SCOTTSDALE—Being aware of the warning signs, finding supportive colleagues, and being courageous enough to make changes are some of the keys to maintaining physician wellness and tackling burnout, a panel of otolaryngologist-head and neck surgeons said in a discussion at the Triological Society Combined Sections Meeting.
Explore this issue:March 2018
During a session in which panelists seemed determined to help other clinicians and surgeons overcome the taboo of taking breathers and making career adjustments to preserve their own well-being, an experienced group of otolaryngologists opened up about how they struggled to strike a balance in their own lives and how they managed to right the ship.
Finding the Joy
Julie Wei, MD, surgeon-in-chief and chief of pediatric otolaryngology and audiology at Nemours Children’s Hospital in Orlando, said that, early in her career, she was consumed with checking “all the boxes” as an academic faculty: high volume clinical patient care, teaching of residents/fellows, mentoring others, research and publications, committee work, society work, and every task presented to her. And it took a major toll on her entire being and led to her high degree of burnout. Her work week was dominated by clinical care, and nights and weekends were largely spent on all other professional pursuits, when, in fact, “we should be resting,” she said.
“Physicians/surgeons have years of experiencing the need to “push” ourselves, and it’s who we are, to just keep doing more, and often without very clear, laser focus on what not to do,” she added. “It came at a significant cost.” When she was about 40 years old, she began to wake up in physical pain. It got so bad that she started to crave a diagnosis for herself that would allow her to “get off the treadmill.”
“I’m living this dream life, I make a blessed living, I have my beautiful family,” she said. But she was irritable and angry all the time. “Every time the pager went off, some expletive went on in my head. I didn’t know what joy meant,” she added. She was eventually helped by personal and marital counseling, and from getting a sense of perspective at a mid-career women faculty development seminar organized by the Association of American Medical Colleges.
She eventually made a career change, taking on a leadership role as division chief and joined Nemours Children’s Health System, where she still works hard but with insight and struggles to do “less” with focus. She has made it a point to raise awareness about physician wellness within and outside her organization. “I can tell you today where the joy always is, without question,” she said. “It’s direct patient care and when I am with my family.”
It’s hard for all of us to be superstars in clinical care, research, and education. For me, it was finding that sweet spot. —Dana Thompson, MD
Practice What You Preach
Michael Johns, MD, director of the University of Southern California Voice Center at the Keck School of Medicine of USC in Los Angeles, said he began researching burnout early in his career because he thought it was an expedient way to bolster his academic credentials, when it finally began to dawn on him that he was violating the very principles he was promoting in his research. “Most of us get involved in scholarship because we’re, to a certain extent, content experts,” he said. “We have expertise about a topic, and we have something that we want to contribute. This was not true for me and burnout.”
After publishing and speaking on the topic, he became “more and more known for having expertise in burnout; all the while, I was working harder and harder and not in any way, shape, or form practicing what I preached in terms of self-assessment, of personal behaviors, and responses to stress.”
A “crisis moment” arrived, he said, when he was asked to deliver a prominent address on burnout at the American Academy of Otolaryngology Annual Meeting, in which he’d be making recommendations he wasn’t abiding by himself. The moment helped transform his life. He engaged in a mindfulness and meditation program, cut out quick-fix coping mechanisms, and began to practice yoga regularly. “I decided to live pretty strictly what I was preaching in my talks about burnout,” Dr. Johns said. He eventually lost 20 pounds and said, “I am a dramatically better person today.”
He said the field of medicine needs to re-embrace its principles of professionalism: an orientation toward public service, roots in a code of ethics, and a move away from a primarily profit-oriented stance. “I think we as a profession have focused so much on our own personal gains and our own personal income, we’ve lost, to a certain extent, our profession,” he said. “This is what I think we’ve got to recapture.”
Dr. Johns also said it’s important for burnout to be seen for what it is. “We talk about burnout almost like it’s a disease, and it’s not,” he said. “It can lead to a variety of diseases or dysfunctions or disorders. But burnout is a consequence of an adverse work environment, period.”
Find Your Niche
Dana Thompson, MD, head of pediatric otolaryngology at Northwestern University in Chicago, said it took a long time to recognize burnout as a problem. “I just assumed that burnout was: This is how it is.” Her solution? “Deal with it,” she said.
Dr. Thompson eventually realized that there were a lot of elements in her background and career that lent themselves to feelings of burnout. She had grown up as a competitive figure skater, up at 4 a.m. to get to the rink for practice before school, with a perfectionism that was not always healthy. Later in life, on the job as an African-American woman, she was always in the minority, leading to a sense of isolation. “I had to deal with my own demons,” she said. “Am I good enough to be here? Does pediatric otolaryngology have a role in my organization?”
She also battled through illness, the strain of having a terminally ill parent, and marital stresses. “We’re all a mosaic of our experiences,” she said. “I think if you think through what has shaped you, you will find your triggers of burnout.”
She eventually found a job in which she is happy, but only after rearranging her career priorities. “The world has become increasingly more complex, and so it’s hard for all of us to be superstars in clinical care, research, and education,” she said. “So for me it was reframing [the question] ‘How am I going to spend my professional time?’ It was finding that sweet spot. I encourage people to find that sweet spot.”
Focus on What You Enjoy
Peak Woo, MD, clinical professor of otolaryngology at Mount Sinai Health System, who also runs a private practice in New York, said the guiding principles he grew up with were working hard, achieving, and saving for a rainy day. These principles led him as an academic physician to be so productive that he had a relative value unit percentage of 200%—numerically, he was the same as two full-time equivalent positions.
But he felt burdened by the faculty metrics and felt he lacked freedom in making decisions on program and funding priorities, he said. “The two things I felt unhappy about were the fairness and the values,” he said. He also lost his zest for teaching. “I didn’t feel like teaching the resident anymore, taking that first-year resident to do a trach. I could do it much faster.” Eventually, he went into private practice, and has been much happier. As physicians reach mid-career, it’s important that they take a “frank look” at their environment. Most physicians, he said, won’t admit to severe burnout. “But, I think mild-moderate burnout is real,” he added.
Dr. Woo said it’s important to have a lifelong mentor and be willing to focus on what you enjoy. “I think it’s important to throw out the things that you don’t love with as much passion and do only the things that you really love passionately,” he said. “And for me, it’s clinical care. It’s being able to give a discount to a poor person who just needs healthcare without having to worry about an institution telling me I can’t.”
Know When to Take a Break
Myles Pensak, MD, chair of otolaryngology-head and neck surgery at the University of Cincinnati and moderator of the session, said physicians are “probably the single-best group at creating mythology and living into that mythology…. It requires an enormous amount of strength to start to acknowledge what some of the weaknesses are.”
“Whether it be reflected in drug use, alcoholism, [or] the fact that we have between 350 and 400 physicians who commit suicide each year, [this information] tells you that we defer our own health and wellness to the benefit of multiple constituencies: family, friends, patients.”
During the comment segment of the session, Albert Merati, MD, professor of otolaryngology-head and neck surgery at the University of Washington in Seattle, said that he took six weeks off two years ago, and it was the most important thing he could have done for his career. He encouraged others to take time off as well when they feel they need it. “The only thing I regret was not doing it earlier,” he said. “I was never going to refuel in flight. It changed my life, and I wish I hadn’t waited 17 years.”
Cynthia Chen, MD, assistant professor of otolaryngology at Nemours, said that, as a younger faculty member, she has certain advantages when it comes to avoiding burnout. Younger faculty are more comfortable with the technology physicians have to use today, she said. She is married and has two children, but is careful about maintaining a work-life balance. She said she thinks that’s true of younger physicians in general. “We’re very conscious about lifestyle and making sure that we take care of our families,” she said. Additionally, as a woman, she added, “I think it helps that a lot of otolaryngologists are female now. We all know that the landscape is changing.”
Tom Collins is a freelance medical writer based in Florida.