In previous Real World Ophthalmology Corner columns, we explored how surgical setbacks can become growth opportunities and how challenging patient interactions can be reframed into moments of trust-building. Yet there is another challenge that intersects practice, performance, and personal wellbeing: burnout in the early years of independent practice. What feels like a finish line after training often becomes the start of a new set of demands: productivity expectations, administrative complexity, decision fatigue, and diminishing structural support. Studies show that many early-career physicians consistently report higher rates of burnout than their mid-career peers,1-6 often because the support systems of training vanish just as the demands of independence and responsibility intensify.
In this month’s column, we will look at why so many ophthalmologists feel more overwhelmed in their first few years of practice than they ever did during training, along with practical strategies to keep the spark early in your career.
Understanding the Pressure Points
Burnout rarely arrives suddenly; it builds over time. In ophthalmology, recent national survey data indicate that nearly 37% of US ophthalmologists report symptoms of burnout, primarily characterized by emotional exhaustion and depersonalization.4 Recent studies have found that time pressure, excessive documentation, and decreased autonomy are key drivers of burnout, consistent with findings across medicine that link administrative load to lower career satisfaction.5 Some additional markers of burnout that are more prevalent amongst recent graduates include:
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Volume shock: After residency, success becomes tied to metrics like patient load, surgical volume, or revenue. Patel et al. note that when productivity becomes the primary measure of value, physicians experience rising emotional fatigue and a decline in personal accomplishment.2
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Boundary erosion: Saying “yes” to every opportunity can lead to overextension. Ambition without boundaries is a fast track to exhaustion.
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Isolation: Without co-residents, chiefs, or mentors in the next room, decision fatigue sets in quickly. Razai et al. found that strong peer networks reduce emotional exhaustion, yet many physicians in early practice lack structured opportunities for connection.3
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Loss of meaning: When every day becomes about throughput, it’s easy to lose sight of the deeper purpose behind patient care.
The transition out of structured training is both exciting and destabilizing. Autonomy, once a goal, becomes something to manage. Recognizing these triggers early allows physicians to name what’s happening and then take steps to counteract it.
Spotting the Signs: A Quick Burnout Self-Check
- Do I feel engaged, not just efficient, at the end of most days?
- Have I done something this week that felt like me outside of work?
- Can I rest without explaining why?
- Do I have someone I trust to talk to when the weight builds?
If any of those give you pause, consider it a signal not of failure, but of humanity.
Strategies to Sustain the Spark
Awareness without action can leave physicians feeling stuck. Sustaining your spark requires small, intentional choices. Here are several strategies that you can try:
Redefine Boundaries Before They’re Tested
Evidence shows that interventions reducing excessive workload meaningfully lower burnout scores.2 Instead of waiting until you’re overwhelmed, clarify what matters most now: which committees align with your goals, which projects energize you, and what time outside work you want to protect. Boundaries are not a sign of weakness; they are a precondition for longevity.
Build An Intentional Peer Network
Structured peer groups reduce emotional exhaustion by providing validation and shared problem-solving.3 Programs like RWOon the Road offer an example of informal spaces where ophthalmologists can come together to discuss the human side of the job. Participating early, even as a trainee, normalizes seeking help and being honest.
Learn in Motion
When time is scarce, podcasts offer a low-barrier connection. The RWO Podcast Series features physicians reflecting on transitions, burnout, and meaning from voices that turn solitary commutes into mentorship moments.
Reconnect With Purpose
Simple reflection practices, such as jotting down 1 meaningful patient encounter or lesson each month, can help maintain perspective. Narrative reflection has been linked to reduced emotional exhaustion in multiple studies.2,6
Build Recovery Into the Routine
Evidence suggests that combining individual coping strategies (such as mindfulness, reflection, and exercise) with organizational interventions (such as policy reform, team-based care, and structured breaks) leads to measurable reductions in burnout.3,6 Simple rituals, like stepping outside between cases or eating away from your desk, can restore clarity and prevent fatigue from compounding.
Find Mentorship That Grounds You
Mentorship buffers against isolation and helps recalibrate expectations. Del Carmen et al. emphasize that institutional culture, not just personal resilience, predicts whether physicians recover from stress or succumb to burnout.5 Seek mentors who normalize struggle, model balance, and remind you that growth takes time.
Conclusion
The early years in practice demand more than endurance; they call for balance, purpose, and connection. Burnout doesn’t define a lack of strength. Rather, it signals that it’s time to redirect our attention towards something more meaningful. By recognizing its signs early, creating boundaries that can protect joy, and leaning into peer communities, we can transform these early years from a state of survival to one of growth. The marathon doesn’t end after training, but with awareness and support, it can become a journey worth running.
Sustaining the spark early in practice requires intention, connection and support. Real World Ophthalmology is built by physicians, for physicians, with year-round educational content designed to address the real challenges of modern ophthalmic practice. Through signature meetings, in-person events and ongoing educational initiatives, RWO creates space for learning, mentorship, and community. Become a part of our educational efforts at www.RealWorldOphthalmology.com. OM
References
1. Maslach C, Jackson SE. Maslach Burnout Inventory Manual. 2nd ed. Palo Alto, California: Consulting Psychologists Press; 1986.
2. Patel RS, Sekhri S, Bhimanadham NN, Imran S, Hossain S. A review on strategies to manage physician burnout. Cureus. 2019;11(6):e4805. Published 2019 Jun 3. doi:10.7759/cureus.4805
3. Razai MS, Kooner P, Majeed A. Strategies and interventions to improve healthcare professionals’ well-being and reduce burnout. J Prim Care Community Health. 2023;14:21501319231178641. doi:10.1177/21501319231178641
4. Sedhom JA, Patnaik JL, McCourt EA, et al. Physician burnout in ophthalmology: U.S. survey. J Cataract Refract Surg. 2022;48(6):723-729. doi:10.1097/j.jcrs.0000000000000837
5. Del Carmen MG, Herman J, Rao S, et al. Trends and factors associated with physician burnout at a multispecialty academic faculty practice organization. JAMA Netw Open. 2019;2(3):e190554. Published 2019 Mar 1. doi:10.1001/jamanetworkopen.2019.0554
6. Gómez C, Lamas A, Ramirez-Martinez FR, Blunk D, Leiner M. Rethinking strategies and programs to improve physical and emotional well-being among healthcare professionals: facing the new normalcy. Med Sci Educ. 2021;31(2):565-572. Published 2021 Feb 24. doi:10.1007/s40670-021-01214-0
