How Do You Know if You’re Burned Out?

Burnout is not going away.

It’s no surprise that nationwide, levels of burnout reached record highs during the pandemic, impacting over 60 percent of physicians. But now that we are back to a semblance of normal, the percentage of physicians experiencing burnout symptoms hovers a little under 50 percent. That’s still far above the “baseline” of 38 percent in 2020.

Topping the list of burnout-inducing specialties are

💉Emergency Medicine,

💉Internal Medicine,

💉OB-GYN

💉Family Medicine

Although burnout has decreased in all of these groups, more than 50 percent of doctors surveyed in these specialties described classic symptoms of burnout.

While any improvement is good news, the fact that nearly one in two physicians across the board are suffering from burnout is nothing to celebrate.

Not only is burnout demoralizing, but it also contributes to job turnover and increased healthcare costs. Not surprisingly, a Mayo Clinic study found that burnout can raise the likelihood of medical errors. And a 2019 study reported a conservative yearly cost to the US healthcare system of $4.6 billion dollars.

So how do you know if you're burned out?

❓ A. Is it just a feeling?
❓ B. Is it something we can measure?

If you answered B, you're right. Burnout isn’t just a trending term. There are standardized tools to measure burnout. The Maslach Burnout Inventory is the granddaddy of burnout tools, and has been in use since 1981.

Burnout affects doctors of all ages and across all spectrums. It is not a personal failing, and it’s not a mental illness.

If you’re experiencing burnout, it’s important to understand that burnout is not your fault, and you’re not alone. Here’s what you need to know:

✴ According to the World Health Organization and the ICD-11, burnout results "from chronic workplace stress that has not been successfully managed."

✴ Symptoms of burnout include:

🚫 feelings of low energy or exhaustion
🚫 negative feelings or cynicism about your job
🚫 loss of motivation and a sense of detachment from work

✴ Burnout is not a mental health condition.

So how do you know if you’re burned out? If you're wondering if you've just hit a rough spot or if you're truly burned out, you could invest in the Maslach Inventory. Or you could save yourself a little time and money and take a simple Two-Minute Burnout Inventory created by Chris Bailey for Harvard Business Review.

If you're a physician living with burnout, you don't need to suffer in silence. There are ways to get through it, but you can't always get there on your own.

Systemic changes to our profession are critical, and there are signs that change is coming. But while we wait for the slow gears of progress, it's important that you take care of yourself now.

Your health, your loved ones, and your patients are counting on you. If you’re feeling burned out, consider coaching, either through your institution, or through a certified Physician Coach. Studies, including a randomized controlled trial published in 2024, have found coaching to be an effective strategy for reducing physician burnout.

There are no easy answers to the complex issues facing healthcare today, but getting clarity on your own needs and values will empower you to chart your own course.

An earlier version of this article was published in April 2023.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

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Perfectionism, Procrastination, and Fear of Failure

An earlier version of this article originally appeared on Doximity.com in December 2022, where I served as an Op-Med Fellow from 2022-2023.

You probably didn’t become a physician without a healthy dose of perfectionism. From preschool through residency and beyond, many of us have survived, thrived, and been rewarded for our perfectionist tendencies. And when you didn’t hit the mark? You may have felt the sting of your parents’ and teachers’ disappointment. Eventually, you may have learned to define yourself by your perfectionism.

Perfectionism seems to be on the rise, especially among people born in the 1980s and later. Those on the outside may mean well when they assure us that perfectionism is an impossible goal, but the truth is that perfectionism is a prized attribute in our profession. Our patients appreciate it as well. After all, who wants a doctor who is willing to just scrape by?

Paradoxically, perfectionism can keep you from doing your best work. It can also hold you back from living your best life. In this article, I’ll talk about how perfectionism and self criticism often go hand in hand with procrastination. And I’ll give you a few actionable steps that can help you to overcome the self-imposed inertia that perfectionism often creates.

Perfectionism, Procrastination, and Imposter Syndrome

It’s not surprising that perfectionists often suffer from impostor syndrome. If you’re a perfectionist, you may fear that you are simply not good enough and that you will eventually be exposed for all to see. And in fearing that you are not going to meet the high standards you set for yourself, you may subconsciously find ways to procrastinate as a means of avoiding that discomfort.

When you fall prey to imposter syndrome, you may overlook or give up opportunities for growth that could lead you to a more rewarding and exciting professional path. Learning new skills, taking on a leadership role, and discovering a position that is more aligned with your values may all fall by the wayside.

And when you’re uncomfortable with embracing a beginner’s mindset, you may find yourself reluctant to take up hobbies or endeavors that might enrich your life and create new connections.

Perfectionism, Procrastination, and Fear of Success

Another factor holding perfectionist physicians back is, perhaps counter-intuitively, a fear of success. This often arises from fear of change and the unknown. The end result may be the same: procrastination and a failure to act in your own best interests.

Fear of failing to meet your highest standards often manifests in such mundane activities as uncompleted charts, unanswered messages, and unopened emails. This compounds the problem, and can create enormous stress, not to mention nasty messages from administration.

Breaking the Cycle of Procrastination

If you’re having a hard time getting started on a task, big or small, don’t beat yourself up. Chastising yourself for feeling overwhelmed and disorganized may only make the procrastination problem worse by confirming your fear of inadequacy and filling you with anxiety. And thus, the problem comes full circle.

To break the cycle of fear, frustration, and despair, it’s important to recognize that procrastination does not mean that you are incapable or irresponsible. And let’s establish right now that as a busy and caring physician, you are certainly not lazy.

So how can you harness your perfectionism? The key is to focus that superpower on providing excellent patient care. Sometimes that also means treatment plans, operative notes and imaging reports. These are things that truly make a difference, and that people are depending on you to complete. They don’t have to be works of art, but they need to be complete and correct.

Often it’s the non-clinical commitments, stacks of insurance paperwork, and lingering home projects that drain your mental energy. If no one’s life or livelihood depends on it being perfect, allow yourself a little grace. Realize that for many of your routine tasks, perfection is not worth the effort and may not even be possible. For many of these, good and done is good enough. Other times, it might be most efficient to simply delegate. And sometimes, when it’s appropriate, you just have to say no.

Below, I share some practical tips for tackling a handful of competing priorities and getting stuff done.

1. Medical documentation

We’ll address the elephant in the room first: your medical charts. As charts start to pile up and paperwork is left unfinished, your anxiety levels may rise, and you may find yourself in a spiral of regret and self-flagellation. If you have a system that works for you, kudos and keep it up.

But for the many physicians for whom the EHR and report generation are a major source of stress and procrastination anxiety, it’s important to get a handle on this beast as early as possible in your medical career. Just get the charts and notes done, either immediately during or after the visit (my preference) or at the end of the session.

The fewer times you have to return to a document, the more focused and efficient you will be.

Yes, the notes need to be succinct, truthful, and useful. And personally, I always found that including a brief personal observation reminded me of the issues that were meaningful to my patients when we met the next time. But your notes do not have to be perfectly crafted works of literature. Punctuation, spelling, even virtual voice transcription errors that don’t change the meaning of the sentence can often be safely overlooked.

Consider using “smart phrases” — text blocks that you use frequently that can be automated through your EHR system — as much as possible when appropriate. Look into using an AI assistant for history taking, if you can assure accuracy. The point is not to be sloppy or incomplete, but to include the pertinent details that assure great patient care and communication as efficiently as possible.

To avoid a horrendous backlog, create a block of time once or twice each day to get patient communication, testing review, insurance, and other paperwork done. This is known as task batching. Do it consistently every day (perhaps using the Pomodoro method), and even though you may not finish everything all at once, you’ll have a process for getting it done. Once you start seeing the results of your efforts, your feeling of self-efficacy will increase.

Let your staff know that you will be working on these tasks within these blocks of time. That way you can set expectations and encourage them to direct pertinent issues to you at a time that works best for you. Ultimately, this may create a clearer sense of work flow within the practice and enhance your teamwork.

2. Professional Commitments

When it comes to committees, research, and other professional commitments, take a good long look at what you’ve signed up for. Be sure that the work is meaningful and actionable for you.

Sometimes taking on more responsibilities is the right thing for your professional growth or your career trajectory. If so, it’s important to stay committed. Procrastinating on these commitments can have a seriously negative impact on your future opportunities.

Consider working with an accountability partner who is on the same committee or working on the same project. You can keep each other on task with quick check-ins by text. Simply committing to a plan can often get you halfway there.

But if you find that you just have a hard time saying no, then it’s time to reassess. As writer and time management guru Oliver Burkeman so aptly puts it, if we’re lucky, we only have Four Thousand Weeks. That means that time is a fixed resource. When you say yes to something, you are saying no to something else.

If your commitments exceed your capacity, you will never get everything done. Choose wisely. And remember that saying no doesn’t mean never or not at all. Is there a way to stay involved with something meaningful without diving all the way in?

3. Your Personal Life

Having a life outside of the clinic or hospital helps you to decompress, stretches your brain, and keeps you connected to the outside world. When it comes to family and close friends, your time and attention matter. And of course regular exercise is critical for just about every aspect of your health.

Unlike taking care of patients, the bar is fairly low. Usually no one is depending on you to be the best. Just being present and engaged is often enough. For your home projects, exercise, and other extracurriculars, consider using a Bullet Journal or other daily log.

Experiment with using a real notebook rather than an app. Not only does writing something down tend to create more solid memory retention, it’s easy for virtual to-do lists to disappear into the ether of the internet, never to be seen again. Most importantly, choose what works best for you, and be consistent.

To get started with something new, commit to just five to 10 minutes a few times a week, or set up an introductory lesson for something that interests you. You’ll be surprised how much you can do, and it may motivate you to keep going. If you’re not perfect, all the better. You’ll learn and grow and maybe even find new life passions.

Procrastination and Self Compassion

If you’re a chronic procrastinator, developing self-compassion is important. But being kind to yourself doesn’t mean you can ignore the pressing problems that procrastination has created. That will only add to your stress, and create more trouble in the long run.

When you put off completing charts or making calls, procrastinating can also hurt your patients and your practice. In the worst cases, medical care may be delayed and important notifications missed, with possibly serious ramifications for the people who depend on you.

If the load feels overwhelming, realize that procrastination-born perfectionism can lead to important mental health conditions including depression, anxiety, and eating disorders. Get help from a mental health professional if you need it. And if you are questioning your efforts, your direction, or experiencing burnout, consider meeting with a physician coach.

Remember: your perfectionism is one of your superpowers as a physician. You have high standards, you solve tough problems, and you keep people safe. Leverage this, cherish it, but don’t let it take you down the road of procrastination.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

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Stop Being So Hard on Yourself: Five Reasons To Celebrate Physicians

If you’re like many physicians, it may be easy to lose sight of your value. Healthcare today faces unprecedented challenges and stressors, and it’s sometimes hard not to take it personally.

Physicians in particular are some of the worst at self-flagellation. It’s common to feel frustrated and disappointed when you feel as if you haven’t lived up to your own ideals, or those that are imposed on you. Some days it can seem as if being a doctor is a thankless task. Doctor’s Day comes once a year, but your work is never done. So I’d like to share five reasons that you deserve to be appreciated and celebrated every day.

You Want to Do Good in the World

Medical practice is a field that naturally attracts individuals who are both highly intelligent as well as driven by a desire to impact the world positively. But wanting to do good and actually doing the work are two very different things. You do the work. Although your efforts may not always be acknowledged, your actions, big and small, directly affect the health and well-being of your patients and your community.

You Do Hard Things Every Day

Physicians face an array of challenges daily, from navigating complex medical and social issues to making life-saving decisions under pressure. On top of that, societal, economic, and administrative pressures may add levels of frustration that test your empathy and determination. The work of a physician requires an extraordinary level of resilience and fortitude, especially when, despite your best efforts, things don’t always turn out as you’d hoped or expected. It is no exaggeration to say that this level of commitment and grit far exceeds that of most other professions.

You Are Passionate About Your Work

Passion is the lifeblood of innovation and motivation. Physicians often pursue their profession because of a deep-seated passion for healing and discovery. This enthusiasm is often what spurs you to continually learn, grow, and push the boundaries of what is medically possible. Even on days where you feel less than enthusiastic, your years of focus and commitment drive you to do your best work.

You Come from All Walks of Life

Each physician comes to the profession with a unique array of backgrounds and experiences. Whether you come from a rural town or a large urban community, from a US metroplex or a country thousands of miles away, each physician carries a distinctive set of perspectives and skills. This diversity enhances your ability to connect with and care for a wide range of patients with a rich mix of cultures and viewpoints.

You Are a Change-Maker

Physicians are often at the forefront of change, not only in their clinics or hospitals but also in the broader context. Collectively, you have the power to initiate significant health policy reforms, improve patient care standards, and lead community health initiatives. What you do makes a difference in ways, big and small, that ripple out into the world.

As a doctor, you are not just a healthcare provider or a widget in a faceless system. You are a resilient, passionate, and dedicated professional committed to making the world a better place, one patient at a time. Most importantly, the work you do matters.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Why Should Healthcare Systems Invest in Coaching?

Changes in the administration of medical care have accelerated at a frenetic pace over the past decade, amplified by changes in practice ownership, healthcare law and COVID-19. With a few exceptions, the time of the solo practitioner, or even the single-specialty group practice, is well past. A recent report from Avalere Health noted that by January 2022, nearly three quarters of all US physicians were employed by hospitals or corporations, with a 19 percent increase over the preceding 3 years.

This consolidation of care comes with important benefits, including cost savings, ease of quantification and other metrics, and streamlining of care. Yet whether they intended to or not, large healthcare systems have also taken on an enormous responsibility for the satisfaction and well-being of their employed physicians.

Although healthcare administrators are a diverse group, and many have some background as healthcare professionals, they may not fully understand or embrace the qualities that lead individuals to pursue the life of a physician.

In general, physicians are highly intelligent, extremely motivated individuals. That’s individual with a capital I. Physicians are typically empathetic yet driven perfectionists. Many see their profession as a personal calling. While admirable, this may put them at risk for exploitation, since physicians with this mindset may find it difficult to say “no” to added responsibilities.

Recognizing these character traits makes it all the more concerning that in a recent survey, nearly half of physicians reported burnout in 2022, compared to about 25 percent in 2000. COVID is partially to blame, but so are systemic changes in healthcare, including less autonomy and greater documentation demands.  

Clearly, our healthcare systems bear a substantial responsibility for the amelioration and reform of many of these underlying factors. This includes workload, clerical and documentation burdens, and leadership culture.

How can coaching help?

Coaching is not the answer to burnout, but it’s an important tool. A study from the Mayo Clinic found that after 6 coaching sessions by credentialed coaches, the rate of burnout decreased by over 17 percent. In the control group, burnout actually increased by nearly 5%. And rates of emotional exhaustion dropped by nearly 20% in the coached group but increased 10% in controls.

Beyond addressing burnout, coaching can help physicians navigate the challenges of daily practice. Discovering the underlying causes of inefficiencies and working through time management practices with coaches may help physicians stay more organized and reduce wasted time. This in turn can improve quality of life for physicians as well as foster patient engagement, staff satisfaction, and timeliness of medical records.

Burned out, dissatisfied, and disconnected physicians are more likely to leave healthcare, which is expensive and disruptive for the system. According to the American Medical Association, it may cost anywhere from $500,000 to $1 million to replace one physician. And burned-out physicians may increase healthcare costs and decrease patient satisfaction. Ultimately this results in lost revenue and loss of social currency. More importantly, quality of care may also suffer and medical errors increase.

As hospital and healthcare systems navigate the years ahead, retaining high quality, satisfied, and engaged physicians will become increasingly important. An investment in coaching is a tangibly supportive and mutually beneficial use of resources.

Coaching alone won’t solve the problems facing healthcare. But when used as part of a comprehensive strategy to enhance physician well-being and streamline efficiency, coaching may ultimately improve patient care and satisfaction, enhance teamwork, and foster a happier, healthier medical staff.

An earlier version of this article originally appeared on this site in August 2022.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

What if You Don’t Know What You Want Next: A Physician’s Guide to Finding Direction

As a physician, you've dedicated years of your life to the practice of medicine. You spend the better part of your waking hours staying current on the latest research, honing your skills, serving your patients with compassion and care, and collaborating with your colleagues and staff.

But, like many doctors, there may come a time in your professional trajectory when you feel a need for change and a yearning for something different. Maybe you feel stuck, unfulfilled, or underappreciated. Or perhaps you simply crave a change of scenery.

In this article, I’ll give you some strategies that will help you to gain clarity and direction when you’re not sure what you want next.

Sometimes the direction to take is crystal clear, but it can often be difficult to envision what that change should or could look like. From medical school to residency and beyond, your path up to this point has probably been clearly marked. As you reached one milestone, the next was likely in view.

It can be comforting to know where you are going next, but it’s not uncommon to find yourself longing for a shift in your professional life that doesn’t conform to the well-worn trail. Whether you're considering changing the way you practice, adjusting your working hours, exploring opportunities outside of clinical medicine, or even contemplating retirement, the uncertainty can be daunting.

Change is often uncomfortable and unsettling, especially when you’re blazing your own path. It's essential to remember that this feeling of ambiguity is a natural part of any career evolution. It’s easy to get stuck at this point, instead of recognizing that this period of contemplation is the first step in a new direction.

Although it’s important to think things through, I’m a firm believer in the adage that action creates clarity. Action however, does not have to mean commitment or a big shift. Giving yourself time and space to actively explore what is possible can make your next steps more clear.

If you’re feeling like you’ve come to a standstill, here are some ideas that can help pull you out of the rut and find some serious traction that will move you forward.

1. Reflect on Your Values and Goals

Take some time to reflect on what truly matters to you, both personally and professionally. What are your core values? Have you identified specific long-term personal and career goals?

Understanding what drives you and what you hope to achieve can provide valuable insight into the direction you should take. If you’re unclear on how to express your personal values, my Values Workbook can help.

2. Assess Your Skills and Interests

Consider your strengths, skills, and areas of interest outside of medicine. Are there particular aspects of your current practice that you enjoy the most? Are there skills you possess that you haven't had the opportunity to fully utilize? Or maybe you’re curious about acquiring new expertise.

Exploring these ideas can help you identify potential career paths that align with your strengths and interests. Don’t be afraid to consider possibilities that may not obviously relate to the practice of medicine. Simply asking yourself what lights you up may spark new ideas and connections. One exercise that can help you discover these connections is a mind map.

3. Seek Guidance and Support

Reach out to mentors and trusted colleagues. You might also choose to work with a coach. Sometimes, an outside perspective can provide valuable insights and help you see possibilities that you may not have considered on your own. While a coach will not tell you what to do next, a coach will help you uncover your own answers. That’s because coaching is a supportive process designed to accelerate your capacity to explore your options and take effective action.

4. Explore Your Options

If you're unsure about the specific direction you want to take, make some time to explore different opportunities and try out new experiences. This could involve taking a course or attending a meeting focused on anything that interests you, volunteering, traveling, or joining an organization or group that resonates with you.

These explorations don’t have to have an obvious connection to the practice of medicine. Experimenting with a variety of options can help you clarify your priorities and identify what intrigues and inspires you.

5. Embrace Flexibility and Adaptability

Your path doesn't have to follow a linear trajectory. It's okay to pivot, change direction, or investigate new opportunities at any stage of your life. Be true to yourself, but keep in mind that it’s always a good idea not to burn any bridges along the way.

When you embrace flexibility, you’ll often find unexpected and even surprising opportunities that may otherwise have gone unnoticed.

6. Take Small Steps

Thinking about a professional change can feel overwhelming, especially for physicians. More than most other professions, we often feel defined by the work that we do.

Remember that you don't have to have all the answers right away. Break down your goals into smaller, manageable steps, and focus on taking action consistently. Simply commit to just one small step at a time.

7. Practice Self-Compassion

Be kind to yourself as you navigate this process. It's normal to feel uncertain or indecisive when you’re facing an important change. Practice self-compassion and remind yourself that it's okay not to have all the answers immediately.

Trust in your abilities and know that by putting in the work, you will find your way forward.

As a physician, you have proven that you are resourceful, intelligent, compassionate, and hard working. By taking the time to reflect on your values and goals, seeking guidance and support, exploring and creating your options and opportunities, and embracing flexibility, you will stay open to possibilities, and you will find your way.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Managing Uncertainty as a Physician

Uncertainty is a fact of life if you are a physician. Patients don’t always get better, there is not always one best choice or right answer, and sometimes our decisions are affected by factors that are completely out of our control.

Managing uncertainty is a skill set that doesn’t come easy for many of us. Perfectionism is likely a way of life, and to be truthful, that’s not always a bad thing. We want to do the best for our patients, we want excellent outcomes, and we want to be acknowledged for the care we provide. But when we set unrealistic standards, it can actually be a barrier to optimal care and to our own well-being.

A recent study examined the connection between tolerance for uncertainty and burnout in 2000 faculty physicians. Not surprisingly, intolerance for uncertainty was associated with a three-fold increased likelihood of burnout.

As you might expect, those who struggled with uncertainty were much less likely to be satisfied with their career, and tended to be less engaged at work. Factors that correlated with a greater intolerance of uncertainty were

• Female gender

• Primary care

• Earlier stage of practice

• Lack of a trusted advisor.

Although these were important risk factors, many men, specialists, and later stage physicians were also burdened by intolerance of uncertainty.

Burnout and physician unhappiness are crucial pain points in our current healthcare environment. Not surprisingly, stress from uncertainty correlates with depression and low levels of resilience. Intolerance of uncertainty has been linked to poorer outcomes and even to increased healthcare costs. And burned out physicians are more likely to leave the practice of medicine.

Our innate perfectionism combined with the prevailing medical culture of stoicism means that physicians may be reluctant to admit that they are dealing with uncertainty. This makes it all the more important for more senior colleagues and mentors to acknowledge that despite all we know and no matter how hard we try, uncertainty will always be a part of the life of a physician. Simply sharing that insight can make it a little easier to come to terms with the fact that we cannot control everything.

Although becoming comfortable with uncertainty may always be a challenge, managing your response to uncertainty can open up opportunities to react to life’s curve balls in ways that are both positive and beneficial to all involved.

In their thorough analysis of the issue, Samuel Reis-Dennis and colleagues describe “three corrective virtues” that might help physicians navigate the challenges that uncertainty creates. These include:

• Courage: avoiding the tendency to run away from threats by developing strategies to cope with new challenges

• Diligence: seeking guidance from trusted colleagues and staying current on the medical literature

• Curiosity: addressing uncertainty by viewing it as an opportunity to learn and grow

It’s not an easy task to recognize the factors that may be holding you back. And it’s even more difficult to be objective and to find your own way while living the unpredictable and demanding life of a physician. Medical schools are increasingly understanding the importance of teaching these skills, but it’s not always enough once you hit the real world. Working with a coach or trusted advisor may help to get you on track, discovering the solutions and opportunities that best fit your needs.

An earlier version of this article originally appeared on this site in July 2022.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Allison, J. J., Kiefe, C. I., Cook, E. F., Gerrity, M. S., Orav, E. J., & Centor, R. (1998). The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Medical decision making : an international journal of the Society for Medical Decision Making

Begin, A. S., Hidrue, M., Lehrhoff, S., Del Carmen, M. G., Armstrong, K., & Wasfy, J. H. (2022). Factors associated with physician tolerance of uncertainty: an observational study. Journal of general internal medicine

Berg, S. (2020). Feeling burned out? Try picking up the phone to call your coach. American Medical Association

Cook, J. (2022). Forget resilience, improve your uncertainty tolerance. Forbes

Iannello, P., Mottini, A., Tirelli, S., Riva, S., & Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Medical education online

Reis-Dennis, S., Gerrity, M. S., & Geller, G. (2021). Tolerance for uncertainty and professional development: a normative analysis. Journal of general internal medicine

Simpkin, A. L., Khan, A., West, D. C., Garcia, B. M., Sectish, T. C., Spector, N. D., & Landrigan, C. P. (2018). Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Academic pediatrics

Sinsky, C. A., Brown, R.L., Stillman, M. J., & Linzer, M. (2021) COVID-related stress and work intentions is a sample of US health care workers. Mayo Clinic proceedings

HALT: A Self-Coaching Stress Management Tool for Physicians

As a physician coach specializing in burnout and professional transitions, I've seen firsthand how the current state of healthcare can push even the most resilient doctors to their limits. Unchecked anger, frustration, and passive aggressive behavior can often be symptoms of the times.

By now you probably know that burnout is not your fault. Nor is it a mental health issue. Instead, it’s the consequence of a broken system.

At the moment, this is the system we are living in. While some headway is being made, the forces that are driving the burnout epidemic are not likely to improve overnight. And while it can be tempting to lash out when you’re stressed, it’s likely to make the situation worse, straining your relationships with colleagues, staff, and patients.

Beyond burning your bridges, the effect that an emotional outburst can have on your own well-being is profound. What’s more, healthcare systems are cracking down on behavior that’s deemed inappropriate or unprofessional.  

Although you didn’t cause the problem, it’s important that you remain mindful of the far-reaching implications of your communications and actions, regardless of the high quality of care that you provide.

To get you back on track, the simple acronym "HALT" – Hungry, Angry, Lonely, Tired – can be an important tool for self-awareness and self-care.

HALT was originally developed by David Streem, MD, a psychiatrist and addiction specialist, as a reminder to stop and identify the triggers that might lead to a relapse.  But for physicians, the acronym is also an intuitive tool that can remind you to mindfully take a pause and check in with how you’re feeling, and why, when something or someone triggers a reaction.

By using HALT, you can slow your roll before impulsively acting in ways that might harm your personal and professional relationships.

Here's how HALT works:

Hungry

When you're hungry, or “hangry”, even small problems can feel overwhelming. Hunger can make your patience wear thin and your trash your tolerance for stress and difficult interactions.

If you’re like many physicians, being hungry may be your default mode. Although it shouldn’t be the norm, it’s painfully common for physicians to skip meals or eat irregularly due to hectic and overbooked schedules.

Junk food from the snack machine or physician’s lounge might fill you up, but it can make you feel even worse. One straightforward strategy that can help is to pack simple but healthy food for the next day each evening.

But hunger isn't just about food. It's often about other unmet needs, whether emotional, physical, or intellectual.

Take action on hunger by getting in a 10–15-minute break to reset your mind and body once or twice daily whenever possible.  You’ll probably find that when you fill up the tank, even out your blood sugar and slow down your sympathetic nervous system, you’re able to maintain a more balanced mood and energy level.

In the long run, the few minutes you set aside to care for yourself will pay off in more respectful relationships, improved productivity, and better health.

Angry

Anger is a natural emotion, but how you handle it in the workplace is crucial. Unchecked anger can lead to conflicts with colleagues and unpleasant meetings with administrators. When it carries over to the bedside or operating room, it may impact the doctor-patient relationship, undermine teamwork, and even affect patient care.

Become aware of this emotion, and how it feels in your body. When you find yourself getting angry, take a moment to pause and step back. Give yourself time to process, reflect, and move on.

Deep breathing, a short walk, or even bluntly but respectfully discussing your feelings with a trusted colleague can open up a fresh perspective and prevent words and actions that you’ll regret later.

Lonely

If you’re feeling lonely, you may react harshly to stress out of a sense of isolation. Although you’re likely surrounded by people all day, medicine, our profession, ironically, can be a lonely one.

The burdens of responsibility, the fear of making mistakes, the ever-present perception of competition, and the need for confidentiality can all leave physicians feeling isolated.

Acknowledging loneliness is the first step towards seeking connection.  Regular interaction with friends, family, and community, even if brief, can hold back isolation and create a sense of belonging. Finding a hobby that gets you out of the doctor mindset or working out with a group of like-minded people can help as well.

Tired

When you’re tired, everything just feels harder. It’s no surprise that fatigue is a common issue among physicians. Long hours, high stress, and fractured sleep while on call mean that more than 40 percent of doctors surveyed report that their work schedule simply doesn’t allow for adequate sleep.

Chronic tiredness can impair your judgment and your empathy. Although it can be hard to feel compassion for your staff and others though the fog of fatigue, noticing what’s driving your irritation can soften your reaction to stress.

How to Use HALT in Your Daily Practice

• Check In: Before reacting, run through your HALT checklist. This simple pause can reset your frame of reference.

• Be Proactive: Make time for healthy meals, use brief but meaningful stress-relief techniques like mindfulness, get regular exercise, cultivate a life outside of work, and do your best to get restful sleep.

• Seek Support: Don't hesitate to seek professional help if you're struggling with anger, loneliness, or fatigue. Therapy, coaching, and peer support groups can all be helpful, depending on your circumstances.

• Communicate with Colleagues: Foster an environment where it's safe to respectfully express what you’re feeling. This openness can build stronger, more supportive team dynamics.

When you’re feeling reactive, upset, or tempted to lash out, use HALT to take a pause. Are you Hungry, Angry, Lonely, or Tired?

Simply becoming aware of your inner state can help you to defuse a situation and craft a different response. It’s also a great reminder that caring for yourself is neither selfish nor optional if you want to work at your optimum.  

When you take care of your own needs, you’ll find that you will be better equipped to care for those whose lives and well-being depend on you.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Physician Stress and Burnout: How Mindful Coaching Can Help

Physician burnout is not a new phenomenon, but over the past several years, it has become a true epidemic. In 2021, 930 academic papers were published on the topic, compared to 129 in 2011. In 1984, the year I started medical school, a total of 4 articles can be found in the PubMed archives.

Today burnout is out in the open. But the tools to manage and prevent burnout remain elusive.

The term “burnout” itself may sound a little nebulous, but there are methods to measure and define it. The Maslach Burnout Inventory defines burnout as “a psychological syndrome” that “occurs among individuals who work with other people”, with symptoms including:

• Emotional exhaustion, feeling unable to give more of yourself

• Depersonalization, resulting in negative or cynical attitudes towards patients

• Reduced sense of personal accomplishment, meaning a tendency towards negativity towards your own accomplishment.

It’s important to understand that burnout is not a psychiatric disorder, but rather it is “ a normal response to a chaotic and stressful environment”.

Many of us have experienced these feelings from time to time, and that’s completely normal. But when these feelings are persistent and overwhelming, then it’s likely that you’re dealing with burnout.

In a 2022 survey, Medscape found that 47% of physicians reported burnout, up from 42% in 2021. Not surprisingly, Emergency Medicine and Critical Care reported the greatest burnout (60% and 56% respectively), but Ob-Gyn (53%), Infectious Disease (51%) and Family Medicine (51%) were close behind.

Women reported more burnout (51%), perhaps due to competing responsibilities at home which were aggravated by the pandemic. But more than a third of men were also affected.

The contributors to burnout reported in the survey are not surprising to anyone in healthcare. Topping the list:

• Bureaucratic tasks

• Lack of respect

• Long hours

• Lack of autonomy

These features are nearly identical to the six factors associated with workplace stress that were identified by the British workplace health and safety regulatory agency:

• High work demands

• Low control over workload and process

• Inadequate support from management and colleagues

• Poor workplace relationships

• Lack of clarity regarding professional role and responsibilities

• Poor management of change within the organization

Beyond making you miserable, stress and burnout affect your quality of life, your self-confidence, your relationships at work and at home, and perhaps even your patient care.

Sometimes it feels as if everyone is talking about stress and burnout, but nothing is being done about it.

Although mindfulness has been shown to be effective in mitigating the symptoms of stress and burnout, it feels disingenuous to tell physicians to get a grip by practicing yoga and meditating.

Clearly, we are not going to yoga our way out of this mess. And hospitals and healthcare systems need to do more than offer lip service. But in the meantime, a little mindfulness may help. Here’s how:

First let’s start with a simple definition of mindfulness. As a certified Mindfulness Meditation Teacher, I’ve been fortunate to learn from Sean Fargo, a former Buddhist monk and gifted teacher. Sean defines mindfulness as “paying attention to the present moment with curiosity and non-judgment”. In other words, simply being present.

This sounds nice, but how can it possibly help you overcome the powerful forces that lead to stress and burnout?

As it turns out, there have been a number of studies in recent years that were designed to answer just this question. A meta-analysis of six high quality randomized controlled studies of mindfulness interventions for medical students, published in 2020, reported substantially lower stress indices in students who participated in the programs.

These programs incorporated interventions that included

• Body scanning

• Awareness of thoughts and emotions

• Breathing exercise

• Walking meditation

• Sitting meditation

• Coping with stress

Most programs were once weekly group sessions, while one used a mobile app.

Not only did stress scores improve in the short term, compared to controls, but studies that reported six-month follow-ups found that the benefits of mindfulness teaching persisted.

Coaching is another effective strategy for physicians at all stages of professional life. Although it is no substitute for system-wide change and mitigation of the issues that lead to burnout in the first place, coaching can help physicians gain traction and make decisions that help them to reclaim their connection to the profession.

That can range from important changes that create a better work-life balance in the current setting to a move to a new position or workplace. In some cases, a coach may work with a physician who decides to leave the profession altogether.

Research supports the role of coaching as a powerful tool for physicians at all stages. A small study from Duke University included primary and specialty care physicians ranging from first year residents to more senior physicians with leadership roles. The program focused on coaching for physician well-being, and reported improvements in coping strategies, resilience and stress.

Regardless of the specific modality or focus, physician coaching as an intervention has clearly been linked to improvement in well-being and resilience. A 2019 randomized controlled trial of primary care physicians in the Mayo Clinic system looked at the effects of 6 telephone coaching sessions on

• Burnout

• Quality of life

• Resilience

• Job satisfaction

• Engagement

• Meaning at work  

After 6 professional coaching sessions by credentialed coaches, the rate of burnout decreased by over 17% in the coached group but increased by nearly 5% in the control group. And absolute rates of emotional exhaustion dropped by nearly 20% in the coached physicians but increased about 10% in controls.

Coaching is a powerful tool. Mindful coaching may help physicians manage and overcome the effects of the sometimes-overwhelming forces that impact them and, indirectly, their patients on a daily basis.

But most importantly, addressing and repairing the underlying sources of burnout and stress is paramount. This is a commitment that needs to come from the highest levels of our healthcare systems.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Berg, S. (2021). Q&A: Clearing up confusion on physician burnout and depression. American Medical Association

Christensen, A. J. et al. (2023). Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Military medicine, 189(Suppl 1), 64–70. https://doi.org/10.1093/milmed/usad277

Drybye, L.N. et al. (2019). Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. Journal of the American Medical Association Internal Medicine

Garcia, C. L. et al. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina

Hathaisaard, C. et al. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: a systematic review and meta-analysis. Asian Journal of Psychiatry

Health and Safety Executive. (2019). Tackling work-related stress using the management standards approach

Kane, L. (2022). Physician burnout and depression report 2022: stress, anxiety, and anger. Medscape

Maslach, C. et al. (1997). The Maslach Burnout Inventory Manual

Schneider, S. et al. (2014). Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention. Explore

Maximize Your Time: Essential Toolkit for Physician Time Management

Being a physician often means that you are expected to be a wizard with time, creating minutes and hours out of thin air. It’s not your imagination. A recent study found that in order for a primary care physician to provide guideline-recommended care and communication, they would have to work nearly 27 hours every single day.

With burnout impacting more than half of US physicians, some healthcare systems and many medical associations are beginning to take note. The problem is multifactorial, but administrative burdens are an important issue for many physicians. System-wide commitments to streamline tasks and automate simple processes are beginning to take hold. But true reform is likely to be several years away.

Meanwhile, when every second of your day seems to belong to someone else, managing your personal time isn’t just an option, it’s a necessity. But despite the ever-growing demands of the profession, the skills of time management are rarely taught in our training years.

As a cardiologist in a busy practice for many years, I developed a keen interest in productivity, educating myself by studying some of the masters in the field. The skills I learned allowed me to practice more efficiently. And equally important, I found meaningful ways to nurture my interests outside of medicine, and to create more time and energy for my friends and family.

As a physician coach, I enjoy sharing these simple techniques and insights with my clients. For some, they can be transformative. By optimizing your personal time, you may find that the more rigid pressures of work feel like less of a burden.

You can pick and choose what works best for you, but the important thing is to commit to making at least one change. When you invest a little time and energy to get started, you may be surprised by how much you get back.

Bullet Journal

A bullet journal is more than just an old-school planner. It's a customizable, hand-written system that combines planning, organizing, goal setting, and reflection.  Here’s why it’s beneficial:

• Customizable Layout: Tailor it to your specific needs, whether it’s daily to-dos, long-term goals, or reflective journaling. Don’t worry about making it look pretty. I use a very simple to-do checklist, and scribble notes as they pop into my head during the day.

• Mindfulness Practice: The act of writing by hand encourages memory retention and mindfulness and will help you to prioritize tasks. I like to take 10 minutes every evening to set up my plans for the next day. Even if I don’t meet all of my goals for the day, simply writing them down creates an intention and makes it more likely that they will be completed in the future.

If you want a deeper dive into bullet journaling, check out The Bullet Journal Method, written by Ryder Carroll. There’s no rush to get through it. Commit to reading just 10 minutes each evening (or morning), and over time you’re likely to create serious momentum.

Colored Pens

Never underestimate the power of colors for organization. When you use your colored pens for your Bullet Journal or to take notes while studying for boards, talks, or other commitments, you will:

• Enhance Organization: Assigning different colors to various tasks or appointments helps create quick visual categorization.

• Boost Memory Retention: Color coding  will help you to remember important ideas, tasks and deadlines.

Audiobooks

In general, multitasking is overrated. That’s because most people tend to do both things halfway. And multitasking can make you more vulnerable to distractions. But listening to a good podcast or audiobook on your commute or while exercising can be a great way to safely and efficiently feed two birds at the same time. That could be CME, a good story, or personal development.

Here’s a brief list of some of my favorite productivity audiobooks:

• Atomic Habits by James Clear focuses on the development of small, incremental habits to achieve significant life changes. The book emphasizes the compound effects of your small daily decisions and the importance of establishing systems rather than focusing solely on goals.

• Stolen Focus by Johann Hari delves into the modern crisis of attention, exploring how various factors in our environment and daily lives erode our ability to concentrate. Hari argues that the decrease in attention spans is not an individual failing, but rather a systemic issue influenced by technology, diet, sleep patterns, and societal structures. Although Hari advises systemic change, simply being aware of these forces can help you to push back.              

• Deep Work: Rules for Focused Success in a Distracted World by Cal Newport advocates for a practice of deep, focused work as opposed to the more common shallow, multitasking approach. The book offers practical advice on how to cultivate a deep work habit, minimize distractions, and maximize your cognitive capabilities. Although the ideas in the book are not always applicable to the reality of a physician’s practice, you will come away with a greater understanding of the importance of focus and the negative impact of constant distractions.

Online Yoga (or other activities)

Physical and mental well-being is integral to managing time effectively. As a registered yoga teacher, I love the option of online yoga classes. That’s because they offer:

• Flexibility: Yoga apps allow you to practice at your convenience, fitting sessions into a busy schedule. Most yoga apps give you a range of types, levels, and duration. I like DownDog, AloMoves, and YogaWorks. All three also offer options besides yoga, including strength training and meditation. And some offer live options as well.

• Stress Relief: Yoga is a great way to unwind and maintain physical and mental health. So are many other forms of physical activity. If you want to start, but exercise isn’t part of your routine, simply commit to 10 minutes twice weekly, and see where that takes you.

One caveat: if you’re new to yoga, Pilates, weight training, or any other chosen activity, consider taking a few classes or working with a private teacher first. That way you’ll have the basics, get your questions answered, and develop a practice that is safer, more effective, and more enjoyable.

 Time Tracking App 

Understanding where your time goes is the first step to better time management. My favorite easy-to-use option is Toggl. Time tracking apps can help you to:

• Identify Time Drains: When you track your time online, you may pinpoint activities that take up unnecessary time. That doesn’t mean you shouldn’t stay up to date on email or social media, but when you know where your time is going, you may find that you naturally begin to make choices that are more aligned with your priorities and values.

• Create Structured Work Intervals: I especially like the Pomodoro Technique. It goes like this: Work for 25 minutes, then take a 5-minute break. This structured and repeatable process can enhance focus and prevent burnout. You can also use time tracking to break larger projects (as well as tasks like charting) into smaller intervals. That way you’ll maintain your focus and create a more manageable and efficient process.

What time management tricks and tools have you found that keep you organized and on task? Drop me a line. I’d love to hear from you!

DISCLAIMER: As an Amazon Associate I may earn from qualifying purchases, which means that if you click on one of the product links, I’ll receive a small commission. This helps support the website, for which I am grateful! Please do your own research before making any important decisions.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Thriving Amidst Chaos: Prioritizing Health, Self-Care, and Mindfulness

In the constant press of your daily life, prioritizing health, self-care, and mindfulness often takes a backseat. But when you make the time to care for yourself, you’ll be better equipped to care for those who depend on you.

In this article, we’ll explore why self-care matters, including the impact of self-care on stress management, and I’ll give you some simple steps that will help you to thrive amidst the daily storm of clinical practice.

The Impact of Stress on Burnout

It’s common to think of stress as harmful and something to be avoided. But stress can affect your health positively as well as negatively.

Positive stress happens when you face a challenge or a deadline that you know you are capable of meeting. It might be a stretch, but you know it’s possible. And importantly, there is a reward on the other side.

While positive stress can propel you towards your goals, negative stress can lead to frustration and burnout. Negative stress is defined as those forms of stress over which you have no control. A boss (or spouse) who is never happy, a job for which you are never rewarded or thanked, and escalating demands at work without adequate time off to recharge are all forms of negative stress.

Constant and unrelenting stress can lead to burnout. The World Health Organization defines burnout as an “occupational phenomenon.” Burnout is characterized by

• Exhaustion and loss of motivation

• Cynicism and negativity

• Inefficiency

Given the current state of healthcare, it’s no surprise that over 60 percent of physicians reported at least one manifestation of burnout in 2021.

It’s important to remember that burnout is not your fault. It is a symptom of a dysfunctional system or workplace. But developing some tools to help you get through tough times can lessen the impact and improve your overall happiness and wellbeing.

Self Care and its Benefits

Self-care is not just about pampering yourself. It's about taking care of your mental, emotional, and physical well-being.

Committing to self-care enhances focus, improves relationships, reduces stress, and leads to less burnout. Acknowledging the mind-body connection is often the first step towards effective self- care.

Nutritional Psychiatry and Stress Management

The new field of Nutritional Psychiatry focuses on the growing body of research that strongly connects what you eat to how you feel. Without a doubt, mental health is complex and multifaceted. Diet is only one part of the big picture.

But when you’re famished and pressed for time, the quickest options can undermine you, sabotaging your best intentions and sapping your energy.

As it turns out, those ultra-processed foods that often pass for nutrition in the doctor’s lounge can raise your risk of anxiety, sleep disturbance, depression, food addiction, alcohol use disorder, and increased inflammation. Artificial sweeteners in particular have been linked to a greater risk for depression.

Instead, consider incorporating simple elements of the Mediterranean diet like fruits, nuts, whole grains, olive oil and fish. You probably know that the Mediterranean diet supports heart health and may reduce the risk for certain cancers. But this diet is also linked to improved symptoms of depression and better mental health and well-being. There’s also emerging evidence that a Mediterranean diet can improve perceptual performance.

It might take a little planning, but going Mediterranean doesn’t have to be complicated. Simply packing a nourishing lunch or advocating for healthier options at work can make a difference.

Exercise and Health

You already know that regular exercise will lower the risk of heart disease, cancer, bone disease, and dementia.

But research has also shown that exercise can reduce anxiety, improve sleep, and improve immune function. It doesn’t take a lot of exercise to reap the benefits. A brisk walk a few days a week is a great way to get started.

Mindfulness and Self-Care

"Mindfulness is the awareness that arises when we nonjudgmentally pay attention in the present moment.” These are the words of Jon Kabat-Zinn, PhD., Professor of Medicine Emeritus at the University of Massachusetts Medical School, and the godfather of mindfulness in healthcare.

Put even more simply, mindfulness is undistracted attention.

Practicing mindfulness can lead to

• Healthier lifestyle choices

• Less stress and anxiety

• Greater parasympathetic tone

• Better cardiovascular health

• Improved immunity.

Mindfulness doesn’t have to be about doing yoga or meditating. Instead, it’s about being undistracted, nonreactive, and fully present in the moment.

Getting started with mindfulness isn’t complicated. You don’t need a special cushion or a meditation app, although those can be nice. Simply set aside 3-10 minutes of quiet time each day to observe the present moment. Notice your thoughts and let them go, returning to the present when your mind wanders.

It is this practice of continually returning to the present moment that develops the “mindfulness muscle.”

When you practice mindfulness, you may find that your communication with patients and colleagues becomes easier and more engaged.

Create an Action plan

Creating an action plan will help you to set realistic goals and track your progress. Write out the steps that you need to take to commit to your self-care. And develop a plan that is realistic and actionable.

Enlisting a partner or friend with whom you can share accountability can help you to stay committed. Something as simple as a daily reminder on your phone may also keep you on track.

The ripple effect of taking your own self-care to heart will show up in your energy level, creativity, and relationships. You’ll develop a greater sense of self-compassion and equanimity. And in time, your path forward toward the goals that matter will become more clear.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Adan, R. A. H. et al. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 29(12), 1321–1332.

Davidson, R. J. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine, 65(4), 564–570.

Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, et al. (2022). Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults. British Journal of Sports Medicine 56:1188-1193.

Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4), 227–234

Lane, M. M. et al. (2022). Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 14(13), 2568.

Loucks, E. B.et al. (2015). Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Current cardiology reports, 17(12), 112.

Martinez-Gonzalez, M. et al. (2019). The Mediterranean Diet and Cardiovascular Health: A Critical Review. Circulation Research 124:779-787

Munoz, M.A. et al. (2009). Adherence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition. 101 (1821-1827),

Samuthpongtorn C et al. (2023). Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023;6(9):e2334770. doi:10.1001/jamanetworkopen.2023.34770

Shanafelt, Tait D. et al. (2022). Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clinic Proceedings, Volume 97, Issue 12, 2248 - 2258

Stubbs, B. et al. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry research, 249, 102–108.

World Health Organization: WHO. “Burn-out an ‘Occupational Phenomenon’: International Classification of Diseases.” World Health Organization, 28 May 2019, www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases.

Yin, W. et al. (2021). Mediterranean Diet and Depression: A Population-based Cohort Study. International Journal of Behavioral Nutrition and Physical Activity, 18(1). https://doi.org/10.1186/s12966-021-01227-3

Young, H. A. et al. (2022). Mediterranean diet, interoception and mental health: Is it time to look beyond the ‘Gut-brain axis’? Physiology & Behavior, Volume 257.

When Physicians are Disrespected: My Guest Appearance on the Podcast by KevinMD

If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.

Dr. Pho posts interviews and articles daily, and I was honored to be invited back as a guest on his podcast.

In this episode, we talk about the epidemic of disrespect faced by physicians today, and steps you can take to advocate for yourself and reclaim your dignity.

When physicians and others in healthcare are treated respectfully, the practice of medicine becomes more sustainable and more inclusive.

This is a topic I wrote about in an earlier article, Preventing Physician Burnout: Reclaiming Your Dignity. A version of the article also appeared on the KevinMD website.

My podcast appearance discussing disrespect on the Podcast by Kevin MD.

Navigating Burnout: My Podcast Appearance on KevinMD

If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.

Kevin posts interviews and articles daily, and I was thrilled to be a recent guest. In the episode, we discussed the burnout epidemic, and why it’s not the same as compassion fatigue.

Burnout is a symptom of a system that is not working for you. In many ways, it’s a form of grief. It’s not your fault. But that doesn’t mean there’s no way out. In the interview, I went over actionable steps you can take to improve your life as a physician and to combat the effects of today’s stressful environment.

My August interview with Dr. Kevin Pho on the KevinMD podcast.

Why Are We Afraid to Talk About Work-Life Balance?

This article originally appeared on Doximity, where I am a 2022-2023 Op-Med Fellow.

For many physicians, work-life balance (WLB) is the elephant in the room. According to CHG Healthcare, in 2018, 63% of physicians finishing residency programs cited WLB as their number one consideration when choosing a job. In 2022, it was 85%.

Dissatisfaction with WLB is strongly correlated with burnout, and is a common reason that many physicians choose to leave their current practice.

Although women physicians tend to rate WLB as somewhat more important than men, among millennials it is a top priority for both genders.

Yet physicians often avoid raising this crucial issue with potential employers and even colleagues for fear of being judged.

This fear of judgment is based in reality: providing the best and most timely care to patients often requires self-sacrifice. We all know that medicine is demanding; we must expect to occasionally, or even often, put personal needs aside in order to care for patients whose needs can’t wait.

But it’s not uncommon for physicians to fall prey to the notion that consistently putting aside their own, or their family’s, well-being is necessary to answer the “calling” of medicine. Perhaps in taking on this mantle of self-sacrifice, the idea of wanting something more, or even something different, can seem disrespectful to the “priesthood” of medicine.

For physicians whose work requires collaboration and partnership with others in the profession, openly wanting more from life may also stir up fears of being perceived as weak, lazy, or not a team player.

While respecting these valid concerns, I believe that if you conquer the angst of admitting that you want more out of life and make an effort to seek WLB, you will find that your relationships, your sense of fulfillment, and ultimately the care you give your patients can flourish.

Research shows that not only do people who make time for family, hobbies, and health feel a greater sense of balance, but they may also become better physicians for it.

• A British study found that employees who engaged in creative activities were more likely to discover creative solutions to problems at work.

• A study of nearly 300 ICU staff members, including physicians, found that those who engaged in hobbies experienced less post-traumatic stress.

• And a Duke study found that higher WLB measures among hospital staff, including physicians, correlated with greater patient safety and improved teamwork.

On the opposite end of the spectrum, not attending to life outside of work can have serious effects on both. A study of members of the American College of Surgeons published in 2012 found that those with conflicts between work and home life were more than twice as likely to experience burnout and depression. In this study, “home” was defined broadly as “personal responsibilities,” and included personal relationships, parental responsibilities, and spousal factors. Experiencing this conflict also meant that the surgeons surveyed were more likely to leave their current practice. Although work-home conflicts might be considered a subset of work-life balance, the implications of this type of conflict are significant.

And yet, balancing your life is easier said than done.

Each of us has a different story. Personally, as a cardiologist I was able to find WLB, although it required a substantial degree of focus and dedication. While in practice, I wrote four books (admittedly health related), became a yoga teacher, and competed successfully with my horses. I also made time to travel and hike around the world.

However, these efforts were not without sacrifice: I had to give up significant income in order to take a half day off a week to train with my horses. And I usually chose to take most of my allotted (uncompensated) vacation time.

Finally, though I was fortunate enough to have an organized system of cross-coverage with my partners, the time off nevertheless meant that I was often catching up on EHR responsibilities late into the evening, sometimes even from the other side of the world.

Still, I believe the loss of income and long nights catching up on charts was worth it. Not only was my life richer, but my diverse experiences and friendships made me a more compassionate and open-minded physician. My patients were always curious about my adventures, and often felt more connected to me when they realized that I shared some of their own interests. And having the opportunity to “fill my cup” gave me more energy and enthusiasm for my work.

Your personal definition of WLB may change over time, depending on your personal commitments.

Admittedly, part of my ability to find WLB earlier in my professional life may be attributed to my decision not to have children, a situation that likely differs from that of many readers. My mother, a physician and parent of five, had a far more difficult time finding balance, and in truth I don’t believe that she was ever able to achieve it.

In the 21st century, there are more options for parents, but it’s still a complicated balancing act. If you’re a parent of young children, there are likely some hobbies and experiences that will need to be put on hold until the little ones are older. Instead, WLB for you may mean finding a way to create and protect family time.

So, how do you get started?

First, realize that there’s no shame in wanting or needing more. You signed up to be a doctor, but you may also be a friend, a spouse, a parent, or a curious human being who craves something new.

Next, create a plan that can get you the time and space that you need, while continuing to serve your patients and collaborate with your colleagues.

Below, I offer some things to consider while embarking on your new path:

1. Think about where you are in your practice. If you’re in training, achieving WLB for the duration of the program may not be a priority. If you are just beginning your career, it may take a few years to find your footing, and that’s normal. Whether or not they admit it, most physicians feel a little out of their depth when they first start out. Over time, you are likely to develop a range of practical skills that will make your day more efficient, leaving you with more personal time.

2. Realize that you might need to take a pay cut, or even a new position. If you need to take a regular day off, or even half a day, it may cut into your productivity. If you are not available, work may be shifted to your colleagues. Sometimes that’s welcomed, but many times it may not be. Weigh the risks, benefits, and the possible outcomes and make your decision from there.

3. Get help. It might cost you something, but could you benefit from a personal assistant, a babysitter, or a scribe? Just a few hours of help each week could free up important blocks of time that you could use to pursue a passion project, or to be more present for your family.

4. Consider your commute. Could you be using the time to enjoy an audiobook, catch up on CME, or learn something new? Or maybe even consider moving closer to work to create more free time in your day.

5. Learn to say no. Sometimes being on that committee or taking on a new project may be just the thing to move you forward professionally. But if you find yourself taking on more responsibilities than you must, realize that you are giving up the precious commodity of time.

6. Give up your perfectionism. Take just 10-15 minutes a day to get started on a new hobby, a quick yoga class on your iPad, or a morning walking meditation. You don’t have to go all in all at once.

7. Figure out where you’re wasting time. If you actually enjoy mindlessly scrolling your social media feeds, then maybe there’s no reason to stop. But if this feels like a compulsion, train yourself to put the phone away whenever possible and pick up a new project, go for a walk, or just sit with your family and read a book.

8. Sign up for a workshop. Take a couple of phone-free hours to learn something new about photography, bread baking, canoeing, knitting, bird watching, or anything else that catches your attention. No one will expect you to know what you’re doing, and you might discover a new passion and a new community.

9. Book a trip. Just go ahead and set a date perhaps six months out, put it on the calendar, and buy your ticket. The first step is often the hardest, but once you start, it’s easier for the rest to fall into place.

No matter what work-life balance means to you, realize that an ideal balance looks different for each person. It can change over the course of a lifetime.

The most important way to achieve it is to put your ideas into action. Your life will be so much richer if you consciously put in the effort, often in ways that you might not anticipate today. And you may find that in the process, you generate more joy, creativity, and resilience in your medical practice.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Colville, G et al. Coping with staff burnout and work-related post-traumatic stress in intensive care. Pediatric Critical Care Medicine. July 2017.

Dyrbye LN et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Arch Surg. 2012 Oct.

Eschleman, K.J. et al. Benefiting from creative activity: The positive relationships between creative activity, recovery experiences, and performance-related outcomes. J. Occup. Organ. Psychol. April 2014.

Saley, C. Survey Report: Millennial doctors still finding jobs the old-fashioned way. CompHealth Blog. April 2018.

Saley, C. Survey: Work/life balance is #1 priority in physicians’ job search. CHG Healthcare. March 2022.

Sexton JB et al. The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions. BMJ Qual Saf. 2017 Aug.

Shanafelt TD et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. October 2012.

Preventing Physician Burnout: Reclaiming Your Dignity

This article appeared in a slightly different version on the KevinMD website.

Treating patients with dignity is a fundamental cornerstone of our profession. Although we can all cite situations where we or our colleagues fell short, most of us aspire to helping our patients feel safe and respected. Yet the flip side of this equation is rarely mentioned. And the truth is that physicians are often not treated with the same dignity by their systems or their patients.

In this article, I’ll go over the fundamental changes that have contributed to this situation, and I’ll give you five strategies you can use to combat the disrespect and reclaim your dignity.

We've been conditioned to expect and even accept that patients in distress may lash out, but the fallout has been enormous over the past few years. As recently as five years ago, there was an expectation of respect for the expertise and sacrifice that a physician’s work entails.

But disrespect from patients is currently at an all-time high, sometimes even escalating to physical violence from patients. A recent study found that more than one third of public health workers in the US experience some form of workplace violence. Examples included stigma or discrimination, job-related threats, and bullying or harassment.

Adding fuel to the fire is the rise of administrative oversight of physicians and their practices by people who may have little experience in direct patient care. Their reach extends not only to metrics and billing, but into personal and professional decisions that once would have been completely off limits.

What’s more, employed physicians may have little say into whether threatening patients can be dismissed from their practices.

And at the intersection of patient and administrative stress are the widely published patient satisfaction scores. Despite these scores having little relevance to patient outcomes, physicians are increasingly required to perform in such a way as to meet an arbitrarily defined level of satisfaction. Consequently, this may undermine their ability to do their best work.

Although physicians are tasked with regular training in sensitivity and respect for patients and employees, they get little instruction in how to protect their own dignity. Often physicians are advised to just let it go.

It’s not unusual for doctors, especially women, to attempt to deal with these situations with passivity and even self-deprecation, in a misguided attempt to get along. Younger physicians who lack strong mentorship may be especially vulnerable to these situations.

Unfortunately, these well-meaning and ingratiating responses often simply serve to empower the bully, and do nothing to improve the situation.

So how can physicians begin to reclaim their dignity? Here are five ideas that you can implement right now:

1.      Establish Boundaries:

Boundaries are crucial in maintaining professional relationships and protecting personal dignity. Being a caring and compassionate physician is not the same as being a friend.

Avoid social media interactions with patients and administrators and keep your work and personal lives separate. Modeling clear expectations for behavior and interactions can help prevent disrespectful situations.

2.      Advocate for a Respectful Work Environment:  

If you don’t speak up for yourself, it is unlikely that anyone else will. Engage your colleagues and address disrespectful behaviors from patients, administrators, and other physicians.

Initiating open discussions about mutual respect and dignity at staff meetings or even through anonymous feedback systems can encourage positive changes. Remind yourself that these are reasonable requests. Pushing for policies that address the root causes of disrespect and burnout can create a more supportive and dignified atmosphere for the entire team.

3.      Focus on Doctor-Patient Communication:

Respectful communication is a cornerstone of the physician-patient relationship. Through empathetic and compassionate communication, you’ll foster and model civil discussion. Active listening, showing genuine interest in patients' concerns, and involving them in decision-making can help build trust and respect.

Keeping EHR messages brief and focused can help to maintain your professional boundaries while addressing patient concerns.

4.      Don’t Accept Disrespect:

Firmly but politely calling out an incident of disrespect can be a first step towards creating a solution. Rather than simply going along to get along, modeling appropriate behavior can set the tone for future communication. And when the misbehavior is significant or repetitive, documentation can make your point much more clearly than a complaint.

But if you feel that your safety or that of your staff is at risk, don’t allow yourself to be talked into accepting a dangerous situation. Sometimes engaging with and reporting to security or even law enforcement personnel is your best option.

5.      Take Care of Yourself:

Prioritize your own well-being. Explore self-care practices such as exercise, meditation, and hobbies to help you recharge emotionally and mentally. Mindfulness techniques can assist you in staying present, focused, and composed during difficult interactions, preventing potential escalation.

Don’t overlook the importance of making time for your family, friends and loved ones. By nurturing these ties, you will stay connected to the world outside of your practice.

Reclaiming your dignity as a physician will require commitment and test your resilience. Although you didn’t create the problem, it is unlikely that it will change without strong advocacy by and for physicians. By following the steps I’ve outlined above, you can begin to cultivate a more dignified and sustainable working environment. And ultimately everyone, including the patients you care for, will benefit.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Fenton JJ et al. The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Archives of Internal Medicine. 2012

Ofri, D. The Business of Health Care Depends on Exploiting Doctors and Nurses . The New York Times. June 8, 2019

Schneider, B.J. et al. The Effect of Patient Satisfaction Scores on Physician Job Satisfaction and Burnout. Future Science. November 12, 2020.

Tiesman, H. M. et al. Workplace Violence and the Mental Health of Public Health Workers During COVID-19. American Journal of Preventive Medicine. March 2023

Yeluru H et al. Physician Burnout Through the Female Lens: A Silent Crisis. Frontiers in Public Health. May 2022

Burnout is an Expression of Grief, Not a Lack of Compassion

This article appeared in a slightly different form on KevinMD.

“The wound is the place where the light enters you.”- Rumi

Over the last 5 years, the word “burnout” has become nearly synonymous with the state of healthcare. With over 60% of physicians surveyed reporting burnout in 2021, it’s an epidemic in our profession.

Burnout is not a personal failing or a psychological illness. Rather, burnout is a response to chronic workplace-related stress.

Symptoms of burnout include:

·         Exhaustion

·         Cynicism

·         Inefficiency

But burnout is not a failure of compassion.

In fact, burnout may be a natural reaction to the recognition that you are unable to provide the compassionate care that your patients need.

The experience of burnout may mirror in some ways the experience of grief. Both are a response to loss. And like burnout, grief is often experienced as exhaustion and difficulty thinking clearly.

Compassion fatigue on the other hand produces a sense of indifference to the suffering of others. It’s an emotional withdrawal generally caused by exposure to traumatic events. For physicians, it may be a response to relentless illness and death.  The COVID-19 pandemic is a classic example of a driver of compassion fatigue, especially for those who worked in the ER and ICU in the early days of this disaster.

It’s not uncommon for physicians to experience compassion fatigue from time to time. It doesn’t mean that they are not compassionate people, but rather that they are suffering and in need of relief.  

We might consider burnout as a type of disenfranchised grief. But it is not compassion fatigue.

Equating burnout with a lack of compassion is a heavy-handed way of placing the blame on physicians while deflecting it from the systems that created the problem.

As a coach, I have found that many physicians with burnout are in fact grieving the lack of connection to their patients. Often this is due to system-wide emphasis on RVUs combined with excessive clerical work that undermines their ability to spend meaningful time with patients.

If you’re experiencing burnout, it’s important to recognize it for the wound that it is, have compassion for yourself, and create a plan to move forward.

As Rumi states so eloquently “the wound is the place where the light enters you.” What does this light illuminate for you?

Are you suffering from burnout? Remember that burnout is not a failure on your part, but rather a symptom of a system that is not working for you. If you feel stuck, consider coaching.

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As a physician coach, I can work with you to explore what’s possible and create a plan that aligns with your personal values and aspirations. Schedule your exploratory conversation with me by clicking the button below.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

References

Compassion Fatigue, Empathy Burnout for Health Care Workers: Which is it? Mental Health America, 2023.

Erickson, M. Good leadership, self-compassion key to tackling physician burnout. Stanford Medicine News Center 2017.

Lathrop D. Disenfranchised grief and physician burnout. Ann Fam Med. 2017

Maslach C. et al. Job burnout. Annu Rev Psychol. 2001

Mughal S. et al. Grief Reaction. [Updated 2022 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023

Shanafelt, TD et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVD-19pandemic. Mayo Clinic Proceedings. 2022

What the Failure of the ER Match Says About the State of Health Care

And How Physician Coaches Can Change The Story

When I was in medical school, the cool, smart kids went into ER medicine. It was a hotly competitive residency, and there was no guarantee that you would match. Now things are entirely different. Over 550 residency spots went unfilled by US med school grads in the residency match this month. Some centers had zero applicants match to their programs. Compare this to 2021, when only 14 ER residency spots were not filled.

The reasons? Just about any physician in the US can tell you:

• Disrespect fueled by social media personalities and irresponsible "news" outlets

• Dangerous working conditions

• Overloaded ERs being used as a source of primary care, often because people lack insurance or access

• Corporatization of medicine with a focus on numbers of patients seen and metrics that often don't relate to patient care

• Management of physicians by business people and those with less responsibility and training

• Intrusive, redundant, and burdensome EHR requirements

• Lack of adequate support staff

Some of my best friends are ER physicians. They are some of the hardest working people I know. These are the doctors who will save your life at 2 am, no matter who you are or whether or not you have insurance. And they are also the doctors that are tasked with waking up their colleagues at all hours of the night to request a consult or hospital admission. Most manage their work with grace, strength, and courage.

The steep decline in the desirability of ER residencies is a really scary trend. It’s easy to say that doctors can be replaced with mid-level care providers, but the truth is that the expertise, skill, responsibility and knowledge that an ER physician provides requires years of education, training, and commitment. Mid-levels can reduce some of the burden of less complex patients, but they are no substitute for a physician.

This sudden and shocking shift should be a call to action for hospital directors, ER directors, and the corporations and private equity firms who own and manage many of these practices.

As we wait to see how this recent revelation will impact the decisions and practices that affect ER physicians, it’s important that physicians take steps to stand up for ourselves and our profession. This is a new way of thinking about medical practice, but times have changed irrevocably. By learning how to work within the systems we now have, we can start to make important changes from the inside out. Ultimately, such changes will benefit not only physicians, but also their patients and indeed the very institutions and corporations that currently control our healthcare systems.

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 How can coaching help? Well clearly, coaching will not fix the problem. Coaching means working with one physician at a time, very much like patient care. But coaching will help you clarify your goals, identify your frustrations and obstacles, and give you the tools to create your way forward. Will that be

• Negotiation, understanding your own value?

• Creating a streamlined workflow that will allow you greater efficiency?

• Acquiring new skills to make your time more effective?

• Courage to make a lateral move to a new facility?

• A switch to a different type of practice altogether?

• A change in working hours?

• Reframing conflicts so that you are able to create a more positive working environment?

• Honing interpersonal skills?

• Advocating for change in EHR management?

Regardless of your specialty, the healthcare world is shifting. The work you do matters. By recognizing your own worth and power, and by taking action that is beneficial to both you and your patients, you will be able to create a happier and more sustainable life.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.