Episode 095: Gear Up for Burnout

Speaker 1: You’re 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 host today. When we do these podcasts we try to provide some interesting topics, some interesting information for our listeners.

Today's topic is going to be one that is of utmost interest to many of the physicians who listen to our podcast. The title for this podcast is Common Issues That Physicians Face and Physician’s Health. To help us discuss this topic today, we have joining us, Dr. Greg Jones. Dr. Jones, welcome.

Dr. Jones: Thank you. Glad to be here.

J. Baugh: Well, it's good to have you here and I appreciate you taking the time to talk about a topic that is as important as this one is. Before we get into the topic, how about if you could give us maybe a brief introduction of yourself?

Dr. Jones: Okay. I'll start with where I'm at right now. I am the Medical Director of the Kentucky Physician Health Foundation. That is the state of Kentucky's physician health programs. Most States have those. My counterpart in Tennessee would be TMF. We work with the board of licensure and with all licensed physicians in the state of Kentucky whenever there's a question or a concern about wellbeing or physician health. Prior to that, most of my career I've been a primary care doctor. I've lived and worked in Alabama and Georgia and Kentucky and Florida. So I'm a Southeastern guy. For most of the last 18 to 19 years I've done physician health issues either as a provider or evaluator and/or the person sitting in the chair of a physician health program. So that's a little bit about my background.

J. Baugh: So we're here with you today to discuss physician health and some of the common issues that you see physicians facing day-to-day. We've all heard of physician burnout, we know it exists, but maybe it's a term that's not very well defined. So I was wondering if we could talk about that term and maybe you could share your perspective and your thoughts on physician burnout.

Dr. Jones: Sure. It is common but some people have estimated it probably impacts at any given point up to 50% of the physician population across all ages and specialties. So that's a big number. Every time I see it I always am sort of taken aback and I kind of wonder is it being over estimated but I don't think we can underestimate the fact that it is real. It does exist.

Depending on who you ask, the definition can vary. There are some key points that seem to be common threads that run through just about everybody's assessment of physician burnout and I'll try to touch on those. Truth of the matter is, when they contacted me about this podcast and they brought up physician burnout, I think I just said flippantly, "I'm about burned out, talking about physician burnout." But it's a common topic everywhere I go.

What I look at and I think are hallmarks of what people are talking about when they talk about physician burnout, is when the professional feels a bit helpless or trapped in their career like maybe they've made a wrong turn somewhere and now they're stuck. That's a pretty common component of it.

Sometimes loss of motivation or self-doubt with what we're doing. I've heard a lot of good physicians who all objective evidence would show that they've been highly effective and highly impactful in a favorable way on people. But when you talk to these individuals, they feel like, what's the point? I'm wasting my time. I don't really help anybody. So there's those kinds of feelings.

The next part is the part where I usually get called is when physicians begin to be cynical and have a negative outlook about their profession and the work they do to the point that it starts rubbing other people the wrong way. And that's usually when I get a call.

But there's a lot of low satisfaction with the work that they do. Feeling overworked with things that they're not good at. I know I'll be preaching to the choir to a lot of the listeners, I can't tell you how many times I've sat and been told by somebody, "Well, you know, this is not why I went to medical school." And I agree with that, but it is where we're at.

One of the other hallmarks of what physician burnout is to me is that outside activities, whether they're home or recreational or something along those lines, those kinds of activities in these physicians so impacted have sort of lost their interest or their enjoyment for them.

So when I see that kind of constellation of things, people feel tired, they feel disconnected from professional enjoyment, they feel, I won't say low self-esteem, but a low level of accomplishment and kind of a give up attitude. You know, what's the use? The system's grinding me down. That's what I look at as burnout.

J. Baugh: Well, it's surprising to hear you say some studies show that somewhere around 50% of physicians experience burnout. I think most people would be surprised by that statistic and maybe even some physicians would be surprised by that.

So I think it's good for the physicians who are listening to this podcast to know that they're not alone, that there are a lot of other physicians who are experiencing something very similar to what they're experiencing when it comes to physician burnout.

Dr. Jones: Yeah. And that number I didn't just pull that out of a hat before we did this. I pulled up some reputable sites and looked at some of their statistics. It's a nice round number obviously. There's actually some studies that show higher percentages than 50%, some that show a little below, but I think 50% is a pretty reasonable thing.

I'll tell you something that's also embedded in one of the surveys I saw, which I thought was very telling. A little over 50% of physicians when asked, would you recommend to your own children they follow in your footsteps in this career? A little over half said no.

J. Baugh: Wow. That is very surprising.

Dr. Jones: Well, it's not to me. I think if I had kids that were looking at something, I'd talk to them real serious before they decided this. So I have to count myself in that number. But it is kind of a raw data point that tells you a lot I think.

J. Baugh: I think you're absolutely right. That one statistic alone says a whole lot about where we are when it comes to physician burnout. You know, one of the big factors in maintaining a healthy lifestyle is self-care. I'm wondering how this affects physicians and what you see in regard to the topic of self-care.

Dr. Jones: I tell physicians all the time in my office that they are excellent at looking out for everybody else's wellbeing but their own. I think that's a pretty ubiquitous characteristic for most physicians. We're great at knowing what other people need to do and even being able to implement very effective plans for other people's wellbeing.

And yet we regularly disregard all of that good behavior and information for ourselves because we think, well with my information and knowledge and training I ought to be above that and I ought to be able to tough it out. We're human beings.

So one of the things I tell physicians about maintaining a healthy lifestyle, you need to focus on the good things. A perfect example, most physicians would agree with this, I think. We remember the one case in the entire year of a patient we took care of where things went sideways or didn't go well, and that's the one we'll ruminate over.

And yet there are literally thousands of others where we were right spot on and we did a great job and people had good outcomes and they're very pleased with us. But we focus on that one or two key things and I'm not going to minimize them. You do what we do, you're going to see some bad things. But we'll focus on that.

So I encourage physicians, focus on the good things in your career. Take time to see what you're doing each day. I like to break things down into short increments. One of the worst things you can do for your wellbeing is to look at the big picture in the long run. You need to look at the snippet right in front of you, what's going on right now and what difference are you making in your patients' lives or your family's life right now today?

I encourage people to avoid group thinking, what I call doctor's lounge conversations. I've been in many of them over the years, and I don't ever remember feeling refreshed or uplifted by most of them. So try to avoid that, and maintain and grow your outside interests.

The physicians, I see that are the healthiest and weather the storms and rigors the best, have good, healthy outside interests, and some of them were the things we don't think about. If someone's maintaining their physical wellbeing, then their emotional wellbeing will be maintained as well. And if they have an intense outside interest in something that their family members are involved in or that they're personally involved in, they make time to do that and have that as part of their life.

I want to start stepping on toes maybe a little bit, avoid self-diagnosis and don't try to tough it out. Doctors are notorious for having aches and pains, twinges and/or emotional or spiritual dings in their life and they just hold it in and keep it to themselves. A lot of it's out of fear. It's out of fear that if I raise my hand and let somebody know I'm hurting or that I'm struggling with something, it'll be reported to somebody and my career will be in jeopardy.

I'm not going to sit here and say that doesn't happen, but Lord have mercy. If we are telling people to talk to a therapist and get something off their chest and it helps them, it'll probably do the same for us.

J. Baugh: That's a great point that physicians are often telling patients that they need to seek further care, whether it's from that physician themselves or maybe refer the patient to another physician for the particular care that they need, and physicians get so focused on what other patients need that they forget to take that type of recommendation for themselves.

I thought it was interesting what you said earlier about physicians tending to focus on the one or two cases that don't go as well as they expected them to. It seems to me that there's some benefit in doing that because you can learn something from it. And yet I can also see a situation in which a physician dwells on it too much and it turns a positive into a negative.

Dr. Jones: That's right. We do need to have critical attention to any untoward or unexpected outcomes. That's part of our profession and it should be built into us. But we don't need to focus on it to the exclusion of the fact that a lot of things go well. Chopping things down into small snippets of time to me has been something that I've seen be helpful with that, the focus on the good things that are happening in front of you right now.

J. Baugh: Yeah. So one of the areas that we hear a little bit about when it comes to not only physicians trying to help themselves, but maybe people in other professions as well has to do with substances. That's something that we hear some about, but maybe we don't want to talk about it all that much. So how should the topic of substances be handled in the world of physicians?

Dr. Jones: Well, you're right, it's the last thing anybody wants to talk about, and no one ever comes to me voluntarily to talk about that. It's usually someone's shoved in here, sometimes metaphorically at gunpoint to talk about that. But it's a big deal. The old elephant in the living room analogy probably wouldn't even be adequate to describe it.

I have to disclose at this point I'm a person in long term recovery myself. That's kind of how you get into this work sometimes. But I do think that I'm pretty objective in that the problem with substances is a big one in our society at large. Physicians are not immune to that. I'm all the time explaining to people that information and knowledge about substances is not a protection against those substances impact in your life.

So I will say the addictions to substances impact maybe 15% of the population. We're a little bit over achievers in healthcare. It's probably closer to 18% at some point in their life and career of our colleagues will be impacted by some substance or other. It may be surprising, it may already be something that everybody knows.

Alcohol is number one with a bullet. It's always the most commonly misused or abused substance in healthcare professionals. I think everybody assumes because of availability and access it will be something a little more exotic or a prescription. We do over represent relative to the general population there a little bit, but alcohol is always the big deal. So I talk a lot about that. I'm asked to speak to medical staffs throughout our state as you can well imagine. And if I leave and don't talk about alcohol, I hadn't done my job.

J. Baugh: Yeah. You know, it seems that when physicians and people in other professions as well, but we're talking today about physicians, when they want to try to address the issue of burnout, they look at more physical type of issues, physical ways in which they can address the problem that they're facing.

But there are also some emotional and spiritual issues and maybe those are the last things that we think about because it's not something that we can see. But those I think are important issues as well. What would you say on the topic of emotional and spiritual issues?

Dr. Jones: Emotional and spiritual issues are key places where I see the healing begin. If you overlook those, then it's the analogous to having a wonderful therapeutic class of drug for a particular diagnosis and never bringing it up in a conversation with a patient who has that diagnosis.

For physician burnout and for substance issues, which they walk hand-in-hand, emotional wellbeing and some spiritual connection, I'm actually kind of proud of you all for letting me get on here and even use the word spiritual.

You know, we physicians, we like to be scientists and pure scientists and anything that can't be pinned down, proven or quantified, then we feel like we can't talk about it. But you know, we're human beings. I think most healthy functioning human beings that I've ever run across, they have some things in common.

They do take care of their physical wellbeing. They do take care of their emotional wellbeing and they have some sort of spiritual connection. It might be a formal community of faith. It might be something that's very personal and even obscure, but to them it makes a difference.

So I think that that's always a key point. I dig into that with people who get sent to me all the time. I start asking them about, "Well how's your mood? How are your connections with your significant other? How are your connections within your family growing up?" And I get to do that.

But generally those of us in healthcare, we're pretty slow to talk about those things. And that's where having your own personal therapist who you can sit down and talk to about those things can be really helpful.

The spirituality thing, I'll just say this about it, I think it's real. I think it's really important and I think it's really an individual and unique thing. Whenever I'm talking to people, I go to great lengths to make sure that they understand I'm not trying to enter them into a conversation to guide them towards or away from any particular spiritual connectivity. I just want them to know that it's something that I see be very useful and protective.

I guess I'm old school. I think those of us who go into the profession of healthcare, it's as much a calling as it is a career choice or a business decision, and I think that's where some of the spiritual connection can be important as well.

J. Baugh: Well, I appreciate you talking about the topic of emotional and spiritual issues. We have a wide variety of members in our audience who listen to this podcast, but I think we have several who would be interested in both emotional and spiritual issues. And I really appreciate you taking the time to address that topic because I do think it's important to some of those who are listening today.

Dr. Jones: Sure. And I will say one last thing. I've run into some people who are very much not sure what spiritual means to them, but they're not closed to it. That's good enough.

J. Baugh: Yeah, that's right. Absolutely. When you speak to a medical staff about alcohol, could you share a few of the points that you like to make because I think that might be information that could help our listeners as well?

Dr. Jones: That's a hard one because so much depends on the audience. What I usually do is I talk to them about what's happened in my life and my career as sort of an example, and I don't want that to be the end all and be all. But it's a place to start because over the years I've learned a lot of the things that are helpful by either experience and in seeing a lot of the things that aren't helpful. Does that make sense?

J. Baugh: Mm-hmm (affirmative).

Dr. Jones: I try to focus on the fact that we as healthcare professionals are in a very unique and very privileged position. We do need to hold ourselves accountable and to a level of self-care and care of others that the general population may not be held to. I like for people to be happy with what they do. I think if people are happy with what they're doing and the way they're doing it, then they're going to do it better.

J. Baugh: Well, I do think that makes a big difference. When you talk to people who really don't enjoy what they're doing and they have to do it day, after day, after day, that just makes life very difficult for those people. And so if you can get someone to a point in which they really enjoy what they're doing, it just exponentially makes so much difference in their life.

So Dr. Jones, we've talked about physicians needing at times to reach out for help for whatever reason it might be with their own health. And I'm wondering what might be some of the things that would prevent a physician for reaching out in order to get the help that they need for their own health needs?

Dr. Jones: Many people feel like the physician health programs are all negative and all punitive. The fact is because of what we do and that we are public licensees, there can and often are consequences when people reach out for help. But it's usually if they've waited till late in the game and there's already been events occur which are already known to the public.

I would just say that physician health programs are here to help. Now we're not perfect and we're helping a pre-selected group of people that are high risk. So bad things do happen even while we're trying to help people. But that goes with the practice of medicine in general.

But fear, fear of being found out, fear of being singled out, people avoid us. All I can say is that we really are here to help people and negotiate through the regulatory and the legal environment that gets called into play because we are healthcare professionals and we do have public license.

Public licensure boards have a requirement to protect the public and when they license us they're saying to the public, this person is good to go and we just try to catch those cases before they become injurious to the individual or to the public. I don't know if that answers the question, but it's a big problem. More people could be helped by our programs than are by a long shot and most of the time it's because they know that they need help and they are avoiding us.

J. Baugh: As we begin to draw this podcast to a close, I just wanted to know if maybe you've got some tips or some advice that you would like to give our listeners, maybe based on your own experience, maybe based on the experience of others, but maybe just some tips or advice that you'd like to close with today?

Dr. Jones: What do we know more about than anything else? We know about what we've done and what we've experienced and so I have to draw on that and I frequently do. I use the example of myself. I came out of school with a lot of ideals, with a lot of optimism and I got into medicine, and I worked hard almost to the exclusion of everything outside of the practice of medicine and it began to wear on me.

I picked up some bad habits along the way. I would self-sooth with substances and with behaviors and it eventually caught up with me. Thank goodness when it caught up in a way that even other people were beginning to notice it, there were people who do what I do now, who sat me down and said, "This has got to stop if you're going to continue this profession, and here's some people that can help you. And then we're going to watch and make sure that you take advantage of that help."

That's been my life story. From that day forward, I've never felt nearly as jaded or burnout about what I get to do. Being a physician is a great privilege, I think. It's not a right, it's a privilege. A lot of people entrust us with a great deal, and we owe it to them and to ourselves to be our best and most authentic selves when we do that.

Recovery from bad events is frequently the beginning of a lot of strength in a lot of people's lives. It's not unusual at all for me to run across people and say, "I didn't have the problem you had Dr. Jones, but I went through this with my family member, and I protracted an illness and became stronger in these ways and I think I practice medicine better as a result of that." I hear those stories all the time.

So draw on the things that challenge us and that we work through in a healthy way and be willing to share that and be authentic with patients when we're caring for them. I think that goes a long way in making us more effective and impactful to people. Everybody knows that we're human and that we have weaknesses. If you point that out to people right off the bat, then they don't have to point it out for you and it becomes a lot more favorable interaction, I think.

J. Baugh: Well, Dr. Jones, I want to thank you for taking the time today to talk about a topic that's as important as physician health and physician burnout. I also want to thank you for all the work that you're doing in trying to help physicians in your community to come to a healthier way of being able to practice medicine, being able to address issues that they themselves are facing so that they can provide better care for their patients. Thank you very much, Dr. Jones.

Dr. Jones: You're welcome. Thank you. Appreciate it.

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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