January 23, 2020

Beat Back Burnout with the 4-Way Win

Forty-two percent of physicians are burned out, according to data from an annual Medscape survey.  Line up 10 doctors you know, and, statistically speaking, more than four of them are struggling.

Psychologist Christina Maslach, whose work gave us a framework for understanding burnout, defines burnout in this way (with her co-author on this paper, Michael Leiter):

“Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. The three key dimensions of this response are:

  • an overwhelming exhaustion
  • feelings of cynicism and detachment from the job, and
  • a sense of ineffectiveness and lack of accomplishment.”

I am so glad clinician burnout is finally getting the attention it deserves.  But in some respects, bringing this issue into the spotlight is the easy part. The drivers of burnout are complex and systemic, and they may feel far beyond the capacity of any of us alone to untangle, let alone fix.  As Dr. Jillian Horton and many other clinicians have noted, paltry gestures like a plate of muffins from hospital leadership are not solutions.  Health system leaders asking us to journal or meditate our way out of burnout will not solve the complex issues behind the epidemic of burnout, and will not improve long-term health (or productivity, if that’s what they really want) of clinicians.

The generational divide

Something interesting that came out of the Medscape survey data was the notion that burnout differs according to generation.  Forty-eight percent of Generation X physicians are experiencing burnout, compared with 39% of Baby Boomers and 38% of millennials.

Perhaps this is unsurprising.  Gen X physicians are smack in the middle of their careers.  They are at a time that they should be hitting their stride, achieving career milestones, seeing their finances improve beyond the days of training, and getting new leadership jobs.  Their personal lives are complex.  They may be raising young children or sending them off to college while perhaps dealing with the challenges of aging parents.  They are working to build a nest egg that will see them through retirement while managing the expenses of today (likely all while still paying off student loans).  Pile on pressure to do more with less, to use technology that doesn’t make sense for their work while requiring more and more evening and weekend time, and to pack their schedules so tightly that there’s no time left for … anything?  No wonder they are struggling.

A balm for burnout

Physicians, nurses and others experiencing burnout are not culpable here, and they have too much on their plates to add “fix my burnout” to the list.

And yet, there are things that can be done to weather the storm, shore up well-being, and perhaps even unlock the motivation to push for the change we all know is needed.  That was the message of a talk I attended at a recent gathering of exceptional women leaders as part of the Executive Leadership in Academic Medicine program.

As part of the Winter Session for ELAM, the fellows in this program were asked to describe something they had done to achieve a “four-way win.”  This is something that benefits them personally, as well as their family, their job and their community – all at the same time.  The idea is that professionals who say “yes” primarily to commitments that deliver wins in all four arenas will feel that their time is well spent and be more likely to achieve what matters most to them.

I have written about this idea before, after it was discussed by my ELAM 2008 classmate Dr. Archie Chatterjee at the Fall Session of ELAM, where she presented about the topic and gave the fellows their assignment.  Last week’s presentations were the outcome of that assignment.  I was particularly struck by the list of takeaways from one team, who gave me permission to share it with you here.  These were the top 10 lessons they learned collectively about what it takes to find that “four-way win,” and to build resilience for themselves.  I hope you will find this list useful, and I want to give a shout-out to Jen Boardman, PhD; April Armstrong, MD; and Evie Lalla, DDS, MS; for their creativity.

And here is their list:

  1. Deep relationships = happiness
  2. Turn off your negative brain
  3. Practice positivity for yourself
  4. Surround yourself with positive influences
  5. Have a confidant to share your struggles
  6. Create space/time for yourself and others
  7. Celebrate successes
  8. Break down obstacles
  9. Be purposeful with your actions
  10. Smile

This list is not intended to put the onus on clinicians to solve the burnout issue for themselves.  The solutions will have to be systemic, and, in my opinion, will have to include a serious examination of our profit-driven motivation for clinical work at the system level.  As long as we are simply pushing clinicians to “make more widgets,” we will keep seeing the very human things that happen to them when this modus operandi is pushed to its limits.  We are seeing the natural conclusion of that experiment.

But for clinicians engaged in the day-to-day struggle to find as many wins as possible, this list provides a helpful set of guidelines for the personal aspect of the situations we find ourselves in as part of this system.

I’m grateful to my colleagues for the chance to share this, and to Dr. Chatterjee, who has just been named dean of the Chicago Medical School at Rosalind Franklin University.  She is a tremendous academic medicine leader, embodying the principles of outstanding professionalism, clinical and scientific talent, administrative acumen and a deep and abiding compassion for the human beings who work in our system of care.  She is a true hero of mine, and somebody I strive to emulate.

Your resilience experience

I’d love to hear more about how you address the personal component of burnout, tips or tricks you or others have employed, and anyone who might be your own “hero” in dealing with this critical issue.