Last episode, we talked about the data between the data — the hallway conversations, the side glances, the offhand comments that carry more information than any report. That led me to reflect a bit deeper into one of the most important places that kind of listening applies: burnout.
Not the burnout that walks in and announces itself. Not the colleague who finally breaks down in your office.
I’m talking about the burnout that looks exactly like excellence.
The kind that gets rewarded. The kind that hides in a perfectly maintained schedule, a calm demeanor, and a reflexive “I’ve got it.”
This episode is about learning to see what our system was never designed to show us. Because by the time performance falters or someone leaves, we’ve already missed it.
And for women physician leaders specifically — who are more likely to internalize, to over-function, to push through in silence — the cost of missing it is enormous.
Stay with me. I’m going to give you a clinical story, a reframe that changed how I lead, and a specific tool you can use in a hallway conversation this week.
Why Physician Burnout Is So Hard to Spot — Especially in High-Performing Women Doctors
Here is the hard truth: the signals of burnout and the signals of success look almost identical in medicine. And our system is designed to reward one of them without ever asking which one it’s actually seeing.
Burnout rarely walks into a room and introduces itself. It disguises itself as reliability. It hides in high performance. It wears the face of the colleague who is always the first to say yes, always the last to leave, always the one holding the most.
Research on physician burnout — published consistently in the Mayo Clinic Proceedings and the Annals of Internal Medicine — shows burnout rates hovering between 40 and 55 percent across specialties, with women physicians reporting higher rates than men.
And here is the part that matters most for leaders: burnout in women physicians is more likely to present as internalizing behaviors. Self-silencing. Over-functioning. Perfectionism.
Not the externalizing signals — conflict, absenteeism, obvious distress — that leaders are actually trained to notice.
We are invisible to a system that only looks for the obvious.
And there’s another layer.
The people burning out often don’t identify as burned out. They identify as dedicated. They’ve normalized the pace. They’ve made the load part of their identity.
So they’re not going to tell you. And if you ask directly, they’ll probably say they’re fine.
This is why learning to listen differently — which we talked about last episode — is not just a leadership skill. In the fight against burnout, it is a clinical skill. It is a protective act.
A Senior Resident, a Lumbar Puncture, and What Silence Was Actually Saying
I want to tell you about a moment I think about often when it comes to this.
I was walking with a senior resident to supervise a lumbar puncture. She was one of the strongest residents I’d worked with — competent, composed, a real leader on our inpatient team. She was also very quiet. On rounds, she was reserved. Efficient. Calm.
And because of her competence, that quietness was easy to read as focus. As confidence. As someone who had it handled.
Before we started the procedure, I turned to her and asked a simple question: “Is there anything you need before we begin?”
Her tears started falling in the hallway.
Not dramatically. Not with warning. Just — the question opened something, and it came out. All of it. The stress she’d been holding. The weight she’d been carrying so quietly and so competently that no one had thought to ask.
I supervised the lumbar puncture myself that day, and I gave her time to decompress. I don’t remember every word of our conversation. But I remember the clarity of that moment:
Her quietness was not composure. It was conservation.
She was doing exactly what the burnout research describes — withdrawing from connection because connection takes energy she didn’t have. Leaving quickly. Staying efficient. Keeping her head down. Every one of those behaviors looked like professionalism. Every one of them was a signal I almost missed.
Here’s what I’ve come to understand:
The very signals of burnout are often the same signals we associate with success.
We don’t notice until performance falters, or conflicts arise, or someone hands in their resignation. And by then, we’ve missed dozens of hallway moments where a different question could have changed the trajectory.
I’ll also tell you something more personal. I have been on the other side of this. I remember being in the height of my own burnout — genuinely struggling — and having the chief of my hospital approach me about taking on a new leadership role. He saw our quality metrics improving. He saw me presenting in meetings. He saw the output.
All of that was a dashboard for the sheer force of will it was taking me to push through each day.
I had finally come to terms with what was actually happening inside me. And I was able, that time, to stand firm and not take on more.
But I want you to notice what that moment represents: burnout that was invisible to leadership, that looked — from every external measure — like thriving.
How to See Burnout Before It Becomes a Crisis: A Three-Part Framework for Physician Leaders
So what do we actually do with this? I want to give you three things that work together.
The first is to learn what you’re actually looking for. Not the dramatic presentation — the subtle one. Watch for emotional flattening: when humor becomes more cynical, when there’s less emotional reactivity to things that used to matter.
Watch for micro-withdrawals — leaving quickly after rounds, skipping the pre-round chatter, less general participation. These behaviors look like efficiency. They are actually conservation. The person is managing an energy deficit, and connection is one of the first things to go.
Watch also for the mismatch between external success and internal narrative. On the outside: promoted, performing, respected. On the inside: off, joyless, running on empty. Our system rewards these people and then wonders why they leave.
The second is to notice changes. Not just states — changes. The question isn’t “is this person quiet?” It’s “is this person quieter than they used to be?” Pay attention in the hallway conversations, the pre-round chatter, the offhand comments after a long call.
The most important data about burnout is rarely presented on a slide. It’s spoken in passing and easily ignored.
The third is a specific tool. It comes from my CTI coach training, and I use it far beyond coaching — with colleagues, with friends, with my kids. It’s called AWGO: Acknowledge What’s Going On.
Instead of asking directly — “Are you okay?” which almost always gets a yes — you name what you’re observing. “I’ve noticed you’ve been carrying a lot this week.” “You haven’t seemed as excited about this project lately.”
Then you stop. You don’t offer a solution. You don’t fill the silence. You just ask an open question: What’s going on? What do you need?
Here’s why this works. Open questions shift the power dynamic.
The person you’re asking becomes the expert on their own experience — not the subject of your assessment.
And when someone simply feels seen, something often unlocks. That resident didn’t need a formal check-in on my calendar. She needed one question asked at the right moment, by someone who was actually paying attention.
I want to call out one more thing: what stops us from doing this, because it’s not that we don’t care.
It’s the pace of our day. It’s the fear that if we open this door, we won’t know how to help. And honestly, the resources at most hospitals aren’t built for early-stage burnout — they’re built for crisis. For addiction, depression, suicidal ideation.
My goal — and I think yours too, if you’re listening to this — is to reach people before they get there.
You don’t have to fix it. You just have to see it. Let them know you see them. That they’re not alone.
And ask what they actually need — because for everyone, it’s different. A day off. A schedule change. A coach. A therapist. You probably can’t answer that for them. But asking the question extends a level of support that person may not have felt they had access to.
Next Steps for Women Physician Leaders Who Want to Protect Their Teams from Burnout
Here is your one action this week. Think of one person on your team — a colleague, a resident, someone you lead — who has seemed a little quieter lately, a little flatter, a little more efficient in a way that feels like withdrawal. And find a moment, not a meeting, not a formal check-in — a hallway moment, before rounds, at the end of a shift — and try AWGO.
Name what you see. Ask what they need. Then listen without a solution on your tongue.
And if you recognize yourself in this episode — if you’re the one whose burnout looks like excellence right now, whose exhaustion is being rewarded and mistaken for dedication — I want you to know I see you too.
This work is personal for me. And if you’re ready to stop pushing through alone and start building something more sustainable, I’d love to work with you.
Apply to work with me at womenmdleaders.com/work-with-stephanie. Let’s build the kind of leadership that protects you and your team before the crisis hits.
Stay true and protect your peace.