I’m not alone in having experienced burnout and its consequences. One of the hardest working and most successful in my medical school class, I experienced early predictors of later struggles: I would get anxious whenever I had to go on away rotations, partly because of being far from my family, friends, and community support network for 6-8 weeks at a time. I felt ashamed and humiliated when called out in front of others for not knowing the answer to a question about anatomy during an operation. I had a hard time showing empathy to patients when I got little or no sleep after being on call before 5:30 AM rounds and the day’s operating room schedule.
My medical school Dean required me to seek counseling to cope with the stress reactions I was experiencing and warned me that what I was going through could put me at risk of struggling later in internship and residency training. I found counseling helpful in understanding my patterns, needs, and preferences; it certainly got me through medical school.
However, soon after I entered my internship, I again felt like I was dreading going to work. I felt anxious and emotionally exhausted and filled with shame that, somehow, I was not cut out for the work I had spent years preparing for. While experiencing all-nighters every third or fourth day, my sleep cycle gone haywire, and again far from my support system, I had no time to reflect on the experience or attend to basic self-care needs, which I later learned are fundamental to becoming a healthy, effective, thriving physician and human being. I even got into a car accident one morning after a 24-hour shift as an intern. Feeling paralyzed by even thinking about the possibility of having to take a leave of absence, I tried so hard to persevere. It was like jumping off a cliff, with little hope of surviving the fall from an identity and path that had consumed my entire being since childhood.
Speaking with my Family Medicine mentor and with the residency training director, I found my way to a psychiatrist and psychotherapist. They helped me see the wounded parts of me that had never had a chance to heal since childhood, perhaps even from generations prior, the survival mode I had been in for my entire life, and the vulnerabilities that sent me over the edge of burnout, anxiety, and depression when the demands of medicine as a career overcame the protective factors that had sustained me until then. Despite selective serotonin reuptake inhibitors to address the depressive episode and more therapy to assist me to return to work, eventually I left the residency program entirely. The shame I felt around that experience was excruciating, to the point I didn’t think I’d ever have what it takes to return to medicine.
It took nearly 5 years of healing, treatment, personal reflection, volunteer work, fostering 3 kids with posttraumatic stress disorder, and a research job to pay the bills before I got to a point where I had built a toolbox of skills, insights, and strengths to allow me to find my way back to residency training, this time in Psychiatry. Now, a decade later, I find myself an ardent advocate for physician well-being and burnout prevention. I’m filled with awe and gratitude for the journey, and I present my story as an introduction to the insights that follow in this 2-part article co-authored with a friend and colleague (the second part will be published in the next issue of this journal).
The notion of burnout originated in the 1960s, when those with extensive chronic substance abuse were deemed “burned out,” describing the toxic effect of substance use. Research by Herbert Freudenberger and Christina Maslach originally explored the phenomenon, and Dr. Maslach’s research led to the development of the Maslach Burnout Inventory,1 a tool that enhanced the capacity to study burnout and its contributing factors and manifestations.
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– Noshene Ranjbar, MDa,, Mari Ricker, MDb
-This article originally appeared in the March issue of The American Journal of Medicine.
