Scratch That: A Dermatologist’s Guide to Battling Burnout

There is a phenomenon in medicine well known to those inside and outside its hallowed halls. It’s not a rare autoimmune condition with a clever, consonant-heavy acronym that requires 3 consults and a fellowship to pronounce—it’s burnout. And despite our reputation as the unicorns of the medical world—gliding through clinic with statuesque physiques, flowing voluminous hair, and skin so smooth and glowing it seems to have never so much as heard of UV radiation—dermatologists are not immune to it.

According to Medscape’s 2023 Physician Burnout & Depression Report, dermatology ranks among one of the specialties experiencing significant burnout, which continues to shock those who assume we spend our weekdays handing out moisturizer samples and weekends racing Jet Skis off tropical islands.¹

Burnout is not simply having a bad Tuesday. The Maslach Burnout Inventory defines it via 3 dimensions: emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment.² Translated from academic to human: You feel empty, you stop caring as warmly as you once did, and you begin to wonder whether medical school was a colossal life mistake. What I have compiled here is an anecdotal discussion of how one dermatologist scratches that burn…out.

Human Connection: The Original Burnout Antidote

A genuine human connection with patients is one of the most potent antidotes to burnout available. This human connection is found in the middle of a packed day of clinic, during a skin check with an older patient from the United Kingdom. While examining for suspicious lesions and discussing which rock bands from the 1960s are the best, she casually remarked that she personally knew all 4 Beatles band members in their early years, having hosted them at her London nightclub. Naturally, I wanted to cancel the rest of clinic and ask about 1000 questions on this topic. Luckily, multitasking has been “burned” into my medical abilities, dating back to holding a retractor as a medical student in surgeries while answering high-stakes questions by my attending surgeon. The atypia of this skin check was positive, and the fact that I interacted with and learned from an individual of such musical historical significance will be one of my greatest memories.

The Art of Learning When It’s Time to Let Go

This I struggle with—and I haven’t even seen Frozen. After caring for genuine sociopaths in the inpatient psychiatric unit during medical school, I promised myself I would never become one. Having said that, there is a difference between not caring for the well-being of others and recognizing your limitations as a clinician.

Every clinician has difficult patients—the ones who a dozen specialists and 3 continents of testing have failed to identify. These encounters, if not mentally processed and filed away, have a remarkable ability to follow a physician home and occupy mental real estate.

Active listening, empathetic engagement, and an appropriate referral are the tools. What is not a tool is carrying the emotional residue of an unwinnable encounter into the next exam room, where a perfectly reasonable patient with a very fixable rash deserves a physician who is fully present. Mental separation is not callousness—it is a professional obligation. In summary, the dermatoscope stays at work (well, not literally; those things are too expensive to keep sitting out).

Hobbies: Because the Walls of the Clinic Are Not a Prison

From the earliest days of medical school, it became increasingly clear that we budding—and eventually board-certified—physicians needed to budget consistent time for nonmedical ventures. I have seen firsthand countless colleagues who eat, sleep, and breathe medicine, and that road is a one-way ticket to burnout. The marginal gains—an extra board exam point here, an additional residency interview there—are, in my view, not worth the premature sacrifice of my luscious flowing hair or what remains of my mental stability.

There are marathon clinic days where my mood and energy are buoyed by knowing I will be defending my unofficial sauna endurance championship title at the gym after work. On other evenings, I sit at my drawing table—sometimes by sheer force of will—to cathartically create more oil pastel pieces of fantastical flying elephants, colorful meadows, roaring waterfalls, and cosmic backdrops. The metaphor I offer patients and colleagues alike regarding the power of a creative hobby is this: A piece of my soul lives on and is immortalized for others to enjoy in a creative piece. Sort of like the good-guy version of Voldemort’s horcruxes without all the killing.

Humor, Meaning, and the Big Picture

Humor, when it humanizes rather than demeans, is genuinely therapeutic. A shared laugh in an exam room, resulting from a toddler patient repeatedly saying, “I’ve got the eggs-ma,” or a patient wondering why their rash is still present despite eating their cream like astronaut food instead of applying it topically, is not unprofessional—it is a survival mechanism.

Equally important is finding meaning in the mundane day-to-day. When a dermatopathologist calls about a peculiar biopsy that requires clinical context, that is not a burden—it is a gift. When a newly trained medical assistant appears to be reading my mind and scribing an impression and treatment plan before I even say a word, it is impossible, at least for that moment, to feel burned out.

That said, it would be naive to discuss burnout without acknowledging the contributors. Tidal waves of prior authorizations of less and less covered therapeutics, electronic health record documentation burdens, shrinking appointment times, and administrative overload are not solved by being the undisputed sauna endurance champion of Columbus, Ohio—however meaningful that is. Institutional support, schedule autonomy, and advocacy for regulatory reform are all part of the tool kit.

Individual coping strategies are the EpiPen for burnout—they’re lifesaving in an acute flare. But what really matters is identifying—and removing—the peanuts from your professional diet in the first place. Prevention is far less dramatic than an injection to the thigh, but it’s also far more sustainable. And yes, that was my obligatory peanut allergy analogy.

Overall, burnout in dermatology is best managed not with a single miracle intervention but with daily maintenance: genuine human connection, a reliable sense of humor, sustained intellectual curiosity, and the disciplined practice of not allowing a difficult patient to emotionally accompany you into the next exam room.

Add to that the preservation of an identity outside of medicine, where your worth is not measured in biopsy margins or inbox zero, and you have something far more protective than any prescription pad can offer.

References

1. Underdahl L, Ditri M, Duthely LM. Physician burnout: evidence-based roadmaps to prioritizing and supporting personal wellbeing. J Healthc Leadersh. 2024;16:15-27. doi:10.2147/JHL.S389245
2. Lee RT, Ashforth BE. On the meaning of Maslach's three dimensions of burnout. J Appl Psychol. 1990;75(6):743-747. doi:10.1037/0021-9010.75.6.743