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Physician Burnout and Stress Are Not One And The Same

Matt Davis | AMP News, Guest Blog Post Series, Healthcare Administrators, Healthcare Information, Physician Recruiting, Physicians, Uncategorized

Burnout and stress are not one in the same. Aside from the physician shortage, physician burnout is one of the hottest topics in healthcare today. To understand burnout, you must know and be able to identify the underlying causes of burnout. They are as follows:

  1. Work Overload
  2. Lack of Control
  3. Insufficient Reward
  4. Breakdown of Community
  5. Absence of Fairness
  6. Conflicting Values

Dr. Gaither, the author of Reignite, discusses the difference between stress and burnout, how to spot it and how to navigate. He will also share a bit about his personal experience with burnout.

Our Conversation with Dr. Gaither

AMP: Dr. Gaither, thank you for your time. When we spoke on the phone, to discuss this post, you mentioned you suffered from burnout as a physician in 2009. Can you provide some insight on how you made it through and came away with purpose on the other side?

Dr. Gaither: In 2009 I went to my practice partner and said, “If something doesn’t change I’m going to have to leave the practice of medicine.” I was just in my seventeenth year of practice. What was once a source of joy, pleasure, and immense satisfaction had turned into drudgery and dread. I couldn’t understand why. Deep down I wasn’t ready to give up on medicine entirely. I just knew something had to change.

This set me on a journey to discover what had happened and what I could do to change the way I felt about my profession and myself. The business and practice of medicine had changed in many undesirable ways and one can only adapt so much as a result of outside interference, dictates, mandates, and constraints. I had lost perspective and did not have the proper knowledge or tools to help myself. Once I discovered I was burned out I endeavored to acquire them. In many ways, it was a very personal journey of self-discovery. I became an expert in the arena of professional job-related burnout. In doing so, I became aware of what I could change and what I couldn’t and adapted accordingly and this made all the difference.

The Book: Reignite

AMP: Your book, Reignite, just hit its one-year anniversary.  What was the genesis for the book?

Dr. Gaither: After discovering I was burned out, I wondered if any of my colleagues were suffering from the same thing. It didn’t take ten minutes of searching on the internet to realize this is a huge problem in many professions and it’s getting demonstrably worse, especially in medicine. I read everything I could find on the subject while searching for solutions. I began to give talks here and there on the topic, and they were well received.

This led me to start blogging about burnout. After two years of blogging, I realized I had more than enough content for a book on professional job-related burnout. Once I committed, it took about six months and several re-writes to get the book to press. I launched REIGNITE on March 20th of 2018. The tag line to the title is, “Transform from Burned Out to On Fire and Find New Meaning in Your Career and Life.” From the feedback I’m getting, it is fulfilling its purpose. I couldn’t be more pleased. 

Burnout vs. Stress

AMP: How is burnout different from stress, specifically for physicians?

Dr. Gaither:  Burnout is decidedly different than stress in many different respects. If you are burned out I can guarantee you’re stressed, but you can be stressed without being burned out. The distinction is important because if you treat burnout as if it were stress, you really haven’t treated burnout. Here are some of the main differences.

Stress is characterized by over-engagement. Burnout is characterized by disengagement.

In stress emotions are overactive. In burnout emotions are blunted.

Stress produces urgency and hyperactivity. Burnout produces helplessness and hopelessness.

Stress leads to loss of energy. Burnout leads to loss of motivation, ideals and hope.

Stress leads to anxiety disorders. Burnout leads to detachment and depression.

With stress, the damage is primarily physical. With burnout, the damage is primarily emotional.

Notice the damage from burnout is more emotional and engenders a sense of hopelessness and helplessness. These are two of the major symptoms of depression. This is why rates of depression and suicide are higher in individuals who are burned out versus individuals who are just overly stressed.

AMP: What are some ways a physician can prevent burnout versus being reactive to it?  Are there warning signs one should look for?

Dr. Gaither:

There are two types of burnout, individual and organizational.  A full 90% of burnout is caused by the work environment. Only 10% of the time does an individual burn themselves out. This is usually due to living a life out of balance. People burn themselves out through workaholism, poor eating habits, lack of exercise, lack of adequate rest, lack of recreation, addiction to drugs or alcohol, lack of healthy relationships, social isolation, or a combination of these. The best way to avoid burning your self out is to avoid those pitfalls and to nourish all four of your life realms – mental, emotional, physical, and spiritual. I talk about this extensively in my book. 

Organizations burn out employees by way of six major underlying job-employee mismatches. They are – Work Overload, Lack of Control, Insufficient Reward, Breakdown of Community, Absence of Fairness, and Conflicting Values. Whenever and wherever these six domains are being negatively impacted, you will find high burnout rates.

The reason prior efforts to mitigate or eliminate burnout have failed is that the focus has been concentrated on the employee who did not cause it and cannot change it. To rid an organization of burnout you must identify and correct the underlying causes.

Organizations must begin to make the structural changes necessary to reduce burnout and foster engagement. If you find yourself in a toxic work environment that cannot be changed, or if the organization has no interest in changing, then you have a big decision to make. Do I just put my head down and grind away, hating my job and detesting the organization I work for? You can do that but if you do you’ll end up bitter, angry, resentful, and it will shorten your life. If on the other hand, you want some things to change, you will have to change some things. Within the pages of REIGNITE, I show people how. 

AMP: There is no doubt that burned out employees are costly to an organization.  What can an administrator, CEO of a hospital, group practice owner or other healthcare leader look for in their employees to spot burnout?

Dr. Gaither: Burnout is costly to organizations. Extremely costly. Depending on the level of the talent lost or sought, it can cost one-and-a-half to five times the annual salary to replace just one individual. The signs of high employee burnout is easy to spot within an organization. The three symptoms or hallmarks of burnout are emotional exhaustion, depersonalization (cynicism), and a lack of a sense of personal accomplishment among employees.

One of the most sensitive indicators that burnout is rampant within an organization is a high employee turnover rate. Other indicators include high and rising customer/patient complaints, high and rising employee complaints, high error rates, high absenteeism, inferior products and services, hostile work environment issues, and high malpractice claims. If in doubt about burnout within an organization, application of specific survey tools can prove most helpful. The Maslach Burnout Inventory (MBI) is still the industry gold standard for measuring burnout in individuals and the Maslach Areas of Work-Life Survey (MAWS) can identify the degree to which any of the six major underlying mismatches (causes) are being negatively impacted. I regularly apply these tools when consulting for organizations as part of a Road Map to Engagement I’ve developed specifically designed to rid businesses of this costly and burdensome workplace malady. 

AMP: Following up to that, what can a healthcare leader do to prevent physician burnout?

Dr. Gaither: I would suggest avoiding guessing what might be going on within your organization concerning burnout and actually seek to actively measure it and take steps to correct any negative impact on the six major job-employee mismatches which cause burnout. At the same time, foster engagement which is the exact opposite of burnout. The hallmarks of engagement are vigor (energy), dedication (involvement), and absorption (efficacy). Every leader wants an engaged workforce so this should be a dynamic, ongoing process that is not only cost saving, it is income generating. 

AMP: In your opinion, what percentage of physicians suffering from burnout leave medicine all together? 

Dr. Gaither: The exact figures are hard to get at. We know that the age a physician considers retiring has been dropping like a stone over the last thirty years. In 1990 if you asked a physician when they might retire the answer was usually, as long as my health is good. Jump to 2000 the answer became retirement age (65). In 2010 physicians began to consider exiting medicine sometime in their 50’s. Clearly, something has changed.

Over half of physician surveyed now routinely score at least one (out of three) on the MBI. Instead of leaving medicine altogether, many physicians are either opting to reduce their hours or transitioning into a different aspect of medicine where the pace and demands are reduced. All of this is contributing to a nationwide physician shortage which can no longer afford to lose experienced providers. The result will be higher healthcare costs. No one is playing the long game and that needs to change.

AMP: Are residents being prepared for what they will see once they are practicing?  Is there a disconnect between expectations and reality? 

Dr. Gaither: Yes, there is an almost complete disconnect between the notion of what practice will be like and actual reality for residents entering practice. It’s sort of like a marriage. There is the ideal mate we carry around in our heads and then there is the one we marry. By and large, residency training programs do not adequately prepare residents for the business and realities of everyday practice. Residents preparing for practice should spend some time looking at different practice models to determine which is best for them. They should have their contract thoroughly reviewed by an attorney with particular attention paid to any performance language contained within the contract.

They should rent a place to live at first and on whatever amount of money they lived on through residency, at least until they get their student loans paid off. This means delaying gratification for a bit longer but they will be happy they did. On a physician’s salary of $200,000.00 per year, taking home 120,000.00 per year, living on $50,000.00 per year, a provider can retire $200,000.00 in student loan debt in less than three years! So, if a newly minted provider discovers they have made a huge mistake by finding themselves in a toxic work environment, they can easily transition to another more favorable practice venue. School loan and mortgage debt will severely limit their options, otherwise. Staying nimble those first few years is key.

AMP: According to your experience, what is the evolution of burnout?  

Dr. Gaither: The evolution of burnout in this country is complex and multi-factorial. One of the biggest drivers of dissatisfaction among providers is the electronic health record, which in my opinion was created by Satan and his minions. For all of its promises to improve efficiencies, reduce errors, reduce costs, and make information more accessible, it has been an utterly catastrophic and abysmal failure. This is the largest part of the administrative burden providers have been saddled with, which they did not ask for and did not train for.

Thirty percent of a providers day is now used to address administrative tasks and requirements, the time taken away from interactions with patients. This is a betrayal of purpose and strikes at the heart of Work Overload, Lack of Control, and even Absence of Fairness, three of the underlying drivers of burnout.

Also, as organizations grow, they tend to want to centralize control and streamline workflow. This stifles innovation and creativity at the point of service. Something which the practice of medicine demands regularly. In short, providers don’t get to do what they were trained to do, at least not easily. If you go back and look at those six underlying causes of burnout, you should begin to understand why providers are burning out at such high rates. It doesn’t have to be this way. It is possible to return to more patient-oriented practice models which reduce burnout without sacrificing the profitability or sustainability of healthcare systems.

AMP: If there was just one thing you wanted everyone to know about burnout, what would that be? 

Dr. Gaither: That’s an easy question to answer. If you believe you’re burned out, don’t believe that your circumstances are just how things are and will continue to be. If you have burned yourself out then you can take steps to re-balance your life and rekindle your passion for what you do, who you serve, and for life itself. If you are burned out because of your work environment, you can change your circumstances. There is a burned out mindset people can become trapped in which tells them it’s too late for me to change, it will be too hard, I’m not good enough, I’m too old to start over somewhere else, I have too much time invested here, I won’t make as much somewhere else, it will cost too much to move, I don’t have the right skill set to make a change, it’s too much trouble to uproot and move, etc.

Remember, the loudest voice, perhaps the only voice, saying these things is in your head and none of them are true. It’s just the burned out part of your brain squawking because it believes the misery you are currently experiencing is better than the unknown. I don’t believe that and neither should you. REIGNITE lays out practical and highly effective steps to lead you from where you are to your preferred future. 

AMP’s Viewpoint

Talking to physicians every day, there is no doubt that burnout is a real issue in medicine.  It was a pleasure visiting with Dr. Gaither and diving deeper into the root of physician burnout and peeling back the layers of an ever-growing issue. 

If you find yourself burned out, headed that way or have a colleague who is, we recommend picking up a copy of Dr. Gaither’s book.  Learn from his personal experience with burnout and how he conquered it.  Diving into the root of the burnout and providing solutions to fight it are all covered by Dr. Gaither.

Thank you, Dr. Gaither, for your time and for your investment into the mental health of physicians and administrators everywhere.

Dr. Gaither’s Bio

I am a writer, speaker, podcast producer and personal coach for physicians and other professionals who suffer from burnout. Also, I enjoyed a career in medicine for the past 23 years as part of an office-based family practice in Goldsboro, NC.

I have given hundreds of lectures up and down the east coast to physicians, professional groups and the public on various topics such as physician burnout, addiction and recovery issues, hypertension, cholesterol disorders, smoking cessation, and various therapeutic pharmaceutical agents.

I planned and helped to establish a free clinic in Wayne county and Goldsboro, NC, now in its thirteenth year. It is in a mobile medical unit which travels to 19 different locations in the county each month in order to provide free care to those that have no resources to obtain medical care otherwise. All the care on the mobile medical unit is free, all the labs are free and almost all of the patient’s medications are free. A satellite clinic was opened at the Family-Y to handle all of the demand. These two clinics see a total of 800+ patients each month for acute care and ongoing chronic disease management. With a staff of sixteen and an annual budget of $950,000.00+, it is the second busiest free clinic in North Carolina.

I am past chair of the North Carolina Physicians Health Program and and Current Medical Director. It is a program devoted to helping troubled physicians recover from alcoholism, drug addiction, gambling addiction, patient boundary violations, and other behavioral disorders.

In 2002, I was named Family Physician of the Year by the North Carolina Academy of Family Physicians. In 2010, I became a Fellow of the American Academy of Family Physicians.

In my play time I enjoy woodworking, amateur astronomy, scuba diving and travel. I also enjoy collecting rocks, minerals and meteorites.