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.

My Podcast Interview With Dr. Cliff Han of AllerPops

I recently had the opportunity to interview Dr. Cliff Shunsheng Han for the Techlink Health podcast. Dr. Han is a physician, a medical researcher with the Human Genome Project, and the creator of AllerPops, an innovative product designed to help fight the seasonal allergies that plague so many of us.

An allergy sufferer himself, when medications failed to get his problem under control, Dr. Han decided to look beyond the traditional factors that contribute to allergies. he was also motivated by the allergies suffered by his young son. That led him to explore the idea of prebiotics and the importance of a healthy oral microbiome.

Dr. Han is a wonderful example of a physician who followed a nontraditional pathway. Although he trained and practiced as a doctor in China, he has worked as a research scientist since coming to the US over 20 years ago. He shares more about his story on the podcast and in his book, Nothing to Sneeze At.

But once a physician, always a physician. Through his curiosity and resilience, Dr. Han has created something completely new with AllerPops. The science is still in the early stages, but the testimonials on his website are inspiring.

As a disclosure, I will note that Dr. Han has kindly offered to supply me with a sample kit of Allerpops. As a nearly year-round allergy sufferer, I am really looking forward to giving them a try.

Listen to my podcast interview with Dr. Cliff Han, co-hosted with David Sanchez, RN.

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.

This post contains Amazon affiliate links. I may earn a small commission when you click on the links, at no additional cost to you. These commissions help to support the website.

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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.

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

Learning the Art of Delegation: A SMART Tool for Physicians

Delegating is not an easy or comfortable task for many physicians. It’s difficult to give up control of every detail, especially when you are ultimately responsible for the outcome.

That’s why you can’t (and won’t) simply assign a task and hope it all works out. When delegating, the idea is to get the same or better result than if you did the task yourself.

As a physician, there can be a blurry line between what you need to do to assure the optimal care for your patients and what others must do in order for you to accomplish your best work. In this article, I’ll give you a template that can help you overcome some of the hurdles that may be preventing you from delegating appropriately to other members of your team.

It starts with creating clarity around responsibilities and purpose. As the physician, you are the team leader. The goal is to provide the best and most timely care for your patients, and to administer that care with compassion and professionalism. By establishing clear and well documented instructions and expectations, you’ll set your team members up for success.

The SMART Delegation mnemonic is tool that will walk you through the steps that will make delegation work for you, allowing and inspiring your team to do their best work.

SMART Delegation

(Based on the work of Kate Christie of Time Stylers)

SELECT: Choose the best person for the task. This may be someone with little experience but a willingness to learn, or it could be someone with years of practice in the same or related field. Be choosy, but consider thinking outside the box.

MOTIVATE: Motivate your team by explaining why the task is important. This will create buy-in and a sense of importance and pride. This step is important to revisit periodically, especially at first.

ACTIVITY: Explain the details of the task in detail. Be sure to include a checklist if appropriate, and a written guideline that can easily be referred to and updated as needed. Once you put in the work to create the guideline, this bit of heavy lifting is done. This is a crucial part of time management.

RESULT: Describe and explain what a good result looks like. Be sure your delegated team member understands the purpose of their work, and how to recognize common complications.

TIME FRAME: Set realistic but firm deadlines. Consider a mid-point check in if appropriate.

As always, trust, but verify. 

Remember that the team or individual may be learning a new skill. Make time at the outset to be available.

Be approachable and patient, especially at the beginning. But be sure that the person to whom you have delegated the task understands their role and that they will be expected to perform this responsibility without you in most cases.

Keep the lines of communication open so that your designated team is comfortable reaching out for help with complications or unexpected situations. But whenever possible, use these questions as teaching opportunities rather than simply providing the answer. Challenge them to come up with the answers themselves.

Involve a supervisor, if appropriate, so that your team members feel comfortable reaching out for help with more minor issues or questions.

Be generous with both praise and with constructive criticism. Remember to practice patience, but if a team member is unable to do the task to your satisfaction, consider finding a different individual to do the job. Don’t allow yourself to fall back into the time-sucking trap of doing it all yourself.

Delegating can feel like giving up control, so expect to feel a little discomfort at first. Be patient with yourself and with your team, but make your expectations clear.

When you have the right people and processes in place, a SMART delegation process can make you more productive, improve safety, promote teamwork, and enhance patient satisfaction. And that benefits everyone.

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.

Twelve Tips for Creating Realistic To-Do Lists for Busy Physicians

Creating a realistic and actionable To-Do list can feel like a daunting task for a busy physician. But the truth is that your To-Do list can free up hours of your valuable time, create structure out of chaos, and help you to reach goals that will bring you closer to your ideal life.

In this article, I’m going to share twelve actionable and realistic tips that will help you to develop your own sustainable To-Do List practice.

Tip Number One: Write it Out

I encourage you to write out your list and carry it with you, rather than using your computer or phone.  Research shows that handwriting notes, including schedule reminders, activates the brain’s memory functions more strongly than entering the information into an electronic device. My favorite tool is my Bullet Journal. But a simple piece of paper will do.

Tip Number Two: Don’t Include Everything

Your To-Do list should not include patient appointments, consults, rounds, or other foundational tasks of your practice. Instead, use it to create and keep track of tasks such as

·        meetings

·        strategic tasks

·        planning

·        study time

·        personal appointments

·        exercise

·        meditation

·        creative endeavors

·        any other personal “wants” that are meaningful to you

Tip Number Three: Make a Weekly Appointment with Your List

Each Sunday night, spend ten to fifteen minutes creating a list of your weekly tasks, keeping the above list in mind.

Be sure to include tasks that may not be due the following week, but that might require planning over the next several weeks to months. For those tasks, make note of the deadline so that you can prompt yourself to plan accordingly. These might include

·        lectures

·        papers

·        vacation planning

·        studying for boards

·        tax preparation

·        business planning

Tip Number Four: Take Ten Minutes Every Evening

Each evening, review your tasks from the day, revisit the weekly task list, and create a list for the following day. Include a general range of time required to complete each task so that you can plan realistically.

Don’t forget to take into account steps that you need to take to reach your upcoming deadlines. Keep these events in mind as you plan your list and break down the necessary steps into actionable tasks.

Tip Number Five: Prioritize, Delegate, and Delete

Prioritize your tasks so that the most important things take priority.

Before committing to your To-Do list, take a look to see if there are tasks that you can delegate or automate. If so, decide how you are going to do that, and put those steps on your list. Although this can take some time at the beginning, it will save you multiples of time once you’ve put the process in place.

Tip Number Six: Batch Your Tasks

Now that you have your To-Do list, think about how you might organize or cluster several related tasks together. This is known as “batching”. Mentally, this keeps you from constantly switching context, as can happen when you try to multitask. It can also help you to avoid procrastination. By batching your tasks, you’ll optimize the time you spend getting the work done and will be more focused as you do the work. And it will give you more breathing room, or margin, for other activities.

If you know that you’ll have specific open times on your work schedule, think about scheduling some of these tasks or clusters of tasks during these pauses. Of course, you may also choose to use those times to catch up on your EHR tasks, so be realistic about your workload.

Tip Number Seven: Take Advantage of Unexpected Open Time

Refer to your list when you find yourself with unexpected open time, especially when the tasks only require limited blocks of concentrated effort.

Tip Number Eight: Use a Timer

After you’ve finished with your patient care responsibilities for the day, or when you have a defined pause, use a timer to encourage yourself to maintain focus. Twenty- to thirty-minute segments are usually a good idea. But when you’re struggling to get started, even a five-to-ten-minute commitment can get the task launched. The important thing is to overcome the inertia that might be holding you back. If possible, turn off the sound on your phone or computer to limit interruptions during high-focus times.

Tip Number Nine: Budget Your Energy

Think about optimizing the way you use your time. Use your low-energy times, like the end of a busy day, for the activities that require the least amount of focus. And use the times where you have the most mental energy for those things that require creativity and mental flow.

Tip Number Ten: Beware of the Energy Drain from Your Devices

It goes without saying that device use is a necessity in patient care and administrative work. But it can also be an attention drain. Consider setting a timer for checking email or surfing the web. And whenever possible, batch your email time so that you’re not constantly checking your inbox. Delete, unsubscribe, or delegate whenever possible.

Tip Number Eleven: Allow Time for a Pause

Whenever feasible, allow time for mental pauses. Most people need at least 5-10 minutes per hour in order to maintain optimal focus. Although that may not always be possible during the busiest times of your workday, try to build brief pauses into the structure of your after-hours time.

Consider adding a daily meditation to your To-Do list. You can use this as one of your mental pauses. A brief meditation using one of many available apps (including HeadSpace and Waking Up) may help you to re-focus the mind and let go of the stress of the day. By practicing mindfulness meditation regularly for even a few minutes, you’ll train yourself to become more present and less irritable.

Tip Number Twelve: Don’t Give Up

No matter how you structure your To-Do list, remember that it can take several weeks for a habit to stick. If you skip a few days, just start over. Choose a method that will be easy to access and easy to remember. And make sure to take a little time at the end of each day to review the day’s tasks and set up your list for tomorrow.

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.

This post contains Amazon affiliate links. I may earn a small commission when you click on the links, at no additional cost to you. These commissions help to support the website.

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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.

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. Vicki Rackner: Surgeon, Entrepreneur, and Financial Coach

I thoroughly enjoyed meeting Vicki Rackner MD on the TechLink Health podcast and learning about her work in the field of physician financial well-being.

It was a fascinating conversation, and her story is inspiring! Through personal adversity and challenge, Dr. Rackner created a business helping physicians discover financial freedom.

While she is not a financial advisor, Dr. Rackner works with physicians to help them leverage their medical expertise, generate multiple income streams, and develop critical business and marketing skills. She has authored three books on the subject, with another one on the way.

Take a listen on Spotify or wherever you listen to podcasts.

My podcast interview on Techlink Health with Dr. Vicki Rackner.

Combating Neurophobia: My Podcast Interview with Dr. Michael Kentris

I recently co-hosted an episode of the TechLink Health podcast featuring neurologist Michael Kentris, D.O.

In a wide-ranging discussion, my co-host David Sanchez, RN and I learned about Dr. Kentris' cutting edge work as a neurologist and as a physician educator. As a podcaster himself, Dr. Kentris combats "neurophobia" by breaking down complicated topics in neurology for clinicians across a broad range of specialties. Look for his entertaining and enlightening podcast "The Neurotransmitters" on Apple or Spotify.

I was also excited to learn that Dr. Kentris and I both studied at Vanderbilt University School of Medicine. I graduated from medical school at VUSM in 1988, and he complete his clinical neurophysiology fellowship there in 2018.

My TechLink Health Podcast interview with Dr. Michael Kentris.

Defeating Superbugs: My Podcast Interview with Dr. Steffanie Strathdee

As a podcast host for TechLink Health, it was a privilege to interview Dr. Steffanie Strathdee, an epidemiologist and Distinguished Professor at UC San Diego.

Dr. Strathdee literally saved her husband's life when he suffered a catastrophic antibiotic-resistant superbug infection.

Through her investigations, Dr. Strathdee uncovered the possibility of phage therapy. Considered a risky and largely unproven treatment modality at the time, it was a last-ditch effort -- and it worked!

Dr. Strathdee is now the Co-Director of the Center for Innovative Phage Applications and Therapeutics at UC San Diego. You can find her book, The Perfect Predator, on Amazon. There’s an audiobook version as well, which I highly recommend.

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.

My Podcast Interview with NeuralPositive’s Dr. Yasmine van Wilt

Recently I was fortunate to have the opportunity to interview Dr. Yasmine van Wilt for the TechLink Health Podcast. Dr. van Wilt has a fascinating story in the field of medical-grade music. She is a founder of Neuralpositive, a company that is on the forefront of medical music innovation. Dr. van Wilt has partnered with Cornell Tech, Columbia University, and Stanford University, among others.

As we work to integrate evidence-based mindfulness and other non-pharmaceutical practices into healthcare, there is a powerful need for well designed research backed up by academic commitment. I’m excited to share this interview with you, and would love to hear your feedback.

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.

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.

How My Experience with Pain Made me a Better Physician

This article originally appeared in Doximity.com, where I am an Op-Med Fellow.

Although I don’t like to admit it, I am a typical Type A cardiologist who takes absolutely everything far too seriously. Like many physicians, this extends well beyond my professional life and reaches into every corner of my existence.

I am also a competitive equestrian. And my big, red, and rather fancy horse really doesn’t care what I do for a living, or how seriously I take myself. In his mind, I am both a reliable source of carrots and a nuisance who sometimes keeps him away from his friends while trying to boss him around. My horse is a source of joy and a beautiful connection to the natural world. He also seems to delight in keeping me humble. But I never expected him to teach me a profound and enduring lesson about the nature of pain, empathy, and mindful compassion.

Several years ago, while training on a cross country jumping course, I suffered a serious fall. One minute I was on top of the world, flying across the open fields with my beloved equine partner, and the next I was on the hard ground, writhing in excruciating pain and unable to walk without assistance. My horse, meanwhile, high-tailed it back to his friends, grateful for the unexpected interruption.

While I fortunately had no broken bones, it turned out I had sustained a severe injury to my right psoas and my left piriformis muscles. I returned to work soon after, hobbling on crutches for support and trying to shrug off my injury as a minor nuisance. However, I quickly became intimately familiar with the anatomy of my lower musculoskeletal system. Initially, it was the psoas muscle that I noticed, since it kept me from walking. But within a few days, the piriformis injury became the center of my existence, as it cruelly squeezed my sciatic nerve. The pain was truly mind-blowing and would sometimes escalate without warning. Because I was back at work, my options for medications were limited.

I am by nature a quiet person, but during this time one of the only ways I could deal with this monstrously searing pain was to scream my head off. This was only possible when I was safely out of earshot of my patients, partners, or any other human beings. I don’t know if it was the endorphins or the temporary distraction, but it was remarkable how well screaming helped, if only for a few minutes.

After more than a week of unrelenting agony, I began Googling similar injuries (because, of course, you Google). I realized with dread that there was no promise that my pain would ever completely go away. Thankfully I had an excellent orthopaedic team. And, as a physician, my pain was always taken seriously. Sadly, I knew this was not the case for many of my patients. 

Although I don’t treat pain, my cardiology patients are among the estimated 8% of Americans who live with what is termed “high-impact chronic pain.” Like a light switch turning on, after my accident I began to recognize the manifestations of pain and misery in their faces. The anxiety of being asked to change positions on the exam table, the fear of having their medications taken away, and the frustration of feeling dismissed and disrespected. I understood deeply that pain could not always be measured, proven, or relieved. 

I found myself engaging more empathetically with these patients, acknowledging their fear and our shared humanity. The 55-year-old woman with chronic back pain who always remained standing during our visits, shifting back and forth, who used to perplex me? Now I realized just how difficult sitting could be. The anxious 45-year-old man with the perpetually furrowed brow and litany of complaints about his medical team whom I had previously written off as a chronic malcontent? With my newly informed awareness, he now came into sharper focus as a suffering human being. And the 70-year-old woman with severe arthritis and scoliosis, who was nonetheless always ready with a smile and a thank you? She became a messenger of grace — someone who showed me that it was possible to rediscover an innate good nature, despite the difficulties life presented. In acknowledging my patients’ pain, and accepting their well wishes for me, our sense of mutual trust and connection deepened.

As physicians, we learn early on to create healthy boundaries between ourselves and our patients. Hard-earned experience teaches us that we can’t always take everyone at their word, and that in some cases patients will exploit their doctors’ compassion for personal gain. For instance, most medical and surgical interns will eventually encounter characters who seek pain medications for what sound like legitimate reasons, but are eventually discovered to have visited multiple doctors and ERs with similar stories. Often a call from an astute pharmacist uncovers the ruse. Consequently, by the end of residency, it’s common to have developed at least a little cynicism. And indeed, we learn quickly that objectivity is critical not only to our decision-making but also to our ability to leave our work behind at the end of the day. 

My practice, as I mentioned, does not include treating pain or prescribing pain medications, and I have not lost my natural sense of vigilance. Yet my intensely personal experience has opened a window of understanding and taught me a new way of relating to my patients without judgment. This shared experience of pain was something I could acknowledge and be a witness to, without the expectation of a solution. In fact, I found that simply recognizing a patient’s pain often created greater trust and made it easier for them to accept my medical advice. On a practical level, our encounters became more efficient and resulted in fewer after-visit phone calls and cancellations. And as a result, I felt that I was able to offer a higher quality of care, with greater satisfaction from all standpoints, despite being powerless to impact their unremitting pain. 

In my case, I was fortunate: after a combination of several rounds of steroids, high quality physical therapy, a mindfulness practice, and time and patience (plus bedtime narcotics on non-call nights), my symptoms subsided and I was granted a near complete recovery. Still, this is not guaranteed for all pain patients — and I know that not everyone has the resources, good fortune, or support to come out mended on the other side. I was also lucky to have friends and family who tolerated my pain-fueled bouts of insolence and short temper. But many people with chronic pain understandably become so focused on their misery that they drive away loved ones and others who offer help or kindness.

Although I would not wish my experience on anyone, I cannot deny that it has taught me so much. Today, I recognize how chronic pain affects everything — it changes our sense of self, and can make even kind and gentle people become mean, angry, and impatient. As a physician and as a patient, I am tremendously grateful for the unexpected pearls of wisdom and empathy that emerged from beneath the layers of pain.