"Practicing medicine is my true calling. I enjoy it immensely," says Crystal Moore, M.D., Ph.D., a successful anatomic and clinical pathologist at Hampton Veterans Affairs Medical Center in Hampton, Virginia. "It’s not just what I do; it’s who I am."
But Moore admits things weren’t always easy. When completing her residency at Duke University, she became irritable, had difficulty sleeping and lost her joy. Difficulties at home added to the drain: Her mother and sister were terminally ill, and she was raising two young sons while dealing with a failing marriage.
"I did what many doctors do: grit my teeth and bear it. Keep moving, no matter how worn out you are by life or work," Moore recalls. Once she successfully completed her residency, she acknowledged the problem. "I had nothing left in the tank. I didn’t look for full-time employment. I was emotionally, physically and psychologically spent."
A visit to her doctor helped - she was able to begin the process of sorting through the issues weighing her down. Looking back, she admits it was "ridiculous" to have gone so long without seeking help.
"Being a physician is hard work on many levels. Add life and stir, and you may have a recipe for the perfect storm," she reflects. "What I know most of all is Physician, heal thyself."
In any profession, it’s normal to feel stressed, tired, even completely fed up at times. But when bad days become the norm and good days are few, it’s time to take action. Career burnout is a real problem - one particularly prevalent among health care workers. In addition to mental and physical suffering, studies show that physician burnout can negatively affect the care you give your patients, causing increased medical errors, riskier prescribing patterns and lower patient adherence to disease management plans.
But burnout doesn’t have to be a career-ender. There are ways to prevent - and recover from - the negative feelings of burnout.
The term "burnout" was the brainchild of psychologist Herbert Freudenberger, who popularized it in the 1970s as a way to collectively describe the consequences that can arise in people employed in high-stress careers with set ideals. He noted that burnout was particularly prevalent among workers in helping professions, such as health care.
In the 1980s, researchers Christina Maslach and Susan E. Jackson, with the University of California, Berkeley, extensively studied burnout in the service industry and devised the Maslach Burnout Inventory, a measurement tool used to assess symptoms. The team defined the syndrome around three constructs:
Not all three must be equally prevalent to classify the overall problem as burnout. Some research suggests intensity of symptoms varies by gender: Men tend to experience more depersonalization, while women tend to suffer more from emotional exhaustion.
Today the problem is not only common among medical practitioners but also on the rise. According to the 2015 Medscape Physician Lifestyle Report, 46 percent of all physician respondents reported burnout, an increase of more than 16 percent from the 2013 survey. Critical care showed the highest rates at 53 percent, while emergency medicine was second at 52 percent. Both internists and family physicians also showed a significant rise, from 43 percent in 2013 to 50 percent in 2015.
Demanding hours, challenging cases, pressure from clients or colleagues - the factors that lead to burnout are many, and vary greatly with each individual. Aside from professional stressors, personal problems like marital or relationship conflicts, child care difficulties or financial concerns further stir up the waters. Everyone processes problems differently, so it’s impossible to point to specific conditions leading to the outcome of burnout.
For physicians, the changing landscape of health care can be a trigger. With more physicians today opting to work for a hospital or health care system - 75 percent in 2011 as compared to 25 percent in 2002 - management difficulties are more common. According to a study by Jackson Healthcare, a significant gap exists between what executives perceive, and what physicians report, as their level of engagement and alignment. Although most physicians responded they were "proud" to be associated with their employers, they also cited negatives: lack of trust in leadership, lack of involvement in decision-making and lack of recognition for their expertise.
If you’ve noticed your job satisfaction waning, a good first step is to visit your own doctor. Underlying medical conditions, a nutritional imbalance or health issues may be exacerbating your negative feelings. Counseling is also beneficial to learn some coping strategies and recognize possible adjustments to make in your lifestyle. Resources may be available through your employer or health insurance company. (You’ll find further tips in the sidebar "Stop! Don’t leave your current job just yet.")
Increasingly, hospitals and practice groups are taking steps to address burnout, recognizing that the alternative - losing skilled employees - is costly. Many have implemented preemptive initiatives to foster unity, address common problems and teach prevention and coping skills. Medical schools are also developing curriculums to teach students ways to manage stress throughout their careers.
The following are some examples of such programs across the country.
California Pacific Medical Center: balanced scheduling. Historically, physicians are known for working long hours spanning consecutive days. But a work-focused lifestyle has been waning in popularity as awareness of the need for balance has become more universal. At California Pacific Medical Center in San Francisco, a group of about 30 hospitalists came together to adopt a scheduling system that would support a more balanced lifestyle.
"We implemented this system about 10 years ago, realizing that the current system wouldn’t be sustainable. Many physicians had young families, and working frequent, entire weekends interferes with that," says medical director Rob Taylor, M.D.
The group advocated for and implemented a system that schedules higher numbers of physicians during the week and in return requires physicians to work fewer weekends. "We wanted to assign greater value to off-hour shifts as well as weekends. The weekends we do work are busier as a result," Taylor adds.
Taylor says he and the group as a whole have enjoyed this approach to scheduling. "It eliminates stress. And if a physician needs to take time off, knowing that we have coverage makes it that much easier," he adds.
Aravind Mani, M.D., a hospitalist in the group, agrees that the balanced clinical schedule helps keep stress at bay. "I have the opportunity to make requests that accommodate my personal time, vacations and other needs."
Cleveland Clinic: coming together for enrichment and learning. At the Cleveland Clinic, a mandatory training program not only strengthens providers’ ability to communicate with patients but also instills a sense of unity.
The eight-hour program, called "R.E.D.E. to Communicate: Foundations of Healthcare Communication" (pronounced "ready"), teaches practical, realistic communication skills, giving participants valuable tips on how to manage their clinical encounters.
"It’s something that many providers struggle with silently," says Kathleen Neuendorf, M.D., medical director of the Center for Excellence in Healthcare Communication at the Cleveland Clinic, which runs the program. "A common reaction we’ll hear from the attendees is relief - knowing they’re not the only one having difficulty with a certain type of patient encounter or conversation."
By enhancing basic communication skills, physicians minimize stress and save time. For example, one tactic covered is sharing an agenda early in patient encounters. "You go into an encounter knowing what you’re going to do: talk, do an exam, discuss labs. Making your patient aware of this agenda in the first few minutes of the visit benefits both the patient and the provider," explains Neuendorf.
Other skills include making empathetic statements and dealing with patient emotions. In addition to the mandatory basic class, which covers situations common to all providers, there are also optional, half-day classes that focus on specific specialties and patient populations.
But beyond just gaining communication skills, Neuendorf adds that the class is a chance for physicians to get away from daily demands, connect with one another and realize that others share similar difficulties.
"We do it in a place where it isn’t easy for a provider to run back to their desk to do some quick work," Neuendorf says. "It’s in a quiet setting, to encourage them to take a step away from their work."
In research done by the Office of Patient Experience, communication skills training has been shown to improve patient satisfaction scores, promote physician empathy and self-efficacy and reduce physician burnout.
University of Wisconsin School of Medicine and Public Health: learning mindfulness. As part of a one-year study on creating a culture of mindfulness in medicine, Cindy Haq, M.D., attended a seminar designed to teach mindfulness to medical professionals. Upon completion, she was optimistic that this was a strategy beneficial to her fellow physicians.
"It was a fabulous opportunity for deeper learning and to learn how to teach strategies to deal with the daily pressure and stress common to a physician," recalls Haq, who was one of five participants in the study through the Integrative Medicine Program in the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health.
A family physician and professor at the University of Wisconsin, Haq soon began sharing her findings with her peers and began incorporating talk about compassion training in the Training in Urban Medicine and Public Health (TRIUMPH) classes she was teaching. These classes prepare students to work in urban, medically underserved populations.
"It’s easy to become engulfed in problems. You can’t solve them on your own; they’re bigger than you," says Haq, adding that she’s seen many well-intentioned students become overwhelmed.
The session was so well-received by her students that she made it a weekly event. Haq looked at the training as a tool she could give to students, "a way to stay in the game without becoming overwhelmed - something hopefully that these students could carry through their careers."
Mindfulness - the practice of training your mind to stay in the present - may be a new concept to many, but its roots extend to Hinduism as early as 1500 B.C. Today the practice is a widely recognized tool for stress reduction and wellness.
"Mindfulness training is a great way to help maintain peace of mind, clarity, and not let the mind run away with itself. It teaches you to recognize your thoughts, and maintain calmness of mind in the face of chaos and confusion," says Haq.
After the one-year study, all five of the primary care leaders who participated reported personal value from the training, with one describing it as "life-changing." Each went on to foster a variety of mindfulness activities to benefit colleagues, medical students and patients.
Carolinas HealthCare System: tapping into external resources. At the Carolinas HealthCare System, a group of senior administrators and physician leaders recently came together to develop ways to improve wellness and decrease burnout among physicians and advanced care practitioners. This physician wellness committee, now in its second year, has launched a number of different efforts, such as creating a website of resources and encouraging regular meetings to come together to discuss difficult cases.
One of the more popular efforts involves lectures delivered by Wayne M. Sotile, Ph.D., from the Sotile Center for Resilience in Davidson, North Carolina.
"It’s not a system-wide effort yet, but he’s met with multiple departments," says wellness committee member David Fisher, M.D., director of neonatology at Levine Children’s Hospital, part of the Carolinas network. "We’ve experienced education of our faculty and staff through recurrent seminars and lectures, which have all been well-attended."
Sotile, who has worked in the area of resilience for more than 30 years, calls burnout "a new, old problem. It’s now getting a lot of attention, but it’s been a problem forever."
Sotile’s seminars present evidence-based strategies and tactics to curb burnout in a hospital setting. "I’ll deliver digestible bites of information, let them think about it a while, then come back again to reinforce it and do more training," he says.
While he says he can help physicians cultivate coping skills, he also points out that they usually can’t do it alone. "I help them take responsibility for what they can change - their own attitudes and coping skills. But change needs to be accompanied by some practice redesign, some engagement from the organizations."
Feedback so far has been positive, from both staff and administrators.
Becoming a physician is the culmination of years of studying and working hard. Like any mental or physical condition, no one chooses to become overcome by the problem of burnout. Fortunately, its effects can be reversible; as Moore found, burnout can be a temporary interruption from a satisfying, fulfilling career in medicine. Taking action early is the best way to regain joy in the career you’ve worked hard to attain.