Physicians Beat Burnout
Get a Grip on Stress Before Getting Run Down

By Erin Romanski
Erin Romanski is a writer for Physicians Practice

Many physicians find themselves overwhelmed by life’s daily stressors: Professional demands, relationship struggles or family issues. Individually, each stressor poses no great health risk. However, once the demands begin to pile up, they can eat away at the physical and emotional well being of physicians to the point of burnout.

Studies show that up to 40 percent of physicians feel burned out by the demands of the health profession. Behavioral health professionals offer suggestions for identifying stressors and ways to get a grip.

How does it all add up? Seemingly out of nowhere, “You find yourself in what I’ve come to call a ‘stress storm,’” said Kernan Manion, M.D., senior consultant for Work/Life Design Associates, a consulting firm for health care professionals based in Wilmington, N.C.

“I got interested in burnout because I got burned out,” Manion said.

For five years, he worked as a consulting psychiatrist at New England Rehabilitation Hospital (NERH), which later became HealthSouth NERH. Manion eventually found himself overwhelmed by changes affecting the hospital at the time, including a modified health care plan, the transition to nonprofit status and the high intensity of the job itself. Add to that a family illness and other personal stresses and you have “a lot contributing to my downright dissatisfaction and pain,” Manion said.

“My experience with most physicians who burn out is they’re really having stresses coming from the personal as well as the professional side,” said Manion. “One of the things that makes it so vexing is that you can’t get your hands around it. You can’t seem to comprehend the multiplicity and causes that are going on simultaneously.”

“These are the doctors that sleep all night and don’t wake up feeling refreshed in the morning,” said Ahnna Lake, M.D., of International Health Consulting and the National Wellness Speakers Bureau in Stowe, Vt.

The major stressors on physicians in practice management tend to be administrative, faulty infrastructure support and scheduling productivity, according to Jayne Oliva, practice management consultant for Croes-Oliva Group, a health care consulting firm in Burlington, Mass.

“There is continued pressure in this industry for increased productivity, and that productivity improvement that administrators seek is without regard for what it really requires to care for a patient,” she said.

Recognize the signs
You know the old saying, “Misery loves company?” Burnout works the same way in that it exhausts not only your emotional happiness, but also cognitive thinking and overall physical health. Burnout’s actual definition is “an occupational stress syndrome which affects people doing ‘people work,’” according to Manion. Its symptoms can vary, but usually consist of varying degrees of fatigue, personal detachment and reduced accomplishment.

“You feel worn out, you feel like you’re pulling away from life, work and others, and your overall output productivity is diminished either in quantity or quality,” Manion said.

Physicians are caught up in the whirlwind of the ever-changing 21st century health care industry. There is no question that the current health care environment is a major contributor to physicians feeling worn down, dissatisfied and burned out. Burnout comes at the expense of patient care.

“If you have a need to turn over a lot of patients to make the money you need to live at the level at which you’re living, you’re definitely undermining one of the primary sources of fulfillment in your work,” Lake said.

Burnout robs physicians of positive resources such as humor, enthusiasm, empathy, appreciation and being present, according to John-Henry Pfifferling, director of the Center for Professional Well-Being in Durham, N.C., and author of Techniques for Coping with Stress and Change.

“Burned-out doctors catch themselves in increasingly common moments being curt, uncaring — or even hating their patients,” Pfifferling said.

Address the problem
Burnout can become the overriding issue in your professional life. If you no longer find satisfaction in your work, you have to regain control over the situation in order to tackle the problem head-on.

“Learn how to tell when you’re burning out,” suggested Lake. “Look over time at some important areas and see what the trend has been. There is a Chinese proverb that says, ‘If you stay on the path you’re on, you’re likely to end up where you’re headed.’ If you’re headed downhill, why would you expect to change unless you do something different?”

Physicians are naturally inundated by the expectations placed on them as members of the medical profession. The scheduling conflicts that accompany such a high demand and low control job can cause a terrific amount of strain to the physician unless handled in a reasonably efficient manner.

“If we don’t have a thoughtful way of developing a schedule that is based on patient need, we end up with arbitrary benchmarks that stress the provider,” Oliva said.

There is hope
You can grab a hold of stress before you get to burnout. It is possible to catch the symptoms early, before the progressive weardown begins.

“It’s very important to distinguish whether we have burnout or depression and the possibility of burnout and depression,” Manion stressed. “Atul Gawande’s book Complications has an excellent story called ‘When Good Doctors Go Bad’ — classic burnout to meltdown.”

Burnout does not have to be the end-all of your career as a physician. Quite the opposite, it can lead to a healthier arrangement of your worklife. “Work shouldn’t make you sick,” Manion said.

“It’s important to stress that burnout is not a terminal event or an irreversible condition,” said Manion. “It can be a wonderful thing in that it’s a wake-up call. Can I live the vision I originally had in med school? I have to make that vision work for me in some way ... or I’m not going to be doing anybody any good.”

Get a grip
How do you cushion the effects of stress before they start?

“Social support is the No. 1 buffer against stress,” said Lake. “Allow for the time to create relationships and nurture the relationships. Not all doctors are good at creating the relationships they need, so they’re deprived of that support.”

Find your personal as well as professional well being. For some, this could mean a vacation, job alternative or even a career change. Overwhelmingly, however, the phrase “knowledge is power” really rings true.

“To develop self-knowledge is my most valuable tool to avoid being trapped by burnout,” said Lake. “It is a practical technique to be able to detect when you’re heading in a downward direction.”

Realizing your limitations as a human being is not an admittance of weakness, although many physicians are hesitant to admit the powerlessness that comes with working in the medical field. In fact, studies show that about 60 percent of doctors don’t even have a physician, but instead self-administer care or get occasional medical consultations from colleagues in the hallway.

According to Manion, physicians see themselves as very efficacious individuals, so being in burnout makes them feel very inadequate and that customarily prevents them from getting the help they need.

“There is a complete imbalance in terms of feeling like a human being that extends beyond the profession,” said Lake. “Just like anyone else, we (physicians) need emotional fulfillment.”

Kernan Manion, M.D., senior consultant for Work/Life Design, can be reached at kmanion@pol.net. To learn more about weardown and burnout, including free self-assessment instructions, go to www.worklifedesign.org.

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