Discover, cope, and dig your way out - it can be a hamster wheel many healthcare providers find themselves in when it comes to burnout. Given the especially hectic times in today's medical world, we felt it appropriate to revisit some past conversations with physicians who both specialized in burnout, and lived through their own burnout experiences. Join us as we recap some helpful tips and advice for overcoming that long-term stress reaction that results in feeling burnt out.
Speaker 1:
You're listening to Your Practice Made Perfect, support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.
Jay:
Welcome back to Your Practice Made Perfect Podcast. Today, SVMIC's Meghan Clark will be diving into previous episodes focusing on physician burnout. Burnout is far too common, but often overlooked in the medical field. We've spoken to a variety of guests throughout the years who have given us personal anecdotes, tips, and information on the topic.
Jay:
We feel like this particular subject is always relevant and most definitely deserves a revisit now more than ever after the COVID pandemic and all the strain our healthcare providers have felt because of the pandemic. So, let's hand it over to Meghan who will take us through these tips and lessons learned.
Meghan Clark:
Thanks, Jay. I'm excited to be here. So yes, unfortunately you are correct, burnout is common and it is at an all-time high. The pandemic has only increased the strain on our healthcare workers, in turn increasing stress and burnout.
Meghan Clark:
According to the American Medical Association, over 40% of physicians are experiencing at least one sign of burnout. These signs can vary from person to person, but it's so important to hear the stories of those who have realized they're in burnout, which is half the battle and discovered ways to cope and find a way out.
Meghan Clark:
Dr. Betty-Ann Svendsen spoke about her story with burnout on our podcast in June of 2020. Let's revisit her tips on combating burnout and how to take the steps to achieve a satisfying work-life balance.
Dr. Betty-Ann 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 till later in the game. 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 you you're way stressed out.
Dr. Betty-Ann Svendsen:
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.
Dr. Betty-Ann Svendsen:
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. I did sometimes and regretted those, so I just don't bring that home.
Dr. Betty-Ann Svendsen:
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 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.
Dr. Betty-Ann Svendsen:
Nurses would often interrupt me in between patients, I would lose my train of thought. I just kind of told them, "Please try not to interrupt me as I'm walking from room to room, unless it's really, really important." 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. It was just really hard for me to stay focused on each patient and what I was doing. 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.
Dr. Betty-Ann Svendsen:
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 the 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.
Dr. Betty-Ann Svendsen:
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 mean, I think I didn't realize how much my attitude affected the rest of the staff. 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.
Meghan Clark:
To hear more about Dr. Svendsen's battle with burnout, you can listen to her entire story on Your Practice Made Perfect's episode 86, Destroying Physician Burnout. Hopefully her tips can be of assistance to anyone listening who feels they are struggling with burnout.
Meghan Clark:
Dr. Sasha Shillcutt spoke with us as well on this same topic. She spoke about her struggles with work-life balance and with burnout, and how she pioneered creating a community of women she terms Brave Enough who are also facing professional burnout. Let's take a listen to her story.
Dr. Sasha Shillcutt:
I think it's important, as we all know in our healthcare systems, we can identify that the likelihood of a physician burning out is pretty high within his or her career. It's positively correlated with not just the number of hours that you're working, but the type of bureaucratic things that you are now forced to do as a physician that at one point was not the majority of your work.
Dr. Sasha Shillcutt:
We know that there's been studies published that show that the average physician spends two hours in front of a computer for every one hour in front of a patient. The problem is that there is a disconnect between what really motivates us to work hard long hours and what we're actually doing. That disconnect can lead to problems such as physician burnout, cynicism, emotional exhaustion, which can then basically cost health systems significantly, not just financially, but more importantly, it can end up in hurting patients.
Dr. Sasha Shillcutt:
So, I think it's really important that we talk about these things both as an individual factors that we can help, but also institutional factors. Since I went through burnout and I experienced it, and I thought to myself at one point, here I am this highly educated qualified person who has spent hours in developing my expertise, and yet tomorrow I don't want to go to work, I would rather go teach yoga or serve soft serve ice cream.
Brian:
Sure.
Dr. Sasha Shillcutt:
This is kind of crazy, right? So, when you get to the point where you actually don't feel engaged and you don't want to go to work and you don't even know if you can do your job to the best of your ability, something's broken.
Brian:
Yeah.
Dr. Sasha Shillcutt:
I think that it's really important that we investigate that, because medicine is human work and that is what is so amazing about it-
Brian:
That's a great point.
Dr. Sasha Shillcutt:
Is it's such human work, but it also has the potential because it is human work to burn you out at a faster rate. I think it's really interesting, because we tend to look at other people and think they probably have it all together, they're doing okay, I must be the only person who may be silently struggling with anxiety or with just feeling the funk that you don't want to get out of bed in the morning and go to work because you're totally completely exhausted and emotionally empty. Then you sit down and actually talk to one or two people and you realize that, wow, everybody's in the same boat. The problem is we don't have time to actually discuss it.
Dr. Sasha Shillcutt:
I always tell people that we can all make a difference, even individual physicians just looking out for our partners. If you're feeling burned out, you feel yourself kind of becoming overwhelmed. It's okay to withdraw from paper and from projects, no one's going to die if you withdraw from paper or projects. But when you start to feel yourself not be able to even communicate with the people in your life who you're closest to, when you start to withdraw from those people, that is a red flag. So you can withdraw from paper projects, not from people. I'm not talking about withdrawing from pen pals-
Brian:
Right.
Dr. Sasha Shillcutt:
I'm talking about your closest people.
Brian:
Your support system.
Dr. Sasha Shillcutt:
Yeah, then you probably are burned out. Five years ago, if you told me that I would be leading a group of women physicians, I would kind of look at you like, "Huh?" Because to be really honest, Brian, I've had success in my career just kind of marching along to the beat of everyone else's drum.
Brian:
Sure.
Dr. Sasha Shillcutt:
I started really in my mid-career as the more I advanced in medicine, the more I felt pushback and the more I felt alone as a woman. It was interesting, because I thought, "Wait a minute. Shouldn't this be getting easier? I'm advancing, I'm gathering skills and expertise, shouldn't I be feeling like one of the in the club now that I actually have street credibility, so to speak?"
Brian:
Right.
Dr. Sasha Shillcutt:
But it's opposite, because I actually felt more obstruction and bias the more I achieved, and I realized as I looked around that I was the only woman around the table. I actually shared with a couple of my male colleagues who are very close friends and supporters, and they were like, "Well, just keep doing what you're doing, because it's working." I'm like, "Well, where are the women?"
Brian:
Right, yeah.
Dr. Sasha Shillcutt:
They're like, "Sasha, do not get on this soap box, because you will actually probably be stunted in your academic growth." At that point, I really faced a crossroads. I thought, "Okay, I'm not doing this for Sasha, I'm doing this for my daughter." I have three sons who I adore and a daughter who I adore, and I just believe that my daughter should have the same opportunities and rights and education and pay and promotion as my sons, I really truly believe that. I knew at that point I needed to start encouraging women, because I saw them shrinking back at a certain point in their career.
Brian:
Right.
Dr. Sasha Shillcutt:
So that is the purpose of Brave Enough, and that's why I started the community. It's really been amazing, because I've had so many women reach out to me and say, "I read this that you wrote, and it really resonated with me. Because of that, I was able to go negotiate or I was able to ask for a promotion, or I put myself out there on this committee and I got on the committee." I've also had a lot of men say, "Thank you for the message you're spreading, because we want to encourage more women to be involved and we really appreciate it." So I think it's been a challenge, but it's why I called my company Brave Enough, because I needed a daily reminder to be brave enough.
Meghan Clark:
I think we could all use a reminder every now and again to be brave enough. If you want to check out Dr. Shillcutt's Brave Enough blog, we will link it on our show notes.
Meghan Clark:
Let's hear a bit more from Dr. Shillcutt and her experience with handling criticism, bias and fighting for herself in this clip.
Dr. Sasha Shillcutt:
Well, I think it's taken me a while and I don't have it all figured out. I'm still working on navigating being a voice for women and really just navigating my own career. But I will tell you that one thing I have learned is when you are criticized or when you maybe feel like bias is coming at you, it likely means you've taken a step forward.
Brian:
Right.
Dr. Sasha Shillcutt:
You should actually see it as a compliment. Which has taken me a long time to understand this, because we think, okay, we're going to go along and we're going to just check all the boxes, and then some fairy godmother is going to come out of the sky and be like, "Dr. Shillcutt, you have achieved all these things. We are going to give you pay and promotion and all these things just like we would give Bob." But that is not the case.
Brian:
Right.
Dr. Sasha Shillcutt:
So, you have to actually step forward and you have to be your own fairy godmother. When you do that, you're probably going to surprise everyone around you, and people are going to be like, "Wait a minute. Why do you think you can do that?" Even other women will be like, "Wait a minute. Why are you stepping forward?"
Brian:
Right.
Dr. Sasha Shillcutt:
So you have to actually see that that obstruction is a positive sign, it means you're stepping forward. It doesn't mean that the answer will always remain no. I think I've gotten really comfortable with the word no. I probably get told no five times before I get told yes.
Brian:
Right.
Dr. Sasha Shillcutt:
That's just reality and it's okay.
Brian:
That is so true. If you never meet obstruction or criticism or pushback, that means you're not pushing forward, right?
Dr. Sasha Shillcutt:
Yes, exactly. I think for women, we are not as confrontational as men. Even my children, if you look at how my boys play versus my daughter, my boys are punching. They think fighting is fun-
Brian:
Yeah. Oh, absolutely.
Dr. Sasha Shillcutt:
So they grow up fighting and they think it's part of their sport and it's fun. I think the way that women are raised, we achieve by staying in line, raising our hands, waiting to be called on. So then when we transition to a career, we're not used to getting dirty, we're not used to the rough and tumble, so we can kind of pause and go, "Wait a minute, Oh, I didn't get picked that time, I guess I'll just keep my hand down."
Brian:
Right.
Dr. Sasha Shillcutt:
So, it's a different playing field and it's dominated in healthcare. 80% of the leaders in healthcare are men, that's just factual. So I think that we have to understand that it's okay to assert ourselves as leaders, and we're probably going to hear no some of the time, we are going to get pushback. That's good, it means you're stepping forward, keep going.
Meghan Clark:
Now, let's dig in a bit more with Dr. Shillcutt as she helps us to understand where we can make simple changes by putting more effort into understanding what we can and cannot control.
Dr. Sasha Shillcutt:
We have to really take a look at what we can control. I mean, I can't control perhaps the operating room schedule let's say-
Brian:
Sure.
Dr. Sasha Shillcutt:
But I can control the fact of how much vacation I take. Sometimes I find myself going six months without taking a week of vacation, and then I wonder why I can't even function. So, I think it's really important that we do some introspection and we look at ourselves and what we can control. I try to give myself 30 minutes a day of my own time. That doesn't sound like a lot, but 30 minutes actually to find in your day where you unplug from other people and devices, for me, it is so important. I tell people that to do that, you actually have to remove something in your life.
Brian:
Yeah.
Dr. Sasha Shillcutt:
So, I always tell physicians when they come up to me after I give talks and they're waiting to talk to me and ask me what's the one thing I can do? Look at your daily schedule and see what you can get rid of, because everybody has something they can get rid of, and then replace that with 30 minutes of you time. Maybe it's getting to the office 30 minutes earlier, shutting your office door and doing a 15 minute meditation app.
Brian:
Right.
Dr. Sasha Shillcutt:
Maybe it's laying on your office couch and just sipping a cup of coffee for 30 minutes before you start your day and getting your mindset. Maybe it's going for a walk with your dog in the evening. For every person it's different, but it's so important, first, that you figure out what you're going to remove, because if it was as easy as just adding 30 minutes, we would all have done it.
Meghan Clark:
Dr. Shillcutt strives to help other professionals achieve the work-life balance you need to survive your busy schedule. You can find Dr. Shillcutt's blog linked in this episode's show notes.
Meghan Clark:
Now, while it's obviously important to nip burnout once it begins, why not try to prevent it together? In 2019, we spoke with Dr. Dike Drummond of The Happy MD, a resource for physicians who are seeking help on practical tips to prevent burnout. Let's take a look back at this conversation.
Dr. Dike Drummond:
So at this point, I have about 2300 hours of one-on-one physician coaching experience helping doctors from all specialties get better. Like I said, people have asked me if I can train, and I've been pretty much full-time as a trainer teaching doctors the lessons we've learned from their colleagues as coaches.
Brian:
What are some of the reasons that you see physicians ending up in burnout? Can you put your finger on any of it?
Dr. Dike Drummond:
Oh, yeah.
Brian:
Tell us a little about that.
Dr. Dike Drummond:
Absolutely, but it's not simple. See, the most difficult thing for doctors to do to understand burnout is realize it's not simple. It's not a problem, there isn't a solution. It's been a perfect storm of overload for the doctors in the frontline. First of all, burnout's a combination of being totally exhausted, being cynical and sarcastic about your patients and wondering whether or not your job or your practice is having any meaningful impact at all. What's the use is a term that comes into your head, and typically that's because of overwhelm.
Dr. Dike Drummond:
So, the most obvious things that's changed about medical practice in the last seven years is two main movements. Again, these aren't the causes of burnout, they're just some of the factors that add together for an individual doctor. One is obviously EMR, electronic medical records.
Brian:
Sure.
Dr. Dike Drummond:
So it used to be that you'd scribble on a chart and you'd be done, that you didn't have to have a perfect storm of clicks and have to type 120 words a minute. Let's remember that it's not just EMR, it's EMR and texts and patient portals and email all coming in all at once without you necessarily having additional staff to handle that load.
Dr. Dike Drummond:
The second big movement is that doctors who used to be independent are now often employees.
Brian:
Yeah.
Dr. Dike Drummond:
It was 2017, that for the first time the majority of physicians were employees rather than independent. So, now you work for the man and you got to fill out the EMR. That's not that dark, right?
Brian:
No.
Dr. Dike Drummond:
However, boom, boom, all of a sudden being a doctor in 2018 is a lot different than being a doctor in 2010. So I would say for most doctors, those two factors are major in their burnout. There's a lot more.
Brian:
Do you see, whenever you're dealing with these physicians, sometimes it probably could be misconstrued as I'm sitting here listening to you of you hear about doctors being, oh, we've got a issue. They're not playing well with others, they're not getting along with the staff or whatever. That could just be a symptom of burnout. Correct?
Dr. Dike Drummond:
Yeah, if you're overwhelmed consistently and can't recharge at home. So for instance, another big cause of burnout is whatever's going on at home, because if you put energy into your practice and you come home and you're supposed to recover, but you can't recover at home, because there's other things going on at home.
Brian:
Right.
Dr. Dike Drummond:
Let's take a doctor who's on the edge coping with their practice just fine, but all of a sudden they have their first child and it turns out it's a special needs child.
Brian:
Wow, yeah.
Dr. Dike Drummond:
Or let's take any doctor and have their marriage start to fall apart or have them give them their own personal health issue, right?
Brian:
Yeah.
Dr. Dike Drummond:
All of a sudden your ability to recharge goes away. So you'll see people burn out beautifully at work, but it doesn't have anything to do with work either. So in any given case, the most important thing is that when you see somebody going down in flames, I call it a downward spiral, is to reach out and ask them how they're doing and see if you can figure out what's going on in that individual doctor.
Dr. Dike Drummond:
The big challenge is we've been conditioned to never show weakness, and so the chance that they'll tell you the truth the first time you reach out to them is pretty slim. Again, one of the things I'll teach is how to reach out to a colleague in distress so that you have a better chance that they'll open up to you.
Brian:
Obviously, there's going to be bleed over your personal life and professional life. Is it important to draw a very distinct line or is that really impossible?
Dr. Dike Drummond:
It's not impossible, but it's not something that's taught.
Brian:
I got you.
Dr. Dike Drummond:
So one of the things, again, that I'll teach is an off switch on your programming. I mean, basically if when you come home at night, you're still thinking about work, you're not recharging, so ideally you would have an ability to flip a switch and turn the doctor off.
Meghan Clark:
Great tips so far from Dr. Drummond on taking a break from work to allow yourself to recharge. Let's listen to a bit more as he shares some myths about physician burnout in this next segment.
Brian:
It's often not as simple as taking a pill or it's not as simple as you do this, and there's myths out there that that can be the case. What are some of the myths that you have encountered when it comes to physician burnout?
Dr. Dike Drummond:
Well, and what you're talking about right now is the universal human urge for a magic potion, snake oil cure all.
Brian:
Yes.
Dr. Dike Drummond:
What's the solution? My answer is always I don't know, I need to ask you some questions to figure out what's causing your burnout in the first place. But there's three myths. Number one, burnout doesn't have anything to do with your batteries being run down. Number two, burnout's fundamentally not a problem, because it doesn't fit the definition criteria for the word problem, so it doesn't have a solution. There's a different way that you address it. It's another S word, the word's actually strategy.
Dr. Dike Drummond:
Here's burnout, okay? I'm just talking to anybody who's listening right now. Remember back to a time in your life, was there ever a time when you were being a good soldier, doing what everybody expected of you, working hard, following orders, staying inside the lines, and it got so uncomfortable that you had to make a change and that change is responsible for who you are today?
Dr. Dike Drummond:
Well, that discomfort at that turning point, that was burnout. It pushed you onto a path with more purpose, you're happier now than you were back in that uncomfortable time. See, the challenge is though in that crisis point of I can't take it anymore, some people drink, drugs, end up statistics. Suicide is even possible for burnout, we lose 400 doctors a year.
Meghan Clark:
If you are struggling with burnout right now or you know someone who is, please don't hesitate to reach out to any of the resources mentioned throughout today's podcast. We at SVMIC support you and encourage you to seek the help you may need, whether that be through the resources we can provide or through mental healthcare and healthy coping skills that you may seek on your own. You do deserve to be healthy and to feel healthy. Thank you for allowing me to walk you through these prior episodes today, I've really truly enjoyed it.
Jay:
Thank you, Meghan, for taking us through these conversations regarding burnout and the tips to handle it. We hope this recap has helped shed light on a problem facing physicians every day in the medical community, as well as helped any of you listeners who may be struggling right now. You can find links to the full episodes mentioned today in the show notes, and thank you for tuning in.
Dr. Betty Ann Svendsen, Dr. Sasha Shillcutt, and Dr. Dike Drummond
Betty-Ann Svendsen, MD, MS, FAAP, is a Board Certified Pediatrician practicing in Central Texas since 1998. She received a BS in Biology from The University of Dallas, MS in Biology from Texas Christian University, and MD from Texas Tech University Health Science Center. Dr. Svendsen was involved in medical education for years and won several teaching awards. She has held leadership positions and most recently serves as a consultant for pediatricians who wish to re-enter clinical medicine after a hiatus. As a busy physician, wife and mother of 4, she is passionate about mentoring young women physicians and helping them gracefully tackle the slippery slope of motherhood, medicine, burnout, and career advancement. Sasha K. Shillcutt, MD, MS, FASE is a Tenured Associate Professor and the Vice Chair of Strategy and Innovation in the Department of Anesthesiology at the University of Nebraska Medical Center (UNMC). She underwent her residency in Anesthesiology at UNMC and completed an Executive Fellowship in Perioperative Echocardiography at the University of Utah Medical Center. She is a board certified Anesthesiologist, is a testamur in the Special Competence in Adult Echocardiography (ASCeXAM) and has certification in advanced perioperative echocardiography (Advanced PTEeXAM) through the National Board of Echocardiography. She is an NIH-funded researcher through the National Institute of Aging. She is a Board Examiner for the American Board of Anesthesiology and holds national leadership positions in the Society of Cardiovascular Anesthesiology and the American Society of Echocardiography. She also serves on the National Board of Echocardiography. Sasha is a wife, mother, physician, clinical scientist, national educator, writer, and speaker. In 2016, Sasha was awarded the national American Medical Associations Women Physician’s Inspiring Physician Award by her peers. Sasha’s greatest passion is empowering and encouraging others to achieve well-being in their professional and personal lives. She speaks frequently to health care executives and physicians on the topics of professional burnout, resilience and gender equity. You can follow her blog at www.becomebraveenough.com. Dr. Dike Drummond is a Mayo trained family doctor, professional coach, author, speaker and trainer whose sole professional focus since 2011 has been addressing the modern burnout epidemic in physicians. He is the CEO and Founder of TheHappyMD.com where he receives 25,000 website visitors a month and hosts an online community of 18,305 physicians from 63 countries around the world. Dr. Drummond has over 2100 hours of one on-one physician coaching experience and has trained over 25,000 doctors on behalf of over 134 corporate clients in the last three years. Dike graduated from the Mayo Medical School in Rochester, Minnesota in 1984 and completed his Family Practice Residency at the Shasta Cascade Program in Redding, California in 1987. Dr. Drummond practiced full spectrum Family Medicine for 11 years as a member of the Skagit Valley Medical Center in Mount Vernon, Washington. He was also the Chairman of the Executive Committee and Managed Care Medical Director for that organization. In 1999, Dr. Drummond left his medical practice due to career ending burnout. He became the COO of Superteams, LLC providing Leadership and Facilitation training to Lean Six Sigma Black Belts in all branches of the US Military. He is a certified Life and Business coach with extensive experience in personal and business development with physicians and entrepreneurs over the last 17 years.
J. Baugh is a Senior Claims Attorney for SVMIC. Mr. Baugh graduated from Lipscomb University with a Bachelor of Science degree in Accounting and from the Nashville School of Law with a J.D. degree. He is currently licensed to practice as a Certified Public Accountant and as an Attorney in the State of Tennessee. He has been a member of the Claims Department of SVMIC since 2000.
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