Burnout and the Dermatologist

Over the years, I have followed the level of happiness of dermatologists with great interest. One of the best aspects of being a dermatologist, in my opinion, is the ability to practice in a positive environment with patients who are, in general, happy and with staff who benefit from the overall satisfaction level and thus reinforce the “happiness loop.” This year’s Medscape ratings on happiness, burnout, and overall job satisfaction concern me greatly, however.¹

The last pre-pandemic survey of physician happiness outside of practice showed dermatologists with an 85% happiness rate (highest in the specialties was pulmonary medicine at 89%, with plastic surgery coming in just under dermatology at 85%).² The most recent survey, which was collected between June and October 2022, tallied out with dermatologists at a mere 62% level of happiness and, even more frustrating, plastic surgeons leading the list with a 71% ratio of happiness.¹

What a difference a pandemic makes! As a specialty, dermatologists dropped from the #8 spot to the #11 spot, but truly, the fact that plastic surgeons were the happiest made me the saddest. Really? On the other hand, we could be infectious disease specialists, with a 47% rate of happiness…¹

Another area of ongoing slide in overall happiness is that of women in dermatology, which reminds us there is much to be done in our specialty. The gulf of happiness between women and men dermatologists, with 51% of women dermatologists experiencing burnout but “only” 35% of men dermatologists reporting this feeling, is palpable.¹ And, 14% of male dermatologists report feeling both burned out and depressed, whereas 15% of female dermatologists report it.¹ Dermatology is the specialty that presumably allows us to “have it all,” but it seems that there is discordance if you are not a male dermatologist.

The important factors that dermatologists ascribed to burnout included bureaucratic tasks (77%), insufficient compensation (35%), EMR woes (30%), and lack of respect (patients 29%, colleagues 28%).¹ Government regulations and lack of autonomy as well as feeling overworked round out the list of causes at a lower, but demonstrable, percentage.

Interestingly, despite this decrease in overall happiness, dermatologists rank second as far as happiest marriages (86%),¹ which hopefully bodes well for their overall family life.

From here, the question is: What can be done about this and is it even something that can be “solved?” My hope is that it can be ameliorated, if even in modest amounts.

The survey seemed to tally a group of potential reasons for happiness ranging from the type of car you drive, the amount you exercise, the amount of vacation you take, spiritual beliefs, hours on the internet, alcohol consumption, and parental conflicts. These are all important contributing factors, but I don’t know that any one of these will make or break your overall happiness—although a new car does seem like an attractive option!

My take on this has been—and will continue to be—that we are our own creators or detractors of our happiness. Whether or not life inside your career is happy there are ample opportunities to positively affect your outside life, which is truly what this study was measuring. These can be as simple as making friends in social activities or spiritual endeavors, rekindling relationships, or taking up a hobby. Often, the most logical solution is the easiest, which could be to start exercising or treating yourself better. In the last editorial I wrote on burnout, when the previous results were published, I considered cutting down my hours in the office (although attempting to see the same number of patients by shortening my lunchbreak). When I started in practice 30 years ago, my staff and I weren’t as efficient and I traveled to satellite offices, which meant I put in an inordinately long lunch break of 90 minutes. We are much more streamlined now and that gap between the morning and afternoon schedule was taken up with emails and unnecessary activities that could be done at home in this digital age. The benefit of this small change has been remarkable. Not only have I spent fewer hours in the office but my staff has been incredibly happy with the changes. On top of this, we cut out any office hours on Friday but due to the compression of the other hours we allowed more staff to work during the remaining 4 days (Monday through Thursday), which allowed my entire staff a 3-day weekend. If you are considering this, I highly encourage it! The one thing that can’t be bought is “time,” but this allows us to reclaim time from our busy practices while also seeing the same number of patients.

In the meantime, I have also changed certain things in my office to in order to experience more joy. These changes were minimal in nature, ranging from changing out light bulbs in the exam rooms with more pleasing lighting to replacing the floors in the examination rooms. These may seem like minor efforts but the overall increase in joy every time I enter the examination rooms has been significant. Of course, in order to appreciate a change you must be “consciously thankful.” This, too, leads to happiness.

Change may be the common denominator in promoting happiness. You may find minor changes in your everyday life or practice that are of minimal cost can bring you maximal happiness if you make the effort. Even if you are in a hospital or corporate practice there may be simple improvements that make financial sense to undertake and are acceptable to your superiors/management.

I also believe that some of the added burnout/fatigue could be because an increasing number of physicians unfortunately seem to have gone into medicine (and dermatology specifically) for the wrong reasons. While dermatology can certainly be a lucrative profession, there are many other easier (albeit, less fulfilling) professions in which high achievers can be accordingly compensated. Those who worship the dollar number on their paycheck or their number of Instagram followers will never have enough money or enough fame and will live less satisfying lives. It is my hope that the newer approaches and the refocus on holistic application review by medical schools and residency programs can filter out those applicants who either misrepresent their motivations or are simply lying to themselves. Sadly, the more rational side of me doubts these non-genuine individuals will be uncovered other than over time.

Lastly, it is important to consider if burnout should be placed on a sliding scale. We talk about it as if it is an all-or-none phenomenon when it really isn’t at all. What about the “I hate my job” phenomenon? I hope that most dermatologists would never be in this category. Instead, perhaps they may not love their job as much or find their work quite as fulfilling, but there is a huge difference between these two extremes and with some luck and a little work on our parts, we find ourselves moving closer to the positive end of things. And hopefully ahead of the plastic surgeons…

1. Koval, ML. Medscape dermatologist lifestyle, happiness & burnout report 2023: contentment amid stress. Medscape. Published February 23, 2023. Accessed March 3, 2023. https://www.medscape.com/slideshow/2023-lifestyle-dermatologist-6016074?reg=1

2. Martin, KL. Medscape dermatologist lifestyle, happiness & burnout report 2020. Medscape. February 12, 2020. Accessed March 4, 2023. https://www.medscape.com/slideshow/2020-lifestyle-dermatologist-6012486