Clinical Presentation Skills: Avoiding Burnout as a Resident and/or Young Physician
by Priya Parthasarathy, DPM
I’ve seen it happen from my earliest days of residency- exceptional physicians with or without family obligations who struggle to cope with the constant demand of being a physician. But the statistics are staggering.
According to the American Medical Association (AMA) more than 40 percent of physicians are experiencing at least one sign of burnout and physicians suffer burnout 2 times more than other US professionals. In a 2014 survey of 504 medical residents at the University of North Carolina, 70 percent met criteria for burnout based on the Maslach Burnout Inventory, a common tool used to assess burnout.
The consequences of physician burnout are serious and wide-ranging. From poor job performance to—in the most extreme cases—medical error and clinician suicide. This piece will focus on a subset of the profession—residents and young physicians.
What is burnout?
Physician burnout is defined as a “syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment that leads to decreased effectiveness at work,” according to Shalafelt et al in the American Journal of Medicine.
It differs from depression because it primarily affects an individual’s relationship to one’s work and it most frequently occurs in people whose work requires an intense involvement with people – physicians, nurses, social workers, and teachers. Challenging circumstances at work are likely to spill over into one’s personal life. It is difficult to keep one’s professional and personal life separate.
Why does it affect Young Physicians and Residents?
Though young physicians and residents have only been in practice for a few years, they are still susceptible to burnout. It is certainly not an overnight change, but overtime, through an accumulation of factors. Physicians can burn out at any stage of their career due to endless documentation requirements, long hours, emotional strain of cases, and patient frustrations from lack of knowledge about their insurance providers. Recently, the new age of patient satisfaction surveys may lead to the practice of overtreatment. Physicians can burn out at any stage of their career. The triggers can be endless, but it is important the individual and the industry find ways to cope.
What are the symptoms of burn out?
Symptoms are different for everyone, but the literature outline’s exhaustion, cynicism, and becoming emotionally detached from patients as the most prevalent signs.
Lack of enthusiasm or motivation for work, frustration, passivity, detachment, reduced efficacy, behavioral extremes, mistakes, compassion fatigue, insomnia, depression and health issues are other symptoms described.
How does it happen?
The AMA highlights 7 scenarios which may put you at risk for burnout.
1. You have a high tolerance to stress.
2. Your practice is exceptionally chaotic.
3. You don’t agree with your boss’ values or leadership.
4. You are the emotional buffer.
5. Your job constantly interferes with family events.
6. You lack control over your work schedule and free time.
7. You don’t take care of yourself
As young doctors, it is important to consider these factors when choosing your place of work or next steps in your career. Yes, it may be impossible to check all these boxes off as you may focus more on salary, benefits and patient volume. Your well-being should be high on the list as well.
Your mental health is important. Here are a few coping mechanisms that can help you avoid burnout.
1. Take your vacation
There are many reasons you may choose not to take a vacation, especially in your first few years out of practice. You may feel guilty because you are the “new hire,” or your place of work may have the attitude that vacation is a luxury. Common sentiments are, “I did not take a vacation for years when building my practice,” or “I have never taken a 2-week vacation.” These should not determine whether you take a vacation or not.
Personally, I am guilty of limiting my vacation. Being percentage based, when I do not work, I do not get paid. Nevertheless, this is not a reason to not take my deserved vacation. My husband and I feel that we overstress about our patients and the office on vacation. However, we have to learn to maintain a positive attitude and not think about work so much when we are away. As my acupuncturist (yes, I see an acupuncturist) says, “we treat our bodies like ATMs, we take and take and take but never deposit.” Think of vacation as paying yourself back for all the hard work that you do.
Exercise is a common stress reliever for many people. It can be especially useful in coping with physician burnout. Working exercise into your day can be as easy as a 10-minute walk at lunch (if you get one) or building in efficient workouts such as HIIT (High Intensity Interval Training) into your schedule. If you continually neglect yourself, you may neglect your patients too. My husband and I have invested in a Peloton so we can jump on the bike for even 15-20 min. We found it is a great stress reliever and so time efficient.
3. Say “NO” more often
When I first started practice, I thought I had to say yes to everyone and everything. I did not want to be known as the lazy new associate as I was building my practice. I slowly began to realize that it is important to slow down and I don’t have to take on every case. It is crucial to set limits for yourself and respect your boundaries. It is important to remember that you don’t have to prove yourself to anyone.
4. Live within your means
This is a big one. Especially after you graduate residency, doctors are frequently expected to have the nice cars and big homes. We make the big bucks, right?
Reducing your monthly expenses will reduce the pressure on you to earn more income.
By reducing your spending, you will have less urgency to work to make money.
Furthermore, when you reduce your spending you may be able to cut down your work hours.
5. Find a place where you are happy
This one is particularly tricky to identify but necessary to prevent burnout. Whether you are at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane.
6. Spend time with your family and loved ones
It is important to build and maintain connections with your family and friends. It is so easy to get caught up in the medicine or upper middle-class bubble. It may change your outlook on life.
7. Share and learn from other physicians
This is especially important in residency. You have an endless network of physicians to talk to about their work and their lives. Learn through their experiences. Attendings can discuss what fulfills them and how they handle fear and failure. We often talk about revisional surgeries and how to deal with complications, but we don’t discuss the effects it has on us mentally. It is important to hear how others deal with challenging situations. Promoting wellness in physician trainees is key to preventing burnout.
We head to the Doctor, Dentist, Optometrist annually for a checkup. What about a mental health check? We often neglect the part of the body we use the most, our brains! Scheduling periodic mental health checks and finding a therapist you can turn to before you need one is a good proactive approach.
There are many resources available to you.
The APMA has a well-being index on their website. The “Well-Being Index” is a quick, confidential survey from the Mayo Clinic to access your own well-being and see how you compare with your peers. There are also many articles and resources on physician wellness. This is a free resource available to members.
The AMA’s STEPS Forward™ open-access platform offers innovative strategies that allow physicians and their staff to thrive in the new health care environment.
It is important to remember that we are both physicians and human beings. There will be nights that we will not be able to sleep worrying about a patient or a surgical outcome and that is ok because we are human. It is important to find your own method of separating your work and personal life. This is particularly challenging for those of you in residency. While residency can be a time of frequent self-doubt and feeling underappreciated, it is important to remember that your patients look to you for guidance as a doctor and you have earned that privilege.
It is also important to remember that the onus is not only on us as doctors but also on the health care community to work on solutions to this complex problem. My goal was to shed light on this very important topic and provide strategies that you can implement now, early in your career.