself of this consistently. And if you go down a wrong path, you can always get off! Action is better than paralysis and no perfect choice ever arrives.
At the end of the day, just listen to yourself and perhaps ask yourself those questions you asked me. I like to flash forward and think about how I want to feel while telling my kids and grandkids about my life. That perspective has helped me make hard choices, especially recently.
Thank you again for sharing where you’re at. I wish you best in figuring it all out.
Ryan