Editor's Note: This story is adapted from ALM's Mid-Market Report. For more business of law coverage exclusively geared toward midsize firms, sign up for a free trial subscription to ALM's new weekly newsletter, The Mid-Market Report.

When Paul Rawlinson, the head of global megafirm Baker McKenzie, announced last month he would be stepping away to address health problems caused by exhaustion, he drew attention from around the legal community.

For many law firm leaders, the news presented a moment to take stock of the heavy toll the position can take on a person. Running a midsize firm may not require tending to 78 offices and nearly 5,000 lawyers, as Rawlinson's role did, but it is a challenging task all its own. In managing attorneys and staff, charting a successful course for a multimillion-dollar business and maintaining a busy practice all at the same time, managing partners at midsize firms are susceptible to overwork and exhaustion.

Deborah Manus has led 150-lawyer Nutter McClennen & Fish for seven years, and she thinks often about managing the stresses of the position.

“Leadership can be isolating, in the sense that you can't please everyone,” Manus said. “If you're running a law firm, even if it's a midsize law firm, it's a really big job.”

On top of the practice of law and running a sizable business, she said, there is still the ceremonial aspect of the job—being the face of the firm, always available externally and internally. And somewhere mixed in there, firm leaders also must tend to family and, hopefully, themselves. Being pulled in so many directions at once, it can be easy to unravel.

“I have a duty of optimism. I have the responsibility of projecting that I have a plan at all times, because people want to think that their leaders are confident people,” Manus said. “They don't want leaders who appear stressed. Believe it or not, appearing not stressed can sometimes be stressful.”

Luise Barrack, managing member at Rosenberg & Estis in New York, can relate to Rawlinson's story. She hasn't dealt with the same type of exhaustion, but clients demand attention at all hours and keeping stress to a minimum is a necessity.

“I've been practicing long enough to remember when there were no cellphones, no faxes, no email, no texting,” Barrack said. “But with technology making it possible to be available at any time, clients expect you to be available all the time.”

Like Barrack, Franklin Jelsma, managing partner of 150-lawyer Wyatt Tarrant & Combs, which has offices in Kentucky, Tennessee and Indiana, can't compare his job to Rawlinson's. But there are aspects of Rawlinson's story that ring true. For anyone running a firm, he said, there are still only 24 hours in a day and seven days in a week.

With partners and clients both in need of attention, “it's awfully hard,” Jelsma said. “It's a busy, busy schedule.”

On top of everything else, the increasingly competitive market means managing partners must constantly be working to protect their talent, Michael Tanenbaum of Tanenbaum Keale in Newark, New Jersey, who spent seven years guiding now-defunct Sedgwick, said. Replacing people is an expensive and time-consuming proposition.

“Part of your responsibility is to keep people in place, focused on doing work for your clients, and minimize movement out of your firm,” Tanenbaum said.

Jelsma, who is based in Louisville, has been managing partner for five years, and part of his arrangement to serve in that role was that he devote half his time to his corporate practice. During his tenure, he's learned at least one important lesson.

“You've got to delegate,” he said.

For law firm leaders, though, allowing others to shoulder the load isn't always as easy as it seems. And when that leaves a managing partner to take on more work than they should, exhaustion is only natural.

“If you're a Type A person in this job, there is always something you could be doing,” Manus said. “You can always be working to make your firm a better place, to advance the cause. It's not at all difficult to imagine burnout. I think everybody has moments where they think, 'How do I put one foot in front of the other?' You have to have strategies around that.”

For Manus, that means working only six days a week—not seven, even if that seems a small allowance. It also means taking vacation, and having friends who understand the stresses of the job, as well as acknowledging successes so they don't slip out of view.

“It's very easy to focus on all the things that are imperfect or still need doing or fixing,” Manus said. “It's incredibly important to take a moment and reflect with satisfaction on the things that you, with the help of those around you, have accomplished. It's so easy to just move on to climb the next mountain.”

For others, staying active helps relieve pressure.

“I get through the stress of being a lawyer through physical exercise,” said Jamie Sullivan, managing partner of Howard, Kohn, Sprague & FitzGerald in Connecticut. “I would not be the lawyer that I am without exercise.”

Carole Topol Orland, co-founding member of Broder & Orland, in Connecticut, said having supportive attorneys and staff around her helps when things get rough. And, like Manus, she tries to focus attention in the right direction.

“I've learned to cope by focusing on positive solutions rather than allowing myself to get mired down in stressful situations,” she said.

If those stressful situations ever do begin to mount and the bad begins to outweigh the good, Rawlinson's example has shown that it's OK to step away.

“On the day when you realize you are more exhausted than exhilarated by it, then probably you need to stop,” Manus said. “Take a break from doing it.”

Jonathan Ringel, Michael Marciano and David Gialanella contributed to this report.