Burnout

You may have noticed that there haven’t been a lot of new posts appearing on the blog lately. That is because your site administrator has been suffering from a bit of burnout. Burnout has been a hot topic lately in the world of resident education. If you are getting ready to graduate medical school and start internship, it’s worth taking some time to think about avoiding and managing burnout. If you haven’t heard this term before, burnout is essentially the constellation of physical, mental, and emotional symptoms that can happen when people feel like they are working hard but getting nowhere.

When you do an image search for burnout, this is what shows up, and it's surprisingly appropriate - burnout is feeling like you are spinning your wheels as fast as you can but aren't getting anywhere.

When you do an image search for burnout, this is what shows up, and it’s surprisingly appropriate – burnout is feeling like you are spinning your wheels as fast as you can but aren’t getting anywhere.

Burnout is more than just a bad day – it is what happens when you can’t seem to recover from a bad day and start the next day fresh. You may find that you can’t sleep well, or that you sleep fine but you wake up from a full night’s sleep feeling like you barely slept at all. It’s looking at your clinic schedule wondering how you’re going to get through it, sometimes wondering if you even want to.

Conditions that are known to predispose to burnout include:

  • Frequent conflicts between work and home life
  • Emotionally demanding work
  • Need to make frequent high-stakes decisions
  • Heavy workload
  • Lack of perceived control
  • Feeling as if your work doesn’t matter or isn’t appreciated

If you are a resident, I would bet good money that ALL of those things sound familiar. The fact is, residency is pretty much the ideal environment to foster burnout.

Many of my days at work go like this:

It starts with walking out the door as my child begs me to stay home. Then I spend 12-14 hours taking care of patients in terrible situations (fetal demises, untreated mental illness, homelessness), running from one room to the next, never feeling like I have enough time to really take care of my patients the way I want to without ending up over an hour behind. Patients show up late or are double-booked, but they have acute problems and have to be seen. I work through lunch. My 15-minute same-day add-on patient has five problems that she wants to talk about, and one of my patients spends her entire appointment time telling me how she didn’t want to come to my clinic but she has been fired by every other practice in town. Then I stay late at work to finish my notes because every 15-minute appointment slot was filled and all of them took at least 20 minutes. By the time I get home, I have missed dinner with my family and my child might already be in bed. 

Surprisingly enough, that’s fine for the first several months. People are surprisingly resilient. After several months, people start to feel less enthusiastic about their jobs. Then you start feeling less refreshed after a weekend off. Then you find yourself coming back from a whole week off not feeling refreshed. Eventually “I’m exhausted but I love my job” turns into “What other jobs could I do and still pay my bills?”

Burnout creates a vicious cycle: when you are burned out, you often find that you have less energy and work less efficiently, so it takes longer to finish your work, giving you even less time to “recharge your batteries” off the job.

So, what do you do about it?

Decrease conflicts between work time and home time

  • If you have a family, try to be present when you are home.
  • Turn off your work phone when you leave work
  • Don’t check your work email on your days off
  • Make plans for when you aren’t at work so you feel like there is more to your life than work

Decrease your workload, if you can.

  • Don’t volunteer for extra projects
  • Delegate any tasks that you can. Med students can help you with data collection for research projects, and may be eager to get involved in research.
  • Which tasks in your personal life do you HAVE to do yourself? Your husband probably can’t breastfeed the baby, but can you hire a cleaning lady? Can your husband do the laundry? Can you pay the kid next door to mow the lawn?

Take control, if you can.

  • If you feel like your clinic schedule is setting you up for failure, talk to your program director. See if the schedule can be changed. As it turns out, my program director didn’t realize that “ER follow-up” visits, which are usually new patients, were being scheduled for 15-minute slots. We brought it up in a resident meeting, and now these visits are going to be 30-minute slots, which will make a big difference.
  • Set limits for yourself. Decide if it is better for you to chart at home (and get out of the clinic as soon as possible) or to finish your charts at work and then go home (so you can be “off” when you get home). Neither is more valid than the other, it’s just a personal choice.

Remember that what you do DOES matter. Your patients are usually stressed when they come to see you. They are not at their best. They aren’t reacting reasonably. Remember that they DO appreciate what you are doing, eventually, they just aren’t really focusing on expressing that gratitude while they are feeling awful.

Most importantly, hang in there. Residency is, in the end, a few short years, and I’m told that life gets a whole lot better after that.

Are you wondering if you’re burned out? Check out this quiz from MindTools, or this one from Scientific American (which doesn’t seem to work on Apple OS). 

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