Physician Stress and Burnout: Learning to Take Care of Yourself

Written by on July 2, 2012 in Features - No comments
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By Alan Rosenstein, MD, MBA

In late 2011, Physician Wellness Services and Cejka Search released the results of the Physician Stress and Burnout Survey, reflecting a nationwide, multi-specialty response from over 2,000 physicians.  Asking questions related to the prevalence, causes and effects of stress and burnout, the findings showed:

  • Almost 87 percent of all respondents identified themselves as moderately to severely stressed and/or burned out on an average day using a 10-point Likert scale, with 37.7 percent specifying severe stress and/or burnout.
  • Almost 63 percent of respondents said they were more stressed and/or burned out than three years ago, using a 5-point Likert scale, compared with just 37.1 percent who reported feeling the same level of stress or less over that period. The largest number of respondents (34.3 percent) identified themselves as “much more stressed” than they were three years ago.
  • When asked if their organizations did anything to help them deal more effectively with stress and burnout, only 15.7 percent said yes.

Respondents, overall, noted many things that they felt would help them better deal with stress and burnout, which fell into these three major areas:

  1. Greater flexibility and control over their working hours to mitigate burnout and stress.
  2. More opportunities for and assistance with taking better care of themselves, and to understand and practice better self-care.
  3. Support on multiple levels in dealing with stress and burnout in their lives.

Starting With Your Work and Practice

Depending on your practice setting and other work-related circumstances, you may have varying degrees of control over your time and how you spend it—so, the goal of achieving greater flexibility and control over your working hours may need to be approached incrementally. In some areas, you’ll need support from your organization. In other cases, your biggest problem may be yourself, as you strive to balance providing good care and service with regaining control over your own work responsibilities and schedule.

Here are some tactics that can help alleviate some of the stress and burnout associated with your work.  The first step is to better understand what you actually want and need before you work to change things in your professional life:

  • Accept that time and age change a person, their personal goals, their priorities and their bedside manner. Take time to examine what is important to you now—and how that might have changed from earlier in your career. Use this knowledge to frame the things that are important to you, as a physician and an individual, on a day to day basis so you can work to incorporate that in your work.
  • Perfectionism is a well-known trait in physicians, and especially surgeons. Striving for perfection is admirable but it can cause a great deal of stress. Is perfection necessary in everything you do?  In what areas can you afford to be more flexible?
  • Related to this, how much of your stress is self-imposed vs. related to external factors?  Understand who you need to ask for permission to change—yourself or your organization.

Once you better understand your needs, as well as the factors in your environment that cause the most stress, start to look at specific tactics where you can free up or rearrange time for other priorities and needs. First, look at help that your organization can possibly provide:

  • Scheduling and time management—are there ways to utilize your time more efficiently? This might involve such things as setting aside specific blocks of time for the things you need to do, whether it’s surgeries, paperwork and charting, following up with patients, or other responsibilities. If you travel between locations, are there ways to optimize that time and minimize the time spent en route?
  • Are there non-critical or lower-priority tasks that can be done by or shared with others?  This may involve administrative help or moving work to ancillary staff, such as some of your paperwork, charting, and some patient-related appointments or communications. Ask yourself and your administrators what is the best use of your time and where you can provide the most value.
  • How can you carve out specific break times that are respected and protected? As noted below, everyone needs time to refresh and reflect—and struggling to find and maintain that time can create more stress.
  • If issues with staff or colleagues are resulting in conflict or other work issues (e.g., operational or process issues, policies, resource allocation, etc.) that contribute to a stressful environment, how can they be resolved in an effective and timely manner? Who in your organization is responsible for facilitating discussions and implementing solutions? Is there a way to provide input in a manner that is professional and receive feedback on results?

These same principles apply even in smaller practices—or may be things you can address on your own.  If collegial communications or cooperation are a problem, sometimes bringing in an outside facilitator or coach can help in identifying both issues and solutions.

Taking Better Care of Yourself

There are no mysteries surrounding self-care, which encompasses such things as:

  • Adequate, good quality sleep
  • Good, nutritious food
  • Exercise and physical fitness
  • Relaxation—physical and mental
  • Mental and emotional health
  • Intellectual stimulation and engagement

One of the biggest barriers for physicians to practice good self-care is time, between the demands of work and non-work responsibilities and relationships such as volunteer and community activities, family and friends, and the demands of daily living. So, how do you find the time?

As previously noted, carving out time in the work day is a good first step. And, making that time matter more goes hand in hand. Some elements of self-care can be synergistic, such as the way exercise can also help “clear the cobwebs” and allow a mental break, as well. Or, sometimes activities that promote intellectual stimulation, such as reading an interesting professional paper, can be relaxing, too.

Similarly, take a look at the time you spend outside of work and go through some of the same evaluation process. Can you be more efficient with your time? Are there tasks or responsibilities that you can have someone else do or help with? What do you do now that really doesn’t provide value or enjoyment?  You might be surprised at how you can re-allocate your time.

But, don’t make this about creating another project on your to-do list that creates more stress.  Remember that with self-care, you might have to start small and approach this incrementally, and that sometimes it’s okay to do nothing that appears to have redeeming value. Reading a novel or occasionally surfing the web can provide the kind of mental break you may need. More than anything, think of setting limits and boundaries on your time as a survival skill with long-term benefits.

Specific things to consider that promote good self-care include:

  • Enroll in a yoga, Pilates or Mindfulness Meditation class, or other groups/activities that distract from or alleviate the stress of life for a time.
  • Take time to reflect on the positive parts of your life. Doing this prior to bedtime will assist with a good night’s sleep.
  • Read fiction, journal or meditate. Engaging in these activities before bedtime will also assist with sleep.
  • Identify more ways to integrate exercise into daily life—it’s the cheapest anti-depressant.
  • Go for a 10-minute walk outside the office—it can re-energize you and clear your mind.
  • Purchase exercise equipment for your home so it’s easier to use and access.
  • Get a “work out” or “running” or activity partner.
  • Improve nutrition practices:
    • Sit down to breakfast.
    • Take a lunch break.
    • Bring healthy snacks to work.
    • Have family dinners whenever possible.

Getting the Support You Need

Nobody can do it all—and nobody has complete control over their lives. As noted earlier, physicians need support to address the things in their lives that contribute to stress and burnout. This is over and above some of the steps outlined above—this is about setting up a framework around your life that supports what you do and need to do to stay healthy. Avenues to obtaining that support may include:

  • Get tips, support and suggestions from others in similar situations. By speaking openly with them, you can gain insight and perspective, as well as suggestions for coping.
  • Even if you aren’t having issues at home—but especially if you are—it can be valuable for you and your spouse or partner to sit down and have frank discussion and negotiation over household roles and responsibilities, which can be a big contributor to conflict. Similarly, discussions about parenting, childcare and eldercare issues, etc. can also be very helpful.
  • Where there is conflict, or potential for conflict, engage in crucial conversations—at home and at work—after thinking them through.
  • Consider the use of resources such as an employment assistance program (EAP), a physician coach, family and marital counseling, or individual counseling to promote mental and emotional health, and get help working on areas common to physicians such as:
    • Reflecting on your priorities and values at home and work
    • Self acceptance, trust and tolerance of others—and trying to be selective with controlling or perfectionist thinking
    • Giving people the benefit of the doubt, avoiding jumping to conclusions—and working on trust and identifying obstacles to it
    • Being more open to reasonable feedback—and seeing when you may be the problem
    • Acknowledging losses and giving yourself permission to grieve
    • Acknowledging and dealing with guilt feelings related to patient and care issues, relationships at work or home, or other parts of your life where you feel you have been deficient in some way

Make a commitment to yourself to take some time to develop an action plan for making your work and your life more manageable, and please consider using some of the suggestions offered in this article.    You’ll have to make time for this activity, waiting until you have a free moment means never getting it done. You might want to start small, and review and build on your plan as time goes by. You’ll be surprised at how much control you really have to make important, meaningful changes to your stress level and overall satisfaction in life.

 

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