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It’s difficult to avoid physician burnout when the demands keep increasing and it feels like the system is against you. For some, burnout becomes the norm, and it takes a big toll. In case you’re unsure, here are the three components of burnout:
- Emotional exhaustion and depletion
- Cynicism, depersonalization, and withdrawal from your work
- Inability to connect with your strengths and your accomplishments
These run together, creating a downward cycle. Looking at the last one, however, we see how a focus on one’s weaknesses can set the stage for burnout. As physicians, we are often our own harshest critics, saying things to ourselves that we wouldn’t say to others. Among the hundreds of physicians I’ve coached, I’ve seen many hyper-focused on their perceived inadequacies. Perhaps you can relate to this? Here are a few questions to help you see if you’re leaning in this direction:
Do you tend to see your strengths or your weaknesses?
Do you pay attention to what you’ve accomplished or what you haven’t?
Do you notice what’s going well or what isn’t?
If you answered yes, know that you probably come by these patterns honestly. They’re the result of our education, our workplace environments, and the broader culture we live in. Changing these habits takes some practice, but it’s a sure way to reverse the cycle of burnout.
Roadblocks to Seeing Our Strengths
Medical training tends to be deficit-based. In residency, our noses were often rubbed in any mistake we made. An Internal Medicine resident recently told me, “On my Onc rotation, the attending kept focusing on how few of the chemo regimens I was up on. On my Cards rotation, the fellow kept at my not being up on the latest STEMI trials. No one seems to notice when I do know something. It’s been so long since I’ve gotten any positive feedback, I’m not even sure if I have any strengths at all.” These types of hypercritical experiences of belittlement create stress, worsen physical and mental health, and can even lead to suicidal thoughts.
Most physicians have stories from their residency about being “pimped,” asked question after question by an attending, just so they’d finally get to the inevitable embarrassment of not knowing the answer. This pattern can leave us focused on our weaknesses.
Experiences like these are pervasive in our training and, for some, may be reminiscent of messages we received earlier in life. Whatever the origin, these self-defeating messages can fuel the downward spiral of burnout.
Physician Burnout and Negative Self-Talk
Let me share with you an example of just how deep this goes. When I give talks on resilience to physicians, I ask:
What’s your typical ratio of self-promoting to self-defeating messages?
And do you know their typical response?
What is a self-promoting message?
Physicians are so used to the self-defeating voices that it’s difficult to identify with the concept of positive self-talk.
In addition to what we learn in our training, this also may result from perfectionism. Many physicians consider perfectionism an asset. And, while it may have served us in taking tests, perfectionism can hold us back today.
Physician Burnout and Perfectionism
Here’s one way of thinking about perfectionism:
- Holding out for a barely attainable standard and then berate yourself for not achieving it.
- Procrastinating to avoid facing self-criticism.
- Believing that berating yourself will improve your performance.
- Ruminating and experiencing anxiety about your performance.
- Experiencing a lack of confidence.
Bottom line: Difficulty appreciating your strengths and successes.
A different frame to consider is: Have I done my very best? Can that be good enough?
Physician Burnout and a Strengths-Based Approach
If this resonates and you notice that the negatives dominate your thought processes, practice giving more attention to your positives. As discussed in a previous post, a strengths-based approach tends to be more motivating than whipping ourselves about our deficits. Here are some practical ways for you to shift focus to your strengths.
- Notice when you get stuck focusing on your weaknesses.
- Push yourself to shift attention to what’s going well.
- Notice the “bright spots” in each day—times when something good happens; when you utilize your strengths.
When you find yourself back in the cycle of self-defeating thoughts, ask yourself:
- What’s right about me?
- What am I doing well?
- What are the three things I’ve accomplished today?
Develop the habit of noticing what’s going well. Celebrate doing your best and practice letting “good enough” be enough. You may just find that this frees up your energy, replacing physician burnout with physician resilience.
Focusing on Your Weaknesses Won’t Make You Stronger
In this week’s post, I break down why physicians should Stress Strengths rather than Strengthen Stress in order to combat physician burnout.
Last week, I was speaking with a medical director at a large practice who was telling me that he couldn’t understand why the physicians in his group were having trouble getting their charts done on time. I asked him what sorts of strategies he’d employed to try and make the situation better, and he told me he had:
- Issued email warnings
- told physicians that their pay would be docked if they didn’t do better, and
- posted comparison charts of members of the group. He could not fathom why the performance wasn’t improving.
I also recently sat in on a meeting with a client of mine (an internist) and her non-physician supervisor. To my disappointment, the entire meeting was focused on patient wait times, an area where the supervisor determined she was not meeting targets. Not one word was spoken about the internist’s improved Press Ganey scores, the gains she’d made in consistently starting her day on time, and the positive comments staff had made about her performance. At the end of the meeting, my client broke down in tears.
“How can anyone expect me to succeed when all they do is point out my shortcomings?”
Physicians are hyper-focused on their own flaws; we don’t need a supervisor to point them out for us. Negative reinforcement is an old and outdated leadership approach. A person’s path to growth and improvement lies in mobilizing their areas of strength.
Meeting with “the big bully” and seeing the “wall of shame” erode self-esteem and don’t lead to improvement. If you’ve been on the receiving end, you have no difficulty understanding how damaging these strategies can be.
What Research Shows About Negative Reinforcement
Gallup conducted a study when they analyzed over one million work teams. They found that only 9% of employees who are forced to work in an area of weakness are engaged, while 74% of their counterparts who are allowed to work in an area that uses their strengths are engaged. This isn’t a minor difference either; the gap is staggering.
Engaged employees tend to be more productive and happier at their work. One of the easiest ways to increase employee engagement is to help them align with their strengths.
Let’s try a simple exercise:
Think of a task you’ve been putting off completing. Imagine that you’re sitting down to do it right now. For 60 seconds, think about all the ways you believe you’re inadequate to get this task done:
- I’m not smart enough
- I’ll never get this all done
- I’m not as disciplined as others
- I’m a great procrastinator
Don’t hold back, pick your poison!
Now, mindfully, check-in with yourself. Rate your level of motivation to do the task on a scale of 1 to 10, where 1 = no motivation at all and 10 = let me at it!
Next, switch your focus to all the ways you’re more than adequate:
- I’ve gotten this type of thing before
- I am accomplished and well-regarded
- I’m good at this type of task
- Even when I procrastinate, I always cross the finish line
Sweeten the pot a little more by giving yourself an extra 30 seconds to think how good you’ll feel once the task is off your list.
Now check-in with yourself again.
Want to combat physician burnout symptoms but not sure what your strengths are?
While you may be used to focusing on your weaknesses, in your roles of physician and family member I can assure you that you have many. You simply could not have made it this far without them.
An easy way to find your strengths is to complete a basic personality traits test like the one provided by the University of Pennsylvania Department of Psychology.
How this relates to physician burnout combat
I’ve written about physician leadership and burnout in the past, and it’s clear that a deficit, weakness-based focus, and burnout go hand in hand.
If we want to avoid burnout or find out how to combat physician burnout, the strategies I mention in this article are key:
- Stop focusing on what went wrong and start focusing on what went right
- Help others see their strengths
Want to learn how you can reduce, deal with physician burnout, and promote healthy physician leadership?
Get my Anti-Burnout Physician Leadership checklist for further FREE tips on how to combat physician burnout.
Data confirms high rates of physician burnout, but it doesn’t tell us how burnout can be avoided. In fact, data on preventing physician burnout is almost nonexistent. One thing we do know, however, is that physician leadership skills a key variable. Physician leaders can make or break a workable culture. A 2015 study from the Mayo Clinic found that qualities of physicians’ leadership accounted for 47% of the variation in physician satisfaction and 11% of the variation in physician burnout. Looking at their study, a number of leadership attributes stand out that can be helpful in avoiding physician burnout.
If you’re a Physician Leader or Executive looking to bolster their management and physician leadership skills, learn more about my Physician Leadership skills and Executive Coaching services.
Physician leadership skills and physician compassion
Compassion is a core value for most physicians but is increasingly bypassed in medical practices. Recently, I coached a 47-year-old Internal Medicine medical director who oversaw 80 primary care physicians. Much of the stress of his job was conveying edicts from the administration to the physicians he supervised. At the end of a particularly terse medical director meeting, the Chief Medical Officer bluntly told the medical directors that, in addition to recent cuts, they would need to inform their physicians of a further 10% pay cut. There was no discussion of the impact this would have and the news was delivered in a cut and dry fashion. My coaching client felt morose, defeated, like a cog in the wheel of the healthcare factory. The communication had flown completely in the face of compassion, a core value for him. He wondered how much longer he could go on in his position. He noted that if the same news had been delivered with concern for the impact it would have, while the consequences would still be painful, he would have experienced a greater sense of hopefulness and community. I coached him around maintaining his values by learning from this experience and never repeating this type of conduct. We continued to focus on making sure that each and every one of his communications conveyed the compassion he knew first-hand was vital in maintaining morale and avoiding physician burnout.
Employee engagement has been hailed as the single most important factor in determining levels of satisfaction with work. In a 2012 meta-analysis of research studies, Gallup found that compared with the bottom quartile, companies in the top quartile for engaged employees had 22% higher profitability, 10% higher customer ratings, and 48% fewer safety incidents.
Engagement is the antithesis of burnout. The many administrative burdens physicians face making it difficult for physicians to engage fully with their most important task: caring for patients. Physician leadership skills makes a pivotal difference. Given the many metrics coming down the pike, leaders need to constantly orient their approach around such questions as: “While metrics need to be pursued, how can I focus on how hard my physicians are trying rather than whether they’re meeting each specific target?” “What actions can I take today to help my physicians feel more energized and engaged.” “How can I facilitate my physicians performing at their best?” Sometimes small actions go a long way to facilitating engagement.
Recognizing a job well done
Everyone wants to feel valued and recognized for their contribution, yet in the current healthcare environment, too often the emphasis is on areas of deficiency rather than successes. A Chief Medical Officer I coached worked with her team to achieve large improvements in productivity. To remain competitive, however, metrics revealed that further improvement was needed. While her tendency was to focus on the gap between where clinicians were and where she wanted them to be, I coached her to focus on the gains rather than the deficits. She worked to ground each communication with her physicians on the strides they had made, identifying what strengths and skills they had used to make improvements, and assisting them in utilizing similar approaches to glean greater success. In a subsequent satisfaction survey, her physicians gave her the highest scores.
Communicating with positivity
We spend most of our waking hours communicating with others, but very often the rush keeps us from doing so in a respectful and positive manner. In a 2004 study of 60 top management teams engaged in annual strategic planning, the single most important factor in predicting organizational performance was the ratio of positive to negative communications. The research revealed that in high-performing organizations, the ratio of positive to negative communications in their top management teams was 5.6 to 1. By contrast, in low-performing organizations, the ratio was 0.36 to 1. In a recent physician resilience retreat I led, I asked the audience how their risk of burnout would improve if their leaders focused more on the positive. The responses were instructive: “It would be infectious,” “I’d be more productive,” “I’d be less irritable,” “There would be less spill-over with my family.” Anecdotally and empirically, the evidence for positive communication is high.
A principle of effective leadership is listening affirmatively and supportively, being open to the input of others, and not jumping in with one’s own opinion and advice. Leaders who inspire dedication, sacrifice and grit are ones who listen openly. As noted by Stephen Covey, effective leaders communicate with the goal of seeking understanding. A key skill is to ask open-ended questions. Open-ended questions communicate a deeper interest in the person’s response, increasing their sense of being heard. By shifting from questions that suggest a right and wrong answer, open-ended questions encourage others to respond more fully, contributing to greater engagement.
If you’re a physician leader, take heart in knowing that your actions can have a significant impact in mitigating physician burnout. Even if you’re suffering from physician burnout yourself, you can help motivate physicians to overcome the challenges they face. If you are a front-line clinician, please feel free to forward this post to your physician leadership. Many physician leaders are excellent clinicians or researchers and bemoan the fact that their physician leadership skills are limited. Most are happy to learn ways that they can improve.
If you’re suspecting a colleague may be suffering, here’s how to respond to physician burnout in a colleague.