Setting boundaries to avoid burnout
Aug 23rd 2022
Physicians are prone to burnout, due to the very nature of who they tend to be: Self-critical perfectionists who are focused, compassionate and people pleasers. Those characteristics are part of what make a good physician.
But most environments where physicians work take advantage of these characteristics. They’re asked to do more with less. They work tirelessly so their patients get the best care, and put themselves last until they hit that proverbial wall and can’t do it anymore.
“Physicians are working within a healthcare system that does not make it easy for them to avoid burnout,” says Rebekah Bernard, MD, owner of Gulph Coast Direct Primary Care in Fort Myers, FL. “Everything about our healthcare system is designed to increase productivity. We’re asked to do all sorts of additional responsibilities outside of practicing medicine.”
Some would say it’s the nature of the beast. But it doesn’t have to be. Physicians can learn to create boundaries so they can continue to love their work.
Just ask Dr. Bernard. About six years ago, she hit that proverbial wall.
“I left the traditional healthcare system and opened my own direct care practice. That was the solution for my burnout. Not that I still don’t have my day-to-day struggles as a physician, but it eliminated at least 90% of the sources of my frustration,” she says. “I know not everyone can open a direct care practice, but there are other steps they can take to avoid burnout.”
Dr. Bernard has co-authored books on physician wellness. Her advice: Start by recognizing your personality and characteristics.
“Self-awareness is important. Physicians need to look at themselves and figure out what characteristics they have that make them good doctors, and what characteristics they have that can also lead to a burnout,” she says.
If they see any signs of burnout creeping into their lives, early intervention is vital.
“If you’re already in a stage where you’re unhappy, dreading going to work, stressed or frustrated, don’t keep going and pushing through,” says Dr. Bernard. “We need to say this is not something I have to continue feeling. My advice is always to seek an excellent psychologist/psychiatrist or even a physician coach to talk to.”
Sometimes it’s a person’s own core thinking and personality type that makes them continue in these unhealthy patterns. Having a professional trained in identifying these areas and offering steps to implement change is beneficial.
Physicians also must focus on work/life balance.
If you ask physicians who they are, most will say a doctor. It’s the first thing they identify as. They forget that there’s much more to them than just being a physician.
“We need to give other things in our lives a high priority, like family, friends and whatever else we love. And we need to have a balance,” says Dr. Bernard. “That way, if things don’t go well in our professional lives, we have other things to focus on.”
Doctors are important. There’s no doubt about it.
But sometimes it’s important to step back and realize that what they do for patients is just a small part of the equation. There are a lot of other things involved.
Physicians often assume that what they do has a direct result in patient outcomes. And it does have an impact. But the choices patients make for themselves have a huge impact. That’s why it’s important for physicians not to hold themselves solely accountable for outcomes.
“Early in my career I had this idea that I was indispensable. If I didn’t go to work, all hell would break loose,” recalls Dr. Bernard. “Then one day I finally realized, that’s not true. If I’m gone tomorrow, they’ll hire someone else, and the world will go on. It was a painful lesson for me to learn, but it was also important for me to recognize that I can’t put those responsibilities on myself.”
Doctors, however, are taught to put everything above themselves. It’s the core tenet of professionalism. But there are times when physicians must put themselves first.
Physicians need to ask themselves what they would continue to do even if they didn’t get paid for it. That’s intrinsic motivation. It’s something you love that gives you great satisfaction.
Studies have shown that if doctors spent 20% of their work time on something that’s an intrinsic motivation, there would be less burn out.
For a doctor that might look like doing research, teaching, or working with the homeless one day a week. It’s something they can do as part of their work week.
But it’s also important for physicians to be passionate about things outside of medicine that get them into a flow state – where time passes, and they don’t realize it. Maybe it’s a hobby they had before medical school or a new interest like baking bread or riding bikes.
“The pandemic opened a lot of physicians’ eyes to past loves, like painting, drawing and doing puzzles, because we were limited in getting out,” says Dr. Bernard. “And that’s what it’s really about, finding something that brings you joy, aside from medicine.”