An Approach to Managing the 3 Main Drivers of Burnout in Healthcare
Recently I interviewed Heather Fork, M.D., a well-known coach who has helped countless healthcare providers avoid burnout and successfully navigate career changes. I’m approached more often these days by physicians and other healthcare providers who are trying to manage the day-to-day and mounting stress of clinical careers, and so I wanted to interview someone who was actively involved in solving the crisis. Dr. Fork was kind enough to answer my questions below.
Dr Manejwala: So, what exactly is burnout?
Dr. Fork: One of my coaching clients, a pediatrician, described her burnout to me by saying, “I feel like I’m the scarecrow in The Wizard of Oz and someone has plucked all the stuffing out of me!” That image told me a lot about how depleted she was. Without her even knowing the classic definition of burnout, she knew she had it. The formal definition of burnout involves three components, emotional exhaustion, depersonalization (patients are seen in a more impersonal way), and a diminished sense of accomplishment and fulfillment.
According to surveys by the AMA, 54% of physicians are experiencing at least one sign of burnout at any given time.* There’s an epidemic of burnout that is not just seen in physicians, but across the board for many healthcare providers. Yesterday I received an email from a burned out physician assistant who was having to see 60 patients a day. It’s crazy what is happening in medicine. Who can enjoy seeing 60 people in a day, let alone provide personalized care?
Dr Manejwala: Why are healthcare providers prone to burnout?
Dr. Fork: You could make an elaborate Venn diagram with all the intersecting factors making healthcare providers prone to burnout, but for simplicity we can focus on 3 factors.
Number one - there is the work itself. Caring for patients is a 24/7, inherently stressful, demanding job with risk, and an ever-present threat of litigation. Chronic diseases and obesity are on the rise, at the same time that patients’ expectations have increased and doctors are being rated and ranked publically without being able to have their own input.
Number two - those who go into medicine tend to be more type A, be prone to perfectionism, and have trouble saying “No.” Many physicians are also motivated by a sense of loyalty. This can result in them staying way too long in jobs (or relationships) that are not healthy for them.
Number three - the pressure to see more patients combined with administrative hassles and a burdensome EMR are creating an environment that is burning out even the most dedicated individuals. Every week doctors call me in great distress, often in tears, because they feel trapped in a system where they are unable to be the kind of doctor they trained so hard to become. The dream that propelled them for all those years has literally become a nightmare.
Dr Manejwala: Why is it so difficult for healthcare providers to ask for and get help?
Dr. Fork: As healthcare providers, we see ourselves as the ones with the answers and the responsibility to be strong and without needs that get in the way of putting the patient first. In training, we learn to keep going when we’re exhausted, to come to work when we’re sick, and to jump when someone says jump. There’s a subtle but powerful message that it is weak to ask for help. Something must be wrong with us if we have to ask for advice, counsel, or medication, even though we’re providing this to others all the time.
In addition, there is the reality that a visit to a mental health professional could potentially compromise our ability to maintain our license, not to mention the stigma that still exists in seeking help.
Dr Manejwala: What are some non-clinical options for physicians who have experienced stress and burnout?
Dr. Fork: The first thing I often ask my clients is whether or not they can reduce their clinical hours. Many healthcare providers are working such long and tiring hours, that they can’t even think about or investigate non-clinical options. Once they have a little free time, doctors often explore areas such as:
Chart Review – remote work related to utilization review, benefits management, peer review, disability and workman’s comp
Teaching – medical schools, nursing or PA schools, community college, precepting, teaching for Kaplan
Physician Advisor – within a hospital system or for a third party company
Consulting – in healthcare, for pharma, medical device companies, equity firms, etc.
Entrepreneurship – having an online business, owning a franchise, real estate investing, inventing a product or device, etc.
Dr Manejwala: Why is coaching helpful to healthcare providers who are experiencing stress and/or burnout?
Dr. Fork: I think one of the immediate benefits of coaching for stressed out healthcare providers is to help them know they are not alone. We may look at our colleagues and assume they are doing fine and wonder what’s wrong with us that we “can’t hack it.” The truth is, many individuals hide their stress very well and it’s only when they get to the breaking point that anyone knows the inner struggle that’s been going on.
A coach will help with self-understanding, goal setting, and accountability to achieve one’s goals, while providing good support and an unbiased, listening ear. A coach who is experienced with healthcare providers specifically can assist with options and resources to custom design a more balanced and fulfilling way to practice, or alternatives to a different path. I have seen countless physicians find happiness again in their chosen profession. And I have also seen doctors pursue a variety of non-clinical directions that bring satisfaction and a renewed sense of service and joy. Just like in The Wizard of Oz, we can each find what we truly need to be happy.
Heather Fork, M.D., CPCC is a physician, coach, and the founder of Doctor’s Crossing, a firm that coaches physicians to avoid burnout and successfully navigate career transitions.