Episode 086: Destroying Physician Burnout

Speaker 1: You are listening to Your Practice Made Perfect; support, protection, and advice for practicing medical professionals, brought to you by SVMIC.

J. Baugh: Hello everyone and welcome to this episode of Your Practice Made Perfect. My name is J. Baugh, and I will be your podcast host for this episode. Today we're going to be talking about personal recovery from physician burnout. And joining us to discuss this very important topic is Dr. Betty-Ann Svendsen. Dr. Svendsen, thank you for being here.

Dr. Svendsen: Sure. Thanks for having me.

J. Baugh: Before we get started talking about this particular issue, maybe you could give us a little bit of your background, so our listeners can know who you are.

Dr. Svendsen: I'm a general pediatrician, and I've been in practice - it'll be 19 years - this September. I'm still employed at my first job that I've had post-residency, married for 27 years with four children ages 13 through 21. And my oldest child is pre-med, and I totally support her decision. 

J. Baugh: Well, that's great. So you're here today to share some of your personal experience with physician burnout that we hear so much about these days. And I'd like to begin though by asking how you're doing today and what you're doing today.

Dr. Svendsen: I'm doing great. I am working four days a week as a general pediatrician. And I love my job again, which I did not think was ever going to happen a few years ago.

J. Baugh: We're so glad to hear that you're doing well and that you're back to practicing medicine and serving the patients that you're able to see. Let's return maybe back to the moments when you began to experience burnout. Maybe you weren't even aware of it yet when it first started happening. Is that true?

Dr. Svendsen: That's true. I don't think that I was really aware. It was a few years ago, and we were right in the middle of electronic medical record, and doing lots of charting after hours, on the weekends. I was very frustrated that I felt like leadership didn't understand how much that we had to go through on a daily basis, those that were in the trenches, seeing patients constantly. I resented that I was spending a lot of off-time charting. Department meetings just became about what we weren't doing right. And I just felt like I was carrying the burden of trying to do the right thing and take care of my pediatric patients, and just external factors were making it difficult for me.

J. Baugh: One of the things that I've picked up on as being an attorney here at SVMIC, is that I think the general public really isn't aware of how busy physicians are outside of actually treating patients. There's so much more to being a physician than simply treating the patient, whether that's in the clinical setting or a hospital setting. And I think most people aren't aware that there's just so much work that a physician does outside of that setting. 

Dr. Svendsen: Right. I agree. And it's much more now than it was years ago.

J. Baugh: Oh, yes. I'm sure that's true. I hear that from physicians as well, that the practice of medicine just isn't what it was 20 or 30 years ago.

Dr. Svendsen: Right. 

J. Baugh: So what happened to make you aware of the burnout? Was there a specific incident? Is there something that happened over a period of time? How did you become aware that you were experiencing burnout?

Dr. Svendsen: I think that the specific incident that I remember, and I remember exactly where I was standing, my youngest child called me on my cell phone, crying. I had forgotten to pick him up at after-school care. And I had just been stuck busy at work, charting, and I just was like, "How could I have forgotten to pick my own child up from daycare?" So I go pick him up. I get home that night, and I just was so upset over that, that I just had had it. And I Googled picking up and moving to Belize. I really thought, "I'm just going to pick up my whole life, take my whole family, and move out of this country," and of course, that was just a pipe dream, and I got over that quickly.

Then I started Googling physician burnout. One of the first websites that popped up was The Happy MD. I stayed up all night reading this website. And there was a section on disruptive physicians. In my mind, I was thinking, "Oh, those are the surgeons." We're general pediatricians, we're happy kind of people. 

J. Baugh: Right.

Dr. Svendsen: And then I realized I was that disruptive physician. I had become the cynical, venting, foot-stomping physician. On doctors' day several years ago, our staff had made a little chalkboard and had painted words, descriptions of us as doctors, and mind said, "Ambitient, sassy, confident, leader." I remember looking at that the next day at work and going, "I don't even remember who that person was anymore." And that's when I realized I have got to get a handle on what's going on because I just really started dreading going to work every single day. So to sum it up, it was forgetting to pick up one of my own children because I was busy caring for other people's children. That made me feel horrible as a mother.

J. Baugh: It's interesting how we can find ourselves as parents learning so much from our children. I'm glad to know that you were able to learn something positive from that experience and to be able to turn it hopefully into something positive for the people who are listening today. So in the midst of your burnout, how did you handle your day to day job responsibilities? And how did this affect your personal life as well?

Dr. Svendsen: I think that I thought I was handling things great, not realizing that my staff was walking on eggshells around me. I would walk in and immediately look at my schedule, see things that were incorrect in my schedule, computer didn't work. Patient to patient, all I wanted to do was get through the day. I just wanted to get to 5:00 and get through the day. I totally lost my compassion and empathy with patients. Looking back, I see it now, but I remember just not feeling like a good listener to parents. I just felt like if they're complaining about their toddler, and I'm thinking, "Well, I'm having problems with my teenager. Just wait until you get to that point." I didn't say it, but that's how I felt.

The majority of my schedule as a general pediatrician is well-child checks. I've been in practice for almost 20 years, packed schedule. And so daily I would hear patients say, "We can never get to see you. Oh, we had to see somebody else." And it just made me feel bad that I couldn't see my patients. And then I would work hard to work patients in, and then it just kind of snowballed. I felt like I was becoming inefficient because I was focusing on the not important things in my job. 

Personal life, oh my gosh. My husband is an oceanographer, lots of travel. And of course, this is the time when appliances went out, and kids were sick, and I was so resentful that he was able to travel to tropical places, and I'm just trying to keep my kids alive and go through the regular day-to-day stuff as a mother. 

J. Baugh: Right. Yeah. That makes sense. Let's expand that just a little bit more and talk about your support system, family and friends. We all have a support system that we need for whatever profession that we're in. And how would you say that your burnout may have affected them? And were they even aware that you were going through burnout?

Dr. Svendsen: I don't think that they were aware. I think they just thought that I had become very passionate about what I was doing, and so I didn't feel like I had support because I didn't think there was a problem. My spouse, who is not a physician, I was often telling him, "You don't understand. Your job can't kill somebody if you make a mistake," which was not a very nice thing to say. My children just got used to me coming home from work, going straight to my room and charting with my dog. 

And I kind of let them fend for themselves for dinner because I had to get that charting done. And again, with coworkers, I think that they all - my physician colleagues - had sensed something different with me. And I've been in practice with these people for 20 years, but I think they were afraid to say something. And I probably at that time would've denied that there was an issue. And so it wasn't until I started saying, "I'm having a hard time," that I realized the support system had always been there. But it's a fine line between asking for help and people just volunteering to help.

J. Baugh: So what do you think the turning point was that allowed you to make positive changes towards being in the better place that you're now in?

Dr. Svendsen: I think for me, attending a retreat in Seattle a couple of years ago, Dike Drummond's Quadruple Aim Physician Leadership Retreat. I was the biggest skeptic there when we started. But I think I was meeting with like-minded physicians that were normal people going through the same things I was, as well as meeting with leadership and understanding kind of what their point of view was. And I got a lot of tools from that retreat that I could take to my personal life and take back to my job, and try to make changes within myself and my reaction to things because there's no way I'm going to make huge changes in medicine. But it was making little changes daily in my practice that made it all bearable for me.

J. Baugh: So I guess you're saying then that the way that you finally recovered from burnout was not just one big change that you implemented and one specific moment. But, it was small changes that you've made over the course of a period of time.

Dr. Svendsen: Yeah. And it's funny because I think recovery is not the right word because it makes it seem like a disease. I feel like I totally destroyed burnout. I took burnout head-on and made changes positively, did a lot of self-coaching. And it seems selfish, but I realized that the change had to come from me first. And so that's where I did a lot of my work and looking at my schedules, and seeing what it was in my day that I could change to help my work-life balance, and me just like my job better when I was there. 

J. Baugh: Yeah. I can see where that's important for you to focus on some things that you could change yourself. As you said, it sounds selfish to say that, but I have to look at the bigger picture and see that the changes that you're making for yourself helps your family. It helps your support system, and ultimately helps your patients, because you're able to provide better medical care for them if you're able to address the burnout that you're facing yourself.

Dr. Svendsen: Right. 

J. Baugh: So let me ask you this question. You mentioned about totally destroying burnout. So what is that you are able to do to keep yourself from going back to a place of burnout?

Dr. Svendsen: I am grateful every day that I have a job where I get to do what I love to do. Pediatrics is the best profession ever. And I have great coworkers that have become friends and family. And so I just become appreciative of that. And I think for us, as physicians, with our busy days, we kind of lost that connection with the other doctors in my practice because we're all just trying to get the job done. And I actually converted one of my exam rooms into an office. And one of my coworkers shares it with me now, and it's kind of our retreat where we can get in and close the door if we need to.

I try to not work through lunch anymore. We've got a beautiful healing garden that even in Texas when it's pretty hot, it's nice to go sit outside by myself, even for five minutes, just to get out of the office. Another thing that I do is I take vacation. I used to not take a lot of vacation time because I worried about the impact it would have on other doctors, my practice. What were they going to do with my patients? And I don't really know where that started from. I think years ago when we went from salary to RVU based, it kind of got hammered into us that vacation day was a day without pay, and we just kind of stopped taking vacations.

I try to be intentional with my schedule, so instead of looking at my schedule and dreading whatever was coming in, I just think of all the positive interactions I could have that day. I journal, I meditate, and I am the last person in the world that ever would be a meditating yogi, but for me, I just needed to have something that separated me completely from being the doctor that I was. And I think exercise, healthy eating, really important. And one thing that I learned is to not vent or gripe because that has no useful purpose at all. I try to nip it in the bud when I hear it at work. It just gets everybody all flustered when we start talking about the system and how nobody understands how hard we work. And I really try to kind of squelch that. And if there are things that we think that we can change, think about positive ways that we can make these changes.

And mentoring young physicians, young women physicians that are mothers, has been a really positive thing for me as well because I was in their shoes 20 years ago, 15 years ago, in terms of trying to raise children and be a practicing physician. So for me, I just have found other areas besides being a doctor that I've realized I have usefulness for.

J. Baugh: Well, that sounds like some great advice. You mentioned about going to a seminar in Seattle. And I'm wondering what it was that caused you to come to the decision that, A) you needed to go to a seminar, and B) that was the seminar that you needed to go to.

Dr. Svendsen: Because when I looked at the website, I felt like I was reading my story. And some of the descriptions of physicians, and I think before I knew what burnout really was, I didn't realize that me being cynical and sarcastic and snarky was a sign of burnout. And so when I was reading this description, I was like, "Oh my gosh. That is me." I was at a point where I was starting to get into leadership positions. And I felt like some of my snarkiness was holding me back a little bit. And so I signed up to go to that retreat. And it was the Quadruple Aim Physician Leadership Retreat. And I actually went two other times and learned something different about myself every time because I was at a different point in my story. 

So when I went the first time, I was the biggest skeptic when they were talking about mindfulness and meditation. I'm thinking, "Oh, my gosh. What a waste this is going to be." And it ended up being one of the best techniques and tools that I had learned just to slow down a little bit and really be present. And then the other big part of the leadership retreat talks about how to approach senior leaders with things that you want to change in your schedule. I think that I had just become so demanding and finger shaking, and that's not the way to get things done. So, I started looking at patient numbers in terms of revenue and patient satisfaction, and really trying to understand things from the leadership standpoint because they have their own set of goals and expectations placed upon them that I knew nothing about. 

And so for me, the retreat really made me start trying to understand why leadership does what they do. It's not us against them. And we are a physician led organization, and so it made me more appreciative of the job that they have to do. And in the end, we just want to take good care of our patients. And I think that they want the same as well, so I attended that retreat three separate times.

J. Baugh: Let me ask you this one last question, because my guess is we may have some listeners to this podcast who are currently experiencing signs or symptoms of burnout. They may even be in the thick of burnout right now. So, what is some advice that you would give to our listeners who may be going through this right now?

Dr. Svendsen: I think that the most important thing is to be able to recognize it, which was not easy for me. I didn't recognize it until later in the game. And I think if you start not attending staff meetings, not answering engagement surveys, I think being non-involved is a sign that maybe you need to consider it. I think if you have colleagues that may have noticed a change in you and bring it up, don't be defensive. Really try to hear them out, so I think recognizing it and also listening to your spouse and your kids if they are telling it, you're way stressed out. I think for me, really, my whole identity was wrapped up in being the best doctor, the best mother that I could. I just felt spread out too thin, and I felt like everything that I touched had suffered. So really, trying to figure out what it is within myself that was making the issue, just taking everything so personally. I didn't feel like the best mother. I didn't feel like the best doctor. 

A few other tips and things that I've tried that have helped is that I don't check my work email after hours or on the weekends. I figure if it's a big enough deal and somebody needs to get ahold of me, they can text me, because I found that I was sleeping horribly, I'd wake up in the middle of the night and think about these emails that I was going to send. And I did sometimes, and regretted those. So I just don't bring that home. I really try to close my charts during the day and not stay too late. I can't. I've got kids to pick up. And I just hate to chart at home and take that time away from them.

My inbox, I check only a few times a day at work, set times of the day. I've found that I would kind of be obsessed about having my inbox empty. And I was handling things multiple times instead of just taking care of it in the first place. So I found that I was doing things that were falling between the cracks, thinking that I was being so efficient, and I wasn't. And nurses would often interrupt me in between patients. I would lose my train of thought. I just kind of told them, "Please, try to not to interrupt me as I'm walking from room to room unless it's really, really important." And so it was having to change the culture a little bit in the office because they knew I always would answer their questions, so that's why they always interrupted me.

And it was just really hard for me to stay focused on each patient and what I was doing. And so, it's really been a learning process for the entire staff. And the other physicians that I've worked with have adopted some of the strategies that I've talked to them about. I just am easy on myself with booking extra time in my schedule if I need it. If I can see that there's a patient that I really need more time with, then we'll play with the schedule, so I don't feel rushed. I think for me, just that feeling that I was on a hamster wheel every single day and could never get off is what I really tried to work on controlling. 

And now I wake up in the morning, I go to work. I still see almost the same number of patients, but just my attitude toward it has changed. And I think it's really reflected in the whole morale. I think I didn't realize how much my attitude affected the rest of the staff. And right now when they see it's been a good day, they always laugh, going, "Dr. Svendsen must be doing more burnout work on herself." A couple of years ago, I never would've thought I'd got to the point where I would really enjoy my job again, and it's fun every day.

J. Baugh: Well, Dr. Svendsen, that is really great to hear. I'm glad to hear that you're now in a place in which you really enjoy your work. I know that makes you a better pediatrician for your patients. And so it's great to hear that you have recovered from the burnout, and that I think provides hope for any listeners that we have, who may be dealing with a similar issue. And so Dr. Svendsen, we want to thank you for being with us today.

Dr. Svendsen: Thank you. 

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect, with your host, J. Baugh. Listen to more episodes, subscribe to the podcast, and find show notes at svmic.com/podcast. 

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