Burnout and Resilience
This article will appear in the April 2022 issue of FOCUS. Dr. Levy will be one of the plenary speakers for our 2022 National Conference. To register, go to www.cmdacanada.org/conference
Waking up one Saturday morning, I knew something needed to change. It was my only weekend off that month and I struggled to get out of bed. Eventually I got on my feet, but had no energy to do anything. I had no place to be since I had stopped making plans for my free weekend because of the frequent need to cancel due to emergency cases. Almost two years into my new job, I craved carbs and could think of nothing that would make me happy. What was the use of all my work? No matter how hard I tried, more patients kept coming and I couldn’t rest except during my annual two weeks of vacation. Emotionally exhausted and cynical, I questioned my decision-making at 2 am that morning when I had finished my last case. Life seemed meaningless. These were all the signs of burnout. Working six and seven days per week, I was hired because of my unique skill set as a neurosurgeon double-specialized in open and endovascular techniques. The ability to do brain surgery without opening the head made me very popular within a year of my arrival. Referrals came from several hours away. Over a year ago I had asked for someone to help me with the workload. “There is no budget,” I was told by my Chief, “but remember, we are all in this together. I’ll submit it for the budget next year. You are doing a great job. Keep it up.”
Monday morning I slowly made it to work and saw our Department Administrator. “I’m not doing well,” I said, “I need help. Why are we not able to hire someone? Why is there no budget when I asked over a year ago?” She looked at me strangely and tilted her head to one side as if she didn’t know what I was talking about.
“We have budget for a Physician’s Assistant or Nurse Practitioner to help you,” she said.
Incredulous, I queried, “We have enough in the budget to hire someone to help me?”
“Yes,” she said, nodding her head with a smile.
“Thank you,” I said, “Thank you for clarifying.”
She gave me the piece of the puzzle I had been missing. Suddenly, the situation became clear to me. The Department Chair had been deceiving me. He didn’t want me to have help. He was jealous of me because my rapid success had pushed him out of the limelight.
Burnout is often about more than the workload. In most cases, it has to do with lack of support or with draining relationships. Christians in healthcare, striving to be Christ-like, may see their that role is to give to the point of exhaustion. Those who burnout are typically persistent, fastidious, and overachieving. Take comfort if you are on the edge of burnout –– lazy people don’t burnout!
Workload is only one of the six categories contributing to burnout according to Maslach, a pioneer in the field.
Workload: Amount of work and its spillover.
Control: Opportunity to make decisions.
Rewards: Ability to receive recognition and financial rewards.
Community: Quality of social contacts and relationships.
Fairness: Sense that the organization is equitable, transparent, consistent.
Values: Similarity between one’s personal values and those of the organization.
In my case, workload was a factor, but there were others as well. Community. I had no time for community outside the hospital. Control. Taking every third night on-call for trauma cases and every night on call for aneurysms, I had no control of the emergency patients coming in, which had to be treated, often on my day off. Fairness was the final factor pushing me to change: my Chief was holding back resources I needed, while claiming “we’re all in this together!”.
Those susceptible to burnout in healthcare are usually emotionally available to patients at a weak point in their lives. Doctors, nurses, social workers and mental health professionals all have high rates of burnout. Technology also impacts burnout –– the more data entry, the quicker the burnout.
Burnout can be addressed by evaluating each of the six categories above to see which are responsible and which can be changed. In my case, I chose to decrease my office hours to allow for emergencies. Instead of adding the emergency cases on top of my normal busy week, I decreased my clinic schedule and office hours, seeing fewer general neurosurgery patients. This impacted the fairness and values categories positively as well, consequently this change freed up time for community.
The Chief was angry when I was no longer compliant with his plans. He attempted to have me fired –– but was unsuccessful. It was an uncomfortable season. I gave up the partnership and benefits. There is always a price for freedom. Until that point in my life, it was the most difficult decision I had ever made. Ultimately, I refused to sell my soul for security. In retrospect, it was also the best decision I had ever made. It charted the course of my life on a much better trajectory, one of kindness to myself and recognition of my gifts and limitations.
God designed me for more than work, even good, caring work. I am responsible for my spiritual, emotional and physical health. We are to love our neighbor as ourselves. We are to respect and care for our physical bodies, which are called the Temple of the Holy Spirit.
Here is a sobering thought: the day you stop working, either from exhaustion, heart attack or retirement, your patients will be assigned to another. Remember, no matter how gifted you are, in the medical system, most are expendable.
By continuing to make withdrawals when our accounts are low, we pay a price. The emotional exhaustion and cynicism that accompany burnout show us something needs to be adjusted.
Although it was a difficult season, after I confronted my boss and made an adjustment to my clinic schedule, my energy slowly returned. I had time for community. I had time to enjoy my patient interactions and procedures. Six months later, the joy of practicing medicine returned.
Dr. David Levy will be one of the keynote speakers at the 2022 CMDA Canada National Conference. To register for the Conference, go to www.cmdacanada.org/conference.