You can run a code without blinking. But planning your kid’s summer schedule makes you want to lose your mind.
I get it. I just finished a stretch of night float. Sick kids. Multiple codes. Residents to supervise, junior attendings to mentor. Hard calls at 2 a.m. that I replayed until sunrise, wondering if the day team would Monday-morning-quarterback every decision I made.
By any measure, that was hard. I was bone-tired.
And fulfilled.
Then I looked at my calendar for the week ahead. Family logistics. Camp registration. Packing and travel. Last minute to-dos before school starts. And I felt a different kind of tired. A heavier kind of tired.
Same body. Same week. Two completely different kinds of exhausted.
Today I want to talk about why. Because I don’t think it’s about how much is on your plate. I think it’s about the nature of it.
Exhaustion vs. Depletion: What Actually Drains Women Physician Leaders
Here’s what I’ve landed on. It’s not the volume of what’s on my plate. It’s the nature of it.
At the hospital, I have 20 years of training under me. I know my role. I know what needs my attention and what doesn’t. In a code, I can stand back, keep the bird’s-eye view, and let the resident lead. Because I know exactly when I need to step in. And just as important, when I don’t.
At home, there’s no PALS algorithm.
I’m the transport department, the social secretary, the travel agent, the contingency planner, the back-to-school project manager, the dog logistics coordinator. I’m the one keeping track of what everyone else is going to need three weeks from now. And there’s no moment where someone says, “Code over. Let’s debrief.”
So here’s the distinction I keep coming back to.
Exhaustion from living according to my values feels completely different in my body than exhaustion from being made responsible for things that shouldn’t be mine alone.
They can look identical on a calendar. A full week is a full week. One drains you. The other one doesn’t.
And there’s also a third kind of tired. And this one isn’t about anything I chose or didn’t choose at home.
It’s the tired that comes from doing right by a patient and having to fight a prior authorization, a broken referral system, and a documentation requirement that has nothing to do with their care, just to get there.
That’s not the fulfilling exhaustion of a hard shift. That’s not the depletion of an undefined role at home. That’s a third thing: getting worn down by a system that makes doing your job harder than the job itself. It can’t be overlooked.
A Code Blue Story: What Delegation Really Looks Like for Women Physicians
Let me take you inside one of those nights.
It’s 2 a.m. The code pager goes off just as I’m sitting down to catch up on notes. It’s a really sick kid. The room fills fast. Nurses, respiratory therapy, a second-year resident running her first code this month.
I could have grabbed the meds myself. I could have pulled rank and taken the lead, since I’m ultimately the one responsible if something goes wrong. But I didn’t.
I stood at the foot of the bed and watched the whole room. I let the resident call the shots. I stepped in exactly twice. Once to redirect a med dose. Once to ask a question out loud so the room could hear the reasoning behind a decision. Then I stepped back again.
20 minutes later: “Code over. Let’s debrief.” We talked through what worked and what we’d do differently. I walked out of that room a little spent and completely fulfilled, because every person in it, including me, was operating exactly where their expertise was needed. Nowhere else.
Now compare that to my calendar the following week. Nobody assigned me the role of family logistics coordinator. I just became it, one task at a time, until I was doing every job in the room whether or not it needed my expertise.
No one called a debrief on that. I just added it to the pile and called it Tuesday.
A 2-Step Framework for Sorting Exhaustion, Depletion, and Systemic Burnout
So here’s what this actually looks like in practice. Two moves. Not ten.
First: sort.
Next time you’re dragging through a task or simply dreading it, ask yourself which category it’s actually in.
Did I choose this? Does this genuinely require me, specifically, and no one else? Have I decided this is simply my response to a situation I don’t love? Or am I doing this because I think I should?
That’s it. Just noticing which bucket a task lands in changes how it sits in your body. Some of what’s making you tired is depletion. Some of it, even on your hardest weeks, is exhaustion you’d choose again.
But sometimes you run through those four questions honestly, and none of them fit. It’s not that you chose it. It’s not simply your response. It’s not a should. It’s that the system made something that should be simple needlessly hard.
That one isn’t yours to sort away. Name it for what it is: structural, not personal. You are not depleted because you’re bad at scheduling that MRI. You’re depleted because the system built the obstacle.
Second: find your resident.
In that code, I wasn’t managing every decision myself. I had a second-year running the show, and I trusted her to run it, because handing her the whole scenario, not just a task, was the entire point of training her.
At home, that means looking for the person or the system who can own an entire decision tree, not just the next item on it.
Maybe that’s a family calendar your partner actually owns end to end, not one you populate and they just consult. Maybe that’s your kids making their lunches and doing their own laundry.
Hand off the whole tree, not just the task.
And some of what’s wearing you down doesn’t have a solution just yet. Maybe you just need to stop carrying it alone and find the people, colleagues, leadership, your own coach, who can actually push back on that system with you.
Ask yourself this week: what’s one decision tree, not one task, I could hand to my resident? Who’s capable of running it without me standing over their shoulder?
You don’t need less on your plate.
You need the right person taking the lead on the right things.
Next Steps for Women Physician Leaders Ready to Stop Carrying It Alone
If this distinction landed for you, sit with it for a minute. You’re not necessarily doing too much. You might be juggling things that were never meant to be yours alone.
I built a values journal with prompts for exactly this work. Not to add another thing to your list, but to help you name what’s actually worth being tired for, and what you’ve just inherited by accident. Find it at womenmdleaders.com/valuesguide.
And if you already know the difference between exhaustion and depletion but you’re still standing in every room anyway, that’s exactly what we work on together. Apply to work with me at womenmdleaders.com/work-with-stephanie.
Thanks for listening, and thanks for leading with heart.