Sylvia Gonsahn-Bollie, MD, had such severe ‘workaholism’ that she not only worked until the day she delivered her son but was so focused on work that she missed her ob/gyn’s repeated calls to tell her that labs showed she had preeclampsia. “That explained why I was so short of breath and gaining 5 pounds a week in the last trimester, symptoms I downplayed to keep working,” she said.
Thankfully Bollie, an obesity and internal medicine specialist and CEO of Embrace You Weight & Wellness in Chevy Chase, Maryland, delivered a healthy baby and returned to work 9 weeks after the birth of her son. Sadly, it took another 2 years before Bollie realized workaholism was taking a toll on her physical and emotional well-being. For many physicians who are not so lucky, recognition only comes with a personal or health crisis.
Work addiction, often called workaholism, has become more well-defined as its prevalence increases. In a 2014 study in Occupational Medicine, physicians practicing at a French university hospital took a survey based on their work addiction risk and psychosocial constraints. Of 445 respondents, 13% were highly work addicted and 35% were mildly work addicted.
And Medscape’s 2022 Physician Lifestyle and Happiness Report, which surveyed more than 13,000 physicians, found 55% of respondents would take a reduction in salary to have a better work/life balance, 70% have had relationships fail because they don’t have time for a social life, and 20% rarely spend enough time on their health.
What’s the difference between Work Addiction and Hard Work?
Workaholic physicians tend to build their lives around their work. They may be perfectionists by nature and often deny any health problems. When they do fall ill, they return to work before a full recovery. They often have an excessive workload, which whether they recognize it or not, contributes to their compulsion to work more.
An article in the Harvard Business Review finds workaholics report more health complaints, more sleep problems, more emotional exhaustion, more cynicism, and more depression than those who merely work long hours — and these workaholics may struggle to psychologically detach from work.
A study in the Journal of Addiction Research Therapy found burnout is a major outcome of workaholism. Other ill effects include greater marital estrangement, strained relationships with children, and poor relationships with others at work and home.
By comparison, those who simply work long hours (more than 40 hours a week) are not mentally preoccupied with work, report fewer health complaints, can switch work off, fall asleep easily, and don’t feel restless when not working.
Is Being a Doctor a Recipe for Workaholism?
Among physicians who are dedicated to their work, highly invested in working long hours, and detail-driven, there’s likely an implicit bias toward overworking. “When we’re in training we hear a lot about this archetype of the self-sacrificing physician and this is what patients talk about admiringly,” said Elisabeth Netherton, MD, a psychiatrist and regional medical director at Mindpath Health in Houston, Texas. ‘Dr. Smith took such good care of me, and he was always there, and he always answered my phone calls.’ “
When you think about what patients value in physicians, it’s these experiences of physicians working after hours, going above and beyond, doing extra. It’s a standard physicians internalize, idealize, and work to uphold. But at what cost?
“It’s taken me many years to even embrace and admit that I was overworking because it was so typical of what was expected. That was the culture — to do everything you can do,” Bollie said.
Netherton explains that work/life balance can be tricky for physicians because within medicine there’s an idea of the ideal doctor who doesn’t take vacations, doesn’t go home for dinner, is dedicated, and stays at the hospital for the requisite amount of hours necessary for everything to be completed, even if that’s not possible.
What’s more, medicine often asks physicians to control every variable to improve patient outcomes — even though physicians know inherently that controlling every outcome isn’t always possible. But the pattern can leave physicians stuck in a cycle of working to control variables and doing more and more until they’re taking on outsized responsibility.
Bollie says physicians don’t articulate their drive to create better outcomes. For instance, physicians don’t claim to be superhuman but, on the other hand, the subculture is that doctors don’t need to sleep or eat; they are there to serve, help people and do everything right. It’s like a badge of honor. And it’s reinforced since doctors are dealing with high stake outcomes — people’s lives — where mistakes can have profound repercussions.
Dike Drummond, MD, a “burnout” survivor, former workaholic physician, and author of Stop Physician Burnout: What to Do When Working Harder Isn’t Working, said doctors are conditioned to be a superhero, workaholic, Lone Ranger, perfectionist. And no one teaches physicians to develop an “off” switch.
Benjamin Ticho, MD, associate professor of ophthalmology at the University of Illinois Eye and Ear Infirmary, and in private practice at Ticho Eye Associates worked in Chicago, has 6 days a week since 1992.
The pediatric and adult ophthalmologist and clinical researcher began offering patients Saturday appointments 30 years ago. Back then, physicians who played golf often took Wednesdays off but since he didn’t play, he ended up working Wednesdays and Saturdays. “What I’ve lost is I haven’t designed things well enough where I have as much flexibility as I could or should have,” he said.
Denying a type-A personality, Ticho does enjoy vacations and time off but admits that he loves what he does and is good at it. “When I ask myself, what do I want to get out of the day, it’s rarely, ‘I’d like to lay back and chill and watch Netflix.'” “
Ticho says he checks in with himself regularly and asks questions like, do I enjoy what I’m doing? Yes. Do I still want to do it? Yes. Am I ready to make any changes or cut back? No.
But he admits helping patients is like getting a little hit of cocaine (a positive reinforcement) every time you’ve done a good job, helped someone, or got a thank you.
Ego-Driven or Ego-Boosting?
Does that mean physician workaholism is ego-driven? Houston psychiatrist Netherton says while she sees that less commonly, it doesn’t mean it’s not there, but she says there is a lot of reward in medicine. It feels good to put in additional work and effort and have a patient say thank you for making a difference.
“Physicians are driven by wanting to do a good job,” she said.
Working with the power and control medicine provides can also be adrenaline-pumping and ego-boosting. There’s a rush that comes with overworking. It’s also a numbing way to cope with some of the hard things of being a physician. “Busyness is a way we can hide and mask ourselves to shield pain from the uncontrollable things, like when a patient dies,” said Bollie.
Bollie remembers her first patient who died. She took care of the “lovely” woman for 10 days and got to know her family. “When she passed, we maybe talked about it for 10 minutes as a team and then we went back to the rest of the day because there was more work to be done.”
Even for physicians who work in-patient, if you have a suicidal patient or you just gave a cancer diagnosis, the next patient is waiting. Physicians must put on a new face and go help someone else. Workaholism can be a way to keep moving.
Of course, other factors like the corporatization of medicine, the endless responsible documentation that physicians are for, as well as physician shortages within certain sectors of medicine, contribute to physicians working later and later to catch up on paperwork or to see more patients than makes sense during a 40-hour workweek.
Overcoming Work Addiction
Experts say that if you want to overcome work addiction, there are tangible steps to take. The first thing to do is pause. That doesn’t mean going on vacation, but rather assessing how you’re spending your time, and like Ticho, asking yourself if you enjoy what you’re doing. Do you have enough time to schedule leisure? Netflix may not be high on your priorities, but downtime is essential to recover, rest, and regroup so you can be an effective physician.
Are you getting breaks during the day? You don’t have to take a 30-minute lunch but 5 minutes to sit by a window and take a mental space several times a day before running to the next task helps. The workaholic culture takes away your sense of control, so creating an atmosphere of better work/life balance can help you feel empowered and back in control.
As with any type of addiction, the sense of reward is strong. Breaking the cycle means finding fulfillment in other ways that don’t involve working.
Netherton recommends taking steps to start cracking the façade of the ideal image of a physician that never goes home, never sleeps, and never takes time off. “We have to recognize that’s a recipe for an unwell physician who might develop substance problems and struggle with burnout.”
Finally, seek assistance. Physicians still hesitate to seek mental health therapy, but if you’re having trouble with work/life wellness, talking to a therapist may help you find more balance. A systematic review published last July in the International Journal of Environmental Research and Public Health On workaholism in occupational medicine found that cognitive behavioral therapy and mindfulness-based interventions show promising results for behavioral addictions like workaholism.
Bollie said when she finally came to terms with work addiction, she felt what war veterans describe as ‘reentry.’ She came to a crossroads where she had to make a choice: Take back her work/life balance or be vulnerable to a physical or mental crisis, because if she kept working 100 hours a week until she burned out, she wouldn’t be able to care for patients — or herself.
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