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Burnout and the paradox of expertise
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- čas přidán 17. 08. 2024
- Let people do more of what they like and they’re good at..? Very novel thinking, I know.
Why do we make our most experienced people do less and less of what they’ve spent years getting good at? I think it’s even more pronounced with nurses, some of the best clinical nurses I know are forced to do unending mountains of admin rather than interacting with patients. Managers, contrary to the common trope, are also highly trained and experienced, with a totally different skill set to me. I’m not cut out for being a manager, and that’s okay to admit. We can’t all be good at everything. Whenever conversations come up about “upskilling” people to do doctors’ work, it’s always about the interesting stuff like operations, strange that no one wants to upskill into taking on medicolegal responsibility and onerous administrative tasks. Anyway, rambling nonsense as usual from me. Slept like a baby last night, 9 hours! That’s literally double my usual but oh my days the sleep after a long on call, where I can just turn my phone off, is glorious beyond words.
This is what happens when you cut back on “those useless paper pushers”. Someone who is trained in something else has to start pushing the paperwork around.
Completely agree. I’ve never been on board with the endless manager-bashing that happens in healthcare. Ok some people are bad, but so are plenty of doctors. A good manager, whose skills are totally different to mine, is worth their weight in gold. To assume doctors can do their jobs (leave aside whether they want to) is dismissive of their training
@@medlife2sounds like you need ... the word "manager" is not always that popular - but an informed administrative shadow & sidekick. Someone who knows enough, *experiences* enough of your work that they can distill questions and draft & prep replies and reports, and then get you to check & sign off their work. Someone good enough to, in that way, cut your admin time by, say, half?
Has there been a reduction in headcount for administrative roles?
I completely agree.
Though my first thought was not "manager". It was "SECRETARY or PA". 🤔
@@christianpadilla4336 it's an easy jab the politicians like to take. The NHS needs more money, they don't want to spend more money so someone does some efficiency analysis, they find that X% of the NHS staff is admin and management, they announce a policy that they're removing useless managers and admin staff to spend the money on doctors (to much public applause), the work they did still needs doing so medical staff have to pick it up instead. Repeat this every couple of years and you're left with doctors and nurses doing all the admin.
Burnout comes from not being in control or not having sufficient authority to do the right things, not from work overload. Work overload makes you tired, but that will go away with some rest. Being in a situation where you know what needs to be done but lacking the power and influence to do something about it is frustrating to the point where you cannot stop thinking about it.
burnout can't be fixed with more money, either...
This sounds like something another psychiatrist on CZcams said. Burnout isn't necessarily from "doing too much" but it's from not doing enough of what you want. It's not the amount of work, but the kind of work you want to do, whether you like being on the floor with patients or if you are someone who actually does like the paperwork.
I think all professions have this. We want to do what we got into the job for. Not stare at a screen doing menial admin tasks. Programmers want to code and problem solve, not sit in meetings; scientists want to do research not write grant applications; techers want to tech, not budget for supplies; engineers want to design and test, not increment contract revisions.
Im an emergegency department administration clerk. I enjoy trying to make the doctors lives as easy as possible by taking on any of the admin load so they can focus on patients. They make me feel appreciated for that
I remember hearing in a podcast that burnout happens when people do work that they don't feel is meaningful, not really overworking as it is seen by a lot of people.
That's exactly it!
This reminds me of last week's BBC radio 4's more or less. They were discussing the Tory plans to save money on the NHS by cutting managers. However, they looked at the stats and think the NHS is chronically undermanaged. Only 2% of NHS staff are managers versus an average of 9.5% in the private sector. What that means is that experienced, highly trained staff are wasting their time doing management jobs instead of the things they spent all that time learning to do. This is exactly what you're experiencing. Trouble is, no one is going to win an election by promising to triple the number of managers in the NHS.
I would like to live in a world where, if I'm so sick that I'm literally dying and need to be rushed to a hospital I'm not being evaluated by a guy who has slept 3hrs in the last 36.
Agree. Airline pilots and other dangerous professions are absolutely banned to do this... and yet doctors can. Insane.
senior doctors need to be provided admin assitants!
Dr Glaucomflecken has his character 'Johnathan the loyal scribe' based on his own assitant, because he truly feels they are supermen, who do paperwork and allow doctors like him to focus on actually practicing medicine.
Will seems to have a good set up but I think ophthalmology isn’t reflective of most fields. You just have to look at what most American doctors are saying to see that having scribes etc hasn’t really fixed the problems at all. I’d say burnout rates are even higher over there 😔
@@medlife2 Sigh, I think admin is a beast that expands to take up all the space available, and maybe providing assitants just increases the paperwork requirement and gives the beast more space to grow.
I was a teacher for eight years and I loved every minute of it. Then they promoted me to department head and I burned out (and quit) in two years. Every word you said - about meetings, paperwork, being deluged with emails - really resonated. Thank you for this video!
I know a guy who works in a concrete goods factory who complained about basically the same thing. There was a tendency for the best team leaders to get promoted into mediocre managers. These guys were valuable for their detailed process knowledge, ability to get new hires up to speed quickly, and generally keep the floor running smoothly. Many of them got into the profession specifically because they found purely mental tasks extremely boring. But now they're mostly stuck in the office doing admin work.
The problem off course is that they don't want some clueless egghead with no floor experience in the office either, bossing the crews around. They want someone with a solid intuition for how things actually work.
Completely agree. I am an oncology RN in the US and with layoff of lower level admin roles we are now expected to take on those tasks. Yesterday there was a note in a patient chart that they needed to sign an insurance related form. No one had heard of this form (why would we as RNs) and we couldn't give this person their chemo treatment until they signed this form. It took all day to figure it out and get them to sign it electronically. All of this caused a delay in patient care because nurses are now expected to navigate insurance paperwork .
As a programmer, i am experiencing the same. 14 years of experience, and now they expect me to do more administrative and "client facing" tasks instead of programming, and i have started to hate my job.
A couple of decades ago the Royal Australian Air Force gave pilots an option to NOT go into admin, but rather to continue flying. Less promotion but stay in the Force. In part it was to curtail the exit to commercial airlines. They were people who wanted to fly planes not desks. I don't know the outcome but is exactly the same problem as you have described.
It happens to teachers too for example. If you become (say) Assistant Head (I’m in England btw), you have your teaching hours cut to give you time for other duties. Some people miss the classroom.
I feel like the biggest source of burnout is the lack of impact, or feedback. Admin work is probably useful and required to help people, but it doesn't make you feel like you saved someone. And if you don't feel like your work matters, it's hard to actually want to do it
I spent 6 years working on NHS change programmes and I was so baffled that there would be consultants spending so much time in meetings or (pre-covid) driving around between sites going to meetings - most of them pretty pointless. The requirement for clinical leadership led to clinicians being involved in every little step and it's not necessary - they need to steer the direction and say yes/no but IMO we should be freeing up as much of their time as possible for patient care and the departmental stuff that very directly relates to this (performance, audits, decision making) then dripping national/regional change programmes at a logical and manageable pace, using contact time with clinicians as efficiently as possible.
This happens across other fields as well. In the USA, I was a software engineer, quite good at analyzing, finding and resolving issues/bugs but as I progressed in the company, the only way to "move up" was joining the "management" team. I didn't want to do this so I joined a consulting firm where the same thing happened (although the money was OK).
The only way to get out of the conundrum for me was to go independent/freelance where my specialty was valued and in-demand - albeit with a different set of challenges/risks.
TLDR: go work for yourself where you have more control over how your time is spent.
You are me, but I'm having trouble adapting to the flat spots.
I left teaching shortly after qualifying and your conceptuon of burnout mirrors my experience. It wasnt the long hours, the high stress of performing in front of 30 kids (despite the added challenge if being adhd and autistic), or even the constant scrambling from one thing to another. I actually kinda liked that, because i was fully immersed in something that felt important. It was the box ticking, the pintless admin, the paperwork. Having to write multiple page lesson plans that could take longer than the lesson you were actually teaching, when you could just as effectively teach from preprepardd materials made by the department or purchased (which thankfully more schools are doing to reduce workload). It was the excessive marking that goes against what research shows to be effective. I could go on, but i love your perspective in burnout. Its not just a product of the quantity of work. Its far more about the quality
I am not sure all teachers would see being required to use lesson plans dictated to them as something which helps them stay in the job.
4:17 This is very similar to the "Peter's principle". This is a concept in management which observes that people in a hierarchy tend to rise to "a level of respective incompetence": employees are promoted based on their success in previous jobs until they reach a level at which they are no longer competent, as skills in one job do not necessarily translate to another.
I work in software, and I think big tech is much better about separating the technical track from the management track. This is probably because doctors have to have much stronger people skills as part of core clinical work than software engineers need for their core work, the average technically skilled software engineer has decidedly poorer people skills than the average skilled doctor (or the average random person picked off the street) and it becomes very obvious very quickly that promoting people with excellent technical skills and poor people skills away from technical tasks and into people management is a very bad, very unprofitable idea.
You can never get away from an increase in meetings & paperwork because if you have developed substantial skills and experience then to make maximum use of it you have to distribute the results of that to as many people as possible (written guidance, using your experience to assist in high-impact discussions on difficult projects, training people to accelerate the development of their skills, so on) but it would never involve people-management, which is a very different skill set with very little cross over.
Good managers need a good baseline of understanding in the technical side of things if they are managing a technical team but they don't actually need to be technically skilled so much as just technically aware. Technical people need to have people skills but nowhere near to the same degree as managers.
I would like to add something that I too noticed at a large scale in many companies. Everywhere you have the trend to promote people that are doing well, very often into new fields of work or into management:
So you basically promote people until they reach mediocrity and therefore can't be promoted any further. Done at scale, you create people that are mediocre at their job, often outside of their expertise. With this comes burnout, i.e. a state where you are dealing with negative stress that is not eu-stress until you collapse.
This is called the Peter principle and is well-known.
This happens in the programming world. One you've been a senior programmer for a while the next level is to be a manager, where you don't write any code? So you spend years getting really good at programming so you can stop programming and tell other people how or what to program instead. Then sit in endless sprint meetings and meetings planning the next sprint.
This system rarely works well because people who get really good at coding tend not to be 'people people'. I'm not saying they're not nice, they are usually very nice, but their skill set isn't managing people. Their skill set is sitting down in a dark dank basement and churning out code
The best software companies have two career ladders - a technical one and a manager one. So somebody who's good at coding can be promoted without switching into management.
Although imho a senior dev role would necessarily still include a lot of "people skills" - training and mentoring juniors, collaborating with other teams... and crafting requirements documentation for the people who are sitting in a dark basement churning out code.
This is a common phenomenon in some engineering disciplines as well just with less burnout as our day to day stresses are probably less acute as you folks would say. I think theres a niggle in the back of our minds which knows we love the technical roles we've trained and enjoyed doing and all these admin, line management or other distractions prevent our enjoyment so we consciously and subconsciously dread those tasks. The work that strokes our inner nerd ego is crucial.
This is so common across many industries I think. As you get more experience you do less of the thing you are supposed to be good at.
This is solved (to some extent) in software companies where there are usually dual tracks for promotion management or engineering.. and often the top devs are earning way more than their managers. I think this is something that needs to be embraced across more industries so experts can be experts in what they want, people managing and admin and engineering(or doctoring or whatever) are different skillsets that belong in different roles
I did years in hospital medicine without getting burn out, despite the horrendous hours and incredible work load.
Having defected to GP later on in my career I finally see what burnout truly is. Working as a GP is like a conveyor belt of admin, it feels more and more like factory work as time goes on. Trying to provide the best care for patients in just a few minutes and the constant fear what something will be missed because we are pressured to see a certain number of patients without any thought to how well we are treating them. Utterly demoralising.
It’s an age old issue. Not wholly a silver bullet but IMO the production world has a model worth considering for adaptation.
The manager equivalent is the ‘Producer’. While folks can be a Production Assistant and in ways work their way up to becoming a Producer, there isn’t really such a route. A lot of Producers are trained to take on a Producer’s role.
While compensation can vary, typically a Producer doesn’t necessarily make that much more than say a Director.
Allow management to become a function and less a reflection of hierarchical/career seniority. So medical professionals can remain doing what they do best (like Directors can focus on directing and Producers can help string things together across various departments).
It’s not perfect but it’s an approach that’s withstood and pulled off large scale operations (massive movie sets with crews and talent numbering in the hundreds and thousands).
I see people mentioning the "Peter Principle" which is clearly not what Medilfe Crisis is talking about. That deals with competency at work, not burnout. Medlife Crisis is clearly talking about enjoyment and why he became a doctor, not that he is incompetent at his job.
The mechanism is similar though.
The other insidious thing about the admin work is that it's not included in the schedule (and in the US, it doesn't earn income, so management wants to pretend it doesn't exist.) You get allowed 15 minutes to see a patient and 0 minutes to deal with the notes.
I think the push to get rid of "middle management" (not just in the NHS) by previous governments has made the admin load for many people get overwhelming. As you said people dont train for years and years as doctors / lawyers / teachers / whatever to do admin like organising rotas, shuffling budgets etc.
People see managers as a waste, but it saves the specialists from using their valuable skills on paperwork
I am a software developer, but I abolutely can relate. Administrative chores are the worst and #1 cause for stress and burnout. Also the more senior you get, the less actual programming you do is true here as well
Same boat here. for me, it has exponential decreased over the years, so much so, that I look forward to when I would do what my job profile says I do.
Makes sense! For software engineers, in some companies, this species of burnout is recognized and addressed by providing two distinct career paths. Juniors become seniors, same as ever, but after that the path bifurcates: if you want to progress further you have to choose whether you are happy to take on more admin/paperwork kind of work and become an Engineering Manager ("EM"), or progress up the Individual Contributor ("IC") path, which is equally respected and paid, but keeps the admin/paperwork to a minimum.
There is an idea (and book) called the Peter principle, which is pretty much what you describe. As you become more competent at your job, you get promoted until you are no longer competent. e.g. great teachers become school principals where they do little to no teaching.
In my experience, many of the best teachers stay in classroom, certainly in British primary schools anyway.
I am sorry but I couldn't focus for that magnificent beard! It's almost out of Tintin Comics
I recently learnt Captain Haddock is based on a family of Navy sailors called Haddock from very near where I now live and Captain Haddock’s ancestor in the stories has my name, Francis! Blistering barnacles!!
I suspect his beard to be the source of his energy and joy, not delirium through sleep deprivation
They just don't hire enough people, what you need is a PA who helps with admin while you can do what you're good at. But people are a burden to how much the top people can scoop off for their own profits and bonuses. Advocate for more employment openings, that'll solve it.
As I noticed everybody else commenting -- I came here to mention research/academia. I got a bit of a sense from this watching my phd neuroscientist dad constantly stressing about grants later in his career, but it became really clear to me whilst doing research for my masters in physics. Seemed like my advisor only ever left his office for meetings -- I don't think I saw him do a single piece of experimental work in all my years working with him. Kind of sad, doesn't seem like a good time
Yes that was one of the many reasons I quit academia, I think it was even worse there
Keeping people busy busy is a great way to keep them from rebelling though.
Imagine what would happen if we all had a chance to understand just how dysfunctional our global society is.
We are crossing 6 out of 9 planetary boundaries and g Earth Overshoot Day is coming up fast 😢
I'm a retired computer programmer now, but in my profession, the same thing happens. I loved to code, but I hated the management part of it. Some people want to go into middle management and beyond, but not all of us. Get some rest, and thanks for your service to medicine, and to your contributions here on CZcams.
Absolutely right, don’t apologise. I’m Technical (not medical) but it’s exactly the same, we bury our best and brightest in paperwork and politics. Sorry, I don’t have a solution either. We need to stop valuing bureaucrats and salespeople over people who actually “do” stuff.
Remember when in antiquity peope had scribes? This should be true now for doctors like you. ❤
It makes perfect sense.
The way I think of it is: our brains are optimised for medicine.
We’ve spent years fine-tuning our neurons to hear patient stories, perform physical exam, do practical procedures. So that becomes fluent, automatic, second-nature.
All the admin/managerial stuff is a foreign language. Even the most menial of tasks can be mentally draining if our brains are working overtime at it!
0:03 Oh thank god! I've been holding my breath for three days straight, I almost died! Thank you so much for telling me to not hold it in!
Admin ballooning is what happens when a centralised system notices things aren't going right and starts to add more and more processes to police the basic process in the fundamentally mistaken belief that this will increase output. Has been happening in the NHS and other areas of UK admin failures for decades. Happens in the private sector as well, particularly when companies grow or merge. You have to train people to do the job and do it right and make the process as mistake proof as possible not train people to add more and more layers of controls and checks of the controls and controls of the checks ad-nauseum.
As a teacher, I can massively relate to this. I’d much rather teach fractions to a class of thirty 7 year-olds, or deal with a pupil throwing stones at glass windows because they didn’t eat breakfast today than complete a load of paperwork in case Ofsted show up. I would imagine the same is also true for the Police, having to do all the paperwork that used to be done by admin people before cutbacks. Massive respect to you and everyone else who works in the public sector.
I've run into another facet of this in the software industry. Here, it's rare to encounter work as meaningful as yours, most devs aren't saving lives. However, it can help a lot with regard to burnout if you learn to enjoy certain types of work. I don't believe that what we like and dislike is something innate and immutable, sometimes a shift in perspective is possible like an acquired taste. eg. if you're going to have to clean your home regularly, you might as well learn to enjoy some part of that process rather than giving in to the feeling of it being miserable
I tell people I do still code, just vicariously through PR reviews!
It’s sucks that the only real steps up from “sr software dev” are managerial or architectural. There’s a limit to how far you can go by writing code.
At some point there's a limit as to what you can achieve, the impact you can have as an individual. That's what leads to the lack of "step-up" potential. I get that's what you've trained for, and what you enjoy, but what's going to get you the big $$ and recognition is taking on responsibility for a wider team, getting a whole group of people working well together and kicking goals together. Doing the admin work like planning around skills shortages, whether through training, or bringing fresh talent into the team, making sure your team remain happy and motivated etc etc. The skills required to be a manager are kind of orthogonal, but in my experience the best managers have come up through the ranks and deeply understand the domain that they operate in. In software, I guess it's _possible_ that you could be an absolute rock-star and sole-build a product that creates (or saves) many millions of dollars and get commensurately compensated for that, but it's much more likely that anything large-scale is going to require multiple people working together and some level of orthogonal co-ordination/planning/bureaucracy. I imagine it's much the same for medicine; you might be able to save 2 or three lives a day as an individual, but if you can build a team around you and support them and remove bureaucratic load to allow them to achieve at _their_ best, you might be able to boost that 10 or 100-fold. I know lots of people, myself included, who have cycled through management and individual contributor roles, because both are rewarding in their own way, but too much of either leads to burnout.
@@gunderd I understand the joy of building something bigger by leadership, and I definitely do that in my own way, but in my case I couldn't handle the management track, and if I get too far from what I'm actually good at, I emotionally break down and I'm not good to anybody for anything. So for be, this video rings very true.
what you were talking about half way through the video is very similar to the peter principle. to quote everyones favourite source of knowledge: "people in a hierarchy tend to rise to "a level of respective incompetence": employees are promoted based on their success in previous jobs until they reach a level at which they are no longer competent, as skills in one job do not necessarily translate to another."
Identical issue in academic research - the more senior you are, the more time you spend writing funding proposals (most of which will fail) and managing your research group, with vanishingly little time for actual research (which is mostly done by grad students and postdocs).
My assumption from my experience in emergency medicine and internal medicine is that - These burnout phases, the sleep deprived nights, and all the continuous long shifts and these acute emergencies; are actually stressful and puts the body in a flight/fight response state, induces cortisol release, and the adrenaline rush is what keeps us thrilled, awake, excited and wanting for more. The high is great. Once you get off, and your satisfaction ends, you tend to crash like there is no tomorrow. But at the same time, I also wonder if it is any good in the long run? 😅
It appears that to save other people’s lives, you must destroy your own…
Acknowledged the bayesian perspective and then updated his belief verbally, what a guy!
Thank you so much for making this. I’m a med student currently, just finished my first year; for a long time I’ve kind of had anxieties and insecurities about not having had many leadership positions in my life and asking myself questions about if I even want those types of positions or if I just feel guilty and weird about not pursuing them because I’m an ambitious person in general, not because I actually want to be in those positions. I think the answer after seeing this vid is really more or less “no.” Depending on what I end up wanting to do, it will probably be important to pursue some sort of leadership, but also, I don’t want to do that admin shit. I know I’ll have to do much more than I probably will ever want in my career, but I think this vid has helped clarify for me that I need to look really carefully at things as I move through my career and determine what the actual day to day work of a job will entail before I pursue it.
This is precisely the kind of work that AI should automate, not generating poetry and art! These soul killing activities!
Thank you. Forwarding this to my GP wife.
Me too!
Every bridge a construction worker makes or repairs allows a medical doctor to get to work; every construction worker a medical doctor saves allows a construction worker to get to work.
Back in the day, Sweden got rid of secretaries for doctors, but didn't really increase the number of doctors. No surprise it was a bad decision but I don't think it's really been resolved, everyone is busy being penny-wise. I think it was seen as an upperclass snobish thing but then forget the secretary has lower salary (so keeping notes costs less), and keeps the doctor engaged with patients instead of writing journals. I think about that every once in a while...
And even if doctors and secretaries were paid the same amount, a sectretary who does adminstrative things all day is more effective at those tasks compared to a doctor who only does those things in between actual doctoring.
It's identical in academe. Absolutely appalling. I miss teaching *terribly*, I miss research, but I am very grateful indeed to be away from all the paperwork and meetings. It simply cannot be necessary--there must be a better way.
As I grow in my software engineering career I think about this a lot. In a perfect organization, senior leaders should not be bogged down with administrative tasks and management. But rather given the tools to take their skill and magnify it by leading / growing their younger peers skills, consulting and guiding.
You may get less day to day direct medical practice (or coding in my case) but you will still be doing the thing you love in a more high level, and thus pretty cool, way.
Sadly not the norm though
Incredibly sensible analysis of this problem, seems to be in every industry now. I think we've all been sold a bit of a lie that constant upward movement is key to a successful career - when in reality a successful career is one that fulfills you and for a lot of people that does not involve being a manager and drowning in paperwork. I also think this explains why so many people are talking about having terrible managers now, because your manager has had no training and has just 'moved up' as they are 'meant to' when in reality being a good manager is a totally different skillset to the actual job they did before!
There is a managent rule that I find marvelous: the burden of getting dashboards or statistics should be borne by the person/dpt who wants to read them. There is some medical writing I could find legitimate, like filling the medical file and instructions/explanations for the next shift, but the rest -> fuck off, I'm a doctor.
This ("promoted" to admin) happened to my primary care physician and I'm bummed for both me and others, because he is an excellent doctor and I really trust him (I don't trust easily). His experience, compassion, etc is so needed by patients, not admin. That said, in my experience, admin people with limited medical background can definitely be prone to mistakes.
Agree. Admin is a monster and I am not really that certain it cldn't be organised differently. What are Administrators for? I used to work as a PA/EA and these are senior administrative jobs. Yet, if you see job ads these days people who don't understand the profession, because they are HR or Management ask for business administration degrees. Business administration is not the same as office administration. So they hire people who lack the right qualifications and mindset and wonder why things go so wrong for them in the long run. A business administrator will be bored out of her mind in an office administration role. Meanwhile a lot of office administration that was the PA's work is done by the manager's themselves and so the role becomes less interesting and you need less qualifications/experiences for it. So senior staff moves on to do something else and we lose the skillset. We are walking in an office administration crisis that will cause issues long term. If you have to do a job that isn't actually your job, you will get bored and burn out or self-sabotage. This breeds inefficiency. Do you really need to be a qualified doctor to maintain that spreadsheet? Your hourly rate is the same for looking at a spreadsheet as it is to save someone's life. So either saving a life is massively underpaid or are you massively overpaid for looking at a spreadsheet? It's probably both since you work for the NHS, but is that efficient?
It was very similar when I was in the police. As a PC I would spend way more time chained to my laptop filling in endless forms and juggling way too many jobs than I could actually focus on than out on the street doing what I joined up to do.
Yeah, seniority is a strange thing. I'm actually dealing with it on two fronts (my day job and my city advisory work that's a substantial volunteer gig). I do feel like I'm getting less time to expand my tech skills at work but am getting somehow more experience/competency with learning how to delegate workload and assess the rest of my team's performance. The one thing that's keeping it from becoming actual burnout is I am also learning the requirements and processes for geographies outside of my home region, so I am at least part time in the trenches. I can't wait to be back at the junior ranks in a different field of my day job. Hopefully soon.
a addition to this could be to do a mentor program (if you care for it). Seeing new (often younger) people going to the same motion you have been can motivate you. In those cases your seniority is actual useful as you can help them with your skills you developed on the job.
plus then you also have to do the down and dirty job in order to show them how to.
If you're familiar with Japanese TV drama (J-dorama for short), this was your Michiko Daimon moment. She is the protagonist of a J-dorama called "Doctor-X" and is basically a female Japanese counterpart to Gregory House, M.D. - only that she has a lot more Japanese hospital bureaucracy to contend with, has to contend with sexism, and she just really wants to take on challenging surgeries, and, y'know, be an actual doctor doing doctor things.
"Doctor-X" becomes repetitive after a while, so it really isn't recommended viewing, but the basic theme is strikingly similar to your situation.
Even House is repetitive imho
They could do that thing in defence where technical people are promoted up the technical levels in parallel to the non-technical or management levels. So just like the management people as a technical person you can keep getting more money and responsibility for your skills, but the managers do the logistics, meetings, selling.
It does indeed happen in every job. I work horticulture but literally only the lowest level actually does horticulture on a daily basis. The higher you go the more time you spend reading emails, sorting forms and negotiating with humans I imagine many of us got into horticulture to avoid dealing with. Tragic tbh.
absolutely agree.
the closer you are in your activity to your purpouse and genuine skills, the more the activity energizes you and puts you in the flow.
what a gift it is, at the end of the day when you are exhausted physically and absolutely bissfull mentally ❤
wishing for people to have the ability to recognize what their sweet spot is and getting a carreer in it. and for the carreers to be flexible enough to be able to share the load. i am sure there is a person who is a genuine supporter by nature, who would enjoy taking on the admin&meeting part of your job so you can be covered in blood and saving lives ❤
It's so unethical to have doctors work so long. Sleep deprivation causes worse cognitive disruption than being blackout drunk.
To be clear, he's getting called in a lot but it's not literally 72 hours of continuous work. Still very hard work but not *quite* as bad as it sounds initially
This is why I turned down an admin position at my university a few years ago. It would have meant better pay and more respect from my peers, but I decided to stay a humble lecturer, since I sensed that if I had to do admin stuff that was impersonal and that would likely go unappreciated by people around me, I’d start hating my work and eventually wouldn’t want to get out of bed in the morning. So for the moment, I get to teach students who care about research and knowledge, and to help them gain important insights. That’s worth more to me than what I would have gained as a program director. An unpopular move but I’m lucky enough that I wasn’t desperate for a pay raise and didn’t feel I had to do it to pay our rent. Agree that senior consultants need to do more medicine and less paperwork, but who is going to agree on the balance that Rohin is calling for?
I think that most ALL jobs (not just medical ones) these days are being rather doused in bureaucratic tasks to the point where its challenging to even DO what one needs to do, much less find the joy in it.
Why do we expect doctors, vets, or farmers that all work with living beings. (complex, self regulating and thus tiotally unpredictable systems) to work much longer shifts than the rest of us?
Probably because they work with unpredictable systems that may need attention at any time for any reason.
God damn that beard is amazing.
A lot of burnout can also be boiled down to things that feel out of our control. Doing a bucket of paperwork because we HAVE to feels out of our control. When there aren't enough resources to go around - that feels out of our control. A couple things that can help is turning the focus to things we DO have control over, and radical acceptance. If this is how it's going to be, how do I utilize the tools at my disposal? What are all the things I have control over?
I've been working with a therapist and it takes repeated practice to change perspective like this. I was surprised at all the little things I was doing for myself that were in my power - I could make coffee or tea and sit in the sun for a few minutes, I could listen to the birds and go for a walk and pick out clothes that made me feel good. I could listen to songs that cheered me up or podcasts that I found interesting. I could take a few deep breaths or make silly noises at my cat. I know this stuff sounds piddly, but when *nothing* feels like it's going your way, it's easy to get bogged down and miss all the things that are, at the very least, okay enough.
What you're describing about seniority also applies to engineering, I find it so weird
I am a senior chaplain at a fairly large school. And your thoughts here capture many similar struggles with pastoral work. The most rewarding work is to be involved in people’s lives, helping them through difficulties, discussions and teaching on matters that give life meaning. And when you reach a certain level, there is some much admin work and “strategic” planning that the pastoral work gets squeezed out.
Similar in teaching. The better the teacher the more admin based you become and the less teaching you do. We are also expected to work 12+ hour days but only be paid for school hours. I think if you were to fill a conference room with teachers and doctors you would be able to smell the Cortisol.
Came here to say this! It's all the paperwork and emails and documentation that's the really draining part of the job. Working with the kids is what I enjoy and signed up to do.
High effort vs low/no reward I think, is what leads to burnout. Especially when you're passionate about the work.
Dude, I scrolled past your video a couple of times before I accidentally clicked on it and realised it was you! TBH, I think you look very handsome without it.
Another intense business, while not comparable to medicine, is food service. As a waiter/owner/manager at a busy restaurant, you find yourself on your feet for 12 hours, not even having had a sip of water, and the time has gone by in a flash. You are fuelled by adrenaline and your occasional day off. Yet you don't get burnout, unlike the pure chefs or cooks, who can become raging alcoholics or drug addicts.
Although I remember sitting bolt upright suddenly at 3 am one morning, remembering that I had given a customer a normdl instead of a diet coke. This was three weeks later.
I can see how the admin is affecting medical staff, at my last procedure, virtually the same questionnaire was filled out twice, and booking in took longer than the op!
Doctor: sober analysis of the paradoxes of professionalism.
Also doctor: BLOOD YES MORE BLOOD AHAHAHAHA
The cost of doing admin/paperwork by a senior clinician compared to a admin clerk is huge.
If only there was a way to clone a few Ronins...😅
Every doctor and other Healthcare workers need and deserve a Jonathan.
I think you and Cal Newport need to collaborate and talk about the intersection of deep work and medicine. I think it would be genuinely interesting and fruitful
Thank you for sharing your thoughts on this! If I may, I'd like to share a couple of my own. The TL;DR is that we become estranged from our work. The issue isn't necessarily high work intensity alone. Though, if high work intensity is combined with a gnawing feeling that one's work might not matter, and that one should be doing something better, then that can over time lead to burnout. I suspect that alienation is a very important, and underrecognized contributor, to mental health issues in modern societies. I suggest that we organize health care in a manner where the mandate of power is issued from the professionals working directly with patient care, instead of top down. This would have to be balanced with the interests of patients, and tax payers of course.
Now, I'd like to allow myself to be even more verbose. I too work as a physician in a rich Western European country with publicly funded health care. It is, generally speaking, a great system. I wouldn't like to have it funded in any other way. But I do believe that our system performed better before.
Where I work, one of our main issues is lack of beds in the hospital wards, which in practice means a lack of nurses. So our senior doctors, in the large (by patient volume) specialties, spend a large portion of their days turning themselves inside and out to find a way to send home patients from the ER and the wards, who still, likely, need inpatient care. The rest of the time they play patient admission tetris. Move a patient with a broken hip from orthopaedics to oncology, and then the gentleman with appendicitis to gynecology, the patient with unclear chest pain to ENT, which releases the COPD-exacerbation patient to gastro, and then we have room for the patient with the broken ankle at the neurosurgery ward. The pinnacle of any medical career, and clearly a great way to use all this medical expertise.
Health care shouldn't be a bad imitation of for profit corporate structures, we aren't making cars after all. A part of this way of managing public functions is the endless cat and mouse game of finding numbers to measure performance on the one hand, and finding ways to make the numbers look prettier on the other. Some suggest AI to help us out with administrative work, and I'm not categorically against it, but I suggest that we first look at what administrative work actually needs to be done, and why.
The selling of public resources to private companies didn't solve our issues, but clearly makes our health care more expensive and access to health care unequal for our patients. For some reason these companies tend to open clinics with a very limited scope and tackle easy-to-plan-for, straightforward health problems. The private clinics for the very most senior patients with multimorbidity, polypharmacy, diffuse symptoms and no social support net, are for some reason nowhere to be seen. And of course, to no one's surprise, the austerity measures don't help. But one of our austerity politicians, sold off many well functioning clinics in the capital, to big private companies, and after her mandate, she landed a great job at one of these companies. Things do have a tendency to work out for some of us!
But the public sector isn't innocent in all of this. As previously mentioned, it tries to emulate corporations which we don't trust. There are so many layers of middle managers before we get to the top, that there is a clear risk that the top has its head in the clouds and hasn't got its feet on the ground. One needs to ask what the pathophysiological mechanism that makes this middle manager group grow unrestrained. Do we need so much management? My coworkers and I know where the patients are, and where the coffee machine is, we do seem to be able to solve problems on a daily basis.
Jokes aside, we do of course need people to work different tasks that help us coordinate, be it our work schedules, the education plan for the students who make their rotations at our clinic, making sure that we have all our material in stock, or has the mandate to have the final say in professional (or far to often not so professional) conflicts. I believe that the issue arises when these functions aren't instituted from the people working directly with patient care, but instead are created top down. One of the very problematic reasons for which a layer of managers can be created, is because the layer above doesn't want to deal with the layer below. This is how we can get an ever growing managing group.
Let me be clear that I don't mean that managers and bosses are bad people, they are people like anybody else. The issue is that this system creates alienation, it drains our jobs of professional satisfaction, and there is nothing to suggest that it leads to better care for our patients. I've met one of the top executives in the region where I work. She is incredible in very many ways. She is a great physician and person. One can only hope to be a fraction as awesome. This is what worries me. If a person like her, at a top position, can't turn this ship, which has been sailing in the wrong direction for about 30-years, around, then what can we hope for? This means that there are fundamental flaws in our system. Something is rotten in a neighboring state to Denmark!
I therefore suggest that we should run an experiment, where we run clinics as coworker co-operatives. Instead of bosses, we will choose our chairmen (or chairpeople?) for a limited mandate, by vote. All the administrative functions will have to be sanctioned from "the floor". If the chairmen find that they need another layer of organizers above them to coordinate themselves, then they will institute that layer. At the top of the organization (and maybe at other levels as well), the worker representatives meet with representatives of the people, who will advocate the interest of the patients, and of the tax payers as well. I'd much prefer for these representatives to be a random selection from the population, rather than career politicians, but my wishlist is long. I hope that this will be implemented in medicine, education, and maybe all public fields.
I hope that this wall of text might be of some interest to someone. At least it is some self therapy for me.
Not just you, not just doctors. Most any professional who is good at what they do will attract enough business/attention to be promoted. And they will be promoted into a position that requires an entirely different skillset from the one they have excelled at and caused their promotion. I have seen this many, many times. All solutions are imperfect but I lean towards the idea of separating the roles into the skillset and the admin for the position and making them a shared role for two people that work closely together. Each then spends ~30% of their time with the other and draws on the others professionalism and with good management should be able to produce at least 70% of the originals persons output but at sustainable and growing levels.
While completely agreeing with this, back in the day I used to think it was a shocking waste having excellent engineers wasted on admin positions in Boeing all the way up to CEO . But it turns out that having a visceral understanding of a subject is not an optional extra for a manager. Now I think that the best leaders don't crave leadership - they regard it as a necessary pain to ensure a smoother functioning of their life passion.
@@DeclanMBrennan Thanks for that, it makes sense, food for thought.
I just can’t wrap my head around the fact you worked 72 HOURS f shift! Like WHAT?! How’s that even allowed and why it’s normal?
Doctors suppose to be well rested, to stay sharp and catch every diagnosis and problem of people, how do you suppose to do it after working 70 hours?!
This is madness…
Yeah you'd think doctors would be well aware of the effects of sleep deprivation
Perhaps they take stimulants. Anything for another buck.
@@none4126 It’s not worth our registration. Btw it’s not all about the money.
I work in a factory with lots of machines, we are 10 people in the maintenance department, we were getting buried in paper work, and the more senior you are, the more paper work you get.
Earlier this year, we "took" one of the girls in the office department as her temporary assignment were done there.
It's fantastic, she does lots of planning and paperwork, don't know much about maintenance yet, but is learning very quickly, and we guys get to work with the skill sets we've learned.
i'm having a similar experience working in admin at a GP surgery. Although frustrating and tiring at times, I really enjoyed working on front desk and answering phones, I found the patient facing work extremely rewarding. As I moved up the ladder into care coordination, most of my time is now spent doing paperwork on the computer, it makes the work day feel extremely stagnant. By the second half of the day, my brain has flown away and i'm barely there.
People ask me why I was just a Band 3 admin at my advanced age and obvious talent. My reply is that what kind of crazy person would want to be a manager?
I used to be involved in teaching medics and vets and I enjoyed the interactions then i was persuaded to go for a promotion and got it, the job involved a bit more admin. Then COVID arrived and the job shifted to pure admin and stayed that way after normality kicked back in, I was not that kind of person and I could not be demoted so I left and took early retirement.
As others have said this is not only happening in the medical field.
When you have specialized people working in a field, where it has taken years to reach the knowledge level they have, don't expect them to feel happy with Admin-work.
I fight with the same issues. I love the core tasks in my job. I love teaching my younger colleagues about our field. But the admin side of things, all the fighting about the money and who should do what for nothing in pay, that drains my will to go to work.
I've never heard explained WHY doctors & presumably other healthcare staff expect or put up with these 72 hour non-stop shifts with no proper sleep!
Is this just a UK thing? Why are they necessary or considered sustainable for any human being, let alone someone making life or death decisions? Why can't there be three shifts, with each shift doing a more normal 8hrs per day?
The pathway to become a doctor is so long that there is a global shortage of doctors. Doctors also generally lack the protections afforded to nurses and other healthcare staff by their unions. As the population ages and patient volumes grow incessantly with time, these two factors force doctors to work longer and longer hours.
Additionally, research exists which shows that handoffs between providers is a major contributory factor towards medical error, so minimizing them by having people work longer hours but fewer shifts is "in the patient's best interest", medical errors by tired people be damned.
French person here, just to say it’s not just a UK thing. Same over here.
I'm in a completely different field, but I've been feeling a lot of the same lately. I find myself dreading going to work and feeling inadequate because the tasks I'm having to do day-to-day just aren't what I'm good at. I got to where I am by being good at my field, and now I'm doing everything but that, and all of my creative projects have been on hold for the past 6 months and I'd been struggling to work on them for a while before that. Every night I go to bed stressed about the next day and wishing I could just skip work, and every morning I wake up and want to go back to sleep because even nightmares feel more worth being in. After work I barely have the energy for the bare minimum tasks. And when I finally feel like I have the energy to work on something, I sit down and it's like the creative part of my brain just isn't there and I just get frustrated and give up.
You need a new job or at least radical change ASAP.
You are having a burnout or is dangerously close to one.
That state can be permanent if you don't listen to your body and seek help in changing things.
I know: I will never hold a paying job again after going down hard with stress 10 years ago 🫤
I'm a scientist and more and more I do less science and more admin work. I still do science because I have few people below me. But I know that if I get a couple more people I will not be able to do much except solve problems so that the younger people can actually work. It's very ironic.
I experienced burnout in a completely different field, and due to different reasons, a few years ago. Like you, I had gotten to a place where I was starting to doub if what I was doing was what I'd want to do for the rest of my life. After some introspection, and a few months break, I realized that this was the only career for me but that I would have to make changes so that the situations that gave rise to the burnout, wouldn't happen again. And for the years since, they haven't. Everyone's situation is different, and there are different levels of change that can be made in each. I sincerely hope you are able to find a way to both keep your enthusiasm and mental health while doing the job you love.
Haven't seen a video in a while and I have to say - the beard is magnificent! This has to be some small source of solace and consolation in a world of turmoil and vexation! ;)
Tech industry is slowly coming around to the idea of having "senior technical person" who is not primarily an administrator. I'm lucky in that respect to be still doing what I love at 55. Most of my parent's generation who managed 'career progression' went into management and hated it. But the alternative was stagnation at half the salary.
The increased burden of administration is a massive problem in many sectors. People keep inventing new processes and procedures in order to "optimize" their little corner. This tragedy of the commons is what creates this unlimited growth of ever more burdening "efficiencies" that paradoxically make everything more inefficient in the end.
Thank you for highlighting this, and I feel it is EXACTLY the same for psychologists, I find the adminstrative burden and paperwork incredibly taxing, working with risk, trauma, and other kinds of really challenging presentations is not the hard part, that's the challenge we came for. Give me one more admin system change and Im out
Great to have you back and in a great humor! This was extremely well stated and insightful. Balance as a standard is unheard of any more…
I like the Russian Royalty look
Please do not draw attention to it, I am biding my time for when Putin is weak and I will reclaim my birthright
There has to be a point where the amount of documentation needed in many professions from medicine to caretaking has to stop being beneficial. I worked in a home for severely disabled people for about a year as an untrained intern (FSJ if a German reads this) and yet did a lot of the work associated with the field while the professionals had to sit in the office filling out pages over pages of paperwork that no one can possibly be able to read let alone use for anything productive.
Of course some documentation has to be there for accountability and keeping track of something for colleagues but it just seems excessive from my non-professional perspective. (I now work in a kitchen where we can luckily just do the job we’re supposed to do)
this is related to another paradox: the Peter principle where you get promotions because you're good, and stop having the promotions as soon as you're not good enough at your job, which leads overall to people having hierarchical position where they are stuck at a level "incompetence"
ahhh, I've heard the pithy refrain, but never actually understood what this meant before, thank you
Yeah... you love your job. Damn, I wish I had a job I was neutral about, liking it seems like a dream. I hope you get a better work-life balance though. Don't overwork yourself, my dude. Thanks for all the tips.