BY DIANE W. SHANNON, MD, MPH, PCC, MMS MEMBER, PROFESSIONAL COACH, AUTHOR, SPEAKER
Image by aquaArts studio via Getty Images.
The story of a physician who “failed” yet succeeded in ways she never could have anticipated.
During internship, I experienced what I now know was severe burnout. I pushed through. I pared down my life, letting go of exercising, hobbies, socializing, and long-term relationships. I didn’t think to ask for help because I thought I was the problem.
I completed training, passed my internal medicine board exam, and practiced primary care. I struggled to find a practice setting that felt compatible with a healthy life over the long term. I thought my only choices were to burn out again or leave clinical
practice. Eventually, I chose the latter and started a new career as a freelance writer, focusing on the U.S. health care system.
In hindsight I can see that I chose that path because I wanted to understand what had happened to me. Why was I unable to practice medicine and be healthy and happy myself? What had I done wrong? Unconsciously, I set off on a journey to answer this question:
What is the key to creating a meaningful, sustainable career that enhances the physician’s life instead of squashing it?
The first clue came while I was writing an article for a nonprofit foundation focused on improving the patient experience. I stumbled across the definition of professional burnout. It took my breath away.
I had a name for what I’d experienced. I started reading everything I could about physician burnout and interviewing experts in the field.
I learned that job burnout has three components: emotional exhaustion (feeling totally spent), depersonalization (separating from the emotional aspects of the job), and inefficacy (diminished sense of professional accomplishment and effectiveness). I
learned that professional burnout is caused by the workplace environment, not individual susceptibility. This was a huge relief, as for years I’d carried the shame that my burnout was due to a weakness or lack in me.
Fifteen years after leaving practice, I finally overcame that shame and shared my story publicly. At that point in 2011, not much had been written about physician burnout, and my article on the Boston NPR website went viral. Physicians began contacting
me to share their experience, grateful to know they weren’t alone. They led me to a newfound mission: to address physician burnout. I researched and co-authored a book on the topic, published in 2016.
After serving on a burnout task force, speaking at national meetings on the topic, and starting a blog on burnout, I decided I needed to be more actively involved in the solution. I trained to become a certified coach after participating in a leadership
program for physicians where coaching was used. What inspired me was that the program didn’t just help individuals; graduates then had the bandwidth to identify and address some of the practice- and system-level drivers of burnout in their organizations.
As a coach, my job is to help my physician clients think about their thinking. (One of my clients called coaching “the school of unlearning.”) I never tell them what to do, as an athletic coach would. Instead, I use questions and specific exercises to
raise their awareness of what they really want, what stands in the way, and how they might make changes to reach their goals. I provide a safe, confidential, objective space where physicians can talk through what’s not working and figure out what
they can do about it.
Finally, three decades later, I feel I’ve discovered the answer to the puzzle that led me from clinical practice to health care writer to physician coach, the secret to creating a sustainable career in medicine while having a full life. I credit my amazing,
courageous clients for teaching me.
I learned as a writer that burnout is driven by the health care system, the health care organization where the physician works, and the myriad frustrations and workarounds in the physician’s immediate practice environment. While I still firmly believe
those are the root causes, there is another truth that is extremely important: individuals have agency to make changes that can transform their experience at work.
When you’re experiencing burnout, you keep your head down and focus on trying to survive that day. The next day is more of the same. You are too busy to try something new and have no energy to consider what you might try to change. Plus, addressing the
larger system issues seems like the only fix — and you as an individual feel powerless to shift that.
What I’ve learned from my clients is the power of micro changes. These are small shifts in how they think, approach their work (including their schedule, visit notes, and agenda-setting with patients), communicate requests to leaders, set boundaries,
and prioritize their time. Today, I encourage my clients to identify and try a small change as an experiment. That means the focus is on gathering information; if something doesn’t help, that’s data, not failure.
The power of micro changes has
surprised me over and over again.
For example, Dr. A had been a primary care physician for 14 years when she contacted me. She had three small children and was heading into burnout.
According to her contract, she worked 0.6 FTE in clinic, just three days per week. However, she was on her computer every day of the week to complete all the required paperwork. “I just want one day in my week completely away from work,” she told me.
I encouraged her to see beyond what she could not change — such as the time-consuming data entry work — and look for any small changes she could make in how she worked. She identified two small changes to try: a short period of precharting the
day before and trying to finish clinic notes before seeing the next patient, neither of which she’d done before.
When we next spoke, two weeks later, she told me, with a tone of complete surprise, “I had a Saturday completely off.”
The small changes in time management made a big difference in her work efficiency. The time she invested in precharting paid dividends on her clinic workflow. And inching up the percentage of notes finished before seeing the next patient left fewer charts
to complete at the end of the day, when she was tired and less efficient. We were both shocked with how much time she saved and at how quickly the small changes made a difference. Having a day off had a ripple effect on her whole life, and she began
to love her work again. “I wish I’d done this 14 years ago,” she told me.
I’ve also learned that micro changes don’t stick if underlying thinking patterns get in the way. These negative thought patterns can also derail our confidence, personal satisfaction, and relationships. For physicians, some common ones are perfectionism,
people-pleasing, excessive worrying, self-criticism, and procrastination.
These patterns serve legitimate functions in certain circumstances. But when used in the wrong setting or to an extreme, the costs outweigh the benefits.
For example, Dr. B, a midcareer obstetrician-gynecologist, was heading for a second bout of burnout when she contacted me. She was still the most productive physician in her 30-physician private practice, but nurses had started complaining about her communication
with them. She told me she was no longer her usual friendly self but “maxed out and grumpy.”
She identified excessive people-pleasing as a problem and experimented with setting better limits around work. For example, she muted the clinicians’ group text when she was not on call and stopped volunteering for extra work tasks. She looked honestly
at why she felt she needed to please others and at the personal costs to her energy, her health, and her outlook on life.
By setting healthier boundaries at work, Dr. B was able to preserve time for a life outside of work. She recovered from burnout, and her relationship with the nurses turned around. In the time she reclaimed, she took on a leadership position in the hospital
that she had coveted and pursued a passion for travel photography.
Sometimes life teaches you lessons when it’s too late to apply them to your own life. But you can share them with others and alter the trajectory of their lives.
If you are feeling overwhelmed with the demands of clinical practice or experiencing burnout, take a lesson from my experience. Don’t cut back or leave medicine until you’ve accessed whatever help you need to find the places where you have the power to
do things differently. Know that you have within you the ability to harness micro changes that can shift your daily experience at work. Know that better is possible.
Diane W. Shannon, MD, MPH, is a former primary care physician with more than 20 years of experience as a professional health care writer and author. Today, as a professional coach, Diane helps women physicians and healthcare leaders succeed in the careers they worked so hard for—without losing themselves.
