An Out-of-Balance Seesaw: Physician Burnout and the ABIM Apology

by | Mar 11, 2017 | Physician Burnout, Physician Coaching

On February 3, 2015, the American Board of Internal Medicine (ABIM) issued an apology to American physicians for subjecting them to an out-of-date and burdensome board recertification exam. The importance of this step cannot be overestimated. Of the ~850,000 active physicians in the U.S., over 200,000 currently hold ABIM certification, which is required of internists and most medical subspecialists. Starting in 1990 (the year I was unfortunate enough to complete Internal Medicine residency!), physicians have been required to take the exam every ten years to maintain their board certification. While the ABIM cites data suggesting that the exam improves quality of care, this has not been definitively established, and questions have arisen from a number of quarters about appropriateness of content, the expense, and whether the exam is contributing to early retirement, a major concern in terms of the growing physician shortage.  The ABIM apology focuses on making the exam more relevant to the practice of medicine, allowing CME credits to be used in place of the esoteric MOC (maintenance of certification) modules, and eliminating the onerous practice assessment and patient survey requirements. Board recertification is expensive, time consuming, and requires intensive preparation. In the setting of increased demands to see more patients in less time, decreased reimbursement, increased scrutiny, increased role definition by non-physicians, and the burdens of the EMR, board recertification is yet one more factor contributing to physician burnout. Physician burnout is a complex phenomenon and yet it can also be summed up with a very simple equation. X = all the things that buoy a physician up X equates to things like positive patient encounters, good relationships with support staff and colleagues, intellectual challenge, or picking up a tricky diagnosis.  X also includes meaningful personal relationships, adequate sleep, and personal health, in addition to a sense of meaning and accomplishment. Y = all the things that drag a physician down Y includes an EMR that is frustrating to use and eats away at precious time, unrealistic patient loads, having more and more administrative hoops to jump through, inadequate staffing, or not having time to just focus on the care of your patients. The math is simple: When Y outweighs  X, you get imbalance and physician burnout, almost like two sides of a seesaw. And board recertification is in the Y category big time. My own experience is telling. When I recertified in 2010, as a hospice physician out of touch with general practice, I prepared for over a year and a half, studying 3 hours a day for 3 months. I spent most “free” moments studying, I was completely drained, and my family was angry and alienated. Prior to that recert, my 13-year-old son had always proudly called himself Dr. Gazelle Junior. By the end of the experience, he said you couldn’t pay him enough to become a doctor. Now, at age 18, he’s planning on a career in engineering. Many things can be done to decrease physician burnout. Not having to spend time that you don’t have studying for an irrelevant test is one important one, but it is still just one factor. Part two of this blog series will discuss the growing body of knowledge on other interventions.
  1. Embrace uncertainty

When you stop and think about it, uncertainty and change are the only things that are certain. Impermanence is one of the basic laws of our world.

After all, everything changes. Our relationships change. Our kids grow up and change. Our bodies age and change. Our environments change. Our planet changes.

All too often, however, we forget this basic truth. We somehow expect things to be predictable and stable.

The problem is that this expectation sets us up for difficulty. It leaves us struggling unnecessarily when something shifts. It adds a layer of suffering above and beyond that caused by all the VUCA around us.

What I’m getting at is that we have a choice. We can meet uncertainty with reactivity or we can meet it with mindful understanding.

More than meditating on a remote mountainside, mindfulness helps us have the calm, steadiness, and clarity we need to work constructively with all the change and uncertainty.

At the same time, while we can find ourselves resisting change, we can remind ourselves that it does not have to mean something bad! Just take a moment right now to think of all the difficulties you have faced in your life and work that are now resolved and far behind you. This can help you see how change has actually been quite the positive.

  1. Respond to complexity with compassion

Even knowing that change is the only thing that is certain, it can still be difficult to weather. Living in such a VUCA time is difficult. You deserve compassion for managing all the challenges.

With mindful awareness, we can bring ourselves compassion for what we’re going through. There is increasing evidence that self-compassion is a powerful antidote to stress and even burnout. From where I sit, I think that it is actually one of the most powerful medicinals available to us.

  1. Take purposeful pauses

With mindfulness, we are aware of what is going on within and around us. We tune in and pay attention to our experience. We learn to utilize our breath to take us out of the fears, worries, stories, and preoccupations our minds are so good at generating about what might come next, and bring us back to the present moment. Here in the present, we leave that overly activated limbic state and can experience a sense of calm.

A pause also serves to allow our prefrontal cortex to come online. It creates a critically important space between our emotional response and conscious, intentional action.

Once we have paused, we can then see more clearly that fear had taken hold. 

With a pause, we become the witness of our experience as opposed to the one trapped by it.

  1. View VUCA as opportunity

I don’t know about you, but I can find myself reacting to the VUCA environment with something of a fixed mindset. With a fixed mindset, I am telling myself things like ‘it shouldn’t be this way’ and ‘why is this happening?’

When I can utilize mindful awareness, I can see that I’ve boxed myself in with a fixed mindset. I can challenge myself to grow. By grow, I mean challenging myself to see whatever difficulty I’m experiencing as an opportunity to learn.

Here again, mindfulness again throws us a lifeline. Mindful awareness involves leaning into curiosity.

I can flip the script and ask myself:

What can I learn from this experience?

How can I use this to be a better version of myself?

How can I help others cope in this VUCA environment?

What do I want to look back and see about how I acted?

In summary, while VUCA is definitely the order of the day in healthcare and beyond, you don’t have to succumb. You don’t have to live in fear. There are constructive actions you can take to help you cope with uncertainty, build calm in chaos, and even thrive in chaos and VUCA. While we can’t control much that is contributing to the VUCA time, with mindfulness we can control how we respond to it.

I hope you’ll try out these 4 mindfulness strategies as I have seen them help countless people. I’d love to hear how it goes.

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To learn more about how mindfulness coaching can help you cope with this VUCA time, please reach out for a complimentary consult.

6 Free Resources To Help You During COVID19 And Beyond.

  1. 14-day meditation series 
  2. Imposter No More PDF
  3. Resilience Book Chapter
  4. Leading In Crisis PDF
  5. Balance To Burnout PDF
  6. 30-minute consult

Take advantage of one or more of these valuable resources created for clinicians and non-clinicians.