Taking care of your patients and your staff consumes vast amounts of your time and energy, as it probably should. Your practice’s success depends on providing excellent care for your patients and ensuring staff are happy and productive.

Yet, you may not give the same attention to your own well-being. You may skip lunch, work late, not attend professional conferences and in general neglect your own needs. Ultimately, those kinds of behaviors may lead to burnout and harm your ability to care for patients and provide for staff.

In this article, we’ll examine burnout, including the lasting impact of COVID, and discuss ways to prevent or mitigate burnout. First, let’s discuss how often it’s experienced.

OPHTHALMOLOGY NOT IMMUNE

More ophthalmologists seem to be talking about burnout, says Scott LaBorwit, MD, chairperson, medical advisory board, Vision Innovation Partners, Elkridge, Md., and assistant professor of ophthalmology, part-time faculty, at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine. He’s even noticed some exhaustion in training physicians with whom he works.

“By the time they start working, it’s almost like they have a little less fuel in the tank to get going,” he says.

That ophthalmologists are experiencing burnout is backed up by the study “Physician burnout in ophthalmology: U.S. survey” published in the June 2022 issue of the Journal of Cataract & Refractive Surgery. Of the 592 ophthalmologists responding to the survey, 37.8% self-reported symptoms of burnout, the study found. On a positive note, most of those reporting burnout were categorized as mild (65.2%), followed by moderate (29.5%) and severe (5.4%).

Although ophthalmology has been regarded as one of the best fields in medicine for work-life balance, the study shows that “ophthalmology is not immune to burnout,” says Leonard K. Seibold, MD, professor and director, glaucoma fellowship, department of ophthalmology, University of Colorado School of Medicine, Aurora, Colo. Still, he was somewhat surprised that more than one-third of the survey respondents in one of the better lifestyle professions in medicine were still prone to burnout. Dr. Seibold, one of the study’s researchers, notes that ophthalmologists tend to work more routine office hours, most of the work is not emergent, and the ability to improve vision is incredibly meaningful to patients, leading to a good deal of fulfillment.

The survey was conducted in January and February 2020, just before the start of the COVID pandemic. Today, 3 years later, “I wouldn’t be all that surprised if [things] weren’t significantly worse because all of the stressors and factors that contributed to burnout before the pandemic are likely still there with the addition of many other work stressors,” Dr. Seibold says.

WOMEN AT RISK

When it comes to being at risk for burnout, the survey found that two groups were most susceptible: “Specifically, female physicians and employed non-owner physicians practicing in academic or hospital-based facilities were at the highest risk for reporting burnout,” the study found.

It may be that women are more likely to report burnout compared to men, who may be more reluctant, Dr. Seibold notes. In addition, he speculates that female mentorship may be less available. Men and women also differ in how they report the experience of burnout.

“In other studies of burnout, men tend to report more of the depersonalization aspect of burnout, whereas women tend to report more of the emotional exhaustion piece of burnout,” says Dr. Seibold.

THE SIGNIFICANCE OF SETTING

When it comes to burnout, the setting where an ophthalmologist works makes a difference, as the study reveals. “In other fields of medicine, they’ve shown that physicians in academic practice were somewhat less likely to experience burnout. Whereas in our study, we found that physicians who were in academic, employed or a hospital-based practice were actually significantly more likely to report burnout compared to those in a private practice setting,” says Dr. Seibold.

Physicians employed in academic or hospital-based facilities reported higher rates of burnout compared with large private groups, according to the study results. Similarly, employed physicians reported higher rates of burnout when compared with physicians who owned their practices.

Ophthalmologists in private practice, notes Dr. Seibold, enjoy more autonomy and have control over their work environment and staff.

“They’re more able to modify their workload if something isn’t working well for them. They have direct input and control in changing that,” he says.

Physicians who work in academic, employed or hospital-based positions, however, lack such autonomy. For them, the process for change is often very slow, Dr. Seibold explains. “They have to go through multiple layers of management to have something fixed or changed. If they don’t align well with their leadership, it can be even more difficult.”

Dr. LaBorwit agrees that ophthalmologists who have bought into a practice engage more with such activities as managing employees and buying equipment than employee ophthalmologists.

“They could feel and touch all those things,” he says. For ophthalmologists who are employees and don’t control such decisions, “that disconnect can be frustrating.”

COVID IMPACT LINGERS

The pandemic might be regarded as a double-edged sword for burnout. On the one hand, during the pandemic, notes Dr. LaBorwit, physicians couldn’t stop working or change to remote work (the option for some telehealth notwithstanding). “As physicians, we don’t really have that luxury. I think some doctors are just feeling a little more trapped or helpless, which I think contributes to burnout as well,” Dr. LaBorwit says.

The pandemic, of course, has led to staff shortages, making the job more difficult. “We still are seeing as many patients, if not more, now but with less staff,” says Dr. Seibold. “Our documentation, our burden in clinic has only gone up.”

On the other hand, the pandemic has spurred some ophthalmologists to recalibrate their work lives. “The one good thing that has come out of it is prioritizing wellness,” says Nicole Fram, MD, managing partner of Advanced Vision Care and a clinical instructor of ophthalmology at the Stein Eye Institute, University of California, Los Angeles (UCLA). “There was a surge of patients, but there was also a time for reflection that no one has ever had in the workforce,” she notes.

After returning to work, there was a sense that “it was not okay to neglect yourself,” she says. “It was important to have some of the time that we had during the pandemic.”

COVID provided ophthalmologists an opportunity to re-evaluate priorities, says John Berdahl, MD, an ophthalmologist at Vance Thompson Vision, Sioux Falls, S.D. “Now we’re going back to doing what we did before, but we realize that there’s an alternative reality that we could live in and maybe we want to,” Dr. Berdahl suggests.

In Dr. Fram’s case, the pandemic led to a significant restructuring of her professional life. Prior to the pandemic, multiple doctors in her practice worked at the same time seeing upwards of 60 patients a day for each doctor. Patients overflowed into the reception and dilating areas, which was chaotic and stressful.

After the pandemic crisis, Dr. Fram, who handles complex surgical cases, realized she didn’t want to practice in such a relentless, fast-paced environment. Today, she focuses on surgical consults.

“Seeing fewer patients didn’t mean making less money,” Dr. Fram says. “It meant working smarter, not harder. It meant figuring out ways to streamline my practice to surgical and move the comprehensive part of my practice to really competent optometrists who I trained and to younger associates.”

Now, she says, “I’m being utilized for what I think are my best talents. And that wouldn’t have happened as quickly without the pandemic.”

Today, Dr. Fram watches for signs of burnout, which for her means beginning to lose empathy. “If you’re really successful, then you’re busy,” she says. “And when you’re busy, colleagues and staff just want more and more and more. I was losing my empathy … I can feel it when it starts to happen.”

BEATING BURNOUT

Recognize the signs

Like many behaviors that can lead to illness, the first step in avoiding burnout involves awareness. Dr. LaBorwit likens burnout to glaucoma. “It has to be recognized early and solved because once it’s evident to others, it’s too late,” he says. “If it’s not properly identified or looked for, it can become catastrophic for a career.”

Physicians, he asserts, need to take ownership of awareness of burnout. “Only you can check on you. You have to be an advocate for yourself, looking in the mirror to check in on your happiness and well-being in your career so you don’t get to a burnout level.”

Take ownership

Besides awareness, ophthalmologists need to realize that they have the power to make changes. “Doctors have more control than they think,” Dr. LaBorwit explains. “Just knowing that you have control and input will allow you to modify things.”

For instance, he notes, if you’re missing lunch every day or are stressed because you continue to stay late at the office, you need to work with your administrators and figure out how to adapt your schedule. “Bulldozing your way through or showing up and just complaining is going to lead to burnout,” Dr. LaBorwit says.

Along those lines, Dr. Fram’s office changed a policy to encourage staff to take time off. With this new policy, they can roll over their vacation time but can’t be paid out for it.

“We have a policy in the office where we used to pay people if they didn’t take all their vacation time. We’ve stopped doing that because we want them to take vacation. We want them to not work from home when they’re sick. We have dedicated people here, but they were all burning themselves out because they were so dedicated to the patients and so dedicated to the doctors that they weren’t taking care of themselves.”

Find support

Another way to help avoid burnout is to connect with colleagues, for instance at conferences. “It’s ironic that taking the time to go to a meeting can help recharge you, but no one understands you like a fellow colleague,” Dr. Fram says. “No one understands what happens in the operating room like a fellow surgeon. No one gets it except for someone who lives it.”

Having a peer support system can help potentially protect against burnout, says Dr. Seibold. Going to meetings can help prevent isolation, he adds, especially for physicians who are in clinic 5 days a week and don’t interact as much with colleagues.

“If you’re feeling bad, it’s okay,” Dr. Berdahl says. “But seek a remedy, whether that’s talking to somebody or actually changing the circumstance of your environment.”

Dr. LaBorwit agrees, but he urges clinicians to resist the desire to complain too much. “Venting is okay, but it should be more about listening and learning. What are the decisions they’ve made? You have two ears, one mouth so make sure you use that ratio, because dumping doesn’t solve a thing.”

Seek joy

Perhaps the most important and meaningful way to avoid burnout centers around fulfilling your purpose, your passion and why you chose to become a physician in the first place.

Like Dr. Fram, Dr. LaBorwit decided to focus his practice on what he enjoyed. Some time ago, he realized that he didn’t get satisfaction out of doing routine exams and refractions. So, he stopped, giving up one third of his practice overnight in the process. Instead, he focused more on what he enjoys, which are surgical consults. “The only appointments on my book at this point are new patient consults,” Dr. LaBorwit says. He also will do cataract surgery.

“If you’re passionate about helping others and taking care of patients, then taking care of yourself first and being happy at work is the only way you’re going to be successful walking in exam rooms and having positive interactions with patients,” Dr. LaBorwit says. “If you focus and recognize what you’re passionate about, that’ll go a long way.” OM