HIPPOCRATIC HYPOCRISY

Unsolicited opinion warning: I see a lot of Hippocratic hypocrisy when I look around medicine.  During our training and careers, we are laser-focused on the clinical skills needed for a career of “doing no harm” to those we care for, yet we never had to pledge to give the same to ourselves, nor did the system-at-large have to do so.  Our altruism and efforts are honorable, but the current state of healthcare worker well-being tells me that we may need to take some of our own medicine.

Sadly, many of us are walking around feeling burned out, underpaid, unable to pay off our student loans, losing hundreds of thousands of dollars on retirement investing and generally feeling unfulfilled.  One of the main reasons is that our medical system doesn’t simultaneously develop our clinical and career skills, leaving us to naively figure out the latter.  During our didactic and clinical educations, we are so focused on learning our trade that we fail to learn about what it takes to have a prosperous and fulfilling career.

It seems that there is not enough time within a compact curriculum to integrate in lectures about critical aspects of our career.  For argument’s sake, let just agree that that is true, making the next opportunity to learn about these career facets once you start your clinical experiences.  My question is: Have you had the experience of a teacher, preceptor, mentor or supervisor taking the time to give you solid career training?  Mostly likely, your answer is no, and that is one of many opportunities lost.

Maybe our clinical training time is not the optimal to learn about and absorb information on compensation plans, 401k investment options, continuing medical education (CME), burnout prevention or any of these things.  Perhaps our mental bandwidth doesn’t allow for concurrent learning of clinical and career skills, and we just need to focus on getting to Day 1 of our new careers, and then will figure it out.  Our employer will be there to act as our financial and well-being fiduciary, guiding us onto the optimal career path, right?  Well, maybe not.

Tell me if this sounds familiar: 

You’re excited and anxious about starting your new job, and your new employer sets up a whirlwind of an orientation.  You are introduced to your new colleagues, meet with HR, sign a mountain of paperwork, and then get set up at your new workplace.  During these hectic first few days, you’re so focused on getting to Day 1 that you can’t even recall what health insurance plan you signed up for, which 401k plan you chose, the details of your compensation plan, or which resources you have for burnout.  All you have to show from your orientation is that folder briming with paperwork and flyers, much of which is impossible to decipher.  You were told that you can always change the elections that you’ve made, once per year during open enrollment.  So, between the ability to do that and those optional meetings with the Fidelity representative, you convince yourself that you’ll be able to figure out these complex issues, but just after you start.

Then comes day 1, and you realize that being in the medical field is quite demanding.  The tasks are complex, consequences of making a mistake dire, and support not as present as you hoped for.  Within those first formative years of your career, the learning curve is steep, and commands most of your attention.  The months and years pass, with each open enrollment coming and going, your financial advisor telling you to stay the course, and that life-work balance not quite where you want it. Nonetheless, you soldier on and vow to figure out how forge your best path forward.

Perhaps you decide that you deserve a raise, but yet don’t know the optimal way to do this?  Or, perhaps you get inspired to better understand your 401k, but get so overwhelmed by the details that you decide to stay the subpar course that you’re already on.  Or, perhaps you want to take control of the burnout that is setting in, but yet don’t know strategies to start the healing process?  If any of this sounds familiar, then you’re not alone, and need to understand that much of this is not your fault or evidence of your inability to hack it.

How can we be expected to thrive in our careers if most of us do not even receive training on critical aspects of our career foundation?  What saddens me is that our ignorance on professional training is causing us harm.  This is evidenced by the burnout epidemic, huge chunks of retirement savings being siphoned away by predatory practices, crippling loan debt and healthcare workers feeling disenfranchised. 

The good news is that there is way to forge a better career path.  There are many things that you can and should be doing on your own, which can serve to empower you to live your best life.  But the onus of responsibility is not just on us as individuals, and should be shared with our medical institutions.  What we need is more educational and healthcare institutions making career training a priority, taking actions to standardize and improve upon this.  Fortunately, some well-renowned public and private establishments are helping us move the needle towards better well-being for medical professionals. 

What I’d like to see is a more pragmatic approach to career development, with practical and meaningful actions being taken to relieve the burden of harm being done to us caregivers.   I’d like to see more institutions swearing to fulfill, to the best of their ability and judgment, with “warmth, sympathy and understanding”, a pledge to improve the lives of medical professionals in order for us to “enjoy life and art” as we so deserve.  And in doing so, may these institutions “experience the joy of healing those who seek their help.”

Want to take some steps forward in your career? Check out The PA Blueprint, where we cover the most pertinent aspects of a career in medicine: Burnout, compensation, loan repayment, retirement accounts and more.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) Remember when I said “Call me MDCalc?” Well, as it turns out, they did, and we have entered into an affiliate agreement. By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #thePAblueprint #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

LEARN ‘N LEVERAGE: BURNOUT (PART 7) –PREVENTION

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Before you just right into Burnout Part 7: Prevention, I’d like to bring attention to this NYT article on Burnout, from 4/30/21. While I agree with the content, these articles are too brief for a good understanding of burnout, and leave us with only a few actionable items. Given that this was an epidemic amongst medical professionals before the pandemic, and likely is at an all-time high now, Jordan Fisher and I dedicated an entire chapter on Burnout in “The PA Blueprint” (early release sale here). In our chapter, we discuss the nuts ‘n bolts of burnout, including signs and symptoms, and then spend the majority of the chapter discussing treatment and prevention. Below is my gift to you: the entire Burnout prevention section. Enjoy, and thanks for your support with the book!

HOW CAN YOU PREVENT BURNOUT?

Now, if you have successfully treated your burnout, or are in the process of doing so, you should be considering ways to keep yourself protected from having a recurrence. The best way to prevent “future you” from once again experiencing burnout is by transitioning from a reactive to a proactive mindset, and also from a fixed to a growth mindset

“An ounce of prevention is worth a pound of cure.”

-Benjamin Franklin

Ben Franklin’s words are a powerful reminder when it comes to burnout. Prevention, although not a guarantee that you will be immune, acts similarly to a vaccine: It makes you less likely to develop the problem in the first place, but can also decrease the severity of a case. 

Prevention is often thought of as a passive and defensive strategy, and although there is absolutely a protective and insulating element to it, you also need to go on the offensive. Take yourself out of the “helpless victim” mindset and into a “master of your destiny” mentality. You can go from feeling like the puppet to feeling like the puppeteer. Even within the medical systems that you find yourself in, all you will need is to learn the nuances of the systems, deconstruct them, and then re-engineer them by tailoring a strategy to fit your needs.

The way to do this is to look at both the causes of burnout and your “DRAIN vs. RECHARGE” list (see this previous post). We’ve already talked about the easy part, rebalancing your scales through this metric. Now, let’s move on to the offensive and talk about flipping the script on causes. 

Have another look at the Mayo Clinic’s causes for burnout, listed earlier in this chapter. Each “cause” is not a dead end; there are many potential solutions if you look at the list through the lens of how you can flip the script.

  • Cause: Lack of control. Solutions: Take control. Be like a stoic, and focus on what is within your control. If you’re a Type A personality, which I’m willing to bet the majority of you are, then focus on some factors that you can control, such as EMR efficiency, healthy eating choices, improving the dialogue in your head, and perhaps limiting time spent with the “angry elves” in your office.   
  • Cause: Unclear job expectations. Solutions: Clear up those job expectations. Ask your office manager, medical director, or whomever is in a leadership position just what exactly is expected of you, and demand specifics.
  • Cause: Challenging dynamics in the workplace. Solutions: Improve those office dynamics. Work to improve your relationship with your boss, coworkers, etc…be the change you wish to see. Send a note of “Thanks,” commend someone for their thorough documentation, or schedule a time to have 5-10 minutes with a coworker. Break down those barriers.
  • Cause: Extreme demands on energy. Solutions: Moderate the activity extremes. Keep in mind that your attention requires energy, and that is finite. If work is slow, don’t fill that gap in with checking Instagram, but instead fill it with silence or something from your RECHARGE list. If work is crazy busy, plug the energy-leaks found in your DRAIN list and minimize the damage. Focus on your breathing, lean on your efficiency systems and be aware of the stories that you may be telling yourself. 
  • Cause: Lack of social support. Solutions: Take concrete actions to build your social support network. Randomly message a colleague with a compliment. Join a committee at work. Deepen the relationships with your coworkers. Find a support group online. Schedule time to chat with your most supportive friends and family.
  • Cause: Life-work imbalance. Solutions: Focus on finding your personal balance point. “Know thyself,” including your own signs and symptoms of burnout. Set clear boundaries and defend them mercilessly. Be intentional about how you spend your non-clinical hours.

Similarly, we can reconsider the Medscape National Physician Burnout & Suicide Report 2020 with the flip the script mindset, to focus our burnout prevention efforts on a few priorities:

  • Cause: Excessive bureaucratic tasks. Solutions: Decrease time spent on bureaucratic tasks. Delegate paperwork to others. Minimize distractions. Batch bureaucratic activities. Increase EMR efficiency and proficiency.   
  • Cause: Too many hours at work. Solutions: Work fewer hours. Say “NO” to extra shifts. Schedule stretches of consecutive days off. Minimize work time spent outside of clinical shifts.
  • Cause: Lack of respect from colleagues. Solutions: Demand and earn more respect from colleagues. Be consistent and calm. Grow your medical knowledge and let that show. Lead by being an example of what work-life balance should look like.
  • Cause: Increased use of EHR. Solutions: Decrease time spent with EMR/EHR. Use Dragon to dictate. Take a FREE EMR proficiency class through IT. Get FREE EMR training as a Super-User in your specialty and then teach others.
  • Cause: Insufficient compensation. Solutions: Get paid more. Go above and beyond what is required (and document examples). Be a leader. Improve your billing and coding skills. Reread your compensation plan, deconstruct it, and re-engineer it to allow you to earn more money. (Read the COMPENSATION chapter of this book for a deeper dive, along with resources and tips.)
  • Cause: Lack of control/autonomy. Solutions: Gain more control and autonomy. Stay focused on what is within your control. Go on the burnout prevention offensive. Keep up on your CME for clinical confidence.

Some will read these lists and think “Sounds like a PA fantasy world, but it’s not realistic.” While it is true that the medical-industrial complex is only recently recognizing the burnout epidemic, there are practical steps that you can take, in conjunction with small changes via reframing your cynical outlook, to make the system work for you. 

Finally, let’s look back at this Mayo Clinic list of burnout-associated statements and flip the script to create some thriving-associated statements:

  • Problem: You identify so strongly with work that you lack balance between your work life and your personal life. Solutions: You identify not solely as a PA, but as a multi-dimensional being who works as a PA. You value the importance of balancing your personal and professional life, for sustainability and for health. You leave work at work, as much as possible.
  • Problem: You have a high workload, including overtime work. Solutions: You set clear work boundaries. You advocate for yourself, take small steps to decrease your work burden, and are thankful for the ability to change jobs if necessary.
  • Problem: You try to be everything to everyone. Solutions: You understand and accept your limits. You remember “everything to everyone” is an impossible goal and remind yourself that doing your best is enough. You know your capabilities and are mindful not to overextend yourself. 
  • Problem: You work in a helping profession, such as health care. Solutions: Physician, heal thyself. You value helping others, but appreciate that you cannot give what you don’t have yourself. Remember, you need to put your own oxygen mask on first before you can be of help to others.
  • Problem: You feel you have little or no control over your work. Solutions: Put your energy where it counts. You appreciate that, although you cannot control everything, you are empowered to focus on the aspects where you do have control, and put energy towards those.
  • Problem: Your job is monotonous. Solutions: Appreciate the little things. You find or intentionally cultivate tiny wins and novel experiences each and every day, and then celebrate them. You see every day as a scavenger hunt for the extraordinary and beautiful. 

Some causes of burnout are likely to be beyond our control (such as “reimbursement rates for services rendered”), so there is little sense in focusing on those. Instead, it’s best for you to focus on the things you can change, keep your expectations reasonable as you build your prevention strategies, and then take small, manageable steps to strengthen your resolve and resilience as they apply to burnout.   

One way of looking at the process of positive change, which we highly recommended, comes from the best-selling book “Atomic Habits” by James Clear. The overarching message is to aim for making yourself 1% better than the day before. These “atomic” changes, via new habits and systems, will amount to exponential benefits when implemented consistently over time. By simply adding in one new EMR template, taking 5 minutes of quiet time during your workday, or reconnecting with your curious PA-S self, you have moved the needle by 1% in the right direction, and need to acknowledge and celebrate that fact. No good deed should go unappreciated, and your future self will be saying “Thanks.” 

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #thePAblueprint #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

THE PA BLUEPRINT: BOOK PREVIEW

Fellow PAs and other medical professionals: We are just about at the finish line and ready to publish “The PA Blueprint”, and below you see a brief preview of the PDF version.

OPPORTUNITY:

We are looking for medical professionals who are interested in a HUGE discount on “The PA Blueprint”, in exchange for a review. If you are interested, email us: thepablueprint@gmail.com. We will send you a discount code and ask that you send us a review within 5-7 days.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #thePAblueprint # author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

“THE PA BLUEPRINT”: A CAREER-CHANGER, COMING SOON

As the saying doesn’t go: “When life hands you a pandemic and leaves you with a lot of time on your hands without the ability to do much, connect with a former student and write a book to improve your profession.”

Well, I took that great advice that nobody has ever said, and ran with it, connecting with another PA-author, Jordan Fisher, whose previous work, “Physician Assistant Next Steps”, is an excellent resource for PA students about to graduate.

“The PA Blueprint: your guide to career advancement, getting rich, beating burnout and finding your dream job” is a resource for PAs and other medical professionals that can and should be used to get what you want and deserve out of your career. In the 100+ pages, packed with hundreds of hyperlinks, tips, hacks, anecdotes and action items, we cover the following:

  1. Compensation.
  2. Loan Repayment.
  3. Retirement Accounts (401k, 403b, etc.).
  4. CME.
  5. Burnout.
  6. Navigating Your Work Environment.

Jordan and I thought that these were the post pertinent topics to cover, and are dimensions that, when you get them right, lead to exceeding your goals and designing of the career path of your choice. I like to think of these career-facets as the foundation of your career, and also as having the potential to make you “pandemic-proof” in the future.

“The PA Blueprint” will be out next week, which I’m excited to announce. It will be available via ebook and PDF, given that the resources contained with it, such as the hyperlinks, do not lend themselves to a hard copy. Our website is www.thepablueprint.com, but is under construction still, with some last minute changes being made.

We are also booking presentations for PA programs across the country, establishing ourselves as a critical piece of the professional education necessary for new clinicians. If you’re interested in this for your PA program, let us know, as we are offering this for FREE still:
efficientclinician@gmail.com

If you’ve liked reading this blog so far, this has just been the beginning, where I’ve cut my teeth and also gained the momentum to tackle larger projects with even bigger impact. Cheers to my readers for their contributions so far, and I encourage you to come along with me for whatever comes next.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #thePAblueprint # author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

LEARN ‘N LEVERAGE: BURNOUT PART 6

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HOW CAN YOU TREAT BURNOUT?

Unfortunately, there is no “secret sauce” or “silver bullet” to treat burnout. Just as unfortunate, if you sit back, feeling like a victim of your circumstances, waiting for your employer to swoop in and save you from this epidemic, it’s going to be a rough and disappointing ride. If you have diagnosed yourself with burnout, then it is time for action.

First of all, you should also be filling out a PHQ-9 (free versions here or here) and pay attention to the recommendations in the scoring. Secondly, you need to take action on this issue, STAT, before you continue to spiral downwards.

PRO TIP: If you are depressed and/or burned out, and work within a larger healthcare organization, consider starting with a call to HR to get connected to your Employee Assistance Program (EAP) network. You can usually get FREE help this way

If you are scoring high on the PHQ-9 and not sure where to turn, start here or here.

Remember part of our definition of burnout included this: your batteries are drained and you are unable to recharge them fast enough to keep up with the demands on your energy (mental, physical and emotional). You need to get back to an energy homeostasis, by tipping the scales in a net positive direction. Here’s the best way to start: take a binary inventory of your personal and professional life, dividing everything you can think of under the following headings: DRAIN vs. RECHARGE. If an activity tends to “drain” your energy, then list it underneath DRAIN,” and if an activity tends to recharge your energy, then list it underneath “RECHARGE.” Be brutally honest here, as you only sabotage your healing process with anything but the truth. The table below is an example of how this exercise may look:

DRAINRECHARGE
Spending time on social mediaSpending time with friends/family
Work meetingsSleep
EMR documentationLifting weights
Being a weekend warriorTaking a walk
Alcohol (restless sleep)Meditation
Seeing difficult patientsReading for pleasure
Working with burned out colleaguesOutdoor recreation

If you are burned out, then your life is imbalanced and weighted too heavily by energy DRAINS. These activities need to be cut out, or at least scaled way back, as continuing them will impede your progress, as well as leaving you susceptible to burnout in the future. Between eliminating and scaling back these energy DRAINS, you should be able to find some additional time and energy to reallocate to those activities in your RECHARGE category. The more aggressive you are in your choices and actions, the faster you will dig out of the burnout state that you find yourself in.

SIDE NOTE:We know you inherently understand the basics of this energy concept, given that you are likely reading this Ebook on a smartphone, tablet, or laptop. Once these electronics are unplugged and put to work, the battery life starts to drain, and the rate at which this happens depends on the demand you are putting on it. At some point, your device will need to be plugged in to recharge, and you understand that it will recharge fastest if you eliminate or minimize the energy demands during that time (like turning the screen off). Now, think about how that analogy applies to your personal energy management.

You may be thinking “My life is too complicated, and these recommendations are overly simplified.”  Well, life is often complicated and complex, but that is usually a result of the decisions we make, both large and small, active and passive, conscious and subconscious, but you can simplify your life by making some intentional decisions. Do not forget that you are empowered to be in control of your life, including digging yourself out from burnout, and it all starts with the one simple step of making your “Drains vs. Recharge” list. Let us also not forget Occam’s Razor, the problem-solving principle that influences our medical decisions during every shift, which tells us that the simplest explanation is usually the right one.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #thePAblueprint #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

LEARN ‘N LEVERAGE: BURNOUT PART 5

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HOW DO YOU KNOW IF YOU ARE BURNED OUT?

Self-awareness is the best way to know if you are burned out, but you can also be deceived by the slow-burning nature of its effects.  In addition, it is easy to subjectively overstate your level of burnout, rendering self-reporting marginally reliable.  Sadly, some individuals will wear their burnout as a badge of honor, and look for validation like something out of the “misery loves company” playbook. (HINT: Resist the inclination to be that polarizing personality that creates a tense and negative working environment)

The best way to self-assess your level of burnout is to remove yourself from your circumstances, figuratively and literally, and then put your $116,773 education to work.  It’s simple: Employ your medical training as you would with any patient interaction: by collecting both subjective and objective information, and seeing if it supports or refutes the diagnosis of burnout.  You know how to do this.

(WARNING:  Medical professionals do not always make the best patients, and could very well play the “(emotional) pain out of proportion to exam” role.)

Subjectively, try to limit bias and run through an HPI on yourself to bring awareness to the history and symptoms of your condition.  Objectively, you can use one of the tools for burnout measurement, from a list of the most valid and reliable found HERE, or from a resource provided by the AAPA, found HERE.  

(PRO TIP:  The Maslach Burnout Inventory (MBI) is the gold standard, but costs money to access, so grab a free tool that you like, as it is best to use it at regular intervals for trending…much like the PHQ-9 or GAD-7.)    

So, as we ask ourselves within our practices each and every day:  Does the subjective and objective information concur and make enough of a case to diagnose yourself with burnout?  If so, just accept it (remembering that approximately 50% of PAs will go through the same experience), without judgment, as the temporary state you are in.  If not, I encourage you to stay tuned, as my future posts may teach you something to help diagnose and treat a possible future episode of burnout.

PERSONAL EXPERIENCES:  In the spirit of Sesame Street’s theme of “Sharing is Caring”, I wanted to convey my experiences with burnout, and how I know when I reach that point:  In addition to the symptoms listed in the “WHAT ARE THE SYMPTOMS OF BURNOUT?” section, my experiences with burnout typically manifest as frustration and anger, with increased sighing and cursing (not directed at anyone, but more as WTF?, as small problems seem like an assault to my sanity).  Other signs and symptoms that have manifested are an increased sympathetic response (Pavlovian response to my setting), cerebral pulsations, ear ringing (tinnitus), slurring of words (dysarthria), debilitating brain fog, difficulty with word finding (anomia) and nearly uncontrollable urges to eat junk food and drink alcohol.  If I had three 12-hour shifts in a row, I could feel that by day 3, I was starting the day with my batteries significantly depleted, which made the threat of missing that atypical MI or other subtle finding seem VERY REAL and VERY SCARY.  It also would sometimes take days to recover, and I would be physically and mentally exhausted, and the bipolar nature of that cycle felt punishing.  I now work in an environment with less stress and more predictability, and rarely feel such burnout symptoms.  

In others, I’ve seen extreme versions of burnout manifest as yelling at cars filled with patients that are about to check in right before closing, blowout arguments with other staff, crying, providers leaving shifts early, along with sarcastic and habitual responses of “Living the Dream” when asked how they are.  If some of these examples sound familiar, then you just might be burned out now, and it is time for action.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

LEARN ‘N LEVERAGE: BURNOUT PART 4

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WHAT CAUSES BURNOUT?

Often overlooked, the mental conditioning from our “mini-medical school” training as PAs acts as a primer for future burnout.  Especially during our clinical rotations, we witness countless medical professionals who are burned out, and their work ethic and traits are silently absorbed by us impressionable PA students.  Although his work is primarily with physicians, Dr. Dike Drummond from www.thehappymd.com states that clinicians are commonly programmed to take on the following roles throughout their training:  Workaholic, Superhero, Perfectionist or Lone Ranger.  You can read more about this concept HERE, but the bottom line is that you may have subconsciously been trained to take on one of these unsustainable roles, leading to burnout.  

In addition to our PA school training and indoctrination into the world of medicine, the causes of burnout while practicing are multifactorial.  The Mayo Clinic states that the following issues are the heart of burnout (click HERE for more information):

  • “Lack of control. An inability to influence decisions that affect your job — such as your schedule, assignments or workload — could lead to job burnout. So could a lack of the resources you need to do your work.
  • Unclear job expectations. If you’re unclear about the degree of authority you have or what your supervisor or others expect from you, you’re not likely to feel comfortable at work.
  • Dysfunctional workplace dynamics. Perhaps you work with an office bully, or you feel undermined by colleagues or your boss micromanages your work. This can contribute to job stress.
  • Extremes of activity. When a job is monotonous or chaotic, you need constant energy to remain focused — which can lead to fatigue and job burnout.
  • Lack of social support. If you feel isolated at work and in your personal life, you might feel more stressed.
  • Work-life imbalance. If your work takes up so much of your time and effort that you don’t have the energy to spend time with your family and friends, you might burn out quickly.”

Less abstract and more concrete, the Medscape National Physician Burnout & Suicide Report 2020 surveyed more than 15,000 clinicians and found the following burnout contributors:

Many of the causes of burnout are systemic and not due to problems associated with you as an individual.  Now, before you put down your copy of Angela Duckworth’s “GRIT and let yourself completely off of the burnout hook, you will need to learn how to optimally navigate the systems you entered when you became a PA.  The questions you need to ask yourself are “How does this system work?”, followed by “How do I make this system work for me?”

BIG PICTURE:  The causes of burnout have been well documented at this point, but the knowledge of these causes alone is not going to treat or prevent burnout.  The data and your experiences need to serve you, and the best way to leverage them is by learning, deconstructing, and then re-engineering the burnout process.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) I don’t earn any money from the hyperlinks that I’ve included, but I’d like to some day.

KEYWORDS: #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

LEARN ‘N LEVERAGE: BURNOUT PART 3

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According to this article by Essary, et. al: “…small studies suggest that rates of burnout among PAs may be similar to rates among physicians, between 34 percent and 64 percent.”  Put another way, burnout affects half of all PAs, and according to this article by Shanafelt, et. al., these rates are higher than that of most other professions.

Within the medical profession, the following demographics and features may increase the likelihood of burnout:  

  • Specialty (Emergency Medicine, Primary Care, Hospice and Palliative Care, and Oncology are shown HERE to have the highest rates for PAs)
  • Female gender (shown HERE)
  • Age (Generation X, 40-54 years old, has the highest rates — shown HERE)

The Mayo Clinic states HERE that if you agree with the following statements, you may be at an  increased risk of developing burnout:

  • “You identify so strongly with work that you lack balance between your work life and your personal life.
  • You have a high workload, including overtime work.
  • You try to be everything to everyone.
  • You work in a helping profession, such as health care.
  • You feel you have little or no control over your work.
  • Your job is monotonous.”

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) I don’t earn any money from the hyperlinks that I’ve included.

KEYWORDS: #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

LEARN ‘N LEVERAGE: BURNOUT PART 2

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WHAT ARE THE SYMPTOMS OF BURNOUT?

Knowing the concept and definition of burnout is one thing, but it is more important to understand and recognize the common symptoms.  Unfortunately, it may be easier to recognize these symptoms in observing others, and you may have witnessed some extreme examples in professors, colleagues, preceptors or other medical professionals.  Although your burnout may manifest somewhat uniquely, here are the most common symptoms associated with burnout, according to THIS article from the Mayo Clinic:

  • Fatigue
  • Headaches
  • Insomnia
  • Sadness
  • Anger or Irritability with patients and colleagues
  • Cynicism
  • Depersonalization
  • Lack of motivation
  • Decreased job satisfaction
  • Increased anxiety
  • Difficulty concentrating
  • Substance use/abuse

Symptoms will differ among individuals, and it is critical to know how your symptoms of burnout may manifest.  It is also vital to recognize that symptoms typically develop slowly over time, often undetected until a critical threshold, such as seen in the fable of the frog in the boiling pot.  Much like the maladies that we diagnose and treat in our patients, emphasis on prevention and early detection are critical for the best outcomes.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) I don’t earn any money from the hyperlinks that I’ve included.

KEYWORDS: #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance

LEARN ‘N LEVERAGE: BURNOUT

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WHAT IS BURNOUT?

According to Christina Maslach, psychology professor and creator of the gold standard for burnout assessments (Maslach Burnout Inventory, or MBI):

“Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. The three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.”

The American Academy of Physician Assistants (AAPA) takes these three dimensions a bit further (click HERE for the AAPA Burnout Blueprint):

  1. Emotional exhaustion“represents the individual level of burnout that includes feelings of being overextended and depleted of one’s emotional and physical resources.”
  2. Cynicism“signifies the interpersonal level of burnout that includes negative or detached responses to various aspects of work.”
  3. Reduced sense of personal accomplishment“characterizes the self-evaluation of burnout that includes negatively evaluating oneself and feeling dissatisfied due to lack of achievement and productivity on the job.”

According to the AAPA’s Joint Task Force on Burnout: Burnout Fact Sheet: “Clinician burnout is related to negative healthcare and personal outcomes, including but not limited to:

  • Increased rates of medical errors or being named in a malpractice suit. 
  • Patient outcomes including healthcare-associated infections.
  • Patient mortality within intensive care, and reduced satisfaction. 
  • Increased healthcare costs and clinician turnover.
  • Alcohol abuse, suicidal ideation, depression and anxiety.”

On the flip side of identifying what burnout is, it’s equally as important to identify what it IS NOT.  First and foremost:  BURNOUT IS NOT YOUR FAULT.  It is not a result of a character flaw, lack of effort or resilience, personal weakness, catalyst for self-loathing, call for 10 more minutes of meditation per day, or inability to “hack it”, and it definitely IS NOT proof that you don’t belong as a PA (aka imposter syndrome).  It is not helpful to assign blame, nor to start down a shame-spiral because you find yourself burned out.  It is a temporary state, with multifactorial roots, when the stressors of our professional lives have overpowered our coping mechanisms.  Simply put, it is when your batteries are drained and you are unable to recharge them fast enough to keep up with the demands on your energy (mental, physical and emotional).

BURNOUT = ENERGY DRAINS > ENERGY RECHARGE     

Burnout is also NOT the same as depression.  Despite the fact that both can occur simultaneously, and can overlap in their symptoms, remember that burnout is, according to the ICD-11, an “occupational phenomenon”.  Depression, on the other hand, “extends to social, occupational, and everyday functioning, not just one’s job”, according to THIS article by Psychology Today.  PAs experiencing burnout may think “Work has been brutal, I might need to change jobs soon”, as opposed to PAs experiencing depression, who may think “Life sucks right now, and everyone can see that I’m a failure.”  If your work-related stressors become pervasive throughout other dimensions of your life, and you start to internalize negative feelings against yourself via sweeping generalizations about your character, then you likely have crossed over from burnout to depression, and need to address this STAT.

BURNOUT ≠ DEPRESSION

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) I don’t earn any money from the hyperlinks that I’ve included.

KEYWORDS: #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance