Professional Burnout

Greg Ozark, M.D.

Professor Internal Medicine & Pediatrics

Vice President Graduate Medical Education Loyola Medical Center

Assistant Dean Stritch School of Medicine

Introduction

Who is this guy?

Burnout/ Resiliency interest

Objectives

To define and understand the concepts of “burnout”, “stress” and “resiliency”

To define and recognize Depersonalization, Emotional Exhaustion, and PersonalAccomplishment as symptoms of burnout.

To understand the scope of burnout amongst physicians and understand who is at risk

To provide some tools to identify and manage feelings of burnout in yourself.

To open dialogue about burnout and professional behavior with your colleagues and trainees.

Disclaimer

I’ve been on the burnout spectrum. (a few times…)

I’ve watched my heroes get burned out and fall.

I’ve watched my burned out peers “loose it” and

hurt others with unprofessional behavior.

I’ve acted in ways in which I am not proud.

It is possible that you will get (or are) burned

out.

I’m not a “touchy-feely” guy.

A wise man has taught me…

Wherever you are, be there.

With anything consider important, practice

because you want to do it better.

So, what is BURNOUT?

Stress Burnout

WHAT ARE YOUR STRESSORS?

Program Coordinator Job Description

ACGME interpreter

“Den Parent”

Meal Planner

“Curator of Large

Mammals”Counselor

Scheduler

Social and Event Planner

Confidant

Human

Resources

Duty Hour TrackerEducator

Data Analyst and Enterer

Educator

Spheres of Influence

Program Coordinator

ACGME

GME Office

Trainees

Faculty

Departmental Administrators

Human Resources

Visa

Expert

Dean’s Office

Program Director(s)

Managing people

Office politics

Problematic Co-Workers &

Trainees

“Do you have a minute…”

Running a program

Conferences

Site Visits

Interview Season

File preparation

CCC/ PEC/ ETCs…

Oh Yeah, don’t forget…

Your Health

Physical

Mental

Spiritual

Your Family

Time with spouse

Time with children

Time with friends

The Reality of Stress

Not always a bad

thing

Keeps us

engaged,

functioning,&

motivated

Has a limit

SO, WHAT IS BURNOUT?

BURNOUT is…

Emotional exhaustion

feelings of being emotionally overextended and exhausted by one's work

Depersonalization

unfeeling and impersonal response toward recipients of one's service, care treatment, or instruction

Decreased feelings of personal accomplishment

lack of feelings of competence and successful achievement in one's work

Maslach, 1997

Workplace Consequences

of True BurnoutPersonal

Mood d/o

Depression

Anxiety d/o

Detachment

Poor Physical Health

Home/ Life Imbalance

Breakdown of personal

relationships

Substance abuse

Professional

Poor Career Satisfaction

Attrition

Decreased Professionalism

Poor Communication

Empathy Decline

Increased Errors

Decreased Productivity

Errors

Why Do We Get Burned-out?

Lack of control and resources

Inability to influence decisions that affect job

Unclear job expectations/poor job fit

Dysfunctional workplace dynamics/lack of social

support

Disconnect in core values

Extremes of activity –monotonous to chaotic

Work/Life imbalance

TAKING YOUR OWN

BURNOUT INVENTORY

Individual Activity

Every Day -> A few times a week/ month -> Never

I deal very effectively with the problems of my trainees/ peers.

I feel I treat some people as if they were impersonal objects.

I feel emotionally drained from my work.

I feel fatigued when I get up in the morning and have to face another

day at work.

I’ve become more calloused towards people since I took this job.

I feel I’m positively influencing other people’s lives through my work.

Working with other people is really a strain for me.

I really don’t care what happens to some of my trainees/ peers.

I feel exhilarated after working closely with my trainees and coworkers.

I think of giving up this job for another career.

I reflect on the satisfaction I get from this job.

I regret my decision to take this job.

How’d you score?

Our history or handling burnout

BURNOUT PREVENTION/

(CURE?)

The 1st step…

Increasing one’s

awareness of

the symptoms and problems

related to stress, burnout, and

compassion fatigue.

its negative effect on both

personal well and professional

well being.

You (yes, you) are at risk.

The second step… (and the hardest)

Addressing the reluctance to admit that it’s true

and be willing to accept outside advice or

assistance.

Second step:

Why the reluctance?

We are used to working under stress

and think we have it within ourselves

to self correct.

We have very strong egos and

admitting that we are under stress is a

blow to our self esteem.

We fear about confidentiality and the

concern about what others may think

about clinical competency.

Rosenstein, Isr J Health Policy Res. 2013

The 3rd Step:

Wellness/ Resiliency

A dynamic and lifelong process involving self-awareness and healthy choices resulting in a successful and balanced lifestyle

Incorporates balance between the physical, emotional, intellectual, social and spiritual aspects of who you are

It results in a sense of accomplishment, mutual respect, and satisfaction.

It provides protection from the difficult demands of our professions.

Resiliency

Part One

Principles of Wellness and

Burnout Prevention

Reflection

Humanism

Mindfulness

Reflection

Maintaining alignment consistent with your

values and ideals

Taking time to assess where you are and where

you are going

Tools

3 good things

Daily Examen

Humanism

Taking time to connect with each person. slowing down, being in the moment (understanding importance of each interaction)

Trainees

Co-worker

Self

Habits to Sustain HumanismSelf- Reflection and Evaluation

Man, I was a jerk today… I need to apologize

Hey, I did a good job today!

Maintaining balance

Establishing boundaries

Mindfulness

Recognize your triggersWhat sets you off and builds “negative energy”

What allows you to feel “positive energy”

Knowing your own triggers can allow you to control them

Recognizing your limitations You are mortal. (sorry…)

There are no more than 24 hours in a day.

Recognize the “demon of busyness”/ competitiveness

You (yes, even you) are important to your friends and family.

Work to maintain your center/ balance

Mindfulness Based Stress

Reduction

The practice of paying attention in the present

with intention and without judgment.

Allows awareness of the present

Helps to orient a person to

focus on positive experiences/ energies

dismiss negative experiences/ energies

Sustaining DrainingWork

Home Home

Work

Mindfulness Exercise

Resiliency

Part Two

ESTABLISHING A BALANCE

Burnout Prevention

Maintaining Balance and the

Burnout Prevention Triangle

Personal

Educational Vocational

Maintaining Professional Balance:

Personal

RelationshipsFriends and family

Use your time off

Schedule time

Physical HealthDiet

Exercise

Sleep

Spiritual Health

Personal

Educational Vocational

Maintaining Professional Balance:

Educational

READ!With all due respect, you don’t know everything…

ConferencesGo to them, participate

Professional DevelopmentPersonal

EducationalVocational

Maintaining Professional Balance:

VocationalA job in which you use your skills to satisfy a

higher calling.

Spiritual

Altruism

Building supportive relationships at work

Allow yourself to connect with your trainees

Mindfulness

Humanism

Personal

Educational Vocational

Perils of working on 1/3:

If all you do is…

Personal:

Self-absorbed, disengaged

Educational:

Miss the calling/

satisfaction of work and life

Vocational:

Nice guy, but ineffective

and odd

Personal

Educational Vocational

Perils of working on 2/3:

If all you do is…

Personal and educational:

Dry job, no passion burnout

Educational and Vocational:

Always at work, no play/ relationships burnout

Personal and Vocational:

No skill/knowledge bad professional outcomes

burnoutPersonal

Educational Vocational

The Most Resilient…

saw the person behind the problems

allowed joy in success

made time for leisure activity and maintained a conscious presence

allowed time for personal reflection

established boundaries

cultivated ones own professionalism

had spiritual practices

planned vacations

Personal

Educational VocationalJ Palliat Med. 2009 Sep.

PHYSICIAN BURNOUT

Physician Burnout in 2017

Burnout by Specialty:

Arch Intern Med. 2012 Medscape Family Medicine, January 2015

Dyrbye, Acad Medicine, Jan,2014

Satisfaction with Work/ Life Balance

Shanafelt, Arch Intern Med. Oct, 2012

Physician Burnout

ConsequencesPersonal

Mood d/o

Depression

Anxiety d/o

Suicide

Poor Physical Health

Home/ Life Imbalance

Breakdown of personal

relationships

Divorce

Substance abuse

Professional

Poor Career Satisfaction

Attrition

Decreased Professionalism

Poor Communication

Empathy Decline

Increased Medical Errors

Decreased Productivity

Suboptimal Patient Care

Errors in Patient Care

Stages of Burnout

1) The Compulsion to Prove Oneself

2) Working Harder

3) Neglecting Needs (emotional, physical, educational)

4) Displacement of Conflicts

5) Revision of Values

“I don’t have the time to deal with these things and they are not a

priority.”

6) Denial of Emerging Problems

cynicism and aggression become more apparent

Ulrich, Scientific Mind: 2006

Stages of Burnout

7) Withdrawal

become isolated and walled off

8) Odd Behavioral Changes

Others in their immediate social circles can no longer overlook

their behavioral changes.

9) Depersonalization

Life becomes a series of mechanical functions.

10) Inner Emptiness

11) Depression

12) Burnout Syndrome

CNN January 2015 (&16):

Professions with the highest Suicide Rate

1) Physicians2) Dentists

2) Police Officers

4) Veterinarians

5) Financial

6) Real-estate

7) Electricians

8) Lawyers

9) Farmers

10) PharmacistsMental Health Daily, Jan. 2015

Why are physicians at

such risk or burnout?The Person

Driven

Goal directed

Not self-forgiving

“M.D.” is what they are, not what they do

Trained to be independent and not ask for help

The Environment

Productivity driven

Cog in a wheel

24/7 access and demands

High stakes

Competitive

SO, WHAT CAN YOU DO TO

BUILD AND MAINTAIN

RESILIENCE IN YOURSELF &

OTHERS?

Burnout Prevention

#1: Realize everyone is at risk for Burnout

#2 Recognize the symptoms of Burnout

Emotional Exhaustion

Depersonalization

Decreased Personal Accomplishment

The third step… (and the hardest)

Admit that it can happen to you.

You are not alone.

Ask for help.

#4: Take time to reflect

Mindfulness

Being open to the moment. Education

Conferences

Professional interactions

Peer interactions

Life relationships

Personal experiences

Recognize your triggers (+&-)stop the progression of negative energy

accept positive energy

Reflect: Is this who I want to be?

#4: Take time to reflect

HumanismTry to remember the importance of what you do EVERYDAY though it may seem routine.

Remember the person at the other end of the encounter.

See Humanity (Divinity) in all you encounter

Including yourself

Illegitimi non carborundum

#5: Work at maintaining/ restoring

your balance

Personal

Educational Vocational

#6: Ask for help

Friends

Family

Peers

Program Directors

GME office

Employee Assistance Program

Physician

Faith Leaders

Closing thoughts

Why it’s the best job in the world.