Night Shift – Burnout

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“You look really exhausted, sweetheart,” my wife said sympathetically as I trudged into the house and plopped down at the breakfast table.  “Did you have a hard night?  Are you feeling OK?”  I just sat there in fatigued stupor.

“No, I’m finally getting burned out,” I said with a sigh.  “I think we need to have another baby.”

“Sweetheart, you’re not burned out,” she said after a long pause.  “You…are losing your…mind.”  I could tell that the pauses between words were the expletives that her mind was censoring.


“Seriously,” I continued without looking at her colorless face.  “I just read in JAMA that emergency medicine has one of the highest burnout rates of any of the specialties but that having children, especially below the age of five, is somewhat protective of burnout.”

“Honey,” she said gently turning my face up to meet hers just like she used to do with our misbehaving children.  “If you gave me a toddler right now, you wouldn’t have to worry about burnout.  Because I would kill you.”

“Ok, so maybe having more children is not the best way to insure longevity in this specialty,” I surrendered.  She just shook her headed as she peered into my vacant stare.


“What is going on in there?  And what is ‘jama got to do with anything?  Have you been looking at the pajama catalog again?”

She broke the spell with that one.

“No, silly.  JAMA is the journal of the American Medical Association.  And they studied the factors that lead to increased physician burnout.  It was pretty enlightening.  At least EM no longer has the worst burnout rate.  Neurology and Urology have that record.  I guess if you deal with neurogenic bladders all day you must be suicidal.”

“Did you know that women have a higher burnout rate than men?” I said.


“So now you are going to tell me that there is a woman hidden inside of your big, hairy, smelly male body that’s causing you to burn out,” she said now chuckling at her own humor.

“That’s sexist,” I said with mock insult.  “But seriously, why do you suppose that is?”

“Women are smarter than men,” she said with a haughty air.  “Working nights, weekends and holidays is simply nutty.  Women have figured that out.  And we are far more likely to leave this craziness to the He-Men like you.”

“Is that a compliment or an insult?” I said.

“Figure it out,” she replied tersely.

“I did notice that residents with the highest household income during residency had the highest burnout rate,” I said.

“See, that certainly wasn’t us,” she said.  “We didn’t have two nickels to rub together when you were in training.  Remember when we were giving platelets twice a week during medical school?  And I had that terrible job at the VA picking up dirty surgical instruments from the OR.  And you worked on weekends in the blood bank?”

“That was medical school.  It got better during residency.  And medical school would have been a lot easier if you had let me be a sperm donor.  They were paying 50 bucks a specimen,” I said with an ‘I told you so’ tilt of the head.  She just shook her head silently.  This was ground we had covered oh so many times.

“And speaking of sex…” I said. “I did notice that Latino men are more likely to burnout than non-Latino men.  Do you suppose that I have more Latin blood in my heritage than I know about?”

“Do you like to Salsa dance?” she said starting to sway her body seductively.  “Do you even know what Salsa dancing is?”

“I like chips and salsa,” I replied with a smart alec smirk.

“Do you love me passionately like Johnny Depp in Don Juan DeMarco who was going to kill himself if his lover didn’t return his passion?” she challenged.

“I think I fell asleep in that movie.” I said. “Did he kill himself?  That’s strange.”

“Believe me sweetheart. says you come from a long line of Bavarian beer drinking Germans who came to the New World to become moonshine distilling Ozark hillbillies.  I think that they pretty much nailed it.”

“Well then, how do you explain why I feel so burned out?”  We both sat there silently for a long moment — me, in my fatigued funk and she, as the sympathetic companion who has shared this life.

“You work really hard, sweetheart,” she finally said softly.  “And yours is a hard job.  Look at me.  Do you know how many birthdays and Christmases you’ve had to miss because of work?  I really appreciate your hard work.  And I know the kids do too.  And I know it’s hard to handle crisis after crisis all night long.”

“You know it isn’t crisis after crisis,” I mumbled.  “That’s only on TV.”

“I know, but you have to deal with annoying patients, administrators who don’t get it, radiologists who don’t read your CTs right away…”

“Have I said that…about radiologists?”

“Everyone single night shift,” she deadpanned.  “Let me see that magazine.  It can’t be all bad news.”

She picked up the journal and began leafing through the study.

“This is fascinating,” she said after reading for a few minutes.  “Despite having one of the highest burnout rates of all the specialties, it has one of the lowest with career choice regrets.  How does that happen?  You’re burned out, but you don’t regret going into the field?”

“I guess it’s like that Marine Corps slogan, ‘the worst job in the world that you will love forever’ or something like that,” I said.

“Hey if you get really burned out you can go into Dermatology,” she opined.  “They have a really low ‘specialty choice regret rate.’

“If I had to look at warts and pimples all day, I’d really want to put a bullet in my head.  No thanks,” I said with fervor.

“Or, you could be a neurosurgeon.  They have a zero percent ‘specialty choice regret per cent’,” she said followed by a long silence.

“Nah,” we both chimed in simultaneously.

“I can’t see you as a neurosurgeon,” she said.

“Thanks for the vote of confidence,” I whined.

“Let me fix you a big breakfast,” she said with a warm smile.  “Then you can take a hot shower and go to bed.  Between the carb load and the relaxing shower you should be able to get a good day’s sleep and wake up feeling better.”

She was right.  Getting my tummy full and the night’s sweat washed off with a ton of hot water and I was ready for bed.  But when I came around the corner to the bed she was already in it.

“You’re not expecting any action, are you?” I said with all the confidence I could muster at that hour.

“Absolutely, Don Juan DeMarco,” she said.  “It took a lot of trying to have our first baby.  I don’t know how long it will take this time.  We better get at it.”

“Well OK, baby,” I said with growing enthusiasm.  “I think I’m feeling better all ready.”

“Besides,” she mumbled.  “I have to keep you working.  If you retire, you are going to drive me crazy.”


FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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