How can docs avoid burnout woes? Three docs share their personal stories.
It was a dead-end job. Everything was the same, every day. Marquette, Mich.-based family physician Jennifer Dehlin, MD, saw her life stretched out before her and wasn’t excited about her role as a physician. She was only in her 30s.
Dehlin didn’t realize it at the time, but she was burned out. She had worked at the same hospital and small clinic for seven years. And she was involved in various committees at the hospital-based practice, including one focused on process improvement. Still, while she continued to suggest improvements, Dehlin discovered that she was powerless to change anything.
For example, no matter how many times she told the scheduler that she’d need more time with a particular 90-year-old patient, nothing changed. There was never enough time scheduled, which meant the patient’s appointments always ran over and that meant she was playing catch up all day. Looking back today, Dehlin describes herself as “constantly frustrated” back then.
Setting up her own practice
Dehlin and her husband, also a physician, wanted to stay in Marquette, where they had started a family. The physician couple had discussed starting their own practice, but both were bound by two-year non-compete contracts.
She was surprised when her hospital’s chief financial officer told her he wouldn’t enforce the non-compete contract. She and her husband gave 90 days’ notice that they would quit their jobs.
The Dehlins hired four employees from her former practice. That team was charged with building the practice while the couple finished their work commitments. The start-up costs for the practice were fueled by a business loan, she says. That was in 2016.
Dehlin’s chosen title at the practice - in addition to physician - is “director of fun,” and that means she’s often organizing 5K races for staff members to run together. What keeps her engaged is the ability to serve her patients, while creating a great workplace for her team.
“I really feel good about my employees having a good job. I’m very careful to make sure no one feels like they’re at a dead end…I look for ways to make sure that our staff feels they can grow and advance individually,” says Dehlin. In addition, practice employees earn higher salaries than in their previous jobs, and they receive holiday bonuses and take part in profit-sharing and a 401K plan, she adds.
A forced break forces a change
The journey of Carol Kimball, MD, from burnout started when she took some time off about two years ago. Kimball, a Woodland, Calif.-based family physician, describes her then-self as “very grumpy, having a hard time concentrating, and irritable.”
Kimball had been told by her employer to take a few weeks off work - with the understanding that she may not be able to return to her job, if she couldn’t figure out how to get focused and work better with her colleagues.
Knowing that she might be out of a job added to Kimball’s stress level; still she persevered. “I really took three steps back. I looked at what I needed to do differently,” she says. That’s when she started meditating. Kimball continues to meditate on an almost-daily basis; she confesses to skipping an occasional Sunday.
Here are some steps physicians can take to develop their own meditation practice, says Kimball:
• Calm down, in a seated position.
• Take your time.
• Check in with your body and your emotions, while focusing on your breathing.
• When a thought enters your mind - and that’s inevitable for everyone - realize that you’re chasing that thought and bring your attention back to your breathing.
But how does her meditation make her a better doctor? Kimbell says meditation - and other practices such as journaling and strengthening her network of friends outside the office - allows her to be more mindful and articulate with patients and colleagues.
For example, she was struggling recently with a patient who wasn’t being transparent about the amount of narcotic pills she was taking. Previously, Kimball might have responded with impatience. These days, she talks to her patient in a calm voice and requests permission to discuss the underlying reasons she’s taking so many narcotic pills.
Asking patients for permission is key, says Kimbell, who adds that it also enables better outcomes for her patients.
Align personal goals with the practice’s mission
Julie Blankemeier, MD, a physician with Oak Street Health, a Chicago-based primary-care group in Illinois, Indiana, and Michigan that focuses on Medicare patients, says she’s lucky that she’s been able to avoid burnout.
What’s her secret? Her personal alignment with Oak Street Health’s mission to treat the underserved. “Even on the days when I feel exhausted and overwhelmed, I’m doing what matters to me,” she says.
In addition, Blankemeier was able to scale back to part-time work when she was raising her four children; as her children have gotten older, she has transitioned to a full-time role. “That has helped immensely. It’s really difficult to live our lives and respond to changing priorities and have your work life change with that,” she says.
Working within a productive care team also prevents burnout, says Blankemeier. For example, Oak Street Health connects patients with a social worker to help them with housing and even household tasks, if medically necessary. “That’s overwhelming for a physician because I don’t have that expertise,” she says.
Team-based care is in evidence in the exam room, she says. Before she enters the room, a medical assistant has taken the patient’s vital signs, reconciled the patient’s medications, and determined the reason for their visit - and that information is shared with her. Also, Blankemeier works with a scribe in the exam room who documents the patient’s story in the EHR, which means she can focus on building an empathic bond with her patients.
Blankemeier has some advice for physicians to manage burnout:
• Be clear on your personal mission and realize that it will change as your life changes.
• Really understand the goals of the practice where you work. And if you’re interviewing for a job, ask questions about what the practice does to support its mission.
• Take 15 minutes in the morning to put aside anxiety for the day.
• Eat healthy foods.