“It’s better to burn out than it is to rust…..”  Neil Young

You’ve fielded the third pre-authorization of the day, two of which have been rejected previously. Your 4 p.m. appointment is 20 minutes late and insists on being seen. What else could logically happen next, but a longtime patient calling with flashes and floaters?  Well, he did call and does not want to be dilated.

How do you handle these challenges, especially if you’ve practiced for decades? How do you keep the fire, without letting it consume you?

Let’s start by saying that this has been a frustrating column to research. The literature is full of platitudes, conjecture, and commonsensical advice. What really works in the war against burnout? It’s anyone’s guess, as our individual endurance, tolerance, and motivation are all over the map.

It’s no secret that we tend to be overwhelmed as optometrists, with insurance and regulatory burdens higher than ever. 

Plan participation and internet health awareness are generating more patient demands than you ever dreamed possible. Many of us feel that personal income has not increased in concert with the additional stress and responsibility that we carry.

The nature of optometry tends to add fuel to that consuming fire. We are expected to be exacting, yet there is folly in applying this physical measurement of refraction to a biological system. The physical measurement may vary, but the biological system is all over the map!

First-hand stories of burnout are seldom written, but if you follow along, I’ll give a little hint of my own. 

Professional burnout can be hard to quantify, but like the mental health issues reviewed in another Dugout Dirt column, “I’ll know it when I see it.” 

Here are some warning signs (Footnote 1):

Not caring about things you should care about, including direct patient care.

Agitation, sleeplessness, substance abuse, extreme fatigue

Failure to be refreshed by vacation or continuing education


Feelings of lack of purpose or aimlessness

Emotional detachment

In over three decades of practice, I have certainly gone through periods where the guy in the mirror has had some of these issues. 

Any age group is vulnerable. I vividly remember feeling like I had had enough of optometry as a young Air Force captain, over 30 years ago. (I was the only OD for a small Air Force hospital that had over 30,000 patient charts! We gave great care, but the schedule was packed with full exams and emergencies. No no-shows, and the usual demands that you get when care is free!)

“Errors” have been a problem on the most recent incarnation of burnout for me. “Doc, did you mean -0.75 on the cyl, instead of -1.75?” Fortunately, it’s not been common or serious, but errors that I NEVER used to make will pop up on occasion.

So, what’s the solution? 

Job One is to figure out a way to get away from what you do professionally, although it’s far from the only answer. As I’ve cut down on my hours in the past year, I’ve found that the stress level while working is higher, not lower. I’m not as accessible as I had been, and it seems like the questions and calls pour in. Still, it’s a start. From there, the key is to make the most of the time away. Try increasing family time, sports, or maybe just parking in that anti-gravity chair on the deck!

Professionally, it’s important to develop interests that elevate ourselves and our practices.  Scleral lenses, vision therapy, glaucoma care, or whatever it may be. These things may help maintain interest and enthusiasm, but I would be quick to caution that specialists burn out, too! Specialization can help, but it is not the entire answer.

In reviewing the “burnout” literature, my favorite piece came from a colleague of our own, written by Antonio Chirumbolo for New Grad Optometry. (Footnote 2) Dr. Chirumbolo emphasizes generating hobbies and outside interests, interacting positively with patients, and keeping negative emotions in check. These items can be a real challenge in the face of what we all confront daily, but the advice is sage and worth repeating.

The cost of burnout is another track to study. 

The financial burdens can be HUGE. The AMA estimates that it can cost a practice as much as $1 million per case to deal with this problem. Lost productivity, recruitment, retraining, and other costs can really add up. Managing partners, take heed! Read more on this at AMA Wire. (Footnote 3)

Channeling Lynyrd Skynyrd’s “I hope Neil Young will remember………,” maybe “rusting” isn’t so bad, after all? Most importantly, we have to put OURSELVES first. That’s right. We’re no good to family or patients if we aren’t hitting on all cylinders. Depression and substance abuse require that we step back and re-evaluate, and seek professional help as needed.  Don’t let burnout get the best of you!

  1. https://www.mededwebs.com/blog/symptoms-of-physician-burnout-know-the-warning-signs
  2. https://newgradoptometry.com/optometry-burnout/
  3. https://wire.ama-assn.org/practice-management/how-much-physician-burnout-costing-your-organization