America’s broken medical system is breaking our doctors. Physician burnout annually costs the medical industry $5 billion dollars. Even before the COVID-19 pandemic, 70 percent of physicians said they would not recommend a medical career to their families. It’s time for a change.
In Determined, academic physician and certified coach, Dr. Jimmy Turner lays out an evidence-based framework to help doctors understand why they’re so burned out in the first place. By re-examining current narratives, reactions and paradigms, not only can doctors reclaim their sense of purpose and autonomy but they can also create a life they love, even if the medical system doesn’t love them back.
Here’s my conversation with Dr. Jimmy Turner.
Welcome to Author Hour. I’m your host Benji Block and today, we’re thrilled to have Jimmy Turner with us who has just authored a new book titled, Determined: How Burned Out Doctors Can Thrive in a Broken Medical System, and Jimmy, we’re so glad to have you here with us today.
Jimmy Turner: Yeah, I’m super excited Benji. Thanks for having me on the show.
Benji Block: Absolutely. Glad to have you and I know this isn’t your first book so tell me why you’re back with this one and the genesis story if you would.
Jimmy Turner: Yeah, So, you know, my background, I’m an academic anesthesiologist so I’m a doctor and early on, I actually developed a passion for personal finance, and part of that was because I discovered that there’s a lot of doctors out there who wanted the freedom to practice medicine because they want to and not because they have to and so I stepped into the personal finance realm and taught financial literacy to doctors.
The first few years my business, The Physician Philosopher, was in existence and wouldn’t life have it, a bit of irony that I would end up getting burned out even though I was using this tool of financial independence to teach other doctors how to create their own financial freedom to defeat burnout and kind of have a way out of medicine or a way to cut back.
And then, you know what? I use the same tools that other doctors I taught would use which, is to build that financial freedom, and when I got burned out, it turned out that that wasn’t the answer and while financial freedom is still super helpful and I love still teaching about personal finance, financial literacy, I really started diving into a completely different realm and understanding how burnout works, where it comes from, what causes it and most importantly, what individual doctors can do when the system is burning them out.
So that launched me through my own journey, through burnout and kind of figuring that process out to want to help other doctors do the same.
Benji Block: Fascinating and I’m excited to hear more of your story here over the next few minutes. Let me ask you, as you’re working on this project, are you basically writing to yourself having experienced burnout and that’s kind of your ideal reader as someone that’s in that position, or who are you thinking of that was giving you motivation?
Jimmy Turner: Yeah, that’s definitely the idea is to help doctors who are feeling like they’re in a system that is so large and so big and so complicated and complex, that they can’t do anything about it and for a lot of doctors that makes them feel trapped in that system, for the doctors that are out there, I want them to know that there’s hope, there’s a way out of this, there’s a way to understand why they feel the way that they feel even though they spent all that time in training.
So absolutely, this book is written for doctors. That said, you know, it really does apply to most medical professionals and even outside of medicine. I think people were late to that journey, through burnout, if you’re feeling burned out in your job and explaining exactly why you feel that way and there are systems in place that can help you do that, but yeah, it’s absolutely geared and written towards me, three or four years ago.
Benji Block: So, okay, let’s talk about you first and then we’ll go more broadly to burnout. You had mentioned in the book that without being able to find many answers that you started to self-medicate and it wasn’t like a drug you’d turn to or anything like that but that you self-medicated through your addiction to what is known as an arrival fallacy, which I found really fascinating.
Could you break that down and talk a little bit more in detail on your journey, having seen levels of success but then arriving at this realization of the fallacy and then ultimately burnout.
Jimmy Turner: Yeah, I can absolutely do that, and you know, this originally comes from Tal Ben Shahar, who is a Harvard-trained psychologist — I think that most doctors relate to this and I bet a bunch of other people will too but in medicine — there’s this very well-prescribed path to becoming a physician.
So you know, you go to undergrad, you spend four years there and then you go to medical school and you spend four years there and then residency for three to four years, three to five years, sometimes longer and then fellowship and each step along the way, what happens is you’re like, “Man, this is not exactly what I dreamed this would be. I bet when I get to, you know, become a doctor, it’s going to get a lot better.”
Then you get to medical school and it’s tough. It’s a lot of training, it’s a lot of reading, it’s a lot of learning, you don’t have much say until you’re like, “Hey, when I become a physician, I’m going to be a doctor and I’m going to have more potential to have that freedom, that autonomy that I’m looking for” and you get there and you end up burning out in residency. For many doctors, the first time they struggle with burnout is actually in training and residency.
And so they’re like, “Okay, but this is all going to be worth it when I become the attending physician and I earn an attending physician a paycheck. So that’s when I’m going to be happy” and then they get there and that’s not, you know, all of these changes lead to this not very well-sustained increase in life satisfaction and then after another three to six months, it kind of levels out and they go back to where they were which is often burned out.
The arrival fallacy as Tal Ben Shahar would explain is this idea that once you get there, you’ll be happy and so, so many of us instead of focusing on the journey that we’re on and you know, living in the moment in the day-to-day, we look forward to these moments that happen as an antidote to how we currently feel and surprisingly, when we get there, it doesn’t really work.
We get that short-term hit of dopamine from whatever change we’re hoping for, expecting, and it does make things better for a little while but in the end, it’s not the answer. It’s not sustainable, and so, it’s why it’s called an arrival fallacy because the idea as Gertrude Stein would say that “there is no there-there.” That when you get there, there’s not as much there as you thought there would be.
So for doctors who go through this, really long training period, hoping that the next step is going to be the answer to it all, it’s really defeating to get there and then to realize you’re practicing medicine in a system run by bureaucracy and politics and electronic medical record systems and insurance companies, administrators and you don’t have control of your job and so you spent your entire 20s or early 30s sacrificing all of these things to get there and then it’s not worth it in the end for many doctors.
So that can be really disheartening but it’s called an arrival fallacy, the idea that when you get to that next arrival, the next accomplishment, the next thing in your life you’re hoping for that it will get better, you’ll have lasting happiness, that’s just not the way things work.
Benji Block: Yeah, it’s so interesting too because there’s all these years where you do have that path that’s very clear for you, to feel like, “Okay, well, just let me just wait this out, let me just wait this out” and I could see how that just gets ingrained over time and then you realize, “Oh, okay. Well, yeah I thought that I would reach a destination and get this figured out and we’d be good to go” but now there’s like, no one really telling me what the next milestone is and I’m just kind of having to live with myself.
Jimmy Turner: Yeah and I think that’s really tough for people when they finish training because now, the world is their oyster and they get to decide what they want and for some people, myself included, that ultimate question of “What do you want?” can be one of the hardest to answer.
Burnout and Its Consequences
Benji Block: Totally. I think that’s well said. I want to define burnout because we’ve thrown that word out several times here now and I know people are probably thinking different things but when you talk about a physician burning out, what are the signs of that, what’s the emotion behind it, how would you define it, Jimmy?
Jimmy Turner: Yeah, so, I think burnout is kind of interesting, right? So, it was originally coined by Freudenbueger in the 1980s. He had a book called Burnout and I think that his original definition is kind of spot on like having that extinction of motivation or incentive. The idea that you no longer have that drive, that intrinsic motivation to really love your job, to pursue your job, to enjoy your job.
You know, it feels like it is weighing on you, it’s a bit of a burden and so, it’s composed of three different things and so depersonalization is one of them, right? It’s the idea that you basically don’t relate to either your patients or your colleagues like you used to. So oftentimes, when this happens, it’s a bit like treating them like an inanimate object and so you know, you have that kind of missing piece there where you’re supposed to have compassion and care and all of a sudden, it just kind of becomes work.
It becomes a job, it becomes something you’re fighting against and I would say that’s probably one of the main components. There’s two others that Freudenberger originally described, emotional exhaustion and then what we call lack of accomplishment. These are kind of the more modern-day terms but emotional exhaustion, lack of accomplishment, and depersonalization and that emotional exhaustion is something that listening to that arrival fallacy story, a lot of people can really relate to.
Like, “Oh, I got there and then it didn’t solve my problems” and then you start realizing you’re in this very big system that you can’t really control by all the powers I just mentioned and it causes apathy in a lot of ways and so, that’s really that emotional exhaustion piece that exists there. Then the third part, which I think is by far the most fascinating just from like, you know, philosophical or kind of curiosity kind of standpoint is the lack of accomplishment, right?
You have these doctors who spent so much of their life becoming experts at what they do, they’re the people that save people’s lives when they come to the hospital, and they could feel like they haven’t accomplished much in their career. And this really is a mind-blowing thing but up to 60 percent of doctors, you know, kind of struggle with that imposter syndrome and you know, that lack of accomplishment that they’re a fraud, that somebody’s going to finally catch them that they aren’t really what people think that they are.
So all of these three components really produce that lack of intrinsic motivation or extinction of motivation as Freudenberger would have originally described it.
Benji Block: Well and it’s interesting too because you bring up the fact that burnout is two times higher in physicians than in the general population. So then you’re going, “Okay, well, it’s extremely prevalent” and then there’s all sorts of consequences because of the position that they’re sitting in and they’re dealing with this depersonalization and emotional exhaustion, feelings of lack of accomplishment.
So what are some of the consequences then, because you’re not going to probably just stay in this place of feeling burnt out forever? You’re going to start making decisions whether it’s to leave the practice or you’re going to have to do something.
Jimmy Turner: Yeah, so you know, higher rates of burnout have been linked to a whole host of negative things including real alcohol abuse, depression, suicide, you know, changes in jobs and we’re seeing this now with the great resignation at large but it’s also happening to physicians who are leaving medicine.
You know, there are Facebook groups out there that are about physician side gigs that have you know, almost a hundred thousand doctors in them and so it is a problem that is both profound and also, you know, quite widespread. The cost to the individual is large but the cost to the system is equally bad.
Burnout cost to the healthcare system $5 billion dollars a year, that’s a billion with a B and so, and the reason why is because, every time a doctor leaves or exits a hospital system or healthcare system that they’re in, it’s going to cost that hospital system about three times their salary to replace that one physician.
So when people aren’t happy in their job, what they often do is change their circumstances in order to try to find that happiness and so that is a very large impact on the system when you see doctors changing jobs and leaving and you know, really trying to get out of their situation that’s morally injuring them.
Systemic Solutions Rely on Closing The Distance
Benji Block: So I guess, and this — you go to really good lengths in the book to share pieces of how we got here but we don’t even have the time, right? To diagnose in 30 minutes to how we got here fully but you point out that there’s been a focus on profit and performance above all else and it’s led to a failing within the culture at large. I wonder if you’d highlight some of how we’ve landed here because you’re totally right.
I could see you feeling like you’re a part of this huge system and then you personally, “How would I even change it from the inside?” and just seeing some of these reoccurring problems like I said that you point out profit and performance maybe above all else.
Jimmy Turner: Yeah, so hospital administrators, you know most of them get business degrees — and I’ll say this upfront because I think that a lot of people in medicine, they really kind of have an avid hatred for administrators, to be honest with you and I wouldn’t go so far as to say that that is what’s happened. I don’t think the administrators are sitting up there on their ivory tower trying to plot their evil plans for the doctors and the nurses that are on the frontlines.
I think these are good people that have become so distanced from the people that they’re leading that is really led to a lot of these problems and one of my favorite experiments I talk about in the book is Milgram’s experiment and you know basically, the end of that experiment, the too-long-didn’t-read synopsis of that experiment is that you know, they basically shocked people that didn’t get answers right to questions they were asked in this experiment and they did three different variations, right?
The person that was being studied with the person administering the shocks from mild shocks to moderate shocks to severe shocks and the shocks that were labeled XXX meaning that they were lethal and you took regular everyday people, put them in those situations and if they had to touch the person’s hand and put it onto a shock plate, they only proceeded to shock them to a lethal extent, you know, about 30 percent of the time.
Then it was almost as high as 67 percent of the time if they were in a different room and could only hear the person and somewhere in between those two numbers, if they could see the person and hear the person and so what the study showed was that basically the further distanced you are from the people that you are interacting with, the more harm you can cause because you just don’t realize what you’re doing.
So as an administrator, who has been trained in business training that if you know, what you can’t measure you can’t change, they focus on numbers that end up being profit and loss, statements and balance sheets and so they make decisions looking at expense columns and revenue and from a very high place, it’s challenging to understand exactly what those changes are going to do on the frontline because they are not on the frontline with the doctors and the nurses that are taking care of people.
So when they focus on profit, a lot of the decisions that they make strip people of their autonomy in terms of how they live their lives and take care of patients, and they make them feel devalued in terms of how they feel like they’re not—really, they don’t really have a say and that these changes impact them in a very negative way and there is nothing that they can do about this. They’ll still feel it’s very important.
So I think the profit focus comes from a good place of trying to run a business and make it last, make it sustainable but the changes often lead to lethal kind of consequences on the frontline because these administrators probably won’t even know most of us if they pass us on the street.
Benji Block: Let me ask you one question, follow-up question there before we go to something different but on that admin side of things, what would be the change then that you would advocate for? Because to get closer I guess to the system, there is a reason why it’s like you are sitting in an office somewhere removed from the patients, right? So what would be the change necessary at a systemic level to make a dent in this problem?
Jimmy Turner: So I think there had to be a fundamental shift in understanding from instead of placing an emphasis on profits to placing emphasis on people and so, you know, Edward D.C. and Richard Ryan did this research in the early 2000s on intrinsic motivation and what really drives people, what helps them to feel engaged, to love what they do for a living and it turns out there is three things.
So autonomy, belonging and competence, or how good you are at your job. I call these things the ABCs of self-determination and so if an organization would just focus on what helps the nurses, the doctors, and the people working in medicine have the ABCs of self-determination to be self-determined physicians, then if every decision was made from that framework and driven through this in terms of, does this increase people’s autonomy?
Does it help them feel like they belong more? Does it help them to be better at their job and if the answer is no, then you don’t do it and if the answer is yes, then even if it costs some money to invest in those things, you know that the long-term reward of people not leaving your job and the cost that we just discussed is going to be driven down, right? So that makes you more profitable in the end.
So when you have a better culture that values its people that helps them become self-determined and love what they do, they don’t leave and that is one of the highest costs that a hospital has is turnover from staff and right now after this pandemic, it has become like I mean, unsustainable. I think the amount of nurses that have left the nursing force here and any that have left working in anesthesia and physicians too, you know this is all happening because these people don’t feel like they’re valued.
So you know, I think it would take a change in mindset to stop focusing so much on profit and to start focusing on their best investment, which is people.
Benji Block: Yep and when it’s simplified like that it can sound like a great catchphrase almost in a sense but it is so much deeper than that and it would impact. I love how you laid that out. It’s essentially a filter for your decision-making.
Jimmy Turner: Yeah and this leads to really real change too, right? So as you filter through those conversations, right? You know, I can give an example from working in the operating room as an anesthesiologist. So if our focus was on autonomy and in this case, maybe personal autonomy in terms of you know, control over your schedule, our goal wouldn’t be to operate as late as we can into the night.
Maybe our goal would be to incentivize payment structures for people such that they’re all incentivized to get all of the work done in the least amount of time to take the best care of patients in the most efficient way possible because at the end of the day, they go home and when you do that, all of a sudden, you can operate more in less time and so it really can have very concrete changes on how we take care of people while we also don’t burn out the doctors and nurses that you hope are going to be there someday when you need them.
Benji Block: Man, thanks for breaking that down. I like one of the other vital shifts and you actually mentioned this in your personal story, one of moving away from just the importance of money as the end goal and shifting your thinking to, “Okay, that can’t be the end all be all.” Let’s talk about that for a second, that shift that you’ve made mentally go, “Okay, money can’t be the main driver.”
Jimmy Turner: Yeah, so I think that what people are looking for, you know when you go back to the autonomy piece that we were just mentioning when they are seeking money for financial freedom, the reason that they’re doing that is that they are trying to create the autonomy that they don’t have their job and so when you have financial freedom, you don’t have to practice in medicine, right?
So if you are a burned-out doctor, the most obvious conclusion that you can probably get to on your own is to say, “Oh, well, if I just created enough financial freedom, I wouldn’t have to practice medicine anymore” because it turns out that the only reason why burned-out doctors continue to stay in medicine is because they can’t afford to leave and so it becomes a very natural conclusion.
People take this step very naturally, they don’t have to go look for it, they just start literally googling, looking up what are ways that doctors can make more money and they end up in real estate courses or they end up learning about money. I did the same thing and what this all does, unfortunately, and I love this part of the book because this idea is highly offensive and so if you go read the book, it’s explained in much further detail.
But the problem with this situation is that you are basically labeling yourself as a victim and I am not saying that and there’s a whole section on moral injury versus burnout because believe it or not in medicine, those two terms, those people that debate which term we should use when we are talking about this and I have an entire section that describes this because the moral injury is the systemic phenomenon that causes burnout.
I think it is not an either/or fallacy, it is at both ends and so, when you feel like the victim of that morally injurious culture, then there is nothing you can do about it and so making the transition through your mindset about how much power you have and who holds that power and who gets to control how you feel, making that mindset shift is fundamentally important to reclaim some of that autonomy.
Because the second that you realized that you are not a victim and that you are actually quite in charge of your life and that you have as much power and control as you need to control how you feel and what you do with your life, that is when you start to realize, “Oh, I can actually work in this system and it could still try to do its worst and I’m going to be strong enough to withstand it by doing this work of reshaping my narrative, my perspective, my paradigm around medicine and around my life and how much control I do or don’t have.”
Because otherwise, you are just saying, “I have no control.” and that is a helpless and hopeless place to be.
Conquering the Victim Mindset
Benji Block: Yeah, what was that narrative shift for you? Like what actually sparks that because I think there would be those that go, “Okay, if I can identify that I’m maybe in a space where I am thinking more of a victim” that just because you can identify that doesn’t necessarily mean you feel that prompt or that push or can get to a place of thinking differently without some help.
Jimmy Turner: Yeah, so the victim mindset is when you start really kind of looking at other things as the cause of how you feel. So if you feel like your job, your spouse, your partner, your kid, or whoever is causing you to feel a certain way, it turns out that what you are doing is handing the keys to that person or that thing over of how you feel and so you might start realizing that you are complaining or blaming a lot of things and taking absolutely no responsibility for yourself.
As I mention, this is a highly offensive thing because people are like, “Wait, what are you saying? Are you saying that I am broken?” and I am actually not saying that you’re broken. What I am saying is that you’re powerful, those are different things but you’ll start to realize that you are blaming everything and everyone else external to you, right? This is why Epictetus, one of the stoic philosophers famously said that basically, the chief task of life is to separate those things, those which are external and those which are internal to us.
To recognize that the things that you can control are the internal things and that the internal things lead to how you feel. So you know, stop trying to control the external and work on the internal, right? These ideas have been around for thousands of years but you know, are just now kind of making their way into medicine interestingly.
Benji Block: Well, this is a fascinating conversation, a fantastic book for an industry that just needs more content like this, so thanks for taking this on. I wonder when a reader completes the book, they put it down, what are you hoping that the takeaway is, the prompt is for them as they complete this?
Jimmy Turner: Yeah, so I guess there are a few things. That’s a really good question, Benji. So the first thing is I want you to know that you are not alone. I want you to know that there are other doctors, there are other medical professionals that are going through these struggles too and I hope this book explains to you in the first half of the book, why that’s happening, how that’s presenting in your life, the moral injury that’s caused by the system that’s leading to your burnout.
That is the focus of the first half of the book, to understand the problem and then in the second half of the book, I hope that you would walk away with really understanding that even if the system is broken, there are ways for you to re-shift, to shift or to reshape your mindset, your perspective, your narrative around your life and know exactly how to do that so that you are no longer the victim of a broken system and that you are thriving in medicine or outside of medicine depending on what you decide to do with your life.
So I hope that people know that they are not alone, they understand what’s going on and how they got there and that they have individual solutions walking away from the book for how they might get better.
Benji Block: Yeah, I love that you spent the back half on just teaching tools that you have learned really from helping hundreds of doctors, so thanks for the work you’ve done to help fight burnout and I think there is just so much here that is practical but also you know, insightful sharing stories and that side of things. You are doing a lot of work man, you got a podcast, and coaching. So tell people where they should connect with you further beyond just this new book, Determined?
Jimmy Turner: Yeah, so obviously check out the book and that should be available to you most places you can buy books, and then the second place is on the website, thephysicianphilosopher.com. So I was a philosopher major as a background in undergrad, so that is why The Physician Philosopher is the name of that and my wife is a teacher, so she loves alliteration and so you can find out more about what we do to help people master their money and their mindset so they can practice medicine because they want to not because they have to over at thephysicianphilosopher.com.
Benji Block: Nice. Okay, the book again is called, Determined: How Burned Out Doctors Can Thrive in a Broken Medical System. You can pick it up on Amazon. Jimmy, thank you so much for stopping by Author Hour. It’s a pleasure to get to chat with you about the new book.
Jimmy Turner: Yeah, thanks, Benji. I really appreciate you having me here.