If you are a physician in 2022, there is no escaping the subject of burnout. Volumes have been written on the topic in recent years, and for good reason: with each passing year, more and more physicians find themselves struggling to cope with it.
In fact, according to The Physicians Foundation’s 2021 Survey of America’s Physicians, 61 percent of physicians report often experiencing feelings of burnout—a significant increase since 2018 as tracked by The Physicians Foundation data. And yet, despite its growing prevalence—and in turn, the amount of attention it receives—only 14 percent of physicians sought out medical attention to address any of their various mental symptoms according to the same data.
Why is that?
The answer is multi-pronged, and almost certainly beyond the scope of any one article. Undoubtedly, there is an institutional component to burnout. Physician satisfaction levels have been waning for years now—a trend that has moved in lockstep with increased bureaucratic and corporate burdens being placed on providers. Things like tending to cumbersome patient EMRs and working for organizations increasingly driven by volume and “quality” metrics continue to chip away at the amount of time physicians can spend listening to—and ultimately caring for—their patients, which is the exact kind of work they always intended to do and what likely drew them to medicine in the first place. That erosion of meaningful work has undoubtedly contributed to the rise of physician burnout, and the COVID-19 pandemic has only served to exacerbate those particular pressures.
All that helps to explain the rise in burnout, but it does little to explain the enormous gulf between those needing help and those who actually seek it.
That is because there is also a personal component to the development of burnout and the management of it, or rather, the lack thereof. In the world of medicine, burnout is easy to dismiss. Many physicians think it is just something that comes with the territory. The long hours, the rapid pace, the sheer intensity and consequence that come along with it—of course there is an inherent level of stress in all of that. But stress and burnout are not necessarily the same thing, and too often the last person most physicians think to treat and diagnose is themselves. And that failure to recognize and address a serious problem at its onset can come with serious consequences.
In short, there is an awareness problem at play in all of this: a lack of awareness for how stress and burnout differ—what is healthy and normal and what is not. A lack of the necessary self-awareness to recognize and address mental and behavioral health concerns amongst providers—for all the tools and training physicians are given to treat others, they are ill-equipped to diagnose and care for themselves. And finally, a lack of awareness about the tools and resources available to help physicians cope should they be able to clear those first two hurdles.
With any luck, this article will help to fill in those gaps.
What Is Stress? What Is Burnout? What Is the Difference?
Medicine is stressful.
There is no escaping that fact. And, importantly, there is also nothing inherently wrong with it. In fact, properly managed, stress can promote growth, development, and resiliency, just as the stress of a deadline or a situation can help one to focus and perform.
The easiest, and perhaps most relevant, analogy is one related to the human body. Every elite athlete trains their body to perform. That training is a form of stress, and growth and performance only come through strain. Properly implemented and managed, stressing one’s body in such a way can produce incredible results. However, there is an important and often overlooked component that goes along with effective training and that is the rest and recovery that must accompany it. Athletes who do not invest adequate time into that side of the equation eventually suffer. At some point, the body breaks down without the rest and recovery it needs—that is when injuries happen; that is when performance suffers.
Managing the everyday stress that comes with being a physician is no different.
“There’s a common misconception among providers that stress and burnout are one and the same, and that’s something we need to work to address,” says V. Simon Mittal, MD, MMM, Physician Consultant at VITAL WorkLife. “Because work-related stress can and does happen, and some degree of it is fine so long as physicians have the time and tools they need to effectively manage it. Burnout, on the other hand, is really more the cumulative manifestation of not being given the time, tools, or resources to manage that stress. When people lose their connection to the parts of their work that bring them happiness and feels purposeful, when they consistently lack that critical balance between their work lives and their professional lives and are left without adequate time to recharge—when these sorts of patterns develop, that’s when things go wrong, that’s when people and organizations suffer.”
In short, burnout is the result of prolonged, chronic, unmanaged stress. And importantly, it is a state one does not reach overnight. But when does one
cross over from being stressed to experiencing burnout? If the onset of burnout is subtle and progresses gradually, how do we recognize and address it before it escalates into something more serious and difficult to overcome?
How to Identify Burnout in Yourself and Your Colleagues
For a multitude of reasons, burnout can be tough for organizations, colleagues and even the person experiencing it to identify, especially at its onset. But from the perspective of the physician suffering, it must start with one simple question: are you willing to be truly honest with yourself?
“Medical stoicism is one of the major roadblocks to physicians being able to notice early warning signs in their own feelings and actions,” says Doctor Mittal. “For a lot of us, if we aren’t struggling, we feel we aren’t working hard enough. We’re not good at looking at ourselves, and we rarely seek help. And if a physician isn’t willing to really be honest with themselves right up front about how they’re feeling, it’s really very easy for them to diminish all the symptoms they’re experiencing.”
Thankfully, there are several physical, emotional, and behavioral signs and symptoms that burnout may developing, and self-identifying those telltale warning signs works much like any other effort to diagnose a problem—it starts with questions:
- Am I having trouble sleeping? Has my appetite changed?
- Am I more irritable at work?
- Do I dread going to work?
- Am I exhausted all the time?
- Am I making more errors?
- Am I no longer enjoying the things I used to enjoy outside of work?
- Am I feeling increasingly cynical?
- Do I feel detached from my work? From my family?
- Am I losing my motivation? My ability to care?
- Am I having trouble in my relationships at work, and especially at home?
Taking a moment to ask and answer these sorts of questions is an excellent first step in trying to determine whether you may be suffering from burnout. And even if you do not think you have a problem, the exercise of taking stock of your feelings from time to time in this manner is a good practice from a wellness standpoint.
“I think some of the earliest symptoms that people tend to miss are the fatigue and no longer enjoying the things outside of work that used to bring them satisfaction,” says Doctor Mittal. “So being mindful of how your feeling in these areas is critical to self-identifying burnout in its early stages.”
Unfortunately, there are too many physicians that do not take the time for this sort of critical self-reflection. Part of that is undoubtedly explained by the time pressures that come with being a physician. Moments for uninterrupted self-reflection can feel like they are few and far between when one also must juggle the needs of their patients, their practices, and their families. However, some of it is also institutionally driven—by and large, physicians are not provided with consistent and adequate guidance on how to look out for themselves.
“Physicians are not trained to look at themselves and say, ‘I need help.’ That’s not where their training is,” says Doctor Mittal. “Their training is, ‘I’m here to help others.’ So, recognizing that the person that needs help is in the mirror is just a very difficult thing for most physicians to do.”
For that reason, it is important that colleagues also be on the lookout for early warning signs that a coworker may be struggling. Subtle changes in a colleague’s demeanor, their remarks, or their ability to follow protocols and function well in a team could all be early warning signs that a coworker is struggling and in need of support.
“As physicians, we tend to not only minimize our own problems but also the struggles of our colleagues,” says Doctor Mittal. “Too often in medicine when we observe another provider who is clearly struggling, we default to thinking, ‘Well, they’re struggling right now, but they’ll be fine,’ rather than saying, ‘Hey, it seems like you may be burned out. Let’s figure that out, and here’s the next step. Let’s give you a place to go that can actually help you deal with this so you can continue to be the successful and productive physician you want to be.’”
SafeHaven™—Safe and Confidential Resources That Can Help
Thankfully, that next step is clear for Michigan physicians. Officially launched in the spring of 2021, SafeHaven™ is a comprehensive and completely confidential physician health care provider well-being program, offering physicians, nurses, and health care providers access to a whole host of resources and support services that can help address career fatigue and behavioral health concerns.
“Physician burnout has been a growing problem for years now and that’s only been exasperated by the COVID-19 pandemic,” says Kevin McFatridge, chief operating officer of MSMS. “The fact is, we need to do a better job of caring for our physicians, nurses, physician assistants, and all health care providers so that they in turn can continue to provide excellent quality care for Michigan’s patients—that’s what SafeHaven™ is all about. Our hope is this resource will go a long way towards relieving our overly burdened provider community and ultimately help them rediscover the meaning, joy, and purpose in practicing medicine.”
SafeHaven™, which is implemented in partnership with VITAL WorkLife, provides a host of discreet and confidential set of tools and resources health care providers can access to stay well, avoid burnout, and connect to their purpose without the fear of undue repercussions to their medical license. Originally launched in Virginia, the program has been a huge success with over 4,400 members and 48 percent utilizing the program—an extraordinary and unmatched usage rate for an employer-sponsored physician wellness program. Gertrude “Trudy” Shahady, MD, a family medicine doctor from Lynchburg, Virginia, is one of them.
“Prior to programs like SafeHaven™, I think a lot of physicians were very hesitant to seek out any sort of help with addressing any signs or symptoms of burnout or other mental health concerns out of fear of consequences from their employer or licensing board,” says Doctor Shahady. “That’s what makes SafeHaven™ so great—the confidentiality piece of it is absolutely critical.”
Doctor Shahady’s decision to pursue help was prompted by the COVID-19 pandemic and the various pressures it presented. Overburdened by staffing shortages, the surge of sick patients, and, finally, those refusing to help themselves by getting vaccinated, Doctor Shahady finally hit her limit.
“At one point, I lost three patients in one week to COVID-19—three patients whom I essentially pleaded with to no avail to get vaccinated in the weeks and months prior,” says Doctor Shahady. “By that time, I had already lost a number of patients and had seen a lot more really suffer with COVID-19, and that just felt like a breaking point for me. I could tell I was losing my motivation to keep plugging away on coming to work and pushing my patients to get vaccinated, and I was also having trouble sleeping. It was then that I decided to call SafeHaven™.”
Just the initial phone call brought Doctor Shahady a sense of relief.
“When you call, you are immediately helped by a master’s level person who is trained to assess and triage you, and as I was talking to this person on the phone, she basically told me, ‘I’m hearing this a lot, you’re not alone,’” says Doctor Shahady. “Just hearing that made me feel a lot better.”
SafeHaven™ offers much more than that though. In addition to in-the-moment, 24-hour telephonic support, SafeHaven™ also offers provides clinicians and their families access to the WorkLife Concierge—an all-purpose virtual assistant that can manage every day tasks—legal and financial consultation services and resources, the VITAL WorkLife App, and peer coaching—something Doctor Mittal has been doing for a number of years now as a certified coach.
“I think the power and real value of the peer coaching lies in the fact that you’re providing clinicians with access to someone who really understands what you’re going through and what you’re experiencing,” says Doctor Mittal. “We’ve been there. We’ve seen it. We’ve experienced it. So, we’re in a position to say, ‘It’s normal, it’s okay, there’s a way forward, and here it is.’”
Through SafeHaven™, physicians are eligible to participate in up to six sessions of confidential peer coaching with one of VITAL WorkLife’s certified coaches. Working together, clinicians and coaches talk through the problems at hand, work to identify values and set goals, and then identify the strategies and action steps necessary to achieve those goals. And while it may not sound like much, the numbers indicate just the opposite.
According to recent research from the Mayo Clinic, physicians receiving peer coaching sessions experienced a 17 percent decrease in burnout compared to a 5 percent increase in burnout for physicians who went without coaching. Vital WorkLife’s own qualitative and quantitative data similarly bears out an impressive positive impact, with pre- and post-coaching surveys indicating that 92 percent of participants reported an improvement in overall well-being with an average improvement of 58 percent across specialties.
After her initial phone call, Doctor Shahady decided to utilize the services of one of VITAL WorkLife’s peer coaches, in this case a psychiatrist from Atlanta. In just one session, Doctor Shahady was provided with a new set of resources and ideas to help her deal with the stresses that came with being a provider during the peak of the pandemic as well as an effective new way to talk with her patients about vaccines that provided exactly what she needed to keep practicing and move forward.
“It was such a helpful and freeing experience for me,” says Doctor Shahady. “In just one session, it reset me enough to say to myself, ‘Alright, here’s what I can do as a provider and here’s what I can’t do, and I have to be okay with that.’”
In addition to the confidentiality component, the in-the-moment availability of SafeHaven™ services and resources make it a particularly attractive tool for busy health care providers.
“Most of us just aren’t going to take a half day off to go and talk with a counselor about an issue we’re having,” says Doctor Shahady. “We’re not going cancel half a day of patients for our own needs—we just don’t work that way, so having in-the-moment access to things like the concierge, the VITAL WorkLife app and the 24-hour phone support—the ease and accessibility of all these tools make SafeHaven™ a really easy thing for physicians to utilize.”
All SafeHaven resources are provided in support of one aim—helping suffering physicians to reset and refocus, to find balance and reconnect to the joy they once found in medicine.
“I think we’ll soon see more and more providers utilizing SafeHaven™ services and say to themselves, ‘Oh my gosh, I needed this. And I really need to tell my colleagues about this because it’s been so helpful to me,’” said Doctor Mittal. “That’s the kind of culture of care that providers and organizations alike need to be building and championing. I’m optimistic that we’ll one day get there, and I think SafeHaven™ will play a big part in that.”
To learn more about the SafeHaven™ program and what it can offer you and your organization, please visit: http://msms.org/safehaven.