When Kara Pepper, MD, took a 6-week sabbatical, the primary care internist from Atlanta, GA, had reached a breaking point. In addition to working more than 60 hours a week, she was raising two young children as a single parent most days because her husband traveled for work.
“I was literally trying to stay alive,” Dr. Pepper said. “I really, truly felt like I was failing. I had finally run out of gas, and I just could not do it anymore.”
According to a survey co-authored by the American Medical Association, Dr. Pepper is not alone. At the end of 2021, nearly 63% of physicians in the United States exhibited at least one symptom of burnout, compared with 38.2% in 2020, 43.9% in 2017, 54.4% in 2014, and 45.5% in 2011. While the COVID-19 pandemic likely increased burnout rates, a 2023 report from the Primary Care Collaborative and Robert Graham Center notes that nearly 40% of practicing physicians felt burned out at least once a week before the pandemic began. Despite more than half of all physicians experiencing similar challenges, discussing them can still feel taboo.
“It felt like everyone else had their act together, and I was the only one struggling,” Dr. Pepper said.
Shame and Stigma Associated with Sharing Burnout
Potential consequences of physician burnout include increased risk of medical errors, malpractice, and serious health concerns like mood disorders, depression, and substance abuse. And yet, some physicians are reluctant to discuss their challenges because society rewards them for being superhuman.
“Like many of my colleagues, I learned very young that achievement felt very good,” Dr. Pepper said. “It felt better than a lot of the discomfort we feel as humans. And so, I got really good at looking good on paper and checking all the boxes.”
When she finally admitted she needed a break back in 2015, Dr. Pepper said she felt shame, frustration, and vulnerability – feelings she was unaccustomed to after years of accolades and achievements. While some described her sabbatical as brave, she called it a self-imposed burnout sabbatical and an act of desperation.
“When I could not wake up and get out of bed anymore – that’s when I took my sabbatical,” Dr. Pepper said. “There’s a stigma with mental healthcare because our licenses are tied to reporting it. Being able to say that you’re struggling is still very challenging.”
(See also our Be Well, Practice Well podcast conversations on physician burnout and stigma.)
Shortly after announcing her sabbatical, something unexpected happened. Other physicians started approaching Dr. Pepper for advice, feeling it was safe to share their struggles because she had shared hers.
“I didn’t sign up to be a leader, but people came to me for help,” Dr. Pepper explained. “And in that process, I recognized that everyone else was struggling, too, but no one was talking about it.” Despite returning to the same practice when her sabbatical ended, a seed had been planted that would take 7 years to sprout.
Forging a New Path – and Practice
In the years following her sabbatical, Dr. Pepper adjusted her hours and service offerings numerous times, but something still felt off. Between work frustrations and a growing understanding of how many other physicians were struggling, she arrived at a crossroads.
“I finally recognized that I was misaligned with the practice in how I wanted to deliver care,” Dr. Pepper said. “So, I decided to leave and start my own practice, which is what I’ve been doing now for the past year and a half.”
Dr. Pepper’s private practice is two-fold. In addition to treating patients, she is now a certified life coach, supporting other physicians through challenging times. She credits her sabbatical experience for leading her down this path.
“My particular realm of coaching is in high-achieving perfectionists who are exhausted, overwhelmed, and burned out,” Dr. Pepper explained. “When people come to me, they’ve usually checked all the boxes and look great on paper but have no idea who they are, what matters to them, what feels good, or what they want the rest of their life to look like.”
Dr. Pepper and her clients discuss sabbaticals as a preventive measure or treatment for burnout. She estimates that as many as 30% are having active suicidal ideations, and that number has increased significantly since the COVID-19 pandemic. While some reduce their hours to give themselves room to breathe, others create space by stepping back from unpaid professional commitments like committees and mentoring. And some take more traditional sabbaticals, stepping away completely for a period. Whatever approach you take, know that help is available.
“They say that there are two reasons we do anything in life,” Dr. Pepper said. “One is because it sets our soul on fire. Two is because it breaks our heart. It is gut-wrenching for me to watch people who have literally sacrificed everything in the name of patient care come close to losing – or lose – their lives because they don’t see a way out. You can have a life that doesn’t feel miserable. And just to know that there’s hope is a really big deal.”
Investing in Yourself Provides the Best Outcome
Sidney Roberts, MD, FACR, is a radiation oncologist and hospice physician in Lufkin, TX. Like Dr. Pepper, he took a mid-career sabbatical and has zero regrets.
“I was getting burned out and needed to take care of my mental and spiritual health,” Dr. Roberts said. “Burnout is very real for physicians. Taking a sabbatical renewed my appreciation for the work and my desire to get back and do it. Sometimes, you have to step away to really see the good and the bad and realize there is far more good.”
Planning a sabbatical took some effort. As a solo practitioner in a private practice, Dr. Roberts had to find coverage for the hospital-based cancer center he served, not an easy task in his rural area. He also had to discuss his plans with others.
“The person I worried about most was my wife, but she was very supportive,” Dr. Roberts said. “I think the people closest to you know the stress you’re under, how you’re feeling, and how you’re handling it or not handling it.”
During his 4-week sabbatical, Dr. Roberts stayed at a Protestant theological seminary in the mountains above Interlaken, Switzerland. While there, he reconnected with an earlier passion that had nothing to do with healthcare or patients.
“I was a German literature major in college, and I wanted to get back to that and do some reading in German and some translating work,” Dr. Roberts said. “It really recharged me and allowed me to get to a point where I felt like I could push ahead, finish out a strong career, and get to retirement. It’s not easy, but you’ve got to work hard and make these things happen when you can. To get 4 weeks off was just amazing.”
Sabbatical Tips for Physicians
Dr. Roberts encourages other physicians to take a sabbatical before the need becomes urgent.
“The stresses of medical practice these days are only getting greater,” Dr. Roberts said. “I think physicians need to be very attuned to those stresses and how it’s affecting them. You don’t want to get to the point where you feel broken or depressed. By then, it’s very tough to try and make it work, and then you’re in crisis mode. You need to prevent the crisis.”
Here are four additional tips from Dr. Roberts:
Take at least 4 weeks. “Length of time is very important. If you’re gone for 1 or 2 weeks, that’s not a sabbatical. That’s a vacation. I think 4 weeks is a minimum.” (See also, which physician specialties take the most, and least, vacation time.)
Leave home if you can. “Physical distance is important. To me, taking a sabbatical at home defeats the purpose. You’re too close to work and to the same stressors that got you to that point. Getting that separation was an important part of the sabbatical for me.”
Try to check out. “I didn’t do a lot of social media posting, and I left work at work. I really tried to check out and stay firm about that because it was the whole reason I was taking a sabbatical.”
Consider it an investment. “I think any loss of income balances against a loss of future income that will happen if you burn out and quit. Taking a sabbatical allowed me to work longer than I think I would have. It was an investment that bought me time and income in the future.”
When Dr. Roberts and Dr. Pepper reflect on their sabbaticals, they both say it was the right decision.
“In my line of work as a cancer physician, I see a lot of people evaluating where they are at a very serious time in their life, and oftentimes at the end of life,” Dr. Roberts said. “I wanted to make sure I was living my life to the fullest and didn’t have any regrets.”
Dr. Pepper shared a similar sentiment, saying, “When we’re on our deathbeds, no one ever looks back and says, ‘I wish I saw one more patient.’ You can decide right now that you’ve made an impact in this world because you exist. You have saved lives, and you have made a difference. It’s important to do what’s right for you and your family. If that means taking a step back from work, either temporarily or permanently, your life is worth that. For me, a sabbatical was lifesaving and career-saving, and I have never been happier.”
Have you taken a sabbatical? We want to hear about it. Email us at contactmc@healthcentral.com.