Clinician Burnout: Why it’s Medicine’s Favorite Misdiagnosis

I didn’t recognize the look in their eyes at first, despite it being familiar somehow. It lingered during code blues, huddles, and was still there at post-shift gatherings, when the drinks flowed but no one really relaxed. I was a medical intern in an overwhelmed Washington, D.C. emergency department, watching the attending physicians float through their shifts like ghosts in scrubs.

At the time, I couldn’t name what I was seeing. Years later, I would learn it was a symptom of PTSD known as the “thousand-yard stare” – something I had recognized from my medical school rotations with combat veterans at the VA, only now I was seeing it in my colleagues. At the time, I thought my colleagues were perhaps “burned out,”a term that was becoming increasingly popular and recognized in our field in the 2000s. But only after my own experience with PTSD and leaving my Emergency Medicine career due to the impact on my own mental health did I realize the harsh truth: the doctors who trained me — while running an overwhelmed, under-funded, high-acuity ER in a city with a staggering violent crime rate — were traumatized. I didn’t recognize it at the time, and I don’t know if they did either.

While PTSD has become a widely recognized affliction among combat veterans, it is still rarely discussed as a job hazard for healthcare workers. As trainees, we’re taught to ignore our body’s signals, to push down our emotions and reactions and just keep going no matter what. It is no wonder then, that after years of onslaught coupled with suppression, our nervous systems start to shut down. My personal belief is that labeling trauma as burnout is an easier pill to swallow, and that our collective blindspot as clinicians is a silent agreement we make with each other for the sake of survival for both our egos and the system that depends on our complicity to function.

But as a result, this has become a silent epidemic in medicine, and it’s well past time to start having more honest dialogue about the issue we mistakenly call burnout. There is definitely more open conversation today around alternative career paths or leaving medicine altogether than when I started down this path over a decade ago, which gives me hope. However I still see traumatized clinicians every single day who completely miss the mark on what they really need to heal and come home to themselves. Because leaving your career in medicine may help your burnout, but it will not miraculously heal your trauma.

Stress vs. Burnout vs. Trauma

The way that I like to think about stress, burnout, and trauma is that they exist on a continuum. We can swing from one end of the spectrum to the other, but what distinguishes trauma from the other two is the lasting imprint it leaves on the nervous system. I’ve noticed that many of my clients start with chronic stress, which leads to burnout, which makes one more vulnerable to developing PTSD.

While we often equate burnout with overwork, I’m here to tell you that it’s a lot more complex than that. For example, I’m busier than I have ever been in my career – juggling coaching healthcare workers, serving as a chief medical officer for a startup, and working as a primary care physician in an inner-city FQHC – but I am not burned out. Why? Because I finally recognized that what we call burnout is often trauma — and once I saw it for what it truly was, I could focus on modalities that actually helped me truly heal vs. the band-aid approaches I was taking.

A simple way to think about it is this:

Stress is a natural response to high-pressure situations, often temporary and manageable. Stress can be alleviated by changing jobs, reducing hours, or getting more sleep.

Burnout develops from prolonged, unrelenting stress, leading to exhaustion, cynicism, and decrease in productivity. Burnout may be alleviated by changing roles, taking a sabbatical, etc. but often requires deeper inner work such as therapy or coaching.

Trauma, whether from a single critical incident or repeated exposure to suffering and loss, is anything that overwhelms our ability to cope. Trauma can lead to PTSD when someone lacks proper support and access to effective healing modalities. If untreated, it will eventually cause what we call a “functional freeze state” aka dissociation. Healing is multi-modal and often consists of a specific sequence of body-centered work under professional guidance and a restructuring of one’s life to focus on healing and rest, at least temporarily.

While we can build skills that contribute to resilience, when something happens to us that is beyond our control or capacity to cope, we cannot always control how our body and nervous system will respond to the event. For so many years, I have held back a groan and an eye roll (often unsuccessfully) when I hear people talk about different wellness initiatives and productivity hacks such as AI tools to help alleviate healthcare worker burnout. Yes, we can absolutely build resilience skills for our mental health and use all the shortcuts to get our charts done and walk out of the door when our shift is over, but when something happens to us that is beyond our control – say an encounter with a threatening and verbally abusive patient – we cannot always manage how our body and nervous system will respond to the event. And this is what I want to make clear: It is not a personal failure or “a lack of resilience” if something that might seem objectively minor becomes a trauma to you — it is always a result of factors that have added up over many years, much like the chronic diseases we all work so hard to manage and prevent. There is always a tipping point when the mind and body say this is too much and start to shut down.

The Real Definition of Trauma

For many years, I thought trauma required a “threat of bodily harm” component, like violent crime, domestic abuse, war, or a natural disaster. These are certainly categories of trauma, but they’re not the whole story. Here’s the real definition of trauma, used by most of us in the field, courtesy of therapist and trauma specialist Resmaa Menakem:

“Trauma is a response to anything that's overwhelming, that happens too much, too fast, too soon, or too long — coupled with a lack of protection or support."

If you’re thinking “wow, that sounds like my every day!” you’re not alone. Literally just working in healthcare can be traumatic in and of itself due to the absolute cognitive overwhelm faced by most of us every single day. Trauma is always defined by how one is able to personally process a situation, and not necessarily based on the event itself. Something really traumatic to one person might just be a blip on the radar to another. Whether or not a person experiences something as traumatic depends on a range of factors including genetics, gender, access to a support network, and priming events such as adverse childhood experiences, or ACEs.

Another important component of understanding trauma in healthcare workers is the discovery of a condition called “Complex PTSD” or c-PTSD, first described in 1988. If you have never heard of it, that’s because it has taken over 30 years for c-PTSD to be recognized as an actual disease entity, as it was finally recognized in the WHO International Classification of Diseases (ICD-11) in 2019. There are distinct differences between “classic” and “complex” PTSD with the main one being that c-PTSD is often relational trauma and more chronic in nature vs. a single catastrophic event which would lead to more classic PTSD symptoms.

Think of c-PTSD like death by a thousand paper cuts. The parents who aren’t physically abusive, but are absent and emotionally neglectful and never make it to their kids’ soccer games. The narcissistic spouse who never hits their partner but slowly chips away at their self-worth over time. Or in the case of an ER doctor, the sad and overwhelming cases witnessed every day/week/month/year without proper support and recovery tools to process them. We suppress, numb, and keep moving, just as we were trained. Over time, this numbness becomes a more permanent state of dissociation, just like I had noticed in my ER attendings years before.

Our autonomic nervous system is much more complex than fight/flight and rest/digest, like I was taught in medical school. Another decades-old discovery that has been largely ignored by the greater medical community is called Polyvagal Theory, which explains how the autonomic nervous system — particularly the vagus nerve — regulates our health and behavior in nuanced ways. The cornerstone of this theory is that our behaviors and physiology are influenced by three blended states that are constantly responding to signals of stress and safety:

1. Ventral Vagal (Social Engagement State) – When we feel safe, connected, and engaged with others. This state promotes calmness, connection, and emotional regulation.

2. Sympathetic (Fight-or-Flight State) – Activated in response to danger or stress, preparing the body to fight or flee. This can cause anxiety, rapid heartbeat, and hypervigilance.

3. Dorsal Vagal (Shutdown/Freeze State) – When stress becomes overwhelming, the body shuts down to conserve energy, leading to dissociation, numbness, or depression.

When I started learning about the role the nervous system plays from the lens of PTSD, everything made sense — my colleagues’ behavior, my own hypervigilance, my patients’ chronic fatigue. This crucial insight is not being widely taught in medical training or sufficiently being put into practice in the real world; and techniques that work to heal it, such as somatic experiencing, are definitely not being covered by insurance. This is true despite the ground-breaking and very publicized work of Gabor Mate, Peter Levine, etc. and the massive wealth of data we now have on somatic work to heal from trauma.

The Way Forward

My journey to understanding trauma in healthcare workers has been the most unexpected and profound experience of my life. And like many in the field, I came to it out of necessity from my own personal experience. I was diagnosed with PTSD in 2020–I had already been in practice for many years at that point, so when I say that we have a collective blindspot about this topic, I am pointing first and foremost at myself.

For most of my adult life I thought – and was told by multiple mental health providers – I had depression and anxiety, which I conveniently attributed to professional burnout once I had been in practice long enough. I did all the classic mental health/burnout remedies – talk therapy, SSRIs, switched fields, switched jobs, worked less, exercised and slept and self-cared more. But nothing seemed to really move the needle in regards to my existential anxiety and angst.

When I finally gained clarity on what was actually happening in my nervous system–for example, my anxiety was only in very specific situations that reminded me of traumatic events– I felt like I was finally reaching land after a long and stormy overseas voyage. I could breathe. I slept soundly. I felt I was walking on solid ground. There was a spaciousness and hope that I never knew was possible. I became delightfully detached from the drama of my profession, not in a dissociated numb way like I was before, but in a healthy way where I am engaged and present but the sh*t no longer impacts my soul.

I want every single one of my brilliant, amazing colleagues (yes, you reading this) to also know what it feels like to reach that shore of understanding. The journey there is not easy, but it’s the most vital one you’ll ever take. And it starts with a brave, honest question: Is this really burnout… or is it something deeper?