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.”
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.
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