Burnout: The Way Out

I took the photograph of the trash bin above (and created the composite image from my mind’s eye) with my phone camera, between patients on a typical overbooked day in clinic. I was sleep-deprived.

It was April, 2015 and I was still struggling with moments of burnout, cynicism, and exhaustion, slowly and clumsily stumbling my way out. 

Years of hidden anxiety, isolation and feelings of helplessness in an overwhelming system had taken their toll on my psyche and my relationships. 

Not Alone

The picture captures my mind state at the time. 

I was wrestling with hopelessness born of a lost sense of purpose as a doctor combined with a sense of powerlessness in a large and seemingly inhuman healthcare system, along with the unexpected tragedy of personal loss. 

And I began to speak of my struggles in quiet corners, and my colleagues began to share with me that I was not alone. I learned the facts about burnout, including the staggering fact that 400 physicians commit suicide each year, more than twice the rate of the general population. And that experts have predicted a shortage of 120,000 physicians by 2030.

Hope Rises

The image also speaks of a stuttering but rising glimmer of optimism at the time.

That hard-won hope was the result of my 10 year journey of deep introspection and personal transformation. I was so fortunate to have discovered mind-body practices and teachers along the way who helped me connect with my pain rather than keep running from it. 

The core framework for my own self-care and recovery were the evidence-based practices of the burgeoning Science of Happiness (“Positive Psychology”), along with meditation, mindfulness, yoga, Tai Chi, self-compassion, and a deepened exploration of optimal nutrition, sleep, and physical fitness. (After months of training, I completed my first triathlon in 2014).

I was learning the meaning of self-care, something not taught in medical school. 

The Causes of Burnout Are Known

Over the past 5 years I have immersed myself in the study of the causes and contributions to the crisis of burnout specifically among healthcare providers, and among organizational employees more generally. These causes are comprised of a relatively small individual (psychological) component and relatively large organizational/systemic contribution. 

Organizational drivers relate to misaligned priorities among stakeholders, and to flawed systemic processes that prevent caregivers and patients from connecting on a mutually-rewarding and deeply human level. Factors include insufficient individual autonomy, lack of scheduling flexibility, workflow inefficiencies including electronic medical record systems, lack of community, to name a few.

Above all, there has been a disregard for the heart of healthcare -- compassion. A commitment to regular iterative process improvement along with an emphasis on actively creating cultures of human connection and empathic communication are core factors on the road to meaningful reform.

A New Wave in Healthcare?

Fortunately, I have experienced the known phenomenon of the self-propelling “upward spiral” of mental well-being. I am still actively continuing on my personal journey of self-care, recovery, and reconnection with the art of medicine. Over the past 2 years I have been heartened by the nation-wide (world-wide) call for a more humane healthcare system. 

Research papers and consensus statements from all major medical and surgical sub-specialties providing strategies for ending burnout are now commonplace in the medical literature. The implementation of effective reform strategies is slowly occurring. 

The healthcare industry has followed the lead of organizational design experts from the non-medical world, with good initial effects. Resource allocation for burnout prevention and elimination programs is currently a limiting factor. 

Spread the Word, Join the Movement

I have committed myself to helping eradicate the unnecessary suffering of those that dedicate their lives to helping others. The solutions are known. The obstacles are known. There is a growing movement of talented and thoughtful individuals and institutions making headway.

Take a moment to check in with yourself and your mental and emotional state right now. Where are you on the spectrum from burnout to optimal well-being? What change will you commit to to take better care of yourself?

For all of my colleagues in healthcare who are silently or openly suffering or know someone who is, remember this: there are reasons for hope. Change is possible. Join the movement. Add your impassioned voice to the conversation. Be a part of the solution. And remember to take care of yourself.