Work-life balance and burn-out have been major issues for professionals for some time. Recently, there have been more attempts to understand and address this. Burn-out is complex and multi-factorial. There are common themes, but it is different for each individual. When you google burn-out prevention, concepts like mindfulness, gratitude, exercise, and sense of purpose pop up. These are readily supported by medical culture and they are part of the solution. In contrast, talking about money is more taboo in medical culture. Yet, financial health underpins our ability to take control and improve our career and personal lives.
A healthy career has balance.
A healthy career has four important intrinsic components. Each must be healthy and a problem in one area can spread to multiple areas as we become more out of balance. The right balance is different for everyone, but no aspect can be completely absent.
Although a career is an integral part of our lives and identity as professionals, it does not exist in a vacuum. Problems at work can spill into our home-life and vice versa. We have a social contract where we help society and in return society rewards us with respect and appreciation. Professionals are self-regulating and waning performance due to burn-out can land us in front of our regulatory college. How we are treated by our colleagues and college affects our work-life.
Compassion
We need compassion to be able to effectively interact and help our patients and our colleagues. Burn-out in this area can manifest as depersonalization – treating people like tasks or problems to solve. Empathy and compassion can be quite emotionally draining as we take on people’s challenges. Our emotional capacity is like a gas-tank. We can burn our fuel by going fast and/or by going a long distance without a break. Either way, if we do not refuel, then empathy and compassion run out.
Mental Stimulation
We need to constantly learn new things and challenge ourselves to keep engaged. Medicine has this facet strongly entrenched. Practice can be as broad as you want to make it. Even specializing, there are always new advances to keep abreast of or nuances to common issues. Most people change their job every 5-10 years or so. With the front-end investment to become a professional, we are less likely to change careers. However, we can change the focus our clinical and non-clinical practices in different directions to keep it fresh. One enemy of mental stimulation are administrative tasks and their increasing prevalence in practice is one factor contributing to physician burn-out.
Sense of Purpose
We need to feel like we are doing something important and meaningful. While not mentally stimulating, an administrative task that also does not serve a readily apparent meaningful purpose is even worse!
We may also encounter a sense of futility in medicine. Pressures to do unnecessary testing or provide futile treatments. This may be an issue of framing – what we see as meaningless may actually provide some form of comfort to our patients or their families. However, we are also pressured to provide for everyone within the context of a constrained system. Someone else will suffer if we are wasteful and we may not have the resources to provide optimal care, even if we are not wasteful. A lack of control over that system exacerbates it.
Financial Health
Our holistic wealth is comprised of our human capital (skills, health, physical/mental capacity), financial capital (money & assets), social capital (relationships & social supports), and economic capital (the economy we operate within). Our compassion and our minds are dependent upon our human capital. We exchange some of that to earn money. The better our financial health, the more we are able to exchange our human capital to build more human capital instead of simply working for money.
Canadian Physicians Need To Pay Attention To Burn-Out.
The 2021 National Physician Health Survey by the CMA showed we spend an average of 10 hours per week (a work day!) on admin tasks. Half struggle to integrate the demands of their career and their lives outside of work. Almost 80% feel that they lack control to do worthwhile work. Half are experiencing symptoms of severe burn-out and half are considering reduced work-hours. Improving medical culture and systemic problems, and providing mental health support are important parts of addressing this. However, they are complex and notoriously slow and difficult to change.
Fortunately, we can control some of this ourselves. Learning about and improving our financial health empowers us to do so. Taking the time to examine our values and relationship with money gives us the direction and knowledge. Using this to build our capital give us the means.
Improve Your Financial Health To Fight Burn-Out
Focus on what you can control. Make a financial plan.
One of the things that can contribute to a lack of control and futility (contributing to burnout) is expending your emotional and mental time on things that you cannot control. You can’t control government, public, and patient expectations. However, you can control your financial health.
You can manage your spending, earning, debt repayment, and investing. Basic financial literacy will quickly show that you cannot out-earn a spending problem. You can spend wisely on what matters and on what is most likely to buy more lasting happiness and how to give of your time and money more effectively.
Having a financial plan removes the stress that lurks in the background due to the uncertainty of “no plan”. Protecting yourself and your family with appropriate insurance gives piece of mind. All of this helps you to balance how you spend your time and money now, with securing your future.
Learning about money and discussing it in a healthy way can help your relationships. Financial problems are a major cause of relationship breakdown. That could at home. It also happens at work. The money-shamers, who pretend to care the least about money often care the most – because they secretly have financial difficulties due their attempts to ignore it. Agreeing on goals and how to get there helps you and your family or colleagues row in the same direction.
Use your financial health to control your practice.
As you gain increasing financial independence, you can use that to improve both your career and your home life. You can buy time at home to outsource jobs that you find less stimulating or enjoyable. You could hire someone to do tasks at work that don’t require your skills or you find less rewarding. Buying time gives you more time to spend on your health, relationships, and the parts of your job that have the most impact.
Control how you practice
When earning money is no longer a major driver, you can change your practice to the way you want it. Even if that means a pay cut. That could be less patients per hour and more time per patient. You could take the risk of starting a new service that fills a needed niche. Filling vacuums is a great way to build a fulfilling practice.
Control how much and when you work
You may decide to work fewer overall hours. Those with medical martyr complex may shout that we are denying our patients service by cutting back. However, the demand is infinite, and the hospital won’t love you back. Further, we may actually see more patients over our career if we work a full career at a reasonable pace rather than lose control and burn out early. Plus, it will be better care along the way. It could be less evenings and weekends. They usually pay a premium, and if not, you can provide a top-up. Our group did this, and the main complaint was from those wanting more nights!
Use your financial base to expand your influence.
As mentioned, simply wailing about the failings of the healthcare system is not going to effect change. It is futile because it is beyond your control. However, at the edge of what you control completely and what you don’t control are the areas where you can influence. If you want to change how things work for the better, you have to use your influence.
In medicine, that usually means being part of medical leadership, committees, mentoring, teaching, and research. That does not pay well, if at all, and costs you time and effort. Having a strong financial position allows you to engage, knowing that your financial needs are taken care of. Still, be sure to consider the investment of your time like you would any other investment. What is the risk and likely return?
Expand your influence to make your work-life better.
Generally, avoid roles that simply want to check off the “we consulted doctor stakeholders” box without any real influence. The only reason to take those on is to make the connections and learn about the stakeholders and process to take on a position with influence. If the opportunity comes along to take on a role that can change how you practice for the better, you want the ability to take it on whether it pays financially or not. These symbiotic opportunities are usually the most rewarding.
Expand your influence in your home and community.
Remember that your career is only one aspect of your circle of influence. The control over your time that strong financial health gives you empowers you to say “Hell, yes!” to those opportunities at home and in your community. Don’t be forced to choose money over your family because of poor financial health. Be present as a parent while you have the most influence. Coach the kids’ team and expand that reach to multiple kids. This isn’t just about kids.
You can influence friends, other family, and community organizations. Physicians and other professionals got to where there are by being amazing people and leaders. Share that beyond medicine. Build the relationships and community that will be there for you in the future.
Burn-out and burn-out prevention is different for everyone.
Medicine can be one of the most freeing fields with many different clinical and non-clinical options for our careers to evolve as we evolve. Yet, many doctors feel trapped. It shouldn’t be this way. Strong financial health can help you to take control and change the factors contributing to burn-out for you. Examine the balance of your career’s intrinsic facets and how they are balanced within your life. Compare that to where you want to be. Make a financial plan.
Where should you make adjustments now? How can you put yourself in a position to course correct further in the future? What is important to us and where we want to be in the future is sure to change as we change and the world around us changes. Regardless, strong financial health puts us in the driver’s seat.
Whether you are well-versed in personal finance or starting from scratch, I hope that Loonie Doctor helps you on that journey. As you build more financial muscle, then the big question become how will you flex them? Feel free to comment below.
LD,
What an amazing post ! I have circulated this to a number of people ! In addition to being a CPA, computer science nerd, financial analyst, you have now proven your worth as a psychologist/psychotherapist !
This should be mandatory reading for all young docs…..problem is they read stuff like this a little too late in their careers.
Cheers
Lyndon
Thanks Lyndon,
I am actually quite hopeful. There seems to be a major interest amongst early and mid-career doctors (and other professionals too). The pandemic seemed to cause some reflection, and burn-out has certainly bubbled up again. Getting the financial piece right helps us have longer & better careers, lives, and impact. Medical schools, residency programmes, and staff associations have become attuned to this gap in training. While my blog was dormant the past couple of years, I was doing a lot of speaking for those groups. I am hoping the basic curriculum that I am rolling out over the next few months helps. Much of finance and wellness is psychological and our relationship with money. So, the first sections will be focused on that. Built on experience from my interactions helping colleagues, my own experiences (and mistakes), and guided by the best research I could find. You can probably tell, I am pretty stoked about it!
-LD
So intrigued (and another great post, as always). What’s this basic curriculum? Where are you planning to teach/share this? I incorporate a bit of financial discussion with my learners, but have realized a slightly more organized manner may be helpful XD
Thanks Dr. FIREfly,
The basic curriculum will be front and center on my blog site. It is going to have 9 sections (Basic Financial Health, Money/Wealth/FI, Earning/Spending/Giving, Debt, Insurance, Housing Basics, Investing Basics, Tax Planning Basics, & Your Financial Plan). You can click on the box for each section & it will go to a page with the posts for that section. There is a smattering of old content in there already, but I plan to release a new post each week to add to it until we have covered it all. That is roughly how I organize the lecture series that I give to trainees and staff associations (in a much more abbreviated fashion given time constraints).
-LD
Thanks for a great post. As a physician who has just started in practice, are there any resources on where to get started on this financial journey? I have been recently made aware that I am in a category called “High Earner Not Rich Yet”. I’m also wondering if there are any different perspectives or strategies given a difference economic landscape compared to 10-20 years ago. Particularly with interest rates and high home prices.
Thanks for an amazing website.
Sincerely,
Kevin
Hey Kevin,
I have been building a comprehensive core curriculum. Start at #1 (Basic Financial Health) and work through. It isn’t done yet, but getting there. I am also working on a podcast version with Ben Felix from PWL. It will be called “The Money-Scope” – Shining a light deep inside personal finance for Canadian professionals. Will be releasing episodes later this year.
There isn’t a lot out there for Canada, but the White Coat Investor also has some great material in the US context.
In terms of the current economic landscape. Interest rates have actually just moved up to what they were about 15-20 years ago. They were much higher prior to that. The biggest aberrancy is the outrageous cost of housing. Driven up by a combination of government policies, demographics, and abnormally low interest rates for the last 20 years or so. I am not sure how that will correct itself, but it has to. Perhaps, price stagnation until affordability catches up or price reduction if it doesn’t. We saw that in the 1990s and it took over a decade for housing prices (in inflation-adjusted dollars) to recover to their previous peak. The status quo is not sustainable. In terms of strategy, the best thing to do is eliminate debt urgently. Don’t buy real estate until you are on really solid financial footing and know that you will be in the property for at least 5-10 years. Don’t count on selling it in the short-term for a profit or renting it out cashflow positive. That type of speculative approach did well over the last 10-20 years, but I wouldn’t count on that moving forward. There is some good discussion about it here. Over multi-decade time frames, real estate tends to outpace inflation by about 1%/yr adjusted for cost and leverage-use . Bonds are similar. Stock markets outperform by ~5%/yr above inflation. Over the short-term, no one knows. Just keep balanced and don’t over-extend. Then, you will be secure and able to capitalize on opportunities when they do present themselves.
-LD