Physician Burnout – the Three Symptoms, Three Phases and Three Cures

Posted by Dike Drummond MD

physician burnout treatment three cures1

Are YOU in the Danger Zone and What You Can DO about it.

In my work with physician burnout and stress … I have come to the conclusion that our current Healthcare “System” (I use that term VERY loosely) is TOXIC to the Workers. There are exceptions to this trend … an occasional group or practice that believes in and supports physician wellness … and these are the classic “exception that prove the rule”.

I have written previously on Physician Burnout, the invisible forces that drain us and why it is simply not a Fair Fight. One statistic is worth repeating.

“Numerous global studies involving nearly every medical and surgical specialty indicate that approximately 1 of every 3 physicians is experiencing burnout at any given time”
Tait Shanafelt MD   JAMA. 2009;302(12): 1338-1340 (physician burnout)

Physician Burnout … Are you At Risk?

The short answer is  YES! Everyone in every workplace is at risk for professional burnout. AND the healthcare environment is especially stressful because of the nature of the work, the nature of the “clients” and the way the providers have been conditioned (brainwashed is another term) by their medical training.

Understanding Burnout – The 3 Energetic Bank Accounts

One of the most useful metaphors to understand Physician Burnout is a Bank Account. In this Bank is a store of your Energy. In my experience, that energy comes in three “flavors”

  • Physical Energy – your basic “get up and go”
  • Emotional Energy – your ability to be emotionally available and compassionate
  • Spiritual Energy – your connection to your Purpose in your work … Your “WHY”

Every Single Day you work … there is a withdrawal from this Physical/Emotional/Spiritual Energetic Bank Account. The amount of the withdrawal is different from person to person and day to day.

Your job – on this energetic level – is to Keep Your Energetic Bank account in a Positive Balance. Your life outside of medicine, your health and your relationships depend on it. These bank accounts are different than the common metaphor of “your batteries”. When your batteries run out, the machine stops. When it comes to physician burnout … you can operate for a very long time on a negative balance in the accounts.

Physician Burnout is just another name for a Negative Balance in these Accounts

Work has drained you beyond your energetic, emotional and spiritual reserves. You have been unable, for whatever reason, to recharge your account. You are in a overdrawn and it hurts. You can feel it and your colleagues and family can see and feel it as well. In many cases you are a last person to recognize your own physician burnout.

 Here’s what Physician Burnout feels like

Physician Burnout – The Three Symptoms

  • Exhaustion – you are dog-tired on one or more of the three levels – Energy, Emotion, Spirit
  • Cynicism – you have lost your ability to care, empathize, and connect with your patients, staff and co-workers. You may even blame, shame or demonize the very people you are charged to care for – and feel guilty about it.
  • Doubt – you may begin to doubt that your work really makes any difference or question the quality of what you do (this is a late and inconsistent symptom that is nearly absent in men)

Here is an article on the different physician burnout symptoms depending on whether you are a woman or man.

These physician burnout symptoms vary from day to day, week to week, depending on how draining your practice is and whether or not you are RECHARGING YOUR ENERGETIC ACCOUNT BALANCE BETWEEN WORK DAYS! I don’t mean to “shout” that phrase … just emphasize the importance of refilling your account when you are not at work.

 

Physician Burnout – the Three Phases

Your level of physician stress and physician burnout is a moving target from day to day. In my experience, this sets up three common physician burnout SYMPTOM PATTERNS. These symptom patterns define three distinct Phases of Physician Burnout.

I will show them to you visually here. See if you can find your own pattern in the charts below.

==========================

Phase 1

Physician Burnout and stress vary from day to day and you never become symptomatic (feel trashed).

physician burnout phase 1

==========================

Phase 2

In Phase 2 you are feeling physician burnout symptoms (fried, exhausted, cynical, uncomfortable) in various amounts.

Phase 2(a)

Physician Burnout Symptoms are only intermittent and you are feeling fine more often than not.

physician burnout phase 2 a

Phase 2(b)

You notice the symptoms of physician burnout more often than not. You only occasionally feel at full strength and “your normal compassionate self”.

physician burnout phase 2 b

Phase 2(c)

It has been a long time since you felt at full strength … and yet, you are “hanging in there” and “doing the best you can”, trying to convince yourself this is how all doctors feel … right?

physician burnout phase 2 c

==========================

Phase 3

In Phase three you are falling into the Danger Zone. Your physician burnout is now having major impact your career and your quality of life outside of medicine. Here you begin to say, “I can’t go on like this for much longer”, or, “I have to find another way to make a living … soon.”

Phase 3(a)

Your baseline is chronic symptomatic physician burnout … you dip occasionally into the danger zone. Note … you never recover to the “doing OK” level of energy and compassion.

physician burnout phase 3 a

Phase 3(b)

You are circling the drain here. Something is going to break very soon. you are seriously contemplating quitting medicine … or have done so already. You may find yourself self medicating with drugs or alcohol, falling into a major depression, your marriage and other significant relationships deteriorating, your health deteriorating …

Your colleagues are probably avoiding you … I know that does not make sense and it is likely to be happening as they are very happy subconsciously that this is happening to ANYONE BUT THEM. You are almost certainly feeling completely isolated and that no one could possibly understand your situation.

physician burnout phase 3 b1

Take a look at the graphs above and find where you are right now.

==========================

Why is there no Phase 0?

There is no zero state because there is no way to  spend even a half day at work without resulting in a withdrawal from your energetic bank account. Not possible. Everyone is at risk … all the time. And as the studies show … one in three docs are symptomatic from physician burnout on any given office day … Worldwide, Regardless of Specialty.

NOTE: We have not even mentioned the other members of the team. Nurses, PA’s, NP’s reception, medical records, administration … all of them are working in the same environment. They have their own issues with stress and burnout. Our challenges with physician burnout are perhaps more severe because of our position at the apex of the team where “all the bucks stop with us”.

 

Physician Burnout – The Three Cures

I believe that all physicians would benefit from an active physician burnout treatment plan. The forces that cause physician burnout never rest … it makes no sense to me that we wait for symptoms and then we are all on our own to figure out how to respond. Here’s the good news…

The tools that work to prevent and treat physician burnout are known, research proven and you can learn them. And I want you to know one very important thing here … (it deserves caps and bold too)

WHAT YOU UNDERSTAND ABOUT PHYSICIAN BURNOUT AND ITS PREVENTION IS MEANINGLESS

YOU MUST TAKE WHAT YOU KNOW AND PUT IT TO USE

The very LAST THING I would want to have happen as a result of you reading this article … is for you to stop there …. comfortable that you now know a bit more about Burnout. Your spouse, your children, your nurse, your colleagues … even your mom … wants you to take the next step and actually do something to lower your own burnout levels.

If you would like personalized recommendations for how to incorporate the physician burnout prevention tools below into your unique practice  … please CONTACT ME using this web form and let’s get started.

Physician Burnout Prevention is a practice … a regular set of habits you were never taught in medical school or residency … that work in three distinct and separate fashions to keep your energetic bank accounts full.

 

The Three “R”s

1) RESIST

Increasing your ability to RESIST the forces of physician burnout while you are on the job is incredibly important. This is much like the shields on the Starship Enterprise. You know the workplace is draining … let’s minimize the drain while you are on the job. Here’s how we do that …

The most well researched methods fall under the heading of “MINDFULNESS”. Now, this is a category of a number of different skills that allow you to be in control of your

  • Intentions
  • Attention
  • Awareness

… from moment to moment while you are on the job. You are aware of stress when it arises, notice negative emotions when you begin to hold on to them … and practice proven techniques to release them in the moment. The effect is you become the “eye of the storm” in the office rather than a victim of physician burnout.

I have created a Guided Imagery Experience you can download for free at this link that will show you how to be the eye of the storm in your office day and get you started on building your RESIST skills.

2) RESTORE

Realizing that the core dynamic of physician burnout is a withdrawal from your accounts of physical, emotional and spiritual energy … the RESTORE step is about restoring your energy and bringing your accounts into a healthy and positive balance.

NOTE: While there are parts of your work that feed you with positive energy (and mindfulness will increase the ability to actually gain energy at work) … most physicians do the majority of recharging off the job.

Curing physician burnout with the Restore step is typically about RESTORING BALANCE. What is important to you outside of your career? What are those things that fill you up, recharge your batteries and your bank accounts.

Sleep, good nutrition and regular exercise are a great start. What relationships, activities, hobbies, experiences build you up, make you smile? What is on your Bucket List?

Restore is also about creating (and defending) BOUNDARIES between your work life and your larger life. This skill is absolutely essential when preventing physician burnout.

Here is our #1 Work Life Balancing tool – the Schedule HACK Training – as an example of how you can strengthen your Restore muscles.

3) REDUCE EXPOSURE

This third physician burnout “cure” is about reducing your day to day exposure to the draining effects of your workplace.

  • Resist is about building up your self defenses against physician burnout while on the job
  • Restore is about rebuilding the energy lost while at work
  • Reduce Exposure is about lowering the stress present in your workplace by exerting some control in one or more of the following four ways.

This is the one physician burnout prevention step where your ORGANIZATION CAN PLAY A SIGNIFICANT ROLE. You can start by agreeing on your Definition of Success for doctors in your group. Is it the typical stereotype of “busier is better” and the amount you bill is your only value to the group? OR can you agree together that a healthy, balanced and productive physician is your collective goal.

As you read through the Reduce Exposure steps below you will see several opportunities for your organization, administration and support systems to kick in some of the heavy lifting to lower your risk of physician burnout.

1) Keep doing what you are doing now … just less of it.
Such as Part time, job sharing, etc.

I only recommend this if you are truly unable to change any aspects of the WAY you work I list below. If your work environment is burning you out when you participate full time … less exposure to that environment will cause less physician burnout. AND I would still recommend you work to make the workplace less toxic using some of the suggestions below.

Your organization can help here by agreeing to support part time schedules for the doctors who choose less than full time employment. Offer flexible hours and don’t treat them like third class citizens or “slackers”.

2) Change the stressors that lead to physician burnout without changing jobs
… changing the WAY you work. Target those aspects of your practice you find most draining and redesign them. In many cases this means becoming a more powerful leader as you create a system and coordinate your team to address tasks that you currently take on all by yourself.

Leverage, delegate, empower your team, Change your patient mix, your compensation mechanism, the way you chart, the way your team addresses your workflow, your staffing levels. “Scribes” in the ER are an example of this.

Your organization and a progressive administration and support team can play a HUGE role here.

3) Change Jobs to a position that is less stressful inside medicine
… a new position, a new practice model (concierge medicine for example), a new group, take on a leadership position. Go back to school for a fellowship or MBA.

4) Quit medicine to retire and/or make a living doing something different. Some positions and careers will utilize your medical credentials … others will not. As an entrepreneur … I can tell you that a clinician’s skill set (the ability to diagnosis and treat) is a universally valuable skill set in any business – even though you almost certainly don’t see that right now.

Creating your Physician Burnout Prevention Matrix

If we are going to mount a robust defense against physician burnout … and live the best life possible … it makes sense to be skilled and working a proactive plan in all three of these areas. Resist | Restore | Reduce Exposure.

Just imagine

  • You are skilled at remaining centered, calm, focused and compassionate at work even on hectic days
  • Your energetic bank accounts are full, your life is balanced because you have proactively structured it to be this way
  • Your workplace has a smoothly functioning team, seeing patients you enjoy in a reasonable volume for a satisfying wage

Each of these three points are not staggering individually … and when you put them together into a complete package the odds of you being anywhere south of physician burnout stage 2(b) is very small.

If you would like personalized recommendations for how to incorporate the physician burnout prevention tools above into your unique practice  … please CONTACT ME using this web form and let’s get started.

=====================

PLEASE LEAVE A COMMENT BELOW and tell us your favorite physician burnout prevention tool.


Tags: physician burnout prevention, Physician burnout, physician stress, physician burnout symptoms, physician burnout phases, physician burnout cure