New M.D.

Strategies to Combat "Burnout"

By Allen Chiang, M.D.

"I seriously think that physician burnout begins in residency," a co-resident said one day at lunch.

"But how is burnout different from just feeling exhausted? And is it avoidable?" I asked.

"I'm not so sure how we can really avoid it once it sets in. Ten years into practice it'll probably pretty much have taken over," she offered with a shrug.

Furiously busy clinic days are virtually the norm at our training program, but genuine discussions about burnout are more unusual. Perhaps it is our competitive type-A personalities, a lack of time or a shared but false assumption that our peers have it all together which are to blame. However, just the fact that we were discussing the problem was a step in combating burnout.

Drawing upon the wisdom and experience of several family members who are physicians and surgeons, as well as from some of my attendings, I've recently uncovered some other effective strategies to ward off burnout and wish to share them. Though conceptually simple, they can be quite challenging to actually implement.

Five Strategies for Sanity

Strategy #1: Don't neglect your other dimensions. Keep working hard on that academic knowledge and those surgical skills, but don't forget to be a whole person. Carve out a little slice of time each week for play as well as physical, mental and spiritual health; don't just hold your breath until your next vacation. For example, a chief resident of mine looks forward to refreshing personal time every Thursday night, with dinner at her favorite restaurant where the chef and regulars know her on a first-name basis.

Strategy #2: Maintain those vital relationships. All relationships require some investment in terms of time; focus on the ones that are invaluable to you. Find ways to incorporate your friends, significant other or spouse into your career and academic pursuits. For instance, my wife and I enjoy café hunting here in Los Angeles. She grades her students' exams and prepares teaching lessons while I study or work on research. We get a lot accomplished and manage to share some quality time over coffee or dessert.

Strategy #3: Remember why you chose ophthalmology. There probably has never been a more exciting time to be in this rapidly changing field of medicine. Sure, the grass may seem greener at times, but we are privileged to play with neat toys, perform elegant surgery and make a profound impact on the quality of our patients' lives.

Strategy #4: Focus on the patient, not just the pathology. As ophthalmologists, we are blessed with being able to visualize pathology firsthand and that allows us to maintain high clinic volumes. But over time, the clinic can begin to feel like a glorified sweatshop, especially for those of us in residency where resources and continuity with patients are limited. Nevertheless, taking a moment, however brief, to make a human connection with a patient won't detract much from clinic flow and will begin to define and differentiate you in a very positive way. In this way, it is possible to regain the joy and satisfaction that comes from caring for patients. One attending that I know of includes mini Post-It notes in the corner of each chart to remind him of a particular patient's hobby, interest or concern, in order to inquire or follow-up on it upon return visits. His patients praise him.

Strategy #5: Don't obsess about the money. We all have real financial concerns, especially those of us who are still in training, but we should seek to maintain a healthy perspective — our potential exceeds that of many other professional occupations. Even with the shifting healthcare landscape and threat of declining reimbursement, we are unlikely to ever be out of work. As one ophthalmologist appropriately put it, "money should follow you, like a shadow."

It's Something We Can Discuss

Chances are many of us will experience symptoms of burnout to some degree at one stage or another in our careers as eye physicians and surgeons. Perhaps by maintaining an open dialogue with fellow colleagues and encouraging each other with helpful strategies we can stave off burnout. OM