By Nicole Ervast, Business Development Associate
and Dawn Patterson, CFNP, ACNP, ENP, Director of Advanced Practice Providers
As a layperson who has experienced feelings of non-medicine related burnout (I once had 4 part-time jobs while going to school full-time and juggling a relationship), I was curious to know how burnout is different for clinicians, and why it seems to have a heavier impact on them. As most of us probably know already, physician suicide rates are downright scary. A quick click to KevinMD.com will show you how frustrated physicians are with so many aspects of the medical system, and how truly difficult their jobs are. It is not surprising that some have trouble coping with the long hours, high productivity requirements, and emotional stress inherent in the practice of medicine.
As part of an effort to discover more about physician burnout, what causes it, and how doctors cope with it, I started to interview some of our own docs. While they had all experienced burnout on some level in the past or present, they each had discovered ways of dealing with it and eventually finding a balance. Almost all of them had two things in common: hobbies and spouses/significant others.
Dr. Levy, an Emergency Physician, escapes through music: “My two loves are music and medicine. I’ve been focusing a lot on the creative side so that way I am able to access that creative side of my brain, put the medicine side on hold and… stimulate a different side of myself.”
Dr. Jensen, a Hospitalist, gets lost in a range of interests online: “I love the internet. I can spend hours researching articles of interest. I have my own blog and follow several others. My interests range from Atkins diet to cars. I could spend an entire day just reading on the internet.”
Dr. Stevens, one of our medical directors, loves shooting and releases stress through spending time in nature fishing and hunting. Dr. Wenner, another medical director, plays hockey. One of our ED nurse practitioners (who chose to remain anonymous) relaxes with a good book and loves to “escape to a different world.” It doesn’t matter what your hobby is–just that you have one. Hobbies can serve as a release for the overwhelming buildup of emotions that are unavoidable in the field of medicine. They can also serve as a simple distraction when you need to get your mind off of work. But the most important purpose of a hobby is to add to your life in a way that work can’t. Work should not be your life.
Then there are the spouses and partners of doctors who must shoulder some of the burden that doctors carry. Most doctors will openly say they couldn’t do it on their own. Dr. Wenner never fails to credit his wife Jackie when praised for his accomplishments. Our anonymous NP admits that her husband is probably more at-risk than she is for burnout because he usually has to care for their preteen triplets. It’s a hot topic right now, on the minds of EP bloggers like Edwin Leap, who constantly mentions his appreciation for his wife in his articles, and recently wrote this article about how indispensable spouses are for doctors.
How do Keystone physicians avoid burnout?
While some of our physicians have unique situations that may not be available to everyone (Dr. Stevens, who works at a tiny rural hospital where he can usually sleep at night while on shift, works two 24-hour shifts back-to-back and basically lives at the hospital for two days), there are easier ways to avoid burnout.
Dr. Levy, who is considered one of our most “prolific” providers, works over 20 shifts a month. According to him, he knows he is burned out “when patients start to really make you question why you do what you do. Obviously, the things that patients sometimes feel are emergent to them aren’t always emergent to providers. When you question why you do what you do, that’s a sign it’s time for a break.”
Clearly, the first step to avoiding burnout is knowing when you have it, or even better, when you feel it start to come on. When this happens, you know it’s time to back off. And it may not always be from working long hours. Being a physician, particularly an ED physician, can be emotionally draining and even traumatic. In Dr. Wenner’s words, “You might save a child from drowning one moment, and then in the next room watch a fifty year old die of a heart attack with his family around him. You can panic, but you can’t let anybody know. If you’re not freaking out when there’s a dying baby, there’s something wrong with you.” Taking adequate time off from this kind of emotional stress is essential.
Our schedulers understand that clinicians have stressful jobs, and that work-life balance is a must. “The more work-life balance that our providers have, the more work-life balance the schedulers have,” says Keystone scheduler Daniel Haggerty. “We are on the same team to accomplish the same goal–so we are mindful of the needs of our providers.”
And they work very hard to help clinicians achieve as much work-life balance as possible: “We have to spend a lot of time understanding the preferred scheduling habits of the providers so that we can anticipate what will be the optimal and most realistic work schedule,” says Clark McGee, also a Keystone scheduler. “What the scheduler has to do… is create a realistic balance in the hours worked in a set time frame, keeping in mind that adequate rest is necessary…. If all of these things are considered in the forefront, schedulers should have no issues making sure their providers have an equitable schedule.”
At Keystone, we also make a point to listen to our physicians. If we are getting complaints from doctors that one of our EDs has been busier than usual, or is understaffed, we make a point to look into the issue, discuss with administration, and add a shift if necessary. This may not affect the amount of time each provider is working, but it definitely improves morale and decreases stress levels while working, which can make it easier for physicians to recover and be well-rested for the next shift.
While people in many professions experience burnout, medicine is unique for many reasons. Shifts are long, stress is high, maximum productivity is essential, and obviously lives are at risk. What causes it and how to avoid it still seem to be mysteries–but as more clinicians write about their experiences and ways they cope, this syndrome becomes less and less mysterious. Not every physician gets burnout, and not every coping mechanism works for every physician who does. But every voice offering advice brings us closer to fixing the problem.
Do you have stories of burnout? Words of advice? Hobbies you enjoy to rejuvenate between shifts? An awesome spouse? Share this article or send me your thoughts! @nicoleervast
Commentary by Sanford Glantz, MD, Chief Medical Officer: What leads to burnout is usually the politics of the profession. Rarely is it the patients or the medicine. People get frustrated and burned out, then they look for a new job, where they end up doing the same work but with different politics. Also, since medicine is a diverse field, people can develop different skill sets such as leadership, teaching, community outreach, EMS mentoring, etc. This gives providers a new perspective on the profession. One of the best things about emergency medicine and hospital medicine is that you can cut down on the number of shifts, take longer vacations, and you can move around to different hospitals. Sometimes working at a different hospital makes you appreciate what you have at your primary hospital. Finally recognizing that you are burned out is the hardest part. That’s where family and friends come in.