Part 2 - Burnout...now what?
Okay, so last time in Part 1, we started to discuss the need to address the solutions for system driven burnout. For a physician experiencing burnout, they're often left with the feeling, “now what?”, despite all of the research and information that exists on the subject. Global interventions and solutions may not, and probably often don't, suffice the unique needs of an individual physician. To illustrate this, we introduced Jane in Part 1. To recap:
“She has been working in a group practice for 12 years, during which time the workload has continued to increase along with the complexity and computerization demands. On most days, she feels completely exhausted and questions why she ever went into medicine. As a result, Jane feels as though she has no energy to do what she needs to do in the course of a day so she gets further behind in her documentation and paperwork, leading to further dissatisfaction with her job.
Jane is well past the point of prevention and doesn’t feel she has time for any self-care given that the one drop of energy she musters at the end of the day goes to her family. She tries to reach out to a colleague who ends up painting a picture of their own life that looks potentially worse than Jane’s, and who is also looking for their own solutions. Despite not wanting to take a pay cut because of trailing debt, and being the primary income earner in the family, she approaches the managing partner of her group and says she would like to reduce her work effort to 80%. Her request ends up being denied because of the fear/inside knowledge that this option will spread quickly leading to an unmanageable workload and unacceptable patient delays in care.
Jane is fully aware that she is burned out. Unfortunately, she's left thinking, okay, so now what?”
Jane is met with two major roadblocks:
1. Support at work and a sense of community: In a systemic review by Wiederhold, et al. titled, Intervention for Physician Burnout: A Systematic Review, they indicate: “Work group cohesion is also a very good predictor of burnout and job satisfaction.” Okay, so what happens when this doesn’t exist?
2. Autonomy, control and flexibility over how she works, how much she works and her volume of work: Another point highlighted in the systematic review is: “Insufficient personal control at the workplace or insufficient authority to pursue the work’s goals is strongly correlated with exhaustion.” Again, this makes complete sense, but what if it isn’t available to a physician?
Tackling some solutions for Jane:
So let’s break it down into two major themes, to stay or to leave, and brainstorm some options for both. Likely, it requires a combination of options.
1. Stay in medicine/stay in current job - Explore options such as:
job share possibilities
meaning in medicine/Balint group
create/find a community
therapist/external support (i.e. PHP)
2. Leave medicine/leave current job - Explore options such as:
leverage Medical Degree and look into non-clinical careers
take a sabbatical to explore options
consider a move and opportunities elsewhere
brainstorm/make a plan
look to a mentor/coach
join like-minded communities online and offline
Unfortunately, no easy answer exists for Jane's situation... because a one-size-fits all approach won't work. When it comes to physician burnout, each and every physician deserves the best for their one and only life, and we just want you (them) to know we see you and hear you.
When system driven burnout infiltrated our home, it took a lot of planning, a move, a mindset change, and a lifestyle overhaul - and much more. In our case, like Jane, the system wasn’t going to change to suit our needs.
Oh, and in case you hear otherwise, yoga and mindfulness are beneficial for our overall well-being, but let us tell you, they're in no way solutions for a physician experiencing burnout.
“Tell me, what is it you plan to do with your one wild and precious life?” ~ Mary Oliver