The Four Horsemen of the Physician-Burnout Apocalypse

Dike Drummond, MD

The subconscious attitudes and behaviors that virtually guarantee burnout

Our medical education indoctrinates us. Yes, indeed. While in training, we are expected to adopt attitudes and behaviors that become subconscious and automatic by the time we are board certified. To most doctors, these behavior patterns are invisible and unrecognized. However, if they continue to sit in your blind spot, they virtually guarantee physician burnout in your forties and fifties.

Here are the four horsemen of the physician-burnout apocalypse in all their glory. See if they feel familiar to you:

  1. Workaholic
  2. Superhero
  3. Emotion Free
  4. Lone Ranger


Burnout results when these four horsemen become “overused strengths.”

Basic training in the military lasts eight weeks. In that time, an 18-year-old can be conditioned to take a bullet on command. Medical education lasts a minimum of seven years. Take a second to count up the time between your first day in medical school to your first day in private practice. I believe there is no conditioning program on the planet more thorough than the one that leads to becoming a practicing doctor.

If your only tool is a hammer, everything looks like a nail.

That is the problem. Not everything in a doctor’s world is a nail–especially after you graduate to private practice and the rest of your life. Burnout results when these four horsemen become “overused strengths.”

Being a workaholic / superhero / emotion-free / lone ranger is an absolute requirement to making it through a 72-hour shift in your residency, but it is not a great way to: 

  • Be in a loving relationship
  • Raise your kids
  • Get your own needs met
  • Live your life

I help my clients see this conditioning when it appears as automatic behavior that is driving their physician burnout; when they are using this set of hammers to drive things that are not nails.


  • When your only response to a challenge or “problem” in your practice is to work harder, that stems from your workaholic programming. I can assure you there are other ways to address almost any practice issue that do not involve you personally working harder.
  • When you feel as if every challenge for your patients, your staff, your family, and yourself sits on your shoulders and you should be able to solve them all, that is your Superhero programming. The truth is, you are human. You are not a god. Learn to say, “I don’t know the answer to that,” or “I wish I could help here; I wonder what you will decide to do?” and let things go that are outside your control. Breathe.
  • When you have strong feelings of fear, sadness, anguish, helplessness, love, joy, compassion, empathy… don’t stuff them according to your emotion-free programming. And please don’t feel guilty for having those feelings in the first place. You are human; you will have feelings. They are part of what makes life rich, juicy, and worth living. Let them flow. Don’t bottle them up. And never be afraid to tell someone—especially your work team—what you are feeling in the moment. It lets them know you are not superhuman.

When you micromanage, can’t let things go, and drive yourself and everyone around you crazy by having to do everything yourself, that is just your Lone Ranger programming. Yes, you are ultimately responsible for the outcomes in your practice (and your life), but you can ask for support. You can delegate and create systems that will take away some of your burden while delivering the quality you demand. It is possible. 

For most of us, these four horsemen and their automatic behaviors are deeply subconscious. Remember that you spent a minimum of seven years installing them in your psyche—deliberately, consciously, and through thousands of hours of dedicated study and on-the-job training. No wonder they poke their heads into all areas of your life—and not always in a good way.


Here’s a simple way to expose your own brainwashing and lower your physician burnout risk. Whenever you find an area of your practice or life that is not working the way you would like, ask yourself: “How am I perhaps acting like a workaholic / superhero / emotion-free / lone ranger here?”

When you notice one of the four horsemen as the source of your automatic behavior in this area, ask, “What might I do differently that will get me more of what I really want?” The power is yours. By being aware of the four horsemen of the physicianburnout apocalypse and making appropriate changes, you can achieve greater health and success in your life and medical career.