In later stages of burnout it seems common for GP and OH to simply "sign a person off sick" - with or without antidepressants. There is a problem with this on several fronts.
Firstly - antidepressants ( or some of them at least) can make a person's depression symptoms worse in the first few weeks.
Secondly work itself - whilst at the core of burnout - can be a limiting factor to the depression in that despite the person suffering at work - removing work can exacerbate several aspects of containment.
Thirdly - the depression may be a dysfunctional coping mechanism for the burnout. What this means is that treating the depression ( much like removing alcohol or dependency forming self medications) allows the burnout to escalate.
Finally - depression and burnout are thought of as two different issues by some researchers but also thought of as the same issue by others. But research is research and does not always translate helpfully ( or at all) to the real world.
What I mean by all this is that an antidepressant and some time off work for burnout complicated by depression is in fact potentially dangerous. There is anecdotal evidence that taking such a simplistic approach to burnout management can push those at stage 11 to stage 12 - a complete mental and or physical collapse with a risk of suicide.
This is a fascinating topic because the real cost is not immediately apparent - particularly the sometimes heavy cost of NOT seeking it.
Whatever way you do it - there are ways to reprioritise the use of funds. Yet sometimes after years of career misery or frustration people just can't get their minds around spending on their career happiness... even though they may be very unhappy indeed.
This may be due to
* not believing there is any way things could get better
* not feeling enough energy to pursue career exploring (?burnout)
* feeling that getting work into a good place is not the top expense priority
* never having experienced independent career guidance support before
* not prioritising career happiness and wellbeing high enough
* genuine lack of funds
The number of times I hear that people describe taking days to wind down and for their holiday to begin in earnest only to start winding back up sometimes in dread of returning - a few days before coming home. That is half of a 2 week holiday wasted - every single holiday and means that one week holidays are almost pointless.
Could it be too that doctors are good at putting themselves second but not that good at putting themselves first?
Could it be that because we are not trained in finances - that our focus is not at all on "opportunity cost" but more on the list of things in front of us.
So - let me challenge you and ask two questions....
"are you worth it?"
"what is the cost of NOT taking action on your career if it's not where you'd like it to be?"
Opportunity cost = the loss of other alternatives when one alternative is chosen.
Organisational change goes apace whether we like it or resist it but as professionals we need to be clear about what we ourselves want to do in the future.
Regular allocation of planning time for career dreams and exploring options and having systems/a structure to that is more important than it has ever been. It means one is doing ones best to "future proof" ones career.
Having clear perspectives on what if scenarios, new career challenges, unfulfilled life aspirations ensures that one can more easily default to plan B or plan Z and nothing comes as too much of a shock. What's more - working on this means one never ever feels trapped. Irons in the fire stops career boredom too.
Having career plans/ options/ visions throughout all phases of your career means
when the unexpected arises - you have ideas already in the pipeline. If illness or other limitations arise - you have already given some constructive thought to your future
Should retirement beckon early - you will not be phased as there are already exciting plans underway or simmering on the back burner.
yThere are a number of ways in which burnout can damage a career. It is my belief that if people knew just how much burnout was damaging both them and their career and their relationships - they would tackle it immediately.
But because burnout is so slow to build up and therefore creeps up on people giving them lots of time to readjust to the new level of burnout - it becomes easier to ignore it.
Then after the burnout has become bad enough - there is no energy with which to tackle the career dissatisfaction and so a state of chronic or cyclical burnout pervades.
So what would I suggest? Without doubt - catching burnout in the early stages is far better than the late stages when damage limitation often has to come into it and career crises are more common. But by far the best is prevention.
Prevention of burnout is achieved by addressing all and every early levels of stress in a career and not merely accepting these as part and parcel of the job. Stress at unhealthy levels - that goes unrecognised or ignored - is the precursor to burnout.
Career change is always an option but for many it is not a career change that they need ( that desire is often a knee jerk reaction) but rather an objective and supported audit of what is stressing them and why and how this is progressing or can be stemmed.
Well - one of three things seems to happen
1 It goes away - because when facing a specific crisis this can eclipse the issues of burnout but has it really....
2 ...gone underground only to recrudesce at a later stage ?
3 It has already got worse.
We have a burnout factsheet to share
Learning more about burnout is the first step in combatting it.
For those wanting support for turning burnout around we have a specific programme for that. If you would like to discuss this please fill in our contact form.
Finding time for career planning
The biggest barrier anyone we see at Medical Forum has when thinking seriously about the trajectory of their career is without any doubt "time".
Without time for reflection - properly allocated and.... preserved - it is hard for anyone to make genuine progress.
The second barrier is fear. Of? Having to face things that perhaps one has been in denial about or which feel insurmountable.
The third barrier is structure - or rather lack of it. The process of reevaluating a career has various stages to it and if one launches in at the wrong stage without having done the preparation first - it is very easy to default back to take no action mode. When early forays into career development are unsupported and don't work out it is all too easy for the individual to give up at that stage and revert to tolerating an unsatisfactory situation. From here - it can only be a few steps away from chronic career disillusionment syndrome and possibly burnout too.
As a way of getting around these barriers - one of the first things we do is a preliminary phone call (after one of our questionnaires is completed) to assess whether burnout is present, whether no time is currently available for career planning and if the latter is true - how to engineer this into place. Where fear is present - we have an ebook which helps to turn that frightening uncertainty around into something more proactive... learning about how to culture the right attitude to career planning from a position of being extremely wary of it.
It is in fact all about putting some structure into the amorphous and at times overwhelming mass ( or mess) that career planning can feel like as well as making you feel supported.
When a career is ailing in any way at all - taking action is the key.
Waiting and waiting and waiting - without action can easily lead to situations where the sparkle is so far back in time and the energy so depleted that even beginning any form of proactive career reevaluation feels terribly painful or scary or both. This is often when burnout sets in.
The key is to start proactive career planning as a student, to learn the key skills required for doing it well and to realise early on that it is YOU who is the driver of your career. Yes other people will require you to jump various hoops if your chosen plan requires that. Yes there are limitations as to which rotation or location you can get an NTN or consultant/ partnership - but it is still YOUR plan and no one elses.
You hold the career chariot reigns. You make the decisions
The big challenges are
- the goal posts keep changing
- the workload keeps increasing
- unacceptable working styles and practices are evident
So how on earth to navigate this and if you are well enmeshed with a mortgage and responsibilities or already at the career points of GP or consultant or wherever you have aimed for.
The trick I believe is to do not just an annual career appraisal ( which is really for your position and effectiveness within the organisation that pays your salary) but an annual career review. This is an altogether different animal to the appraisal.
Firstly - you don't have to do a review.
Secondly - it is an optional expense for keeping your career on track at all times ( and thereby avoiding drifting into situations from which it is hard to back paddle).
Thirdly - it is 100% entirely for YOUR benefit - and not for anyone else and is thus 100% private.
My view is that people often book holidays and buy new cars - yet find their work is destroying their very enjoyment of life.
What is the point of having a fab holiday only to be dreading the return to work.
So I think it must be a perception for many doctors that they can't do anything about their working lives. A view that I think is very wrong but it otherwise doesn't make sense to spend money on holidays when your working life is slowly killing if not you - then the passion which you once had for your career.
I should point out here that our career review programme comes with a guarantee - you can fill in the workbook listen to the audio and read the guide and if you feel you have joined the wrong thing for you - there is a full no questions asked refund.
The NHS and the government has a tendency to think it somehow "owns" its doctors' careers.
It does not.
But it attempts to and everyone appears to assume that it does. This disempowerment has to stop.
Tying medical students into five years of contracts once they start work might seem a good idea but when the armed forces do this - they pay for the student training or offer tempting grants. So yes - by all means say that "if we pay everything for your training then you need to remain for x years". That sounds like a fair deal.
But to say that you pay for your training - you get the loan - you pay for the privilege of studying medicine, you pay for all the postgrad exams ( and often the courses) but ..... we then insist that you stay - is somehow wrong and will I believe backfire like has never been seen before in medical recruitment terms. It is an under sea tectonic plate just waiting to sublux.
Will that reverse the trend and make medicine an attractive career option again?
Err that'll be a NO then!
Conversely - make medicine ( as a purely vocational degree that has shortages of applicants and shortages of doctors) a grant supported degree with no fees.. and the numbers of applicants will increase and so will the quality and bredth of candidate applying.
I won't even go into selections procedures for how to get the right sort of doctors who don't WANT to leave and what sort of career planning support should be given at medical school - I could write BOOKS on the topic. But 27 years working with doctors whose careers have in some way or other become stuck or drifting or on a plateau etc - probably makes me uniquely qualified to advise on what modifications to make to the curriculum and selection.
But of course - the medical schools, GMC, BMA and the government know best (?)
I should mention that I have been ever so slightly on the subversive side since childhood and just adore questioning the status quo - but they do say that it is people on the outer edge of the envelope who influence the tipping of the spinning plate - not the sheep huddled in the middle. I rest my case.
It is really easy - if ones career is not bringing joy - to view career planning with great suspicion.
How could it possibly make any difference to a drifting or stalling trainee or a plateau after CCST or partnership.
However, attitude to career planning is key here.
First and foremost career planning should be an enjoyable activity that one looks forward to doing from which one gets results that take one closer to where one would like to go.
It is vital that one maintains this attitude and realises that whilst you may be welded to your own idea of what a career in medicine should be - the scenery and systems change so fast that adaptability is fast becoming the top medical career planning skill.
People don't career plan for a number of reasons
They assume they can't change things
They feel trapped
They are exhausted and or with no time in which to do it
They think it means leaving what one has achieved behind
They feel it is financially unwise
They don't know where to start
They think it is somehow "not nice" to do so
However, well supported career planning addresses all of these concerns and encourages ways around them, attitudinal expansion and plenty of risk management. It is never ever about leaping into the blue yonder without a parachute.
By the time some people reach out to Medical Forum they can be quite sceptical about career planning - such is their disillusionment with where they are right now.
If there is a dissonance between where you are and where you expected to be - there is bound to be some dissatisfaction. However it can be even worse if you never had clear expectations and clear career goals in the first place. If the latter is the case - how on earth can one think one could end up somewhere that meets needs and matches what one wanst when one never defined these? It sounds such an obvious thing to say yet it seems many people step onto what they think is a training conveyor belt and hope that will take them to where they want to go.
You can take 100 trainees in the same specialty and not all of them will end up with the same careers. Far from it. The difficulty lies with lack of time being put to career planning, lack of training, lack of culture that s
"but I am planning to take my MRCP - that's planning"
Well yes and no
MRCP is a hurdle
A stage along the pathway
But it is not strictly career planning - it is about 5% of a career plan.
Doctors need far more help in steering through the career maze , defining their own particular blend of talents and how best to use these.
When I set up Medical Forum 27 years ago - everyone said "but doctors do not need career guidance".
The current burgeoning of career coaching and career conferences I think finally has proven me right.
But we were the first - by some margin!! (sorry but I think a wee trumpet blow is called for there).