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How Do You Avoid Burnout?

Daniel Kalish, DC

Dan Kalish discusses the importance of practitioners new to Functional Medicine connecting with a seasoned colleague to address emerging patient concerns.

Early in my Functional Medicine career, a doctor explained to me that there were three stages of practice development ahead. Like the differences between an infant, toddler, and teenager, Functional Medicine clinicians, too, face different challenges in three different predictable stages of growth. Knowing about these stages ahead of time has helped me navigate them with some grace.

Years 0–5

In those first five years of practice, I experienced what we all do—abject fear! This included fear of patients not getting better, fear of financial ruin, and primarily fear of the unknown. In this phase, there is so much to learn. This phase is about growth like you see in a newborn where there are day-to-day, week-to-week changes. Each element of patient interaction takes on an exaggerated importance because you’re not sure of how to contextualize it. Does everyone react to B vitamins like that? How long does it take for a typical autoimmune case to respond to a detox program? And so on.

As we build our confidence in those first five years, we also experience our first failures, including programs that don’t work and patients who get worse. In these early years, every new patient is truly “new”—your first Hashimoto’s case, your first H. pylori, your first patient with night sweats, and your first fertility case. This clinical learning curve is steep and understandably demands our full attention.

The mistake made during this phase is to ignore the business side of your clinic. It feels unrealistic to take even one hour away from precious time spent on cases. Yet the risk here is that you may so overly focus on clinical skills development that you’ll fail financially due to poor business infrastructure. It’s horrible to watch Functional Medicine clinicians exit practice because of weak infrastructure that leads to overwork and burnout.

Avoid this pitfall by setting aside 90 minutes one day a week to focus on the business. It’s that simple. Focus on whatever area of running your clinic you need the most help with. You can find balance and build clinical and business skills side-by-side using IFM’s free Functional Medicine Matrix.

During those first five years, you begin to see how effective Functional Medicine is. You get your first complex cases to improve. Confidence builds. You learn what you can and cannot do. You start to develop a referral network that includes dentists, chiropractors, and MDs with various specialties so you can offer more comprehensive care. This ushers clinicians into the second phase of development.

Years 5–10

In years five to 10, you are well-loved and respected by patients. You’ve had enough successes to build a reputation (a good reputation!) and receive referrals left and right. Once you help one patient with depression, you’ll end up with 10 referrals. Next, you will inherit progressively harder cases, which means more complexity and more work. This is the inevitable path of all good Functional Medicine practitioners.

The typical reaction to this is for you to work harder and harder to figure out these tough cases. You may choose to study mold treatments, Lyme disease, and the interpretation of more advanced labs. In this second phase, you are truly becoming an expert in chronic, high complexity cases.

During these years, your time is necessarily consumed by more advanced learning, making it easy to neglect the business. How could you possibly fit in a business class when you have to figure out that new case that came in Tuesday? No one can do it all. Year after year, you put off the business coaching. As your clinical expertise grows, the business dysfunction compounds.

You end up with decent steady income tied to excessive work hours with little profit because your expenses skyrocket. Your supplement inventory grows like the vines in Stranger Things.* The variety of labs you order surges. You’ll end up with progressively less efficient business systems in place as you develop workarounds for individual patients who have such complex cases that they require unique solutions. In summary, your work hours go up and your hourly income may drop.

This happens to almost every Functional Medicine practitioner.

No one notices any of these business trends because, in the meantime, they are intent on helping patients. This “crazy train” crashes at some point, usually with the doctor burning out. I’ve seen too many of the best folks walk away from their clinics, leaving patients to fend for themselves. It’s unfortunate and avoidable with basic practice implementation training.

Year 10 & Beyond

As you go past year 10, you’ll face the highest risk moments of your entire career arc. It feels like when your child has grown into a teenager and you finally hand them the car keys. In the toddler phase, they could burn themselves on the stove, but now you have to confront the real concern that they could die in a car accident. With the stakes this high, there are two roads to choose from. Folks either rip apart and rebuild practice systems, create efficiency and profitability, and get in another 15–20 years of practice, or they burn out and walk away—or, perhaps worse, they burn out and stay in practice to their own personal detriment. If you are burned out AND stay in practice, this can equal divorce, financial stress, and eventually the doctor who becomes the patient and gets sick.

Years 10–20 can be the best years if doctors tend to the business development issues that inevitably show up at this phase. Ideally, these years can be characterized by maturity as clinicians develop business skills (because it’s never too late), streamline their clinic, improve profitability, and, most importantly, reduce stress. With this time and with your practice experience, you can now write a book, start a blog, teach a class, or expand your ability to help more people.

I work with students in all three phases and find, in general, that the earlier we can get your business skills developed, the happier you will be and the more people you will be able to help.

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*Footnote: If you haven’t heard of Stranger Things, it’s the best series ever, available on Netflix.

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