As physicians, we don’t talk about self-care much. But perhaps we should.
Burnout amongst physicians is disturbingly prevalent. One recent survey of US physicians revealed that 45% of respondents (n=7,288) displayed at least one manifestation of burnout, which is defined by emotional exhaustion, feeling more callous or cynical, and/or a poor sense of accomplishment. (1)
Many studies elucidating the problem of physician burnout have been performed, but few address solutions. Therefore, I was glad to find a recent study exploring the self-care (or resilience) strategies of 200 healthy, non-burned-out physicians in Germany. In this qualitative study, respondents (which included 38 psychiatrists) discussed with the help of a structured interview their coping strategies for maintaining mental health and preventing burnout. (2) They also shared the ways in which they derived gratification from their work.
Resilience is the ability to thrive despite external stressors. In the German study, the most common resilience strategies employed by the physicians were ones I think most providers would find unsurprising. These included creating work-life balance and making time for leisure activities, family, and friends.
Other resilience strategies mentioned in the study included setting firm limits, not only with patients and colleagues, but also with paperwork and hours spent on the job. Physicians also mentioned the importance of scheduling regular breaks throughout the day.
The authors of the study note that resilience behaviors do not always involve withdrawing from work or setting limits. In fact, the healthy physicians cited various strategies that allow them to cope with work more effectively. For example, 55% of all physicians and 69% of psychiatrists interviewed made sure to schedule regular contact with colleagues, and many used these opportunities to discuss difficult patients or reflect on errors. Resilience strategies also included personal reflection, goal setting, and regular continuing education. Psychiatrists in particular were likely to utilize one-on-one support in the form of supervision, coaching, or psychotherapy.
Another key to preventing burnout involves cultivating the right attitude. Adaptive attitudes mentioned included accepting each situation as it comes - rather than wishing it away - and finding appreciation for the positive events in life. Self-awareness was also thought to be a helpful attitude, which fits with the growing body of evidence suggesting that mindfulness can promote physician well-being. (3) When stress was high, some doctors found solace in remembering that they could always find a different job. Leaving an unsatisfactory job at the right time was thought to be especially valuable for early career physicians.
Almost all the healthy, resilient physicians described the ability to derive satisfaction from their work. If they did not feel satisfaction from curing illnesses, then they found it in the connections they made with their patients.
This study resonates with me in that my most content and productive times in medicine have been those times in which I was more engaged - not less - with my work. Sometimes that looked like a positive attitude, such as being grateful for each learning experience, however unpleasant - and sometimes it looked like widening my sphere of involvement by organizing educational events, doing research, or attending conferences.
As the study suggests, connecting with colleagues can be hugely helpful, and peers can provide valuable feedback, support, and new ideas to help improve one’s practice. Enjoying positive relationships with mentors and colleagues can further bring meaning and gratification to the practice of medicine. I have also found it adaptive to not only to work creatively within the constraints of the job, but also to ask for help when things seem unworkable.
The study did not mention, to my surprise, strategies for supporting one’s physical well-being, such as healthy eating, exercise, and regular sleep. It makes sense that physicians who are physically feeling good will feel less exhausted and have more to offer their patients. I found one study supporting this idea: US surgeons who get regular aerobic exercise appear to be less frequently burned out (25% vs 30%) than those who are more sedentary. (4)
It’s not clear which resilience strategies are the most effective, if any – the data from the German study is only exploratory and correlational. Still, the study offers some relevant ideas for physicians interested in improving their level of wellness at work. The inclusion of a sub-analysis of psychiatrists makes it especially interesting to me, as the nature of psychiatry can differ from that of other specialties.
Since resident physicians are at especially high risk of burnout, I’d like to offer some specific recommendations for this population. To start, I suggest reflecting upon your unique stress vulnerabilities – that is, the situations known to strain you. Then, devise a strategy for addressing each one. If physical stamina is a weak point, for example, try outsourcing domestic activities such as housecleaning, food preparation, and running errands in order to maximize your off-duty time.
Educational debt may be a risk factor for resident burnout, suggesting some residents can feel resentful about their finances. (Burnout literature calls this an “insufficient external reward”.) Since residents’ salaries are relatively fixed, one idea is to direct your attention to the intrinsic rewards of the profession, such as the opportunity to help others. (5)
If you find that you feel frustrated with psychiatry-related issues, try talking to your supervisor or attending; while stress from your personal life may be better alleviated with the help of a skilled therapist. Finally, if something structural about residency is causing you undue duress, sit down with your chief resident or program director. In general, I find that feeling unsupported can be a potent catalyst for burnout, so it is important to ask for help when you need it.
These resilience strategies have all been offered with the individual provider in mind. Yet some would argue that the best burnout prevention occurs at the level of the organization. This may be true. In the meantime, as individuals we are not powerless to improve our lot. (6)
How do you stay engaged with your work and prevent burnout? I’d love to hear your thoughts.
3. Krasner MS, Epstein RM, Bechman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 2009; 302:1284-1293.
5. West CP, Shanafelt TD, and Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among Internal Medicine residents. JAMA 2011; 306(9):952-960.
Leigh Jennings, MD, is a senior psychiatry resident in the Department of Neurology and Psychiatry at Saint Louis University School of Medicine.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.