Nearly 2 years into the COVID-19 pandemic, many physicians, health-care executives and workers in the United States are experiencing extreme “burnout.” Physicians have long been managing existing issues of the administrative burden of practicing medicine — additional required documentation, pre-authorizations, downward pressure on physician fees — that have increased in recent years and are not going away anytime soon.

In addition, the pandemic, which has continued to rage in recent months, has only added fuel to a fire that was already burning. Some of the many consequences of the pandemic include massive staff shortages, upward pressure on employee wages and the daily health and safety concerns that many physicians face. Considering all of these factors, it’s easy to see why practicing medicine has become, for many, a less attractive profession than ever before.

This article is about getting in shape, mentally/emotionally, and developing healthy personal power as your internal driver to be better equipped to handle the very real challenges you face. This is accomplished by working inside out rather than being driven by the people and situations surrounding you. Developing resilience is building core strength to face problems proactively rather than reactively. Here, we’ll provide the common indicators of burnout along with practical tips on resilience development and burnout prevention.

RECOGNIZE THE INDICATORS

The first step to overcoming burnout is to recognize it. Some of the most common indicators of burnout include physical and/or emotional exhaustion; becoming cynical and overly critical towards oneself and/or others; and struggling to find enthusiasm, motivation and positive focus. Ongoing symptoms should prompt you to stop any self-defeating behaviors, escape the workaholic treadmill if necessary and reinvigorate yourself. The best remedy for burnout is a combination of healthy self-care and personal empowerment.

Unfortunately, most people make the mistake of looking primarily, or even exclusively, outside themselves to identify problems, such as a hard-driving supervisor, a difficult-to-please physician, disengaged staff and demanding, unappreciative patients.If this sounds familiar, you’re in good company — but, then again, “misery loves company,” so why not break out of the pack?

BOLSTER YOUR RESILIENCE

Psychologist, Donald Meichenbaum, PhD, is one of the founders of Cognitive Behavioral Therapy and was voted “one of the 10 most influential psychotherapists of the 20th century.” In his article, “We Are the Stories We Tell: A Constructive Narrative Perspective of PTSD,” he asserts that people do a number of unhelpful things when they are severely stressed or even traumatized. These actions have the effect of keeping people stuck where they continue to suffer painful, often debilitating symptoms, such as thinking of themselves as victims who lack control or sufficient personal power to overcome their circumstances and/or manage their difficult emotions.

Similarly, people who continue to struggle and suffer emotionally from burnout or worse tell themselves stories (ie, personal narratives) in which they are weak, ineffective and otherwise destined to live their lives with ongoing emotional distress, and ultimately as failures. Accordingly, they persist in living down to their own pessimistic expectations and predictions, therein demonstrating self-fulfilling prophecy.

Dr. Meichenbaum’s greatest contribution for resiliency development may be his concept of “building-blocks” to bolster resilience across six domains (physical, interpersonal, emotional, cognitive, behavioral and spiritual). These “pillars” can be developed as follows:

1. Building and making effective use of meaningful interpersonal relationships. This is especially important during times of challenge and duress. All truly great relationships are mutually empowering in healthy ways; therefore, resilient individuals are able to access people and resources who can provide emotional, informational and practical support, especially in times of great need, and they willingly reciprocate when “the shoe is on the other foot.”
2. Finding purpose and making sense of challenging situations. Usually based upon one’s faith and sense of spirituality, this helps people to remain more calmly focused and present so they can engage in problem-solving activities. This is in sharp contrast to people who remain stuck in their past, reliving their trauma or otherwise reexperiencing negative emotions that interfere with being more mindfully present and effective, here and now.
3. Increasing and making broader use of positive emotions. Using emotions such as optimism, acceptance, forgiveness, gratitude, humor and love enables us to reframe and redefine our stories, moving from narratives of victimization, failure and suffering to ones of redemption and healing.

AVOID STRESS AND BURNOUT

Understand and accept reality

Information is power, and acceptance of reality. No matter how unpleasant or unfair, information liberates energy being wasted in denying or avoiding the truth. If you are religiously inclined, you might follow the wisdom of the Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can and wisdom to know the difference.” Stay focused on playing your position, work within your wheelhouse and stop trying to change people and/or things beyond your control. Accept (holding your nose as necessary) and move forward!

Become non-defensive

By developing personal responsibility, genuineness and humility, you will become non-defensive. Be accountable for your choices with confidence and transparency. No one can make you do anything without your permission, so stop giving your power away to those who have learned how to push your buttons. Learn to be nonreactive!

Become mindfully present

Focus upon and engage in each and every moment. A past or future focus detracts from such engagement and limits your being present to others. As Eckhart Tolle has said, “Stress is caused by being here but wanting to be there.” Be here now!

Dare to dream

Have a sense of adventure and excitement about embracing appropriate risks. Faith in your dreams generates hope, and hope provides you and those sharing your dreams with energy for living and striving. Keep your eyes on the prize and look beyond, remembering that “this too shall pass.”

Walk to the beat of your own drum

Think, feel and act as the “driver” of your life. Honor yourself as the author and creator of your life by doing what is right for you, assuredly paying the toll when someone else disapproves. Instead of feeling trapped and bemoaning all the things you have to do, take charge by taking ownership of your choices and asserting what you need to do. Promote yourself to become “president and CEO” of your life!

Look internally for joy

Joy originates from deep within, while pleasures come from outside. Even healthy pleasures when overdone eventually steal our power. Hedonism — seeking pleasure, avoiding pain — is fraught with pitfalls that can trap and disempower us. Instead of going too far down such enticing but self-defeating paths (eg, overeating, abusing alcohol, compulsive gambling), finding appropriate ways to express love and joy will return in fulfillment and freedom.

Strengthen your social connections

Healthy interdependence creates a sense of wholeness, safety and fulfillment. I’ve found that about 90% of people respond well to appropriate ice-breaking invitations. Therefore, muster the courage to take the lead to connect well with others.

Become optimistic

Adopt a positive attitude, perspective and expectations. When you fail, bounce back with self-forgiveness and renewed faith that you will succeed, eventually, through perseverance. Remember, self-fulfilling prophecy works for or against us, depending upon our expectations. Be careful what you expect — you’re likely to be right!

Count your blessings with gratitude

Do not compare yourself and your life situation with anyone else’s. Failure to appreciate your blessings is the root of discontentment, a sense of want and painful envy. What you focus upon tends to expand, whether positive or negative, so focus upon the good people and things in your life to enjoy a positive expansion.

Find a purpose greater than yourself

When you find a purpose greater than yourself, and a mission for serving that purpose, you will avoid becoming self-absorbed or preoccupied with personal issues. Happiness flows from such unselfish, outwardly directed service, and refreshing, life-generating energy upwells within us far greater than that which we expend in such service.

CONCLUSION

We hope this article not only brings to light some of the statistics associated with burnout, but also provides some practice solutions for physicians and executives who are experiencing increased stress as we learn to live in a post-pandemic world. OM

James D. Dawes, MHA, CMPE, COE, is president and CEO of the J. Dawes Group.

Craig N. Piso, PhD, is president of Piso and Associates, LLC.