Anemia In Academia: Part 3 - Burnout (#535)

Force #3: The quadruple mandate.

There is a particular look I have started to recognize in young faculty.

It isn’t incompetence.

It isn’t indifference.

It certainly isn’t lack of commitment.

It’s fatigue.

Not the ordinary kind.

Not the end-of-a-long-week kind that a good night’s sleep fixes.

Something deeper.

A thinning of spirit.

As though the light that brought them into academia in the first place has quietly dimmed.

Early in my career, exhaustion usually meant one thing:

You had worked hard.

You had stayed late with a complicated case.

You had taught all morning, operated all afternoon, and still found time to discuss a paper with a resident over coffee.

You went home tired, but satisfied.

The tiredness had meaning.

It felt earned.

There is a difference between being tired from purpose and tired from depletion.

Today, I see more of the second.

Academic medicine likes to describe itself as a quadruple mandate:

Clinical service.

Teaching.

Research.

Service.

Four pillars.

Four equal commitments.

It sounds noble.

Balanced.

Manageable.

But anyone who has lived it knows the truth:

It isn’t four jobs.

It’s five or six.

Because we quietly add more:

Committee service.

Compliance training.

Email.

Grant administration.

Recruitment.

Reporting metrics.

Documentation for documentation’s sake.

And somehow all of it is supposed to fit into the same 24-hour day.

I used to sit with junior colleagues and ask them what their week looked like.

The answers come in a rush.

Clinic overflow.

Two lectures to prepare.

A resident in difficulty who needs mentoring.

An IACUC revision.

A grant resubmission.

Three committee meetings.

A performance review due.

Dozens - sometimes hundreds - of emails.

And somewhere in there, they are supposed to read, think, research, and grow as scholars.

It is like asking someone to sprint a marathon.

Eventually, something gives.

Usually, it’s them.

Burnout is often described clinically as emotional exhaustion, depersonalization, and reduced sense of accomplishment.

But those words feel empty to me.

When I see it, it looks more human.

It looks like a gifted teacher who stops volunteering for lectures because she simply has nothing left to give.

It looks like a surgeon who once stayed late to explain every step to students now rushing through the day just to keep up.

It looks like a researcher quietly abandoning a line of inquiry because there is no uninterrupted time to think.

Not laziness.

Self-preservation.

The cruel irony is that the very people most likely to burn out are the ones we most want to keep.

The conscientious ones.

The ones who say yes.

The ones who take the extra case, the extra student, the extra responsibility.

Academia quietly rewards self-sacrifice, until it collapses under its own weight.

Academia doesn’t lose the disengaged first.

Academia loses the devoted first.

Don’t misunderstand me.

Private practice is not easy.

Long hours.

Difficult clients.

Financial pressure.

But again, and again, I hear the same quiet observation from those who leave academia:

At least I get to focus.

Focus.

Such a simple word.

See patients.

Teach interns.

Go home.

One primary mission.

Not five or six competing ones.

There is a kind of mercy in that clarity.

In academia, fragmentation is the norm.

You are never fully present anywhere because you are needed everywhere.

Half a clinician.

Half a teacher.

Half a scientist.

Never whole.

That kind of divided life slowly erodes joy.

Burnout also carries a quieter consequence - guilt.

Faculty feel they are failing everyone.

Not seeing enough patients.

Not publishing enough papers.

Not mentoring enough students.

Not answering emails fast enough.

The system is impossible, yet the failure feels personal.

So instead of saying, “This structure is unsustainable,” they say, “I’m not good enough.”

That breaks my heart a little, because often they are excellent.

The system is what’s broken.

I think back to my own early mentors:

Clive Eger. Jim Archibald. Terry Holliday. Ralph Kitchell. George Cardinet.

They worked hard - extraordinarily hard.

But when they were with an animal, they were fully there.

No laptop.

No metrics dashboard.

No committee report due at midnight.

Just craft.

Just presence.

They were tired at the end of the day.

But they were not hollowed out.

There is a difference.

Burnout, to me, is not simply fatigue.

It is the loss of meaning.

When the work that once nourished you begins to drain you.

When Sunday evenings carry dread instead of anticipation.

When the job you once loved starts to feel like something you must survive.

At that point, a higher salary elsewhere isn’t temptation.

It’s relief.

Money may open the door.

Bureaucracy may slow your steps.

But burnout is often what finally pushes you across the threshold.

Because no one can live indefinitely in a state of depletion.

Not students.

Not patients.

Not faculty.

If we want academic medicine to thrive, we cannot simply ask people to be tougher.

We must design jobs that are humanly possible.

Protected time.

Fewer competing mandates.

Realistic expectations.

Space to breathe.

Space to think.

Space to care.

Because anemia is not only blood loss.

Sometimes it is simple exhaustion.

The body cannot keep up with the demands placed upon it.

And so, it weakens.

Quietly.

Gradually.

Until one day the halls feel emptier than they used to.

In Part 4, I want to explore another force that follows close behind burnout.

Something more subtle, but just as corrosive:

The loss of autonomy.

What happens when decisions about teaching, clinics, and values, drift further and further away from the people actually doing the work?

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