Editors' Message: Don't Burn Out

Merriam-Webster defines burnout as the condition of someone who has become very physically and emotionally tired after doing a difficult job for a long time. What physician hasn't felt that way at some point during training or practice? And, unfortunately, the positive aspects of a career in medicine don't always outweigh the bad. A 2012 national survey found that US physicians suffer more burnout than other US workers.¹ The Medscape 2015 Lifestyle Report had a 16 percent rise in the incidence of burnout between 2013 and 2015.²

Although studies like this generally show the highest rates of burnout among physicians in “front line” specialties like internal medicine, surgery, and emergency medicine, aesthetic physicians are not immune. Recent studies revealed that nearly 40 percent of US surgeons, and almost 30 percent of plastic surgeons experienced burnout.³ Interestingly, the Medscape report showed dermatology had the lowest reported burnout at 37 percent, compared to 45 percent for plastic surgery (the only two core cosmetic specialties surveyed). Dermatology also had the highest rate of happiness at work. But in both specialties, ≥10 percent reported the highest severity scores for burnout (severe enough to interfere with work and consider leaving medicine).

Increasing burnout among physicians isn't surprising. Bureaucracy, income, liability, and public opinion have all veered against practicing physicians. Aesthetic physicians are free from changing reimbursement schedules, but not from pressure to reduce prices to compete. Adding insult to injury, the “competition” may not be physicians (or board certified in a core cosmetic specialty). Especially for those of us in practice over a decade, medicine was a career choice based on love of the art and science involved and desire to help people—not an interest in marketing or business. But now some of the top “providers” of aesthetic services arrived on a wave of social media rather than academic or clinical experience. Aesthetic “factories” get better prices on disposables, because pricing is based on doing more not doing it better. So how do aesthetic physicians maintain a passion for practice?

First and foremost, none of us would do what we do if not for our patients. The majority of our patients are appreciative of us and our work. We treat healthy patients and are given the privilege to impact their self-esteem. Whether it is a bit of filler and toxin to make a stressed mom look vibrant or a rhinoplasty to help a teen feel more confident, what we do matters to patient's daily lives. Difficult patients come and go, but in today's world of aesthetics, we can continue to care for our happy patients and their families. The difficult ones may make our lives difficult, but the happy ones keep us going. We get to “grow old while looking young” along with them and get the satisfaction of seeing their joy when they look in the mirror.

Another way we avoid burnout is by feeding the science nerd who lives in every physician. We all love something about the science of medicine and surgery that attracted us to our chosen specialties. Becoming expert at known techniques is just the beginning. We can learn and even develop better treatments and protocols. Teaching is another way to keep our brains bubbling. Whether it's training local physicians, supervising residents, or lecturing large audiences, the process can help us stay fresh and excited about work. The mechanics, philosophy, and psychology of what we do is fascinating. Figuring out how best to pass that information to others and getting feedback saying you did it well can be a rush.

Our colleagues are another integral ingredient. It is important to build a circle of trusted friends and colleagues in the field with whom to share the trials and tribulations of practice. Practical advice from personal experience as well as empathetic support among members make the whole group stronger. Discussions with peers expand our horizons. Plus the friendships that develop can be lifelong.

Finally, maintaining a life outside medicine is important for anyone who works. Combining work and play by attending work events where you can see far-away friends or explore a new place is a bonus. But medicine can easily become all encompassing, so creating balance must be a priority. Balance means different things to different people: time with family, friends, or alone, with activities or just at rest. The key is to find time to do things that make you happy. Carving out this time can be tricky, but in 2016, outsourcing everything from grocery shopping to waiting in lines for tickets is possible. Your attendance at your children's soccer game can't be substituted, but store-bought cookies in place of home baked for the PTA bake sale is a no-brainer. The Medscape Report found that non-burned out physicians were more likely to have taken at least two weeks vacation off a year than their burned out colleagues. Other small studies have suggested that stress reduction and mindfulness exercises may be helpful.

So stay positive. There are ways to control the effect of work on our lives rather than be victim to it. Remember and rekindle the reasons you entered aesthetic medicine. Tap into what makes you happy in the office and out, at work and at play.

1. Shanafelt TD, Boone S, Tan L, et al. Arch Intern Med. 2012; 172(18): 1377-1385.

2. Physician Burnout: It Just Keeps Getting Worse. Medscape. Jan 26, 2015.

3. Qureshi HS, Rawlani R, et al. Burnout phenomenon in US Plastic Surgeons: risk factors and impact on quality of life. Plast Reconstr Surg. 2015 Feb: 135(2) 619-26.

Co-Chief Editors

Heidi Waldorf, MD, FAAD, and Steven Dayan, MD, FACS