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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.