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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking 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

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

Overcoming Your Roadblocks: A Physician's Guide to Navigating Change

Not too many years ago, most physicians in the private sector expected to settle into a medical practice straight out of training and to stay put until retirement decades into the future. The idea of moving, changing practices in the same town, or leaving before a ripe old age was almost unheard of. While change has often been part of the career path of academicians, physicians in all sectors are increasingly finding themselves dissatisfied, frustrated, or simply seeking something new.

In fact, a recent Mayo clinic survey reported that one in five physicians plan to leave their practices within the next two years, and one in three expect to reduce work hours. Burnout and perceived lack of appreciation by their organizations were the two primary issues cited in the study.

If you’re considering a move, this change can feel daunting. Physicians are often motivated by loyalty and compassion. But we are also creatures of habit.

For many of us, the roadmap was clearly defined: college, medical school, residency, maybe fellowship. As long as you followed this straight and narrow path, and nothing unexpected knocked you off course, you would make it down the road.

The promise at the end of the trail was a satisfying and gratifying professional life, with a high probability of a happy and fulfilling home life as well.   

Over the past decade, that promise has frayed. Burnout due to lack of autonomy, higher patient demands, a sicker and older population, falling reimbursements, the endless clicks and messages on the EHR: all have contributed. This new perspective means that physicians are more likely to seek change, or at least to consider it.

But the decision to embark on a new professional journey can often feel like traversing uncharted territory.

And the process of choosing a new path can be riddled with mental roadblocks. As a physician coach, I have found that guiding individuals through these challenges can be transformative, bringing new and unexpected possibilities to light.

Getting started can be the hardest part of the process, but once you begin, you’ll notice that the momentum will slowly build. In this article, we will explore actionable steps that can help you to overcome some of the mental barriers that may stand in your way.

1. Self-Reflection

Before embarking on a new professional path, it's essential to engage in deep self-reflection. Journaling for a few minutes every day can really help.

You don’t have to have a clear endpoint in mind to get started, but you do need to know what matters to you, and why. Consider the specific skills, interests, and passions you want to prioritize, and how you want your personal life to look. Take time to identify your values, strengths, passions, and personal goals.

Ask yourself:

• What are my core values and priorities in life?

• What aspects of my current role do I find most fulfilling and unfulfilling?

• What are my unique skills and talents?

• What are my long-term career and life aspirations?

By understanding yourself on this deeper level, you can better align your career choices with your values and objectives. For more prompts and tips to help you with this process, see my recent article about finding your “why”.

  2. Recognize Your Triggers and Limiting Beliefs:

As you work through self-reflection, you might encounter triggers and limiting beliefs that hold you back. If so, don’t be afraid to ask yourself probing questions such as:

• What specific thoughts or patterns arise when considering a new direction?

• Have you or someone else created any self-defeating narratives about your capabilities or limitations that might be influencing your mindset?

• What might these limiting beliefs be trying to protect you from?

• And how might they be proven wrong?

• If there are meaningful limitations that are keeping you from moving forward, how might you close gaps in your knowledge or skills?

When you pinpoint these mental roadblocks, you’ll take the first step towards disarming their power. Often a coach can be helpful when working through this process.

 3. Seek Guidance

Don't hesitate to seek guidance from mentors, career counselors, and trusted colleagues who have gone through similar transitions.

There can be great value in networking and connecting with others who have found fulfillment in their medical practice or who have ventured into alternative career paths. Their insights and experiences can provide valuable perspectives and inspire you to take bold steps in your own professional journey. Of course, you will want to be discerning about who you confide in, especially if you are leaving your current practice.

 4. Set Achievable Goals

Break your career change into smaller, manageable goals. This not only makes the process less intimidating but also allows you to track your progress. Create a timeline with milestones. These might include

• Gaining specific qualifications or licensure

• Attending relevant conferences,

• Researching places you might want to live

• Reaching out to potential employers or colleagues in your desired field.

Setting specific, measurable, attainable, relevant, and time-bound (SMART) goals can provide you with a clear roadmap and motivate you to move forward despite any mental hurdles.

 5. Embrace Setbacks as a Learning Opportunity

Rejection can sting. It's important to acknowledge that setbacks are part of any professional journey. Instead of seeing them as failures, view them as valuable learning experiences.

Approach unexpected challenges as opportunities for personal and professional growth. Be flexible and willing to pivot, if necessary, but don’t lose sight of your values and your “why”. The key is to use these uncomfortable experiences as opportunities to learn, adapt, and refine your approach.

 6. Get Comfortable with the Unknown

Fear of the unknown is a common mental roadblock for anyone making a career change. This may be especially true for physicians, since so much of our life has been neatly defined for us. Counteract this fear by engaging in thorough research into your desired path.

If you’re looking into a nonclinical job, understand the industry, its trends, and the challenges you might face.

And if you’re changing focus or practice, get to know more about the system, individuals, and culture you may be working with. Will you need new skills or certifications? If so, how and when can you achieve them? This knowledge will help you feel more prepared and confident as you take the leap.

 7. Keep an Open Mind

Maintaining an open mind is crucial during a career transition. Your initial path may evolve as you gain more insights and experiences. Embracing change and adaptation opens the door to broader opportunities. There may be something you may not have considered, but which may turn out to be a perfect fit.

Conclusion

Choosing a new professional path as a physician takes courage, contemplation, and perseverance. Know that you almost surely will need to step outside of your comfort zone to get somewhere new and more fulfilling.

By facing your roadblocks head on, you will build the skills and resilience you need to embark on this new journey. Remember that your background as a physician has equipped you with valuable skills, fortitude, and experience that are needed both in clinical medicine and in a wide range of connected fields.

Embrace the opportunities that arise, trust in yourself, and move forward towards a more fulfilling professional future that aligns with your values and your strengths.

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.

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

My Podcast Interview with Dr. Naomi Lawrence-Reid

After appearing on a recent segment of TechLink Health’s Podcast, I was invited to interview Dr. Naomi Lawrence-Reid of Doctoring Differently. Dr. Naomi, as she prefers to be called, describes how she pivoted from full-time practice and found new opportunities to use her skills as a physician.

Her story is inspiring and engaging. You can take a listen right here.