physician burnout

The Ultimate Guide To Physician Burnout

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physician burnout

physician burnout

Physician burnout image courtesy Pexels

Healthcare Keynote Speaker, Physician burnout and mindfulness Coach Dr. Gail Gazelle

By Gail Gazelle MD, MCC

Gail Gazelle MD, MCC is a former 20-year practicing hospice physician, current Master Certified Coach and faculty at Harvard Medical School, and the leading voice on physician burnout. She is the author of Everyday Resilience and Mindful MD, a book that helps physicians master the skills they need to get out of burnout.

Having personally coached over 500 physicians and physician leaders, Dr. Gazelle’s passion is helping physicians learn the resilience skills not taught in training that make the difference between burnout and a career full of meaning and satisfaction.

Her work has been featured in CNN, NPR, The New England Journal of Medicine, Medical Economics, Fox News, Oprah Magazine, the AMA podcast, and Psychiatric Times, amongst many other publications.

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In this ultimate guide, we’ll cover everything you need to know about physician burnout: symptoms, stats, causes, prevention, specialty and most importantly, how to move past physician burnout.

Want To Move Past Physician Burnout?

Good! ​​Grab the FREE 10-Step Guide to move from Burnout to Balance. Start enjoying the career you’ve worked so hard for!

By Gail Gazelle, MD, MCC | 500+ Physicians Coached

HOMEPAGE LEAD MAGNET: Burnout to Balance - 10 Steps

You’re A Modern-day Physician

You earned your dream career – after a decade + of training, countless exams, sleepless nights, hundreds of thousands of dollars of debt, and more.

You faced all of this while your peers were earning large signing bonuses, purchasing their first (and even second) homes, and rising the ranks in corporate America.

When you look around you see other doctors seemingly free from doctor burnout, effortlessly breezing through their practice while your life feels like anything but.

In A Single Day You See Dozens of Patients

There never seem to be enough hours for everything you’re tasked with.

You take on the emotional burdens of your patients and in many cases wear plenty of hats besides being a stressed-out doctor. When you aren’t sprinting from patient to patient, you’re dealing with the EMR, insurance companies, or bureaucratic/administrative junk within your hospital or practice.

Your woes probably don’t end there – because life is hard. You may have kids or aging parents that contribute to your stress. You may have a marriage that could use some work. Between all of these demands and people, you rarely have time for the most important person in your life – yourself.

So, Where Does All of This Take Us?

For many physicians, the above adds up to the perfect recipe for burnout. And if you’re a burned-out physician reading this, you’re nodding your head. Physician burnout is the exhausting, soul-crushing state where you never feel good enough or like you’re doing enough, you’re tired, you’re not present, and you might be wondering if you picked the right career.

Have no fear – you’re in the right place. We’ve helped hundreds (approaching thousands) of physicians overcome burnout and get their lives back. I’m Dr. Gazelle, a former burned-out palliative care doctor turned executive coach for physicians.

Over the past decade, I’ve coached hundreds of physicians, taught mindfulness, and employed and mentored several other physician coaches. I also wrote Mindful MD, what I consider the “Burnout Bible” which comes out in the spring of 2023.

In This Guide

I’m going to give you everything I’ve learned over the past decade + of helping physicians fight burnout.

We’re going to cover:

  • What is physician burnout
  • How to recognize the signs of physician burnout before it’s too late
  • What medical school didn’t teach you and why it’s directly causing your burnout
  • Why 50% of physicians are burned out (and why it’s nothing be ashamed of)
  • The leading causes of physician burnout and how to address each one
  • How to prevent physician burnout and how to cure it once it’s started
  • How to remove EMR stress and get your charting done in record time
  • Plus – how coaching can help physicians through burnout

Introduction To Physician Burnout

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What Is Physician Burnout

What Is Physician Burnout

Physician burnout is the state of emotional and physical exhaustion that so many physicians find themselves in. Burned out doctors often feel helpless and/or “stuck,” and have trouble maintaining motivation.

This lack of motivation centers around low energy (physical and emotional exhaustion), detachment and depersonalization (impaired ability and will to connect with patients and colleagues), and a loss of sense of purpose and personal achievement behind your work (no longer feeling like you are making a difference).

Physicians that consistently do not get enough rest (which is almost all physicians!) are prime targets for healthcare burnout. When energy stores erode, we begin to experience detachment and a lack of inner autonomy and achievement, and here begins the vicious cycle that sets us towards physician burnout.

50% of physicians are burned out (we’ll touch on burnout stats in a moment) and the symptoms of physician burnout are not pretty (we’ll also go over burnout symptoms shortly).

But for now, the key thing to understand is the three core tenants (read: triad) of the physician burnout definition are: Physical and emotional exhaustion, detachment, cynicism, and depersonalization, and a lack of sense of personal accomplishment.

AKA Doctor Burnout and Medical Burnout

Is burnout only experienced by physicians in the medical landscape? Absolutely not. Medical burnout affects almost all healthcare sectors. Our modern healthcare system is in a fairly dysfunctional state and all practitioners bear the burdens. More patients in less time, more bureaucracy, and less autonomy and humanity all set the stage for burnout. However, as doctors we are especially susceptible for a number of reasons.

Firstly, physicians are the bottleneck of the system. Patients can only move through the system as fast as we can see them – meaning we can feel like the reason things are held up.

Secondly, as physicians we are especially hard on ourselves. We’re used to being perfect, and having all the right answers, habits we learned in our medical training when anything less than 100% was a failure. We often beat ourselves up for our shortcomings as physicians and people, which can set us up for burnout. We also bear the pressure of being the leader of the healthcare team.

Lastly, there are unique stressors that only physicians face. Long hours, high patient volumes, administrative tasks and the EMR, risk of malpractice suits, and the emotional toll of dealing with pain, trauma, and death face-to-face are all forces that we feel with increased intensity. Let’s face it: while we work in teams, we are the ones that bear ultimate responsibility for patient outcome. All of this contributes to stressed out doctors and burned out doctors as well.

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Physician Burnout Statistics

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physician coaching

Physician Burnout Rates – Just how many doctors are burned out?

Here are some physician burnout stats: In the U.S. there is a physician burnout rate of 50% with 63% of physicians reporting at least one manifestation of burnout in 2022. Physician suicides are more than double the rate of the general population, and depression and anxiety are both more prevalent among physicians.

The average physician graduates with over $200,000 in educational debt – which likely contributes to high physician burnout rates.

According to physician burnout research, we work on average 53 hours per week, which is likely underreported, compared to a U.S. population average of 34. And over 4 of those hours daily are spent charting – it’s no surprise there are so many burned-out doctors!

If Half of Physicians are Burned Out, why does it feel like I’m the only one?

Half of your colleagues are experiencing physician burnout. So why can it seem like you’re the only one?

This mistake is a classic example of the availability heuristic. We see our own lives (and flaws) in high def 1080p every single day. We’re exposed to the workings of our mind, the somewhat screwed up thoughts we have about ourselves, the mistakes we make as physicians and as people, and the messiness and imperfections of our lives. Not to mention the fact that we learn to have very high standards for ourselves, so we can apply a harsh magnifying glass to our own lives.

We compare this to the 144p view we have of other doctor’s shiny, polished exteriors. All we can see is the side of themselves that they choose to show the world – which (of course) looks better than our messy interiors. This is a fundamental cause of imposter syndrome and of all the sense of shame that comes with physician burnout.

Physician burnout can feel embarrassing. As physicians, we’re used to aiming for perfection, having all the answers, and getting things right. So when our careers and lives are in burnout, we can feel a deep sense of shame and unworthiness. The first key step to getting over physician burnout is recognizing that you aren’t alone, and that there’s nothing wrong with you for being burned out.

1. Provider Burnout, National Library of Medicine; Pandemic Pushes U.S. Doctor Burnout to All-Time High, AMA

2. Physicians Experience Highest Suicide Rate of Any Profession, Medscape

3. Physician Education Debt and the Cost to Attend Medical School, AAMC

4. Average Physician Workweek, Staffcare.com; Average Hours Worked, BLS

5. Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record. Joukes E, Abu-Hanna A, Cornet R, de Keizer NF. Appl Clin Inform. 2018.

Physicians Burnout Stats Infographic

The following infographic of physician burnout stats in the United states will help you understand what the physician burnout rate looks like in this country alone.

Burned Out Physician Studies

The Mayo Clinic completes a regular physician burnout study and, with a decade of data, we can see that physician burnout is at an all-time high. 63% of physicians reported an incident of burnout in 2021, compared to 44% in 2017 and 46% in 2011. Meanwhile, emotional exhaustion and depersonalization scores were also higher than 2017 and 2011, as were incidence rates of depression.

The rate of physicians satisfied with their Work-Life Balance was just 30%, compared to 46% in 2020 pre-pandemic.

There is more burned out physician research that reports frightening numbers:

The 2022 Medscape Physician Burnout and Depression report reported a similar figure of 47% of physicians burned out.

These studies reveal alarming results – that physician burnout is getting worse.

Want To Move Past Physician Burnout?

Good! ​​Grab the FREE 10-Step Guide to move from Burnout to Balance. Start enjoying the career you’ve worked so hard for!

By Gail Gazelle, MD, MCC | 500+ Physicians Coached

HOMEPAGE LEAD MAGNET: Burnout to Balance - 10 Steps
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Physician Burnout Symptoms

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Physician Burnout Symptoms

Symptoms of Physician Burnout

Earlier we talked about the three main symptoms of physician burnout: Emotional/physical exhaustion, cynicism and depersonalization, and a loss of sense of purpose and accomplishment. Let’s take a look at what each of these actually looks like:

Physical and Emotional Exhaustion aka Physician Fatigue:

  • Lack of quality sleep
  • Fatigue/physician fatigue
  • Feeling drained and unable to cope with the demands of work
  • Changes in mood
  • Being irritable, stressed, and cranky
  • Not experiencing joy at work or at home
  • Increased risk of medical errors

Physician Depersonalization:

  • Feeling detached or indifferent with patients and coworkers.
  • Cynical or negative towards the healthcare system – a sense of “why bother.
  • Not looking forward to work/lack of interest in work.
  • Feeling “eh” about your career and life.
  • Loss of interest in activities outside of work.
  • Procrastinating on charts or other challenging aspects of work.

Lack of Sense of Personal Accomplishment:

  • Experiencing self-doubt or feelings of incompetence
  • Feeling inferior to colleagues or other doctors
  • Feeling like an “imposter” or being unworthy of what you have accomplished
  • Unable to see the good that you are doing
  • Wondering if medicine is the right career for you

As you can see, physician burnout is a miserable state to be in, and it’s a huge problem that more than half of our nation’s healers are experiencing these symptoms every day.

6. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2020. Shanafelt TD, et al. Mayo Clin Proc. 2022.

7. 2022 Medscape Physician Burnout and Depression Report, Medscape

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Physician Burnout Causes

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Physician Burnout Causes

What Causes Physician Burnout?

There are several factors that can cause physician burnout. While some of these are inherent to the modern practice of medicine, many we can address and work through to maintain this difficult, albeit fulfilling and critically important career.

The Top Reasons For Physician Burnout:

- Long hours

Many physicians, especially those in training, work extremely long hours, often in excess of 70 hours per week. The Mayo Clinic burnout study referenced above reported 60% of physicians work more than 50 hours a week, a stark contrast to the average American workweek of 34 hours, according to the Bureau of Labor Statistics.

Simply put, physicians are expected to work excessively – which is exhausting, and also leaves less time for sustaining activities like time with loved ones, exercise, rest, and time for hobbies and personal pursuits.

- High patient volume

Dealing with high volume of patients can lead to a high level of stress, which can contribute to burnout.

Especially post-COVID, and as healthcare becomes more and more of a business, we are expected to see more patients in less time. Our brain has little time to reset between our 17th and 18th patients of the day, and when we get home at the end of the day we find it difficult to turn off our busy mind.

- Administrative burdens

In addition to our workload with patients, we have to spend hours dealing with administrative junk, on the phone with insurance companies haggling on behalf of our patients, or trying to catch up with charting and the inbox long past when we should be home for the day.

- Lack of support

Within this broken healthcare system there is little support for it’s practitioners. Many of our leaders didn’t receive adequate training on how to support and lead, or they’re also bogged down by the bureaucracies and inefficiencies of the system. As a physician, you can often feel like you’re isolated and completely unsupported in your work.

- Workplace drama

Conflict within the workplace and petty politics make it harder for us to show up and focus on our patients.

- Life outside of work

Many of us have aging parents, children, important relationships to manage and maintain, marriages, and stressors outside of work. More likely than not, there are imperfections in each of these. These normal parts of life do cause additional stress, which can be the straw that breaks the camel’s back. Additionally, these imperfections can be especially stressful for perfectionistic physicians (most of us!)

- Emotional toll

Dealing with illness and death and bearing the fear of making a mistake on a daily basis can take a significant emotional toll on us. We take on the emotional burdens of our patients, and when combined with the rest of these factors, it can be a recipe for burnout.

- Chronic stress

We work in high pressure environments – our work is often quite literally life or death. The body can only take so much cortisol and eventually we can be overwhelmed by unregulated stress day in and day out. Fear of malpractice suit or legal repercussion for a mistake can add to this stress.

- Things get stale

Even Tom got bored of chasing Jerry. After years and years in a specialty, it can begin to feel like Groundhog day.

- The COVID-19 pandemic

The pandemic has increased the workload and stress of everyone in healthcare and while thankfully it has brought the burnout epidemic to light, it has also contributed to burnout.

What Causes Burnout In Healthcare

Here’s an additional hidden cause of physician burnout – The Medical Mindset.

The modern medical system is broken, there’s no doubt about it. However, there is also a hidden culprit contributing to burnout amongst our societies healers: the Medical Mindset.

In order to become a physician, it’s all but necessary to develop an unhealthy level of perfectionism, workaholic-ism, and disconnection from one’s own wellness. Doctors-to-be are expected to have perfect undergraduate grades and MCAT scores, and in medical school study for hours on end to ace exams and get mock diagnoses right.

With average medical school acceptance rates of under 6%, only the most perfectionistic students rise to the top. In medical school, physicians work even harder, and it’s not uncommon for residents to work more than 80 hours per week.

Those that make it through the grueling process have spent literally decades dependent on external validation and honing single-mindedness in becoming doctors such that they lose sight of their own well-being.

We are trained to develop patterns of thinking that work for exams and diagnosing patients but turn out to be maladaptive for the mental and emotional toll of our own lives. What happens when working harder, being harder on ourselves, and “diagnosing” more doesn’t work?

Of course, we should work hard, and we should be reluctant to make mistakes. These are healthy mindsets that our training has fostered. But when the highly diagnostic, critical, perfectionistic mindset that physicians are forced to develop inevitably turns on itself, we become exhausted, insecure, and ironically, more likely to make costly mistakes with our patients.

This mindset is a direct contributor to physician burnout.

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Physician Burnout By Specialty

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physician coaching

Which Physicians Are Most Burned Out

As to be expected, the percentage of physicians burned out varies widely by specialty. According to a 2022 Medscape study on physician burnout, incidence ranged from 60% for Emergency Medicine doctors, to just 26% for Public Health and Preventative Medicine specialists.

The top 5 specialties with the highest physician burnout rate were:

  1. Emergency Medicine (60%)
  2. Critical Care (56%)
  3. OBGYN (53%)
  4. Infectious Disease (51%)
  5. Family Medicine (51%)

The bottom 5 specialties for physician burnout were:

  1.  Orthopedics (37%)
  2. Oncology (36%)
  3. Pathology (35%)
  4. Dermatology (33%
  5. Public Health and Preventative Medicine (26%)

The fact that even in the specialty where burnout is the least prevalent, more than a quarter of doctors are burned out speaks to how big of a problem this is.

Burnout By Specialty Chart

Here you can see which physicians are most burned out, visually.

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Burnout Prevention

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Burnout prevention

Prevention Of Burnout In Physicians

There is a slew of burnout prevention strategies that physicians can take to stop burnout before it happens. Burnout prevention is, of course, the most important preemptive step that individuals and hospitals can take – it’s easier to stop burnout before it arises than to treat it once it’s present.

Here are some burnout prevention strategies you can utilize to stop burnout before it happens:

- Put your most important patient first

It is absolutely imperative that we prioritize ourselves and work as hard as we can to pour from a cup that is full. We can’t consistently show up for our patients and our loved ones until we consistently show up for ourselves.

The leading symptom of physician burnout is physical and emotional exhaustion, and tackling this symptom head-on and prioritizing self-care, and maintaining a life outside of work is the only way to get our energy back.

For the physicians that I coach, we call this “mindful selfishness.” This may sound pedantic but as physicians, we need to practice taking care of our most important patient: ourselves.

The most important preventative measures you can take are getting enough rest, and sustaining a social and personal life outside of work. Additionally, exercising and eating healthily, and intentionally prioritizing activities that sustain you are key. For me, the two things that really sustain me are time in nature and playing pickleball. (I have definitely caught the pickleball bug!).

- Be mindful

Managing your own mind and stress responses is one of the most powerful tools we have in preventing burnout. The human mind produces upwards of 20,000 thoughts per day, a crazy number! Many are helpful but by noticing what your mind is up to, you begin to see just how many are completely unhelpful.

With mindfulness, we can pay attention to the often negative and out-of-proportion thoughts that our mind generates, and we can build our ability to be less attached to the fears, worries, and preoccupations our mind generates. This helps us attack burnout where the rubber meets the road.

While there is a great deal in healthcare that we can’t control, we can control how we respond. It is this autonomy that all the dysfunction in healthcare cannot take from us. It is this that is behind the fact that over a dozen well-conducted studies reveal the power mindfulness has to reduce burnout.

I’m thrilled to announce my new book, Mindful MD, which launches in the spring of 2023. 

- Move from inner bully to inner ally:

Two of the core symptoms of burnout relate to detachment and a lack of personal achievement. When we’re burned out, we stop being able to see the good that we are doing. In order to prevent burnout, we have to intentionally focus and remind ourselves of how meaningful our work as physicians is.

The brain has a powerful negativity bias meant to keep us alive, and this is exacerbated by the aforementioned medical mindset. So it is easy to feel like your work is meaningless. As healers, this couldn’t be further from the truth.

However, our brains and the powerful negativity bias are great at replaying in 1080p any misstep we’ve ever made, and are reluctant to show us our own highlight reel. We can get around this by intentionally reminding ourselves of the good we are doing and the positive impact we have, at work and at home.

- Learn to overcome charting stress

The EMR is one of the biggest contributors to workplace stress and burnout, and I’ve written a free guide to stress-free charting.

Physician Charting doesn’t have to be the death of you!

Take control of this challenging task with the key steps outlined in this resource.

Download

Physicians and other healthcare workers can overcome charting stress by accepting that the EMR is a part of the job that is here to stay. I say this as the annoyance and frustration we experience about charting actually play a big part in the charting inefficiency I’ve successfully coached dozens of physicians on. All that emotion makes it more difficult to get our charts done! So we need to mindfully let go of the emotional charge and we also have to let go of a sense of perfectionism or that our note somehow proves our worth.

Another helpful strategy is reminding yourself that your note is just a note, and also that you don’t need to get an A+ for every note you write. While this may sound silly, I have seen these strategies be game-changers for many overburdened physicians.

- Do your part to create a positive work environment

We all know that workplace drama and politics can sap our energy and make our workplace somewhere we dread going to. Contributing to strong relationships with colleagues and coworkers, and working to build a positive culture despite whatever our organization may lack can be a powerful antidote to burnout.

You can ask yourself:

What can I do today to contribute to the positive culture I want to work in?

How can I help those I work with have a better day?

Focusing on positive actions you can take contributes to a needed sense of agency and autonomy and helps us feel good about ourselves and our work.

- Seek support

Seeking support often flies in the face of the medical mindset reinforced in our training which teaches us to never appear weak or ask for help. Ironically, when we can be open about our shortcomings and what we’re struggling with, it helps break the sense of isolation inherent in being burnout out. Push yourself to speak to colleagues, friends, or a coach about the challenges you are facing and seek help when you need it.

The US Physician Support Line is an important resource (888) 409-0141. This confidential, free phone line is staffed by volunteer psychiatrists who help physicians and trainees navigate stress, burnout, and desperation.

Preventing Burnout In Healthcare

While may causes of healthcare burnout are inherent to our broken healthcare system, at risk of recommending “change everything” I will outline some changes that healthcare systems can make to better support clinicians through burnout.

1 - Providing support and resources

As a lack of perceived support is a leading cause of burnout, healthcare systems can offer resources such as coaching to help physicians cope with the demands of their jobs.

2 - Reducing administrative burdens

Organizations can streamline administrative processes and paperwork, and/or hire scribes and more medical assistants to reduce the amount of time physicians spend on below-grade tasks.

3 - Creating a culture of teamwork and collaboration

It takes a village to raise a child and to run a hospital or practice. Leadership can foster a culture of teamwork and collaboration among physicians, nurses, and other healthcare professionals to promote a sense of shared responsibility and support.

4 - Promoting work-life balance

Organizations can encourage physicians and other healthcare professionals to maintain a healthy work-life balance by setting realistic expectations and providing flexible scheduling options.

5 - Improving communication

Improve communication within the healthcare system to promote transparency and build trust among physicians, nurses, and other healthcare professionals.

6 - Recognizing and rewarding good work

For physicians who feel underappreciated and that their work is not making an impact, organizations have the ability to completely reshape a sense of personal accomplishment. Leadership can recognize and reward physicians and other healthcare professionals for their hard work and dedication to improve job satisfaction and motivation.

7 - Encouraging leadership development

Amongst the many things that medical school does not teach us is how to be an effective leader. By investing in physicians and equipping us with the tools we need to lead, we can overcome burnout as we rise in our organizations.

8 - Implementing a burnout screening program

Regularly screen and track burnout rates among physicians and provide additional resources for those most at risk.

Providing coaching for your physicians, something that there is increasing data to support as a means of decreasing physician burnout.

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Physician Burnout Treatment

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Physician Burnout Treatment

How To Deal With Physician Burnout

In the above section, we covered how to prevent burnout. Treatment for physician burnout once its onset is similar, but requires a slightly different protocol. Understand that there is no “one-size fits all” solution to physician burnout, but a multifactorial approach combined with consistent effort will help put burnout in the rear-view mirror.

A large part of dealing with burnout in your life is understanding what is at stake. You’ve already invested decades of your life becoming a doctor, and hundreds of thousands of dollars.

This is your career, and this is your life. You are the one person responsible for its success and you are currently in a position where either your career is in jeopardy, or you’re trudging through but you’re unhappy, exhausted, unfulfilled, and burned out.

Either way, this can feel like a very bad position to be in after everything that you’ve invested. And likely not what you anticipated at the beginning of your medical journey.

So That’s A Big Piece Of What Is At Stake Here

Your career, and your life. On top of all of that, because burnout spills over and has tremendous ripple effects, what’s also at stake is:

  • Your time and presence with your children, spouse, aging parents, and loved ones
  • Your ability to be present with your patients
  • Your relationships and quality of care that you provide to your patients
  • Your calm when you go to sleep, when you look in the mirror, and when you are alone with your thoughts
  • Your relationship with yourself

There is a LOT at stake when it comes to getting over burnout. And you definitely can and you will – I’ve coached hundreds of doctors through it and I know with 100% certainty that if you can do what it takes to become a doctor, and you put your mind to it, you can also find real satisfaction and happiness. You can overcome physician burnout.

Next, make a commitment to getting out of physician burnout. It may seem like you’re in a mile-deep hole. But recognize that you can get out of burnout and actually enjoy the career and life you’ve worked so hard for.

Lastly, identify the causes of burnout that are impacting you. The three main symptoms of burnout – fatigue, depersonalization, and a lack of esteem when it comes to your work – are three areas to tackle when it comes to overcoming burnout. Make a plan of action to move past these causes, be “mindfully selfish,” and prioritize your most important patient until you have your career and life back.

For many physicians, working with an experienced, physician coach who gets it and has helped many other physicians out of burnout is one of the most effective ways forward.

How To Cure Burnout

This title is a bit of a misnomer – physician burnout is a “chronic condition.” That is, it requires continued attention to stay out of burnout – you can’t just take a pill and forget about it. However, by developing mindful habits and integrating the strategies outlined above, you can create a sustainable life and career as a physician that will leave you happy, fulfilled, and largely burnout free.

The key here is integrating the habits and mindfulness tools that are most effective and maintaining them as part of your life – not just when burnout pops up.

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Physician Burnout Coaching

The Benefits Of Physician Coaching

If all of the above sounds like a lot, that’s because it is. Undoing the patterns that set you up for burnout in the first place is no small task, and isn’t a project that is easy to DIY. Having an outside perspective and advocate to help you make the changes is why physician coaching is so effective.

Working with a dedicated physician coach, who has been in your shoes and has helped other physicians through burnout, can be instrumental in regaining your life and career.

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physician burnout coaching

About Physician Burnout Coach Dr. Gail Gazelle

Dr. Gail Gazelle is a former hospice physician who has coached over 500 physicians personally through burnout. She is faculty at Harvard Medical School, a founding member of the Harvard Institute of Coaching, a certified mindfulness teacher, and the CEO of MD Can Help, her organization dedicated to fighting healthcare burnout. Dr. Gazelle is also the author of the 2020 Everyday Resilience, and the upcoming book Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout (June 2023).

A Note From Dr. Gazelle

My 30 years as a physician, 20 years as Harvard Medical School faculty, 12 years as a career and leadership coach for doctors, and 25 years as a mother have all led me to the purpose I live by today.

My Mission Is Simple: I Help Physicians Live The Lives They Deserve

There is so much, internally and externally, that gets in the way of physicians enjoying the career and lives they’ve worked hard to create. I help physicians work through both the internal and external, so they can get back to living.

My coaching is founded on a number of core beliefs:

  • That there has never been a more difficult time to be a physician.
  • You cannot pour from an empty cup.
  • Way, way too many doctors are walking around feeling stressed, burned out, and inadequate, as a physician and as a family members.
  • For all the medical training that we received, we got very little training on how to manage the stresses of the profession, and how to manage our most important instrument: our mind.
  • A small dose of physician mindfulness goes a long way.
    What I see time and time again is that small changes have a massive impact on the quality of life of the physicians that I coach and their coworkers, patients, and loved ones.
  • It’s every physician’s right to live a healthy, balanced life.
  • No matter how powerless they may feel, every physician can feel happy, in control of their life, and confident.
  • And perhaps most importantly – I believe in you. And I’m here to help.

Gail

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Physician Burnout Solutions

Six Free Physician Burnout Resources

These FREE physician burnout resources are meant to give you exactly what you need to build inner strength and weather the challenges you face.

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Stress Free Charting

This free resource is aimed to help you better manage your physician charting tasks so you can save time to do what’s important – enjoy your life.

View this resource

The Daily Dose of Calm

A free 14-Day mini mindfulness course. In less than 10 minutes per day, you’ll learn about mindfulness and get practice meditating.

View this resource

Imposter No More

Everything you need to take full credit for all your accomplishments and strengths and vanquish Imposter Syndrome from your life!

View this resource

Leading In A Time of Crisis

What healthcare leaders need to know. Leadership in healthcare has never been more difficult than it is now. Get exactly what you need to cope and thrive.

View this resource

From Balance To Burnout

Struggling with burnout? This brief must-read guide provides just the right practical resilience strategies you need.

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Everyday Resilience

Read a free chapter and get the exact practical knowledge and strategies you need to weather whatever challenges come your way.

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Shoulds and the Paradox of Self-Motivation

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I was coaching a physician recently who was struggling to start an exercise regimen. To protect her anonymity, I’ll call her Jamie.

Jamie had started and stopped exercising many times in the past but had never stuck with it. I could well understand this as she’s a mother of three with a busy career — her days are anything but quiet and full of free time.

Like many, Jamie had put on weight with her pregnancies and struggled to lose it. She also had a family history of diabetes and was worried about the extra weight increasing familial risk.

She’d tried everything from the Whole30 diet to Noom, from working out at her Y to shifting to an elliptical in her basement, and from having her husband push her to keep her accountable to app upon app, but nothing stuck. She just couldn’t get herself to stay motivated, no matter what she tried.

Like many others, Jamie didn’t know why she couldn’t do regular exercise. She just knew that she couldn’t. Having never gotten below an A- in her life, Jamie felt that, with exercise and self-care more generally, she was getting a big fat F.

So, Jamie and I got deep into discussion, and I asked her a few questions to help her understand what was getting in her way. I first asked her to share her thoughts on exercising. Here’s what she said:

  • I should get up at 5:15 every day and get on the elliptical.
  • I should be able to stick to my exercise routine.
  • I should be better at this.
  • I should be like other physician moms who figure out how to fit exercise into their busy lives.

Unfortunately, none of these thoughts improved her ability to sustain an exercise program. Something was still missing. 

Could it be that all these “shoulds” were actually getting in her way?

I’m wondering how you approach making a lifestyle change, developing a new habit, or getting some demanding task crossed off your to-do list. If you’re like me, Jamie, and many others, you may approach the issue by telling yourself that you should make the change. You should improve, you should become a kinder, more efficient, better person, you should just do whatever it is that you’re wanting to do. 

Unfortunately, all this “shoulding” may actually be stealing your motivation, rather than building it. As I discuss in my 2020 book, Everyday Resilience, these inner ‘should’ voices are ones we all have, yet without proper tools and skills, can really erode the inner resilience we all possess. At times, this voice of should can even become one that is punishing, harsh, and shaming, can’t it? It can even creep into our thinking around all kinds of things.

  • I should get out of bed early and get on the exercise bike.
  • I should be able to stick to my diet.
  • I should start meditating.
  • I should be nicer to my spouse.
  • I should be more patient.
  • I should get that work done.

Before you know it, all these shoulds then lead to a whole other level of self-judgment:  

  • What’s wrong with me not getting out of bed early and exercising?
  • Everyone else seems to be able to know how to manage their weight issues, but not me.
  • If I don’t get it together, I’m going to end up a fat diabetic sloth.
  • Why am I so unmotivated? What’s wrong with me that I don’t have the willpower everyone else has?
  • Why can’t I just suck it up and do better?

All of this begs the question: Have your shoulds motivated you? Have they helped you make the changes you want?

There’s a reason why so many of us can answer with a resounding ‘no.’ The fact is that telling ourselves that we should do something takes us away from the intrinsic or internal motivation that is what truly motivates us to do anything. The should takes us to an external source of motivation, one that is less likely to get the job done. The should leaves us trying to motivate ourselves because society says so or your parents told you to or how you think you should be doing something or other. It takes us away from what truly drives us in life — our desires, our passion, and what’s in it for us to take the action we want to take. We may believe that an external entity like money, keeping up appearances, or receiving praise from others will get us there, and they might for a brief while, but rarely in a sustainable way.

Let’s take a deeper dive into what it is that will truly provide the motivation you need. When you think about why all the shoulds actually erode our motivation, you can likely see the answer. After all, we humans tend to do things when there is something in it for us to do so. The old WIFM, or what’s in it for me, is an important truism.

The key is to make sure you’re aligning with your WIFM as opposed to the internalized voice of parents, teachers, and others which actually only serves to tap into our brain’s threat-defense system. Recall that this is the fight/flight/freeze system that our primitive brains developed to protect us from danger. Thank goodness our brains evolved in this way to ensure that our species rose up the evolutionary ladder! But in the modern world, this system is activated by threats of a psychological nature, ones that tell us we’re not good enough, smart enough, thin enough, or, in Jamie’s case, fit enough. And once the threat-defense system is activated, we’re operating in survival mode, small, withdrawn, fearful, and only focused on getting by. All too often, the result is procrastination, distraction, or avoidance.

For true self-motivation, we can go to an important psychological theory. One of the most influential theories on human motivation, in fact, is self-determination theory, which originated from the work of psychologists Edward Deci and Richard Ryan, who published Self-Determination and Intrinsic Motivation in Human Behavior in 1985.

The SDT informs that we tend to be driven by a need to grow and gain fulfillment. One of the core assumptions behind the SDT is that developing mastery over challenges, learning, and growing is essential for our sense of self.

SDT also points to the fact that while we may be temporarily motivated by external rewards (money, prizes, societal messages, recognition or validation by others), internal sources of motivation fuel the most desire and commitment toward our goals. Also, tapping into our intrinsic desire to achieve a goal can be a powerful motivator and keep us going when external rewards aren’t enough. While the idea of intrinsic motivation may seem like a new concept, it’s something we’ve known about for quite some time. Many studies confirm the truth of SDT, bolstering the fact that intrinsically motivated people are more able to reach their goals – resulting in happier and healthier (and more motivated) people.

Tips to self-motivate

Reading this, you may be wondering: what’s the alternative?

SDT helps us understand the true ways we can motivate ourselves. What’s key is getting in touch with the “why” behind the change you want to make. That will take you to your WIFM and help you move forward toward your goal.

When I asked Jamie about her WIFM, she readily identified that exercising was important for her so she could avoid diabetes and have the longevity she wanted to be there for her family. Her WIFM also meant how good it felt to fit into some cool clothes she had worn before giving birth. Instead of beating herself up with a litany of shoulds, when she focused on what was truly in it for her, she felt more of a sense of ease about exercising. In our next coaching session, she proudly told me that she had stayed on her exercise program for the entire prior month, a first for her. Of course, it was still challenging to fit this into her busy days but now she was able to do so.

Since I’m all about pragmatic approaches, here are 5 tips to self-motivate and reach your goals.

    1) Pay attention to the voice of the shoulds. Honing this type of self-awareness is always the first step in effecting any change. And guess what? This type of self-awareness is also known as mindfulness. After all, mindfulness is about getting to know what is going on inside and around us. We pay mindful attention in a kind and friendly way, not by adding more “shoulds” onto the existing pile! Why is mindfulness so important? The simple answer is that it helps us to be more present and aware in our lives. And this can make a huge difference in how we feel and experience both ourselves as well as the world around us.

    2) Now that you’re aware of when the shoulds are present, broaden your awareness by noticing how you feel mentally and physically when you experience them. Do you feel uplifted and excited to move forward? Alternatively, perhaps you experience a sense of dis-ease, a downward sense of gravity that pulls you back toward the shoulds. Get in touch with how different the extrinsic and intrinsic motivation feels to you. Since the latter likely leaves you much more uplifted, this will also contribute to greater motivation.

    3) Now ask yourself: what is in it for me to make this change? What’s important about this? How will it help me? If it’s still unclear, try to identify the consequences of staying in the situation versus making a change. What will happen if you stay? What will happen if you change? Again, focus on what is important about this—not what other people might think or how they will react to your decision, but what’s in it for you. To enliven this, take a few moments to try on the desired state. Just like trying on a new sweater, notice what this will feel like for you. Notice how your body will feel. Perhaps there’s a sense of relief, a release of physical tension. You may also find that you’re feeling lighter, more energetic, or clear in your mind. Perhaps there’s a feeling of confidence, certainty, and freedom.

    4) Replace the should with “I want to because ___”. Fill in your reasons at the end of this sentence. Whenever your mind takes to a should, go back to this key sentence. Make it a mantra for what truly has meaning for you.

    5) Lastly and most importantly, be kind to yourself. Be patient with yourself. If you fall off your path, avoid the temptation to add more shoulds (and shame) to the situation. Remind yourself that establishing new patterns takes time and the willingness to keep starting anew. Remind yourself that you are an imperfect human amongst other imperfect humans.

    A little self-kindness and self-acceptance go a very long way.

    In conclusion, changing and establishing new habits takes work. Motivating ourselves is something we all have to work toward. But if you want to reach your goals, you’ll motivate yourself by focusing on what’s in it for you to do so. This is the surefire way to build true, lasting, and successful change. With the right combination of factors, it’s more than possible to stay motivated and achieve any goal you may have. 

    Practice these 5 tips and you’ll free yourself from the tyranny of shoulds.  I can almost guarantee that you’ll soon be the one moving forward on whatever goal is truly important to you. The more you practice, the better you will become at creating exactly what it is you desire. And the better you get at creating your desired states, the more successful and happy you will be in life, in every possible way.

    It’s a VUCA Time in Healthcare

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    I don’t have to tell you that these are complicated times in the world. The pandemic. Global warming. The war in Ukraine, and violence in many other parts of the globe. Inflation. Growing levels of inequity. The Great Resignation.

    In healthcare, in particular, these are very complicated times. The pandemic has brought to light many of the problems that were already brewing below the surface. Under resourcing. Shortages in staff. Negativity and discord. Burnout.

     It’s no surprise that the term VUCA is being used more and more to describe what’s occurring in healthcare. It’s a term that first arose in the military following the 9/11 attacks, and the same term is all too applicable to healthcare, everywhere on the globe.

    What Is VUCA

    We can think of VUCA as a big, tangled mess. A mess that is occurring in healthcare and elsewhere.

    V is for Volatility

    Upon an already stressed healthcare system, the pandemic brought with it many rapid and challenging changes in healthcare. Volatility is at bay in many ways but is most evident in the high levels of attrition and turnover we’re seeing — in physicians, nurses, technicians, therapists, and even in those who clean patient rooms.

    Indeed, a recent article in the Mayo Clinic Proceedings shed light on this issue. Looking at more than 20,000 respondents at 124 institutions, the study revealed that one in five physicians are planning on leaving their position in the next twelve months. For nurses, intent to leave was present in 40%. For advanced practice providers, 33%. This means a great deal of turmoil in hospitals and outpatient medical settings. It also raises questions about the sustainability of the entire enterprise.

    This “Great Resignation” in healthcare is something I was quoted in earlier this year in over half a dozen major news venues. While I was happy to be involved as an expert on the topic, I, like others in the field did not have a lot of tangible solutions to stem this tide.

    U is for Uncertainty

    With all this change, there is a massive sense of unpredictability and uncertainty about what will happen next.

    When will the pandemic end?

    What difficulty will come next?

    How will we do our jobs without adequate staff to support our efforts?

    What will the new normal be?

    C is for Complexity and Chaos

    The level of complexity in healthcare these days is almost inconceivable. So many moving parts. So much dissatisfaction and burnout. So much chaos. And the complexity and chaos have contributed to what can only be thought of as a giant vortex of negativity pulling all of healthcare into its hold.

    Additionally, there is so much change occurring that it has the makings of a dark joke:

    You work in a major urban area where you are in competition with the other major medical practice across town. You leave for a well-needed vacation on a Friday and return a week from Monday only to find that your health system has been acquired by your that practice. Guess what? Now you have to work side-by-side with the clinicians who were just 2 weeks ago, your biggest adversary.

    I hate to say it but, it can seem that, with all this VUCA, the joke may be on all of us in healthcare…

    A is for Ambiguity

    At the end of the day, we don’t know what all the changes in healthcare mean.

    What does all of this mean for my current situation?

    What does it mean for my future?

    If this continues, who will be left to take care of me and my loved ones?

    It is truly an ambiguous situation.

    Since many of us are experiencing a VUCA reality, it’s important to understand the impact it has.

    Certainly, a VUCA environment is both a disrupted and a disruptive one. It impacts all of us, doctors, nurses, technicians, therapists alike. Patients are certainly not spared. It can leave us:

    • Feeling unstable and ungrounded
    • Unsure of how to react to all the changes that are occurring
    • With lack of clarity on what our role is in a rapidly changing system
    • With reduced motivation to take actions that contribute to the greater good

    Most importantly, living and working in a VUCA environment can leave us fearful, reactive, and feeling out of control. This means that our limbic system is frequently activated, taking us into a fight/flight/freeze state. Unfortunately, in this state, we’re trapped in survival mode. And survival mode means that our world narrows, and that we are reduced to looking out for #1, ourselves. When we’re looking out for #1, we invariably have less left over to give to others. And yet, perhaps VUCA times require a greater degree of leaning into connection and shared community than ever.

    So, what can you do? 

    Let’s Look At 4 Ways To Overcome Uncertainty

    While the challenges of a VUCA world can seem inescapable and insurmountable, there are a number of steps you can take to manage yourself so you still show up in ways that you feel good about. So you can look back and feel proud about yourself and your actions.

    A mindful approach can help you hold steady amidst these challenging times. Here are 4 mindfulness strategies you can employ.

    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.

    How to Respond to Physician Burnout in a Colleague

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    Physician Burnout in a Colleague

    Dealing with physician burnout in a colleague

    Two hours of administrative tasks for every hour with patients. A proliferation of non-physician administrators deciding how the day is going to run. Little in our training about how to cope with uncertainty and change. It’s no surprise that physician burnout rates are approaching 60%. Despite being so common, when we see a colleague struggling with physician burnout, we may not know what to say. Responding appropriately can bring someone back from burnout and may even save a life. Here are some tips to help with physician burnout in a colleague.

    Approach the situation with compassion

    Burnout is often referred to as erosion of the soul, and for good reason. With it comes a great sense of despair, hopelessness, and isolation. We lose our perspective.

    Often there is no better remedy than the kindness of a colleague, someone who has walked in our shoes and knows what we’re experiencing. Approach the colleague with the empathetic aim of letting them know that you care about them, you’ve noticed that they are struggling, and you’re there for them. Afraid of saying the wrong thing? Here are some ways to convey your concern.

    “I can see you’ve had a rough week.”
    “I’m concerned about you.”
    “I get why you’re feeling this way.”
    “I don’t have answers but I want you to know I’m here and I care about you.”
    “You deserve to feel better.”
    “I know these feelings will pass.”

    Normalize the experience

    With burnout comes a sense of personal inadequacy. Everyone else seems to be coping with all the stress. What’s wrong with me? Tell your colleague that what they’re experiencing is normal and that many physicians are having the same feelings. Let them know there’s nothing wrong with them. Make it clear that these harsh feelings do not mean that they are a failure. And, no matter what they’re thinking, that experiencing physician burnout is a normal response to the stressors of modern practice and doesn’t mean they’re in the wrong career.

    Don’t problem solve or give advice

    As physicians, we’re conditioned to fix whatever problem the person in front of us has. It is quite literally what we are trained to do. But with burnout, we need to suspend our desire to problem-solve. Instead of doing something, we need to focus on simply being present with a colleague’s suffering.

    On that same note, we also need to avoid giving advice. Giving advice sends an implicit message that the person doesn’t have the inner resources to solve their problem. Not only that, but the last thing someone wants to hear when they’re low on energy, overwhelmed by demands, and disconnected from any sense of meaning is “I know how to solve your problem, here’s what you should do.”  Simply listening without suggesting any action can help someone in burnout begin the critical step of gaining perspective on their situation.

    Help them connect with their accomplishments

    When we’re in burnout, we’re focused on everything that’s wrong, with the workplace and with ourselves. We’re disconnected from meaning and purpose. Positives slide off us like Teflon and negatives stick as if attached by Velcro. Whatever our strengths and accomplishments may be, we believe we have none. It’s critical to find a way to reconnect with the things we are accomplishing.

    Ask your colleague if they’d consider keeping a running list of three things they accomplish every day. This simple exercise can provide ballast against the pull to inadequacy and negativity, and potentially help relieve some of the symptoms of physician burnout.

    Let them know seeking help is not a sign of weakness

    We learn early in training that seeking help is a sign of weakness. We’re the head of the team and we’re supposed to have all the answers. Yet, we can’t solve every problem by ourselves (no one can.) Reassure your colleague that asking for help is a sign of health, not weakness. Recommend that they speak to loved ones and other colleagues. Encourage them to seek coaching or other professional help.
    While you can’t change the external landscape, know that applying these tips can make a big difference in a colleague’s ability to see a way forward.

    In summary, remind yourself to listen compassionately. Normalize their experience. Avoid the temptation to give advice or problem-solve. Help them see their strengths and accomplishments.  Let them know that seeking help is often vital and is not a sign of weakness. Reassure that they can find a way to meet the intense demands of practice with much less anguish.

    Get more resources on physician burnout.

    Physician Burnout: Are You Engaged Yet?

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    When you wake up in the morning, are you ready to take on the day, or do you want to pull the covers up over your head and crawl into a cave?

    As noted in a recent  New York Times  article, “Why You Hate Work,” a 2013 Harvard Business Review study of 12,115 white-collar workers revealed that 70% of workers do not have time for creative or strategic thinking at work, and 50% do not find meaning and significance in their workplace.

    This problem of finding purpose or engagement at work affects all white-collar workers, including physicians in nearly every specialty and field. A pioneer in burnout research, Christina Maslach defines burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and lack of sense of meaning and accomplishment. Does any of this resonate for you or the physicians you know?

    As a physician coach, I have worked with many clients suffering from physician burnout who are not only dissatisfied in their work, but feel disillusioned and without purpose.

    I recently worked with a mid-career neurologist who was frustrated by the never-ending changes in her workplace. It seemed as if the rules changed by the week, with hard-to-understand updates to the EMR, and rotating practice managers, one more challenging to work with than the next. My client became so lost in frustration and negativity that she wondered why she was even practicing medicine anymore.

    Engagement is the antithesis of physician burnout, and is defined as a positive, fulfilling, state of mind characterized by vigor, dedication, and a sense of flow in one’s day.

    The New York Times article points out that employees are more satisfied and productive when their foundational needs are met, including creativity, value, and a sense of connection and purpose at work.

    When engaged, white collar employees are more motivated, feel more personally invested, and tend to become absorbed in their work. When they come up against challenges, they are inspired to find creative ways to problem-solve. In addition, these employees find greater work-life balance, and have an overall sense of optimism and happiness. This is critical for physicians, given that they experience levels of burnout of 30-60%.

    Engagement is increasingly recognized as vital for self-determination and productivity in the workplace. Organizations that encourage employee engagement are experiencing higher profits, improved safety records, and higher retention rates. Simple workplace measure such as providing breaks and acknowledging hard work can go a long way in increasing engagement.

    Through physician coaching, my neurologist client experienced renewed motivation to effect change in her workplace.  She pushed leadership to develop a wellness committee. We worked on many strategies to help her manage the changes and stresses of her position. Over time, she learned to focus more on her strengths, celebrate small daily accomplishments, and gradually re-engage.

    If you find yourself overcome by disengagement and burnout, please check out my new FREE ebook, Building Your Resilient Self: 52 Tips to Move from Physician Burnout to Balance. I created this resource specifically for physicians. In the book you’ll find specific strategies to prevent and counter physician burnout.