The Ultimate Guide to Combating Burnout

Do you feel stressed, overwhelmed, sense of depersonalization or lack of personal accomplishment?

Chances are that you are suffering from burnout.

Introduction

Symptoms of burnout may include decreased energy, easily irritable, decreased concentration, and decreased satisfaction from achievements. Other symptoms of burnout may be insomnia, unexplained headaches, body aches, stomach upset or other physical complaints. You may not feel like your usual self. If you find that you are using food, alcohol, drugs, or overspending to feel better, this may also indicate that you have burnout.

The prevalence of physician burnout is rising. According to a Medscape survey, about 50% of physicians reported feeling burned out, and in 2021, more than 70% of the physicians reported burnout.

The Five Stages of Burnout

1. Honeymoon phase – characterized by enthusiasm

2. Onset of stress
   1. Anxiety
   2. Headache
   3. Fatigue
   4. Change in appetite
   5. Reduced sleep quality
   6. Inability to focus
   7. Irritability
   8. Avoidance of decision making
   9. Decreased productivity
   10. Lack of social interaction
   11. Neglect of personal needs

3. Chronic stress
   1. Chronic exhaustion, persistent tiredness
   2. Feeling pressured
   3. Apathy
   4. Resentfulness
   5. Procrastination
   6. Aggressive behavior
   7. Denial of problems
   8. Feeling threatened
   9. Cynical attitude
   10. Social withdrawal
   11. Decreased sexual desire
   12. Alcohol or drug consumption

4. Burnout
   1. Chronic headaches
   2. Chronic GI problems
   3. Behavioral changes
   4. Other physical symptoms
   5. Obsession with problems
   6. Pessimistic outlook
   7. Self-doubt
   8. Social isolation
   9. Neglect of personal needs
   10. Escapist activities

5. Habitual burnout
   1. Chronic sadness
   2. Chronic mental fatigue
   3. Chronic physical fatigue
   4. Depression

Risk Factors for Burnout

There are usually multiple factors contributing to burnout. These can be divided into external and internal factors:

1. External factors (to name a few)
   1. Extended Hours – full-time physicians often work beyond the standard 40-hour work week.
   2. Time pressure – many clinicians (especially as employees) have a set amount of time to see a certain number of physicians in order to meet a certain threshold as determined by the institution.
   3. Lack of freedom to make decisions – usually the rules and boundaries are pre-set by administration.
      1. Hierarchy structure
      2. Administrative constraints

• Limited opportunities to participate in how the practice is operated

1. Lack of resources
   1. Staffing – especially in the Covid pandemic era
   2. Funding
2. The work environment structure
3. Work place bullying/abuse
4. Lack of Clarity about roles
5. Absence of social support

2. Internal factors
   1. Perfectionism – physicians are trained, and most believe that one needs to be perfect all the time.
   2. High expectation of oneself
   3. People pleasing – we feel the need to make everyone happy and satisfied.
   4. Suppressing own needs – we have long been taught to take care of patients/others first before anything else.
   5. Strong need for recognition
   6. Work as the only meaningful activity – physicians may feel that our work is the only thing that gives us meaning in life.
   7. Work as substitute for social life – physicians may consider it as normal to have all work and no play/no social life.

For more information, please visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604257/

Burnout – What To Do?

Many people react to burnout in anger and frustration. They try to control the world – whatever they feel lack of control in the work place, it is transferred to controlling at home or in their relationships. Some people may avoid the feeling of burnout, push it away, or hide it in some imaginary abyss in their bodies. The more you avoid it, the more the burnout is obvious. You start to obsess over it. It is spinning in your head. You perform a task and you cannot concentrate, so you have to go back to attempt it yet again. You feel like you are going nowhere. All these perpetuates that you feel burned out.

“Combat burnout” is probably not the best way to describe how to process burnout. “Combat” implies that you are resisting it and is bouncing it away somewhere – which, in reality, will bounce back to you even harder. Right now it is not quite the time to quit your job or to talk to the administrators in your institution. Instead, face burnout head-on. Look at it in the eye and look deep.

Step 1: Awareness

The first step to resolve burnout is to be aware of it. Notice the signs and symptoms of burnout (as discussed above). For most physicians, burnout is coming from work-related situations.

Don’t avoid or resist the feeling of burnout. Process it with compassion for yourself. Don’t beat yourself up by saying, “You shouldn’t feel burned out. It’s fine. You’re fine. This is no big deal.”

Be aware that there are intense and repeating thoughts about certain things which cause you to feel burned out. It is the mind that creates the burnout, and not your situations or circumstances. It is what you think about your circumstances that creates burnout.

Go to a quiet place, sit down, and say to yourself, “I am burned out and it is okay to feel it.” (The okay part is acknowledging what you are feeling.) Feeling is just a vibration in the body. You are not going to die by feeling a vibration in the body. That vibration eventually passes. However, indulging in feeling burned out will cost you to stay stagnant and not move forward.

Breathe in and breathe out. Dive deep into the burnout. Allow that vibration in your body. Does it come up as tightness in your chest, shaking of your body, burning sensation from inside out, tears pouring out, or some other physical representations?

Step 2: Ask yourself – What are the 3 main thoughts causing you to have burnout?

Acknowledge what you are thinking. There may be many thoughts associated with burnout for you, but let’s just focus on the top 3 thoughts.

Separate the facts from your thoughts. Facts are things you cannot change or control (at least at the moment – more about this later).

For example: Fact – you work 14 hours a day, 5 days a week.

• Physician A – Thought – 14-hour work day is too much for me to handle. This thought causes Dr. A to feel overwhelmed and stressed.
• Physician B – Thought – 14-hour work day is amazing, I get things done and I have time off in the weekends. This thought causes Dr. B to feel energized and excited.

A person may have multiple thoughts about one fact. Choose the dominant thought pertaining to that particular situation.

In step 2, we are still processing the burnout. We are not ready to get rid of the burnout just yet (as much as you want to do that eons ago). We are understanding it, understanding the thoughts causing it. We are feeling it. It is not comfortable, yet we are allowing it.

By allowing the burnout to be there, we take down the fear of having it. We can survive burnout.

Step 3: Identify the energy: What is the fuel we use?

Not all fuels are equal. Some fuels cause early depletion and rapid exhaustion. These are the “negative fuels”. Some examples are fear, frustration, greed and scarcity. Such fuels cause us to run out of gas faster, regardless of the number of hours we work. These fuels are not designed to sustain us. These negative fuels also interfere with our attention span, which will cost us to complete a task longer than expected. We may feel rushed, and stressed (added to the fact that we are taking longer to do things). Then thoughts which provoke stress come up – now it is not just the stress from your job but also stress in your brain. Sleeping is likely going to be affected. Imagine when you are sleep deprived, you don’t want to get up but a whole day of work awaits you. This vicious cycle perpetuates – all because of the negative fuels.

Fuels are stemmed from our emotions, from our feelings. Feelings are caused by our thinking.

Positive fuels energize us from a place without limits. Some examples are abundance, generosity, focused, calm and peace. These fuels keep us energized, and we work with full of passion. We feel the momentum to move forward, to complete tasks, to show up in the world and offer our help. We feel where we are supposed to be. We are present. Physically we feel better using this energy, and we are ready to take care of ourselves and serve others.

If you realize that you have a full tank of negative fuel – don’t panic! Find out in you, what are the thoughts you have that cause the feeling(s)?

The good news is, although most situations cannot be changed, or are difficult to change, we can control what we think about those situations or circumstances. It is not “wrong” to have negative fuel source, as it is about what we are thinking to generate it. Recognizing your thoughts about the situation cause the feeling and the fuel is a crucial step manage burnout.

Step 4: What are the actions we can take?

Go through steps 1 to 3 before arriving to step 4. Before taking any action, come from a place where you want to improve, you want a positive result, rather than because you are lacking something or running away from something. It is very important to ask “Why” you want to do these things. Here are some recommendations – by no means a comprehensive list; a good place to start.

1. Set boundaries – are we saying “yes” to anything and everything? Is it true that we have to say “yes” all the time? Are we saying “yes” because we don’t want to upset others, because we are avoiding any potential conflicts?

2. Time management –
   1. Charting – that’s a significant part of a clinical physician. Are there ways to cut down on the charting time?
   2. Phone calls – is there a way to limit the phone call times? Is it possible to have your staff return some, if not all, of the phone calls?
   3. Other administrative duties – Are we taking on more roles than we want? Is it possible to delegate any tasks?
   4. Plan out the day in advance.
   5. Plan some “free time” in your schedule – this is the time when you get to do whatever you want, to focus on yourself, to live the moment. The free time period can be 15-30 minutes. Make sure that is truly your own time without any interruptions.

3. Financial management –
   1. Examine what source(s) of income you have.
   2. What is your monthly expenditure? Examine your spending habits. What are you buying and why are you buying those things?
   3. Is it possible to have other streams of income?
      1. Stocks, side gigs, real estate investing, etc.

4. Work-Life Balance
   1. What is the ideal balance for you? Where are you at?

5. Before you decide to change your job or career:
   1. Is there anything you can do to improve your current situation? Ask! The worst is you’ll get a “No”, but it may be a “Yes”!
      1. Negotiate your contract
      2. Adjust your work hours

• Redefine your role at work