Cure Physician Burnout with Dr. Dike Drummond – Podcast #193 | White Coat Investor

Intro:
This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We’ve been helping doctors and other high-income professionals stop doing dumb things with their money since 2011. Here’s your host, Dr. Jim Dahle.
Dr. Jim Dahle:

This is White Coat Investor podcast number 193 – Stop physician burnout with Dike Drummond.
Dr. Jim Dahle:
Thanks for what you do. This last year has been hard I think on all of us. We get paid less, we do more. We have a lot of extra demands at work. We’ve been wearing PPE for months, making it difficult to enjoy our practice. I know a couple of my partners have put in for retirement this year and I’m not sure they would have without the pandemic. I think they might’ve worked a couple more years.
Dr. Jim Dahle:
It’s been a hard year on all of us, so thanks for what you do. It’s not easy work. And you may be on your way into work, on your way home, maybe you’re working out, whatever, but if nobody’s told you thanks for what you do, let me be the first today.
Dr. Jim Dahle:
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Dr. Jim Dahle:
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Dr. Jim Dahle:
The quote of the day today comes from Phil DeMuth. He said, “People’s comfort with investment volatility is dependent on their current state of mind. When the stock market is racing up, people are comfortable with volatility”. Isn’t that the truth, right? We only dislike volatility when it’s going down.

Dr. Jim Dahle:
All right. It’s January. It’s January, which means it’s time to be thinking about your finances. It’s time to get stuff taken care of. It’s time to get caught up to where you want to be in your financial life.
Dr. Jim Dahle:
We have a couple of things this month that can help you do that. That we’ll be announcing on the blog. One of which is a book. I spent most of last year working on. It’s aimed at medical and dental students. So, watch the blog for more information about that.
Dr. Jim Dahle:
All right, we’ve got a special guest today. Let’s get him on and then I’ll introduce him. My guest today is Dike Drummond MD. He’s a Mayo trained Family Practice Physician and a leading coach trainer and consultant on the prevention of burnout in individual physicians.
Dr. Jim Dahle:
He’s the CEO and founder of thehappymd.com. A website that gets 25,000 visitors a month and hosting online community of about 18,000 physicians from 63 countries. He spent over 3,000 hours doing one-on-one physician coaching and has trained over 40,000 doctors on behalf of 175 corporate clients to date, including me. He came and spoke to our group a few years ago as well. So welcome to the White Coat Investor podcast.
Dike Drummond:
I remember that day.
Dr. Jim Dahle:
Yeah, it’s been a little bit different this last year and how much you can get out and do that, I imagine.
Dike Drummond:
Well, yes. I remember the week of March 9th this year. I had several dozen trainings lined up over the course of the year and they all disappeared in five days.

Dr. Jim Dahle:
Oh yeah, I know. I know those five days well. We were in Las Vegas running a conference during those five days. So, it was stressful time for sure. Yeah, yeah, for sure. The NBA canceled its games in the middle of our opening reception. So, it was an interesting time for sure.
Dr. Jim Dahle:
But let’s start with a little bit about you. I want to hear about your childhood, how it affected your views on work and money, and then we’ll move into your training and your medical career and what you’ve done since your medical career as well. So, let’s start with the childhood.
Dike Drummond:
I was born and raised in Columbus, Indiana, the Athens of the Prairie. My dad worked for Cummins engine company. A standard Midwestern upbringing, upper middle class until I was in ninth grade when my dad took a job in England and we moved to England for three and a half years. I was an English school boy. We didn’t go to the American school in London. We went to one of the English schools and I got my O levels and learned to play rugby and drink warm beer.
Dike Drummond:
And those movies that you see where the English school boys are all in their uniforms and the teacher turns their back and they’re throwing spit wads and fighting and everything. The teacher turns around, they all sit back down again. It’s exactly like that. And in England, they are asynchronous to the American school calendar. So, when you would graduate from high school, they still have another year with a training to get a thing called A levels before you go to college.
Dike Drummond:
So, I do not have a high school diploma. When I came back, I went to Indiana University. I was a captain of the rugby team there for four years. I got a BS in biology. I went up to Mayo and did my undergrad at Mayo.
Dike Drummond:
In my family, my great grandfather was a GP back in the depression at St. Louis Illinois. And my grandmother grew up remembering times when people would put a warm pie on the front banister of the porch or tied chicken to the back porch because they couldn’t pay for their treatments from my grandfather. So, both my great grandfather, my grandmother and my mother went off to college wanting to be doctors, but came back as teachers.

Dike Drummond:
And when I was born as the first male grandchild, it was sort of predestined in my family that I was going to be a doctor, but nobody ever talked about it. Some families are very verbal about it. You’re going to be a doctor. You’re always going to be a doctor. Well, that was never that with me.
Dr. Jim Dahle:
Or you can do whatever you want, as long as it’s a doctor or a lawyer.
Dike Drummond:
There you go. But as I was the first born, I went off to Mayo and I got in. And when I went, I thought to myself, there’s only one kind of doctor I would ever want to be. And that’s like Dr. Schmidt, my GP growing up. So, I always wanted to be a family doc, full-service country family doc.
Dike Drummond:
I did my residency in the UC Davis system. Year as an ER doc, a little rural emergency room. I call it a reverse mash unit because it would stabilize people and then fly them out. And then 10 years of full service, primary care in Mount Vernon, Washington, where I was a chairperson in the executive committee of our 40-doctor group. And second busiest family doc delivered 500 babies, all that kind of stuff.
Dike Drummond:
And for me, money programming was, if you have to talk about it, something’s wrong. That’s how we grew up. If you had to talk about it, something’s wrong. So, we didn’t talk much about money. And we had pretty much what we wanted because my dad was a member of the leadership team of Cummins engine company in Columbus, Indiana. But that was my money programming. So, we didn’t talk a lot about it. And I went into a field where we had some of it, so I didn’t need to talk a lot about it when I was a young professional either.
Dike Drummond:
As a resident, we had to budget and be careful with things. She’s now my ex-wife but when my wife and I got married all the way back in Wisconsin and paid for the entire wedding out of a resident salary, which was a little over $20,000 at that point in time per year.
Dike Drummond:
And then 10 years into my career at the age of 40, in 1999, I had a really unusual episode with burnout where over the course of couple of weeks in my practice, every time I went in, it felt like somebody was choking me like a rear naked choke is what they call it in the UFC. It’s a submission move.
Dike Drummond:
I didn’t know what it was. I thought I needed some time off. I took a sabbatical for 30 days. I shaved my head. I did a bunch of yoga. I didn’t do anything medical and prayed that when I came back that that feeling would go away but it did not. It returned the very first day I went back. So, I didn’t have a lot of coping skills at the time. So, what I did was I went and signed my resignation and walked away from my medical career that day.
Dike Drummond:
And if there’s anybody on who’s listening to this right now, who is thinking, “Yeah, I should chuck it too. Just quit and leave.” I would recommend you don’t do that. And the reason is it burns too many bridges because burnout is the number one threat to your financial wellbeing. It’s the number one threat to your practice, to your career, to your family, to your marriage.
Dike Drummond:
For physicians, burnout is the number one threat to all of those things. So please don’t chuck your career and walk away. Give me a call and let’s talk about it because there’s all sorts of things you can do to get better without needing to throw it all away.
Dike Drummond:
It set me up for a bunch of struggles. About three or four years, I was working walk-in clinics. I got certified as a coach immediately. And so, I’ve been coaching doctors for about 20 years now, but ultimately my wife became certified as a facilitator, strategic planning facilitator and a facilitation skills trainer. And we developed a little training company called Super Teams. And we were actually faculty to the US Navy’s Lean Six Sigma black belt certification program for a while.
Dike Drummond:
And then in 2010 that marriage and that business went away. I was burnt to the ground for the second time and I decided to see if there was a way that I could grow a business as a coach to burnout doctors. Because I had realized at that point in time that that’s what had taken me out.
Dike Drummond:
And I launched a little website in 2010 with a name that was meant to be an oxymoron, The Happy MD. Happy MD? What the heck is this guy talking about? There’s no such thing. So, it’s meant to be a head snap. It’s meant to get your attention because most people don’t see doctors that way.

Dr. Jim Dahle:
So, we’re going to get into talking about burnout and stuff, but I wanted to talk first a little bit about this transition you made. You left a relatively high paid, relatively guaranteed high-income career for essentially an entrepreneurial pursuit that you really had no guarantees with whatsoever.
Dike Drummond:
No, I had no idea what I was doing.
Dr. Jim Dahle:
Tell us what that was like. The fear you felt, the financial struggles, if any at the beginning of that. Tell us a little bit about that transition.
Dike Drummond:
No fear, no struggle. I had to buy out. I bought into the group. I had a buyout and unwisely I use that to support my life expenses for a year and did not push myself to work in the first year after I quit. I had no fear. I just knew that I could not continue. I felt like my life was physically threatened.
Dike Drummond:
I wasn’t depressed. I wasn’t down. It was a really unusual physical sensation and everybody’s burnout’s different. But then what I did was I went back to what I knew. And so, I was learning how to create websites. I can remember within a year after I quit a buddy of mine and I started a website called check this URL out, Physician Career Expansion.
Dike Drummond:
And we were going to try and start a coaching company for doctors right at that point in time. But I was coding things with disks on a Mac and all that kind of stuff. I didn’t have the skillset and the awareness at that point in time. So, I put food on the table as a walk-in clinic doc on an hourly wage. A lot of times it was less than the agency nurse on overtime that was manning the urgent care with me.
Dike Drummond:
But for me at that point in time, it felt like a piece of me was dying every time I went in and started seeing patients again. And it wasn’t until my wife’s ability to earn income made her the most income dense person in the family that I then stopped seeing patients for insurance payments and devoted myself to supporting her business and my coaching practice.

Dike Drummond:
And by the way, you said since my medical career, I don’t consider myself to have retired. All my patients right now are doctors. I work with leadership teams of all sorts of organizations and individual doctors to create ecosystems where burnout is much less common, but I don’t consider myself to have retired.
Dike Drummond:
And I believe that most doctors don’t feel that way either because once you’ve been a doctor, your mindset and your way of seeing world is set in a way that I noticed a lot of doctors have trouble even contemplating retirement, because they wouldn’t know what they do if they weren’t seeing patients.
Dr. Jim Dahle:
You say, you viewed it as a continuation of your career rather than a different career.
Dike Drummond:
All my patients are doctors now.
Dr. Jim Dahle:
Well, let’s talk a little bit more about burnout for a minute. I’ve spent a lot of time thinking about burnout. A little bit of time writing about burnout. It seems to me there’s four big factors causing it, affecting it. And I consider them to be the first, the professional stresses of medicine. This is something that’s probably not going away with medicine. It’s dealing with the sick and injured. It’s working evenings, nights, weekends, holidays, wearing PPE these days, maintaining your licensure and board certification, et cetera. So that’s the first stress. It’s just being a doc.
Dr. Jim Dahle:
The second one is toxic jobs. These jobs where docs are under supported, undervalued, underpaid, understaffed. They got a crummy EMR. They got ridiculous administrative demands, et cetera.
Dr. Jim Dahle:
Three personal factors, things that are going on in the doctor’s life, in their personality, et cetera. And forth, financial stresses, which is essentially or especially come to root in the last decade, decade and a half or so as the cost of becoming a doctor has become so high that some people are entering the profession already owing hundreds of thousands of dollars.

Dr. Jim Dahle:
What do you think about those poor factors? I’m not sure what percentage of burnout I would blame on each one of them. Are there other things that you would add in there? How would you ascribe percentages to those causes of burnout?
Dike Drummond:
Well, I don’t think it’s a useful exercise because everybody’s burnout is different. Here’s the way I split it up. There are what I call universal causes of burnout, meaning things that all of us have to deal with that are stresses on doctors. And it’s universal. You’ve got the same stress as I do in this particular area. And there are five universal causes of burnout. And then there’s a thousand more that can be the last straw. And there’s one big one that you and I will never have to deal with. And we’ll talk about that in just a second.
Dike Drummond:
Universal causes of burnout. You chose to go into medicine. You chose to be what I call a Lightworker. At some point in time, you said to yourself, “Should I go to medical school or should I do anything else?” And that’s when your stoner friends all said “Anything else” and they were gone, man. And you are cut from a different cloth. You decided to be a helper and a healer. You ended up allying your professional life with the forces of light in the universe as they battle the forces of darkness, specific forces of darkness, illness, suffering, death, dying, family members crazed attempts to deal with those things.
Dike Drummond:
And in taking this fork at the Lightworkers fork in the road and becoming a Lightworker, you put yourself at risk for burnout, for suicide. You put yourself at high risk because in the act of helping and healing people, you can overextend yourself into burnout.
Dike Drummond:
So that’s number one. You chose to be a doctor and that is a stressful choice. You’ll be traumatized along the way, because none of your patients are going to survive. They’re all dying. You are dying too. It’s the human condition and you’ve chosen to be in the front lines of very important places in people’s lives when horrible things happen. You’re an ER doc, right?
Dr. Jim Dahle:
Yeah, yeah.
Dike Drummond:
So, you put yourself in harm’s way and an even higher level of intensity than say, I don’t know, an outpatient pediatrician. But there are things going on in emergency rooms and specifically El Paso and other places around the country right now that are traumatizing people. If they had not chosen to be doctors, they would not be in those positions right now. So being a doctor.
Dike Drummond:
Number two, whatever is your job. And most jobs suck. Because what happens when you’re taught your beautiful practice of medicine and then dropped into a corporate position, it’s the classic square peg in a round hole. And when you signed the contract, you gave the boss a great big mallet to keep driving you in that hole. So, there’ll always be things about your job that add to the stress of the fact that you’re a physician in the first place.
Dike Drummond:
The third universal stress is bad leadership. If you happen to have a bad or absentee leader or worst of all is a psychopath boss. That person will drive you out of your job and will burn you out. In my experience 30% of the people that I work with who are burned out as a coach have to change their jobs. Only 30%. 70% can recover insights you, but the 30% of have to change their jobs almost always have a conflict with their boss.
Dike Drummond:
Fourth, life. They are any one of the thousand things it’d be going on in your life. You just had your first baby. You just had your eighth baby, right? You’ve got a special needs child. You’ve got twins. You got money problems. You got health problems. You got anything that’s going on. But what ends up happening is people see somebody burning out of work and they naturally assume it’s work-related. That’s not necessarily true.
Dike Drummond:
So, one of the questions you have to ask early on is “How’s it going at home?” because that may be where the problem is. And the person simply can’t recharge when they get home and that’s why they should appear to be burning out at work.
Dike Drummond:
The fifth cause is the conditioning of our medical education. Remember at the fork in the road, you went to the side of becoming a doctor. And at some point, in time, you had to acknowledge you just made a choice that was going to give you a long, difficult road to walk. And you thought to yourself, “I wonder if I got what it takes”. And you looked at yourself and said, “Yeah, I think I do”.
Dike Drummond:
And the reason you said that is because you’re different than your stoner friends who ran screaming for the hills. You had some grades, you had some performance, you were driven, you had some character traits unique to you that you share with all doctors. Workaholic, superhero, lone ranger, perfectionist. I’ll say those again a little more slowly. Workaholic, superhero, lone ranger, perfectionist.
Dike Drummond:
I’ll give you an example. If you had ever gotten to be in high school, perfectionist would say, that’s not acceptable. Workaholic would pull the all-nighter and ace the test to preserve your 4.0.
Dike Drummond:
So now you go into 6, 7 to 16 years’ worth of medical education. We’re going to use those character traits every single day. We tend to become those things. Ask your kids about what it’s like to be your kid. Because their dad is different than some of the other dads, because he’s a doctor.
Dike Drummond:
And then there’s a couple more prime directives. You’ve got these character traits, but there’s the patient comes first, which everybody knows, which by itself is toxic if you have no off switch. When you’re with the patient, patient comes first, but you have to be able to turn that off to recover.
Dike Drummond:
And the second one that nobody talks about is never show weakness. So, we follow these character traits. We follow these rules and it sets us up for burnout because we don’t know how to take care of ourselves when we graduate from our residency program, because it wasn’t okay to take care of yourself in residency in the first place. It’s a learned behavior. It’s programming, right? So that’s the fifth one.
Dike Drummond:
And then of the non-universal causes of burnout, the things that can be your last straw, there’s a whole bunch. Money is one. Your own personal health or the health of your spouse or your kids is another. Another really common one is malpractice risk. You don’t need to get sued or lose a case to be overwhelmed by malpractice as your last straw. All you need is a threatening letter from a patient that’s not your favorite.
Dike Drummond:
And then I’m just going to put this out here because two guys like me, you and I wouldn’t see this, our society and our medical education system and our healthcare delivery system is riddled through with bias and discrimination. So, I don’t know if people are watching this on video, but you and I are big old white guys, big old straight American born native English speaking white guys. And if you, as the listener are different from Jim and I in any of those categories, any single one, you will have been discriminated against along the way.
Dike Drummond:
Heaven forbid you’re a petite young Brown, English is your second language, female. Because that is something that will get you rabidly discriminated against along the road that you had to come to get to being a physician here in the United States or wherever you are right now.
Dike Drummond:
And then in a number of situations over the course of any given year, the last straw for my client has been some sort of bias and discrimination. Little cherry on the sundae, right there.
Dr. Jim Dahle:
Interesting that it has been so many.
Dike Drummond:
That’s how I see this laying out in terms of patterns across the thousands of folks that I’ve worked with. But in terms of assigning a percentage, I don’t know that it makes any sense. What I want to know is when I’m meeting somebody, “What’s going on, tell me your story and what would you like it to be? What is it? What would you like it to be?” And we closed that gap. And they could come from any piece of the spectrum of causes. It doesn’t matter. What happened is whatever the combination of causes is and it’s always multifactorial, right now it’s driven their energy to a persistently negative level and they cannot psychologically handle it any longer.
Dr. Jim Dahle:
Now there are some people out there arguing the burnout doesn’t exist. That it’s a myth, et cetera. I think it was Marissa Meyer, the CEO of Yahoo who said, “I don’t really believe in burnout. A lot of people work really hard for decades and decades”.
Dike Drummond:
She’s the lean in person, right?
Dr. Jim Dahle:
I think so. Yeah.
Dike Drummond:
All I can say is I’m going to echo what I’ve seen. Other people say this, but I jumped right on her case as soon as she did that. That’s really great. I wonder how many nannies she’s got, what her monthly house cleaning bill is. Not that you shouldn’t have help for your family, but all I’m saying is to you to say categorically burnout doesn’t exist because I’m a rich woman with all the help I need, it’s just fundamentally flawed. Fundamentally flawed.
Dike Drummond:
So, burnout absolutely exists. And there is a couple of different kinds, just pure physical overwhelms. And then there is the caring professions like ours, who have the additional risk of helping other people as part of our mantra. The patient comes first, where we don’t necessarily pay great attention to our own energy reserves and can put ourselves over the edge.
Dike Drummond:
Real quick. This is a universal experience for most people, right? When a doctor is exhausted and burned out, they’ll say, “I’m not sure how much longer I can keep going like this”. That is also an almost universal phrase in all parents, because the closest thing to the kind of giving Lightworker energy that you have for your patients as a physician, is the love that you have for your children. And you will righteously overextend yourself to help your kids, if the situation demands it.
Dr. Jim Dahle:
How much of this do you think is doctors with this expectation in their career, that it’s going to be this gratifying, rewarding experience all the time. Then they get into it and they realize, “Hey, this is a job too. It’s work”. They call it work because someone has to pay you to do it. And there is a support group for that. They meet at the bar on Fridays. How much of this is doctors who thought that work, that this career is going to be something different than other people find in their careers?
Dike Drummond:
Well, there’s obviously a piece of that. Let me just go back to that Lightworkers fork in the road. When you sent back your reply to your med school acceptance, when you sent back that letter, did you have any idea what you were getting into?
Dr. Jim Dahle:
I like to think I was pretty well-informed going in, but I’d never practiced before. Right? I couldn’t have known what it was like exactly.
Dike Drummond:
You’ve had never experienced any of it.
Dr. Jim Dahle:
And the crazy part about it is you couldn’t experience it for another eight years.
Dike Drummond:
Right. And for us, that’s it. You had to go through the rite of passage. So, for instance, bootcamp. Bootcamp in the military is 6 to 13 weeks, depending on what branch of the service you go in. What’s bootcamp for a doctor? 7 to 13 years. If you had a vision when you said “yes” to being a doctor of what it would be like to being a doctor that’s 7 to 16 years into the future, going through the hell of medical school and residency. Now, I’m not saying it wasn’t without its rewards, but it’s taxing. It’s difficult. It’s emotionally and physically and spiritually difficult to make it through that kind of a training. And fundamentally, none of us had any idea what we were getting into when we went into medicine.
Dr. Jim Dahle:
I think even bigger factor is not only did you not know what it was going to be like, you didn’t know what you were going to be like. 10 or 15 years later, you’re not the same person. And it’s not just the training. You’re just different.
Dike Drummond:
Well, check this out. There are people in the addiction world who say, “When a person starts using their emotional maturation stopped and when they stop using, there’s still the same emotional age as when they started”. So, if I started using drugs at 17 and I recovered at 30, I’m still a 17-year-old waking up at the age of 30.
Dike Drummond:
Medical education, medical school and residency is stressful enough that we tend to jettison friendships, jettison hobbies, and devote ourselves purely to the educational process. I believe there’s a certain aspect of a halt on our emotional growth at that point that maybe opens back up again once you’ve graduated.
Dike Drummond:
So yes, you grow up. You give your twenties. You give your twenties. And I swear, most doctors somewhere along the way say, “Man, do I want to keep pushing through?” Fortunately, they don’t teach the theory of opportunity costs in medical school.
Dr. Jim Dahle:
I think we should stop on all this economic and financial training for doctors, we’re going down. We’re not going to have anybody to take care of us.
Dike Drummond:
Right. Don’t teach them about opportunity cost. Confirmation bias and opportunity costs and all that good sunk cost fallacy. There you go. All that good stuff.
Dr. Jim Dahle:
Let’s talk for a minute about depression. Studies have shown that the correlation between burnout and depression is about 0.5 and a slightly lower for burnout and anxiety. How can someone who feels burnt out know whether it’s just depression or anxiety or whether it’s true burnout?

Dike Drummond:
Yeah. I have no idea because there’s an active brush fire war between coaches and psychiatrists about who should be taking care of these people. So, let’s just talk just a little bit. Certainly, if you’re thinking about taking your own life, right? If you’re losing or gaining weight, can’t get up, can’t motivate, maybe you’ve got something that requires something other than medication. But remember something like medication, just remember that cognitive behavioral therapy is as effective in depression as drugs are.
Dike Drummond:
So, when I think about coaching and when I think about therapy, I think about it very simplistically and somebody is going to get on my case for this but this is the way I think about it. If therapy wants to treat disease, you’re going to be in the DSM, diagnosis is going to be made, watch out for your license or get ready to lie when you re-up. So, all that stuff is all of a sudden in play.
Dike Drummond:
And typically, when you’re working with a therapist, they’re looking in the rear-view mirror back in time to see where this all started and how you got messed up like this. As a coach, it’s not in the DSM III. Burnout is not a psychiatric illness. It’s not diagnosable recordable. It doesn’t affect your license at all.
Dike Drummond:
And as a coach, what I do is I help you look forward. The only reason I would look back at what’s happened in the past with you is if what happened in the past is getting in the way of you moving forward. Otherwise, we focus on what you want.
Dike Drummond:
Here’s a super important distinction too. Most of the people that I meet who are considering getting a coach are in a pretty bad situation. And they want to tell you about all this stuff they don’t like about their current reality. All this stuff they want to run away from. And that’s interesting, right? But I have to acquaint them with the reality that you can avoid everything you don’t want, and you still won’t get what you want because there’s only one way to get what you want and that’s figure out what that is and go get it.
Dike Drummond:
So, what we work on as coaches is what’s your ideal job or practice or career description. Ideally, it’s your ideal life description. What would you run towards? How would you like it to be in an ideal world? Let’s move in that direction, regardless of what’s going on right now. Does that make sense?
Dr. Jim Dahle:
Absolutely.

Dike Drummond:
But there’s a big controversy about burnout versus depression. And the other thing I’ll tell you is that they are both in any population of doctors. Example, every study that’s ever been done on physicians where they are measured for burnout. So even the big three sequential Mayo studies that everybody heard about where they did it in 2012, 2014, 2017. Even in those studies, they checked for burnout, depression and suicidal ideation. So, burnout was between 40% and 50%. And in the same population, positive screen for depression was 40%. Solid all across those three studies.
Dike Drummond:
And in each one of those studies where they asked, “Have you thought about suicide in the last 12 months?” Guess what percentage of doctors will always answer that positive? If you thought about suicide in the last 12 months, what’s the percentage that will always say yes?
Dr. Jim Dahle:
I would guess around 10% to 15%.
Dike Drummond:
It’s 6% or 7%.
Dr. Jim Dahle:
6% or 7%.
Dike Drummond:
Which is if you do the math one in about 15 and that’s constant. Absolutely rock solid, constant. By the way, let me give you another little voice cue for you and your listeners. The first little voice cue of exhaustion that burnout causes is “I’m not sure how much longer I can keep going like this”. Little voice in your head.
Dike Drummond:
Here’s a really dangerous one, although it masquerades as gallows humor. If you’ve been feeling really down and beat up and you’re not recovered, you’re getting ready to go to work and think to yourself, “Maybe if I’m lucky, I’ll get hit by a car on the way to work and I won’t have to see patients today”. That may sound a little bit funny. Somebody to actually say it out loud and you’ll get some giggles.
Dike Drummond:
That’s a huge red flag. That’s just huge because you know what? You won’t going to get hit by a car on the way to work. And this feeling is going to continue until you change what you’re doing. Because you’re down in a hole at that point, I would encourage you to ask for help if you’re noticing that voice regularly right now.
Dr. Jim Dahle:
Now, you mentioned recovery time. And I think when people come to me and tell me they’re burnt out, I tell them maybe the first thing you ought to do is cut back to full time because so many doctors are working 60, 80 hours a week. How often do you think cutting back is the solution to people’s burnout? To give them more recovery time between shifts or between patient encounters?
Dike Drummond:
Well, there’s obviously a dose response curve. So, if your work environment is stressful, let’s call it a hostile work environment for whatever reason. And there could be any one of a number of things. You could be short-staffed right. You could have a bad boss. It could be things going on at home.
Dike Drummond:
If the work environment is toxic and you do not feel that you can make it less stressful than the only way to lower your energy expenditure would be to limit your exposure. So, cutting hours is a solution.
Dike Drummond:
But what I’ve found is that it’s almost never the case that you cannot modify the stress in the workplace. It’s almost never true that you cannot modify and lower the stress in the workplace. If you have a second pair of eyes, take all the pieces apart and look at the way you’re doing things in your normal operating procedure and it will show you some different ways to do what you’ve always done.
Dike Drummond:
It’s Einstein’s insanity trap basically. If you always do what you’ve always done, you’ll always get what you always got. If you don’t like your balance right now, we have to change your actions in order to change that.
Dr. Jim Dahle:
And how much focus should people be putting on the workplace and its changes that it needs to make versus your adaptations to it?
Dike Drummond:
Yeah. 50/50 if you have a cooperative leadership team. When you have decided to be an employee, and I think that’s in the background of what you’re talking about right now is I have signed a contract to work this job description, not my ideal job description, their job description for this position, in their systems with their staff and their management and their leadership and their supplies and their pay scale and their compensation formula, all of that stuff.
Dike Drummond:
Okay, if I’ve accepted that bargain and I want to modify that workplace, it’s going to be me adapting myself and the way I work with my personal work team underneath the radar of the leadership team to make sure we work together as a team. And then hoping to influence the leadership team when I see things that need systemic change.
Dike Drummond:
So, when we work with doctors, there a couple of things we teach. How to build a more ideal practice, how to get home sooner, how to develop more life balance, how to be a better leader to share the load that you have at work. And last but not least is how to manage your boss. Because it’s one of the clear missing skill sets for physicians. You were never trained to be inserted in the middle of a large bureaucracy as an employee. Never.
Dike Drummond:
And physicians do all the wrong things when they’re trying to negotiate for some wiggle room in their job. We tend to be too urgent, pound the table, accuse people of having manure for brains and get ourselves in trouble really quick.
Dr. Jim Dahle:
That sounds like a physician. Tell us what you mean by training your boss.
Dike Drummond:
Not training your boss, manage your boss. So, if you think about what an organization is, it’s a hierarchy of relationships. And as physicians, we’re trained to be the king or the queen of the practice, the apex of the pyramid, the alpha, the omega, everybody waits for us to give orders and they won’t do anything until we tell them what to do. It’s crazy. Crazy top down, right?
Dike Drummond:
You’re trained to do that. But then when you graduate, if you decided to be an employee, they stick you right in the middle of a layer cake of a very complicated bureaucracy, where you have your direct reports below you, your care team, but you also have layer after layer, after layer of folks that are either beside you or above you in the organization.
Dike Drummond:
And for a lot of the things that are bugging you at work, you would need someone else’s either permission or someone else’s order to change a workflow or change the way that the patients are cared for. You would need their permission for you to develop a more ideal practice. You say, “I really want this, but I can’t get it without my boss saying yes”. Does that make sense?
Dr. Jim Dahle:
Yeah.
Dike Drummond:
And inside most organizations, I know that isn’t ever going to happen. And it’s because nobody has managed the relationship with their boss. Now realize if you were my boss and I was a doctor in your emergency room. So, let’s say you’re the director of the emergency department. And you might be, I don’t know.
Dr. Jim Dahle:
Not right now. I’m not.
Dike Drummond:
And I’m one of your worker bee doctors, right? Ideally, we have a relationship. What’s a relationship? Well, we talk to each other every once in a while, and I’m going to be very specific. We talk to each other every once in a while, outside of a crisis. Like when I’m not in trouble. Because we can’t really have a relationship if the only time I see my boss is when I’m in trouble. And there’s a very easy way to figure this out. I call it the lookup trust test. If I say to you, it’s like, hey Jim. Do you know who your boss is? Do you have a boss?
Dr. Jim Dahle:
I do.
Dike Drummond:
Okay, cool. If your boss showed unannounced during one of your shifts, is that a good thing?
Dr. Jim Dahle:
Sure. Maybe he’s coming in early to take over for me.
Dike Drummond:
So, you would look him in the eye and say, “Hey boss, what’s going on? To what do we owe this unexpected pleasure?
Dr. Jim Dahle:
Yeah, probably.

Dike Drummond:
Yeah. That means the two of you have a relationship and it has some trust in it. When I’m in front of a room full of doctors and I asked that question, if your receptionist came to you between patients and said, “Your boss is in the waiting room. He wants to talk to you when you get a break”. Is that a good thing? The answer is almost never no. And I say, why are they there? Because I’m in and they all say trouble, big trouble echoes through the room.
Dike Drummond:
You can’t have a relationship with your boss and you can’t manage that relationship if the only time you see them is when you’re in trouble. So, you have to have regular meetings with your boss outside times of crisis. They don’t have to be long. And in order to get on their schedule, you tell them you want to have a regular meeting to stay on the same page. That’s the phrase that works. But you want to develop some sort of a relationship, right? Where their presence is not a bad thing.
Dike Drummond:
And once you’ve developed that relationship, and there’s a ratio five to one that you use to figure out how long this is going to take. Once you’ve developed that relationship, you understand what their boss is asking of them. You understand their personality and what’s important to them. It’s relatively straight forward to craft a question, to craft a request, to craft an innovation project that will get a “yes”, rather than getting slapped down with a “no”, because you didn’t know how to manage your boss.
Dr. Jim Dahle:
That’s a good tip. I appreciate that.
Dike Drummond:
It can be checklisted just like a pre-op checklist. I have a seven-part checklist for the process.
Dr. Jim Dahle:
So, a lot of doctors see these surveys that 40% of doctors are burned out or whatever, and they wonder, “Well, am I burned out?” What’s the best way to know if you’re burned out?
Dike Drummond:
That’s an interesting question because what you’re talking about is scales on a survey versus your own personal experience. So, let me give you an example. One of the main surveys actually was the gold standard for burnout. A measurement for years is a survey called The Maslach Burnout Inventory by Christina Maslach.

Dike Drummond:
She started doing this 22-question test back in the 1970s and it measures the three symptoms of burnout. The three symptoms are exhaustion – “I’m not sure how much longer I can keep going like this”. Cynical, sarcastic. It’s also known as compassion, fatigue, where you start to have to vent about the patients that you’re serving. And the last one is “What’s the use? My work is really not serving a purpose here”. Exhausted, cynical, sarcastic, what’s the use.
Dike Drummond:
And so, these 22 questions in her survey measured those three scales. And the researchers have these cutoffs for the number that you score on each of those three scales. They’ll say that the person who is above that point score on that cutoff is suffering from that symptom of burnout. It’s an arbitrary score.
Dike Drummond:
I’m not sure that we can tell the difference between burned down and not burned out on a single score in our own physical experience. But if you look at the way that they diagnose burnout in these surveys, it says suffering from at least one symptom of burnout. And the most common symptom that doctors suffer from is which one do you think it has?
Dr. Jim Dahle:
I guess exhaustion.
Dike Drummond:
Exhaustion. Because everybody’s had their little voice say, “I’m not sure how much longer I can keep going like this”. And if you look at the studies that connect burnout with low patient satisfaction, low quality, low safety, error rates, turnover, and all the negative consequences, all it takes is that suffering from one symptom.
Dike Drummond:
But if you talk to Christina Maslach, she’ll tell you, “You people in healthcare used my test all wrong. First of all, I would never have a solid cutoff where somebody was burned out if they were above it and not if they were below it. And if I did, it would be across all three scales. I would want you to be missing all three. Exhausted and cynical and sarcastic and what’s the use”.
Dike Drummond:
Because in my experience, she’ll tell you that’s when a person is burned out. So, what you’ll find is that, and again, doctors, their self-awareness of their own energy levels and their self-awareness and their own personal needs has been wiped out by the trial of residency education.
Dike Drummond:
But if you are looking at a group of doctors and you’re asking if they think they’re burned out, I would think that far fewer of them would say they’re burned out then would score as burned out by the standard way it’s measured.
Dr. Jim Dahle:
So maybe it’s over calling it. The surveys are over calling it.
Dike Drummond:
No, it’s not over calling it because that measurement is what’s associated with the low patient satisfaction, low quality, higher error rates. All the negative effects are matched with the way it’s diagnosed. I’m just telling you that subjectively, would you call yourself burned out at that level? The answer is probably no. You’d have to be farther down in the hole. But it just shows you if you are stressed. And again, remember, you’ve been trained to ignore that. Never show weakness, right?
Dike Drummond:
If you are stressed, there is a pretty dramatic effect on your ability to be present with a patient and do a really good job that comes on pretty darn early as soon as you start to drop down in your energy levels.
Dr. Jim Dahle:
Maybe before you’d even recognize it.
Dike Drummond:
Maybe before you’d even recognize it, just like most disease like how much pulmonary function do you have to lose from COPD before you’re actually dismissed? It’s like 80%, right? We all know these curves. It only becomes symptomatic in their extreme pathologic states.
Dr. Jim Dahle:
Speaking of extreme times, let’s talk about this last year. COVID-19 pandemic has put a lot of additional stress on workplaces, on doctors, et cetera. What has been your take over the last year on physician burnout. Is it worse? Is it better? Is it about the same as it’s always been? What’s your take?
Dike Drummond:
Well, first of all, there haven’t been a lot of burnout surveys since COVID hit, but we know that it was a prevalence of that measurement that I just told you about. It was 40% to 50% prior to COVID. We also know that not all physician practices were hit the same by COVID and we know that the best from the first wave.
Dike Drummond:
So, if you looked at a large hospital system with a whole bunch of inpatient and outpatient doctors, comprehensive delivery system, back in the spring, one third of the physicians and staff were overwhelmed by that first wave. Two thirds were almost completely laid off for a short period of time. What ended up happening was unless you were on capitation at that point in time, huge losses, huge financial losses for those companies and a lot of layoffs and wage cuts and other things for the doctors in most companies around the USA.
Dike Drummond:
So, I can tell you though, what’s more stressful? Being super busy in the ER, or being laid off? I mean, you tell me. So, there’s very various different kinds of stress for the different doctors. But what it did is the whirlwind of your practice that swallows you as you walk in every day, I say doctors, it’s like being in a whirlwind. That whirlwind has been sped up by COVID.
Dike Drummond:
The other thing is COVID now is putting stress on you at home. You can’t go out to eat. You might get sick at the grocery store. Your kids, are they at school or not? So, what’s happened is your ability to recharge when you go home has been compromised by COVID effects there. And secondly, wouldn’t we have liked COVID to have been a standard natural disaster? A one-shot hurricane, tornado, right? A terrorist attack? “911 just give us that one shot hit. Give it to us one day and let us recover from it from that point forward”.
Dike Drummond:
It’s been a slow rolling repetitive title wave and we’re still in the middle of it right now. So, it is a chronic disaster. It can hurt you at work and at home. It can speed you up, slow you down. It could kill your grandma. And we are just talking about COVID. We haven’t talked about the elections. We haven’t talked about politics in America. We haven’t talked about it but it’s still going on. It shouldn’t be, but it’s still going on. And then somebody is going to have to govern in January and we’re still going to be in the middle of a pandemic.
Dike Drummond:
Let me ask you this, Jim. If the COVID-19 pandemic was a baseball game, what inning are we in in your mind?
Dr. Jim Dahle:
I think we’re in the seventh inning.

Dike Drummond:
Really? Okay, excellent.
Dr. Jim Dahle:
Well, I got a vaccine scheduled in three days. So, I’m seeing some light at the end of the tunnel.
Dike Drummond:
You’re going to go all, “Oh, I got mine. Screw the rest of you”. Is that where we’re going here?
Dr. Jim Dahle:
I’m getting mine in the seventh inning and then everybody else gets theirs in the ninth inning and then it’s over. So yeah, I think we’re certainly past halfway without a doubt.
Dike Drummond:
Okay. So, I don’t know if you’re an optimist or not, but most people I’m asking that question to are not giving me anything near seven.
Dr. Jim Dahle:
Maybe I am an optimist then.
Dike Drummond:
I’m not sure. But what I can say is that if we can get herd immunity sufficient enough to be able to go to outdoor sporting events by Labor Day, I’ll be happy. Anything earlier than that is a bonus in my book.
Dr. Jim Dahle:
I think we are probably in for a bonus, it would be my best guess. But I guess we’ll see how it plays out. All right. Well, this is supposed to be a financial podcast. So, we got to talk at least about a little bit of financial stuff. You’ve had a pretty interesting transition in career. Lots of docs get to be about the age you were at the time of that transition 10 years, 70,000 patient encounters, et cetera. And they start looking at nonclinical, less clinical, something else careers. What wisdom have you learned over the last decade that you can pass on to them?
Dike Drummond:
Well, I had 35,000 patient visits by the time I was 10 years in as a family doc. It’s always a good exercise to multiply it out and see what you think your total is. I think that there’s a lot more smoke than there is actual fire when it comes to people saying, “I’m going to quit earlier, I’m going to get a side gig or I’m going to move to a new career”. There’s a lot of talk about it, a lot of Facebook posturing about it, but I don’t think there’s a lot of people actually leaving medicine personally, because of the money.
Dike Drummond:
A burnout is the biggest risk to your finances because your fastest path to cash is a board-certified doctor. You continue to practice medicine, at least here in the United States of America. And I talked to a couple of people a month who say, “Yeah, I want to open a pizza joint”. And it’s like, “Well, what kind of financial expectations do you have? – I think the $300,000 I’m getting as a doctor will work just fine”. It’s like, “Well, good luck with that”.
Dike Drummond:
So, all I can say is this and I think it’s Ben Franklin. No matter what you do, put a little aside. No matter what you do, put a little aside. Always make more that you spend. And I personally don’t know how you get to $300,000 or $400,000 worth of student loan debts. I don’t know how you do that, but it’s obviously something that can be done. But I also know there are all sorts of loan forgiveness programs out there that can get that trimmed in very short order if you find that debt is your big issue.
Dike Drummond:
But right now, your fastest path to cash for most of the people that are listening to this is to continue to practice as a doctor. No matter what your business model is for your practice. It’s your physician skills in the United States that will continue to drive superior financial performance for you.
Dr. Jim Dahle:
How would you try to treat burnout differently in somebody that’s already financially independent versus somebody who really does need that income?
Dike Drummond:
Yeah. That’s the challenge. This point of financial freedom is a super important one for doctors. So, I’m 63. I’ll be 63 next year. There is a generation of boomer gunners like me, who don’t need to be working. They are way past financially free and they can’t stop because it’s all they’ve ever known. And at least in part because they came through none work hour restricted residency programs, which is submersed them in the burnout culture of medicine.
Dike Drummond:
And when we’re gone, there’s going to be a lot less of that kind of activity in healthcare. But I think there’s a whole bunch of people for whom that point of financial freedom is more confusing than anything else. I mean, when I meet somebody and I say, “What’s your net worth?” And they say, “What’s that?” I say, “You need a financial planner. Come back and see me”.
Dike Drummond:
But if I say, “What’s your net worth?” And they say $6 million. And I say, “Okay, how much does it cost for you to pay your bills every month?” And they say $8,000. All I do is get out my calculator and say, “Why are you working? – What do you mean? – Well, look, you can take that amount of money out of your net worth every month for 65 years. Why are you working? You’re past the point of financial freedom”. And they’re unfamiliar with the concept.
Dike Drummond:
And I say, look, anything you do vocationally in the future when you decide what it is you want to do and how many hours a week you want to do it and who you want to do it with, you don’t have to worry about making money. You can take money completely out of your decision process. And I guarantee you, you’ll never not be a doctor. And I also guarantee you, there are literally thousands of people who would take you on as a volunteer to do your clinical thing any day of the week. You can be as busy doctoring as you want to. You just don’t have to make your decisions based upon money. And for most doctors that I talked to, that is an absolutely revolutionary concept.
Dr. Jim Dahle:
Well, I hope a lot of them when they do that calculation realize they are already financially free. I run into a lot who would love to make changes, would love to cut back, would love to do something different and they run the numbers and they’re not quite there. So, it makes for lot more difficult decisions.
Dike Drummond:
Well, and that’s the tail. So, there is a couple of crests of burnout these days. First of all, there’s an early crest of burnout in the folks that are coming out of work hour restricted residency programs that are starting to work with people like me, right? Boomer gunners, right? They’ve never worked as hard as their first few months in their practice because they didn’t have to work that hard in residency.
Dike Drummond:
Whereas in my generation, we came out and in practice it wasn’t necessarily as busy as you were as a resident because they beat the crap out of us in residency. So, there’s that early bump, right? For primary care doctors who pride themselves on, “Wow. I’ve never seen anything like that before.” We think that’s cool. Especially that don’t necessarily think that’s so cool when you can’t diagnose something.
Dike Drummond:
So about 10 years in, when you are starting to see less and less of the new things that you’ve never seen before, it starts to lose its shine. And what you’re talking about is that third bump where I’m in my fifties, I’ve been doing this a long time and I’m just not quite there with my financial people. I just not got enough money yet. That’s difficult to gut that out sometimes.
Dr. Jim Dahle:
All right. We better wrap up here soon, but you’ve got the ear of 30,000 or 40,000 docs and similar high-income professionals by the time this podcast is run and listened. What have we not covered today that you think they ought to know?
Dike Drummond:
Well, the first thing I would say is that those of us who are in the giving professions, those of us who are helpers, healers, or care about your clients whatever it is that you do, one of the things we almost never do is look in the mirror and ask ourselves, “How do we think we’re doing?”
Dike Drummond:
So, the first thing I would say is grab a piece of paper, take a big breath and think back over the last couple of weeks in your practice, your job, your career, your life, and just give yourself a satisfaction score from 0 to 10. 0 meaning your satisfaction couldn’t be any lower. 10 meaning your satisfaction couldn’t be any higher. And give yourself a score. Write that number down on that piece of paper and put today’s date next to it. For me right now, it’s the 15th of December.
Dike Drummond:
Now, close your eyes, take another breath and open your eyes and look at that number. How do you feel about that number? How do you feel about that being your satisfaction with your life, your career, your practice, your job? Are you okay with that number or would you like to be just a little bit higher?
Dike Drummond:
By the way, if your number is 2, 3, 4, you need to do something about that. You need to change your actions to raise that up, or you’re in a world of hurt pretty quick. If your number is 6, 7, 8, you’re doing great. You have a fundamental overlap with your ideal job or career and I wouldn’t change too much of what you’re doing except fine tuning.
Dike Drummond:
But if any of you listening want to do something different, to get more satisfaction out of your career, your life, you’re going to need to change your actions. It starts by writing down the things that stress you out and circling one and taking a baby step in a new direction towards a more ideal job or a more ideal practice.
Dike Drummond:
Recovering from burnout and preventing burnout and building a wonderful life is just to connect a series of baby steps, but it takes new actions to get new results. If you don’t like the number you’re looking at, you would have to change your actions to make that go away. No amount of whining is going to save you. And it’s always later than you think. Always.
Dr. Jim Dahle:
Awesome. Thank you for sharing that. Dr. Dike Drummond author, coach, burnout expert. You can learn more about him at thehappymd.com. Thank you for your time with us today on the podcast.

Dike Drummond:
You bet. Make sure you put the word “THE” on the front of Happy MD otherwise you’re going to a porn site.
Dr. Jim Dahle:
Thehappymd.com. We’ll make sure we get that right in the show notes.
Dr. Jim Dahle:
I hope you enjoyed that interview. Be sure to watch the blog for the new stuff we got coming out this month with the new book.
Dr. Jim Dahle:
Thanks to our sponsor. Gain the expertise to manage the business of medicine with the Physicians Executive MBA at Auburn University’s Herbert College of Business. Tailored to the practicing physician, Auburn’s Physicians Executive MBA program is currently enrolling for fall 2021. Take control of your future during these challenging times. Learn more at auburn-pemba.com. That’s Physicians Executive MBA.
Dr. Jim Dahle:
Thanks for those of you who’ve left us a five-star review. We appreciate that. It helps spread the word about the podcast. Thanks for those who are spreading the word with your trainees, with your attendings, with your students, residents, interns, whatever. We appreciate you doing that as well.
Dr. Jim Dahle:
Our most recent review came in from Scott, or actually this was a few months ago. He said, “Don’t miss this. If you are a six-figure earner (or will be after school), you should listen to this. Jim very clearly and succinctly helps you become financially literate so you can decide what you want to spend, save, or give away and achieve your life goals. This is no simplified “cut up all your credit cards” advice, and it won’t help you get rich quick, but if you follow even some of the advice you will become financially independent. The more advice you follow, the sooner you hit FI. Great work. Thanks”. Five stars. Thank you for that. I appreciate that kind review, Scott.
Dr. Jim Dahle:
For the rest of you, keep your head up, your shoulders back. You’ve got this and we can help. We’ll see you next time on the White Coat Investor podcast.

Disclaimer:
My dad, your host, Dr. Dahle, is a practicing emergency physician, blogger, author, and podcaster. He’s not a licensed accountant, attorney or financial advisor. So, this podcast is for your entertainment and information only and should not be considered official personalized financial advice.