“Today you are in for a frank conversation on burnout.” -Master Certified Coach Jill Farmer

In this episode, Coach Jill Farmer leads our founder and CEO, Jen Barna MD and Coach Gabriella Dennery MD in an honest discussion  that scratches the surface of their experiences with burnout and what it was that helped them get to the other side. Each has a different story of how it affected them and how a multifaceted approach is needed to result in resolution and moving forward. We hope that this episode will help those experiencing burnout to know there is hope and relief, and will help listeners to know how to identify the signs in themselves and others, and also to know that this is preventable.

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Jill: Today, you are in for a frank conversation on burnout. 

 

[music]

 

Jill: Hello and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, one of the lead coaches at DocWorking. Today, you are in for a frank conversation on burnout. I’m really excited today to be joined by the founder of DocWorking with Jen Barna, who is also a working physician, and of course the other co-lead coach at DocWorking, Gabriella Dennery. Both physicians who’ve been through the same medical school training that you guys all have, and both people who honestly are open about the fact that they have experienced burnout. I’ve talked to a lot of people who have experienced burnout, but I haven’t watched through the shoes of being a physician who has lived with burnout. Gabriella, I’m going to start with you. Can you tell us a little bit about your journey of experiencing burnout as a primary care doc?

 

Gabriella: Hindsight is 2020, so I’m going to use it. I can honestly say that burnout began in med school really, again, looking back. It was definitely accentuated during residency, and then, in my attending years, I think I’ve started and continued in my attending years just functioning on fumes. I really had very little to give. But I kept pushing, and kept pushing, and kept pushing, thinking that, okay, if I pushed hard enough, if I pushed long enough, if I took my next vacation, everything will be okay. It didn’t turn out that way, Jill. It was always, always this kind of interesting pattern, even I would say probably since internship, especially since internship, that I would take a week off, and notice that by the time, the week was ending and back at work the next day, it’s like I never went. [laughs] The pattern continued over and over again, and just kept getting worse. 

 

Again, hindsight is 2020. I didn’t think about it that way. I didn’t see it as anything wrong. It was just part of the internal conversation. As I got into my attending years, the pressures were different as an attending physician. But as you know, the paperwork, the EMR, the catching up this mountain of charts at the end of the day, at the end of the week that never seem to go down, and trying my best to catch up. Did I do this? Nope. Did I not do this? Nope. What the heck happened to this patient? Oh, my goodness, it was a different set of pressures as opposed to residency, but it was significant all the same. In primary care, while you need to see 20 patients before we add more staff. This is some of what the administrators would say depending on the location. I could go on, and on, and on about what it felt like in that experience. But what I knew at one point, I had to finally admit to myself that I was in trouble. It took me years to get there. 

 

That would be my first thing, is I didn’t even know it was burnout. All I knew is, I wasn’t feeling well. [laughs] All I knew is, I had no more energy, and I didn’t even want to get up to go to work anymore. There was the loss of fulfillment, what am I doing here, I just feel like an overpaid drug rep. They’ve probably made more money than I did anyway. [laughs] I just spent my days writing referrals, and prescriptions, and trying to catch up on charts, and that was life. The ties to what it is to be a doctor, and why went into medicine got lost. I’ll be honest with you. To make a very, very long story short, it started early, and once I was able to finally say, “Hey, you know what? Something’s not going right here,” and able to seek the support I needed, things started to shift little by little by little.

 

Jill: We’ll talk in a couple minutes again about what some of those shifts that you made in order to support yourself were. Jen, what about you? What has been your experience as a physician related to burnout?

 

Jen: I would say like Gabriella, looking back, the origins began in medical school and residency. My kids were born, both of them in medical school. It was a struggle. But during medical school and residency, I did have the support of my peers, and that made a difference. What happened for me was, I accepted a job as what turned out to be a solo radiology job right out of residency. I was supposed to be the third in a team of three. But when I got there, there were no other radiologists there. [laughs] It was just me, and I started July 1st, I believe, and there were studies stacked up from April, and they said, “When you get a chance, could you please read those as well, because we’ve been without a radiologist for a while.” [laughs] It was really the red flag that should have made me walk away right that moment. It was kind of out of the frying pan into the fire for me. I got through residency thinking, “Okay, it’s five years. I’m just in it for five years, but after that the schedule is going to get better, and that’s what I would say to my family. And then, the schedule got worse. 

 

What happened was, and I could tell you some stories that happened subsequent to that multiple, but ultimately what happened is I stayed there for two years, and then, I made a change, that was a huge improvement, and I never had another job that was similar to that, because I made sure that I never did. But what I found was that the effects from that were long lasting, and followed me really, until I started working with you two, Gabriella and Jill, and a lot of the insights that you guys have provided have made a tremendous difference for me. I really thought that I had solved those problems. But I still had residual angst and anxiety about work that to be honest with you, I didn’t even understand, because I liked my team, I liked my job, and so, it has been very transformational for me to work with you guys, and all of the tools and tricks that you’ve shown me that give me insight into the way I’m thinking, and ways that I can control things have made such a huge difference.

 

Jill: Let’s talk a little bit about just a couple of ideas each if you have them for ways that, as you said, Gabrielle, sometimes, a lot of physicians, a lot of docs like yourself just didn’t even know that was burnout. This perpetual exhaustion, this idea that you’d rather do anything, and not having anyone say to you, “Hey, these are things to look out for, so that we can get you some support.” Identifying that you are burned out, being familiar with those is important, and then, as you said, taking some steps to get some support to be able to heal from it. Can you talk a little bit about those?

 

Gabriella: Well, absolutely. I got to the point where I can honestly say, I was at my wit’s end. I just didn’t understand what other direction I was going to go. I thank God every day for my psychiatrist mother, [laughs] who said, “Look, Gabriella. It’s not working. You need help.” It took years for me to finally take that step and look for a therapist. I actually finally asked a friend who had nothing to do with medicine, which I think is very, very important, because I had to feel safe. I did not feel safe going to my bosses, I did not feel safe going to colleagues. I felt safe going to a friend of mine who happened to be a social worker, and I said, “Hey, can you recommend someone?” Once that process started, it was really, really eye opening. That I gave myself permission to even speak about my experience was huge, because I’m an introvert, and I tend to hold things to myself. And to be able to go to somebody, and actually admit that I felt weak that I felt out of sorts, out of place, directionless, despite the fact that I had a beautiful diploma on my wall, I had my board certification, I did everything that was right. I know, I did my best as best as I could for my patients. I worked hard. There’s no question about that. But I was miserable. 

 

Just being able to articulate that, “I’m not happy. I don’t know. Something must be wrong with me, because I’m doing everything right, and life should be as it should be. But something’s not connecting here.” To have that person, have that weekly conversation was huge. I have to say, there were points where I decided that I was not going to put it through my insurance company, because there was that kind of fear that somehow somebody at the job is going to find out that I’m in therapy, and I did not want that to happen. So, I paid out of pocket. Thank goodness, I had the resources to do that. 

 

But I think it’s very telling that when you do need support, and I still hear those stories, how many more years later, that when you do need support, where’s the comfort in seeking that support within the medical industry, within the medical model, and how many physicians still feel that they need to go outside. Which actually is not a bad thing, that they need to go outside of that model to be able to feel free about saying, “Hey, this is what I need. This is the kind of support I need.” It took me years to even identify what that support would look like. But just having those conversations, giving myself the freedom to have that conversation was a huge, massive, big step for me. There were a lot of wonderful steps that followed, but I think that was the primary thing. When I actually had to say, “I don’t have all the answers, I cannot fix myself, I cannot be my own doctor. I need help.”

 

Jill: Such great information, with more to come. Stay tuned. We’re going to have more for you right after this important message from BoardVitals.

 

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Jill: Jen, you’ve talked about hearing some things in some of the conversations and ideas that Gabriella and I share here on the podcast and through other resources that DocWorking has. Can you think of one or two things that now you know that maybe if you could have told your past self earlier that it might have helped with that burnout?

 

Jen: Yeah, there are a number of things. One thing that I realized just through this whole process is that, I am not the only person who is dealing with this and thinking these thoughts. I think what I was thinking before is that, everyone else seems to be coping fine. Everyone else seems to be not having a problem, and not complaining about anything, so I should read faster. I should be able to, like you said, Gabriella, I should be finding happiness here, and I don’t want to ask anyone else about that, because there’s just not time in the day. [laughs] I’m reading a large volume of studies. In fact, in that first job, I would often work until midnight that’d started eight in the morning, until I got a workstation at home that was the same as my workstation at work, and then, I worked past midnight. Sometimes, I’d just take a break, go home, and get called through the night. 

 

There’s not time to talk with each other often. Even in my more ideal role that I’ve made sure to work out since then, we’re all about getting the work done when we’re at work, and often even work in different locations from our partners. We don’t necessarily see our coworkers during the day. We might speak to them on the phone, or we might not, depending on our specialty. It was really eye opening to me when we started talking, and then to hear about experiences that you’ve had with coaching physicians over the years, and also, to talk with other physicians once I began to see that this is a pattern that many of us are facing the same problems. That made me realize how important it is to create a community where physicians can begin to reach out to each other outside of work, and maybe not the same physicians that you’re working with. Like Gabriella said, you don’t want to go to your colleagues necessarily, you don’t want to go to your own administrators, but you would like to talk to someone who might be sharing a similar experience. It might actually have some good solutions too. Other people that are at different stages of their careers, and maybe they faced this, and maybe they found a way that worked. 

 

The other thing that I found definitely that works is simply asking for solutions, thinking creatively about what would help. If you’ve got a problem that’s weighing you down and you’re feeling overwhelmed by it. If you can think of a solution that in your mind would work to help improve it, why not take that to your partners and take it to your administrator. Because in my experience, it’s been surprising how often is a solution that other people think is a good solution. Once it’s in place, it works quite well, and you really want to welcome other people to do that too, because they may think of things that you haven’t thought of to solve problems. Once people start really supporting each other and coming forward with their ideas of how to improve things, then it’s definitely a win-win.

 

Jill: Yeah, I really, really appreciate. I know I can speak on behalf of all of, I think, our listeners here, too. Both of your candor, because we do have to shine a light on burnout. It’s been talked about a lot. It gets thrown around a lot in conversations. Physicians are used to hearing about it, but a lot of times, it’s still feels like it’s this kind of nebulous thing. Nobody’s actually saying, “Yeah, I’m experiencing it.” So, to hear both of your experiences firsthand, and knowing that you are extremely intelligent people that you couldn’t overwork yourself or overthink yourself out of burnout, I think is really an important message that you’re both saying, and what do you want to add to that, Gabriella?

 

Gabriella: One more thing. One of the big aha moments I had to realize is that, as a physician, my mindset was I had a patient with symptoms, a prescription pad, a referral form, and a pen back in the day before EMR and even during EMR, it was a mixture of the two. At the same time, I’ve realized that for my own recovery from burnout, for my own growth past burnout, to be able to see burnout, not as a bad thing, but as a transformative part of life, as a movement into a new era. I had to accept that my healing, if you will, had to come from multiple directions at the same time. There’s not one direct route from point A to point B, it’s about learning about different tools, moving forward, and different tools will appeal to different people at different times, and certain things that appealed to me 10 years ago are very different than what they are now. It’s a combination of spiritual, emotional, physical, and a mental balance. It’s not just, “Okay, well, let me do this one thing, and life will get better for me.” It’s like, “Nah.” As complex as we are as individuals, as human beings, to look at burnout, and to go through burnout, and to move beyond burnout is actually not a super complicated thing. Believe it or not. But it’s accepting that, let me write a prescription for a symptom and be done with it is not the approach. The approach is let me be open to different possibilities. So, that’s the only thing I wanted to add.

 

Jill: Yeah, I think you’re so right. It needs to be a multifaceted approach. You need to shine a light on the fact that it is happening. We need to be talking about systems that need to happen to the system, like putting more meaning back into the work. I know a lot of the positions that I work with. The problem is not that they’re working too hard, it is that they don’t feel a lot of their work matters, because it has to do with bureaucracy and paperwork. It’s separate from solving patient needs. That’s part of the challenge that I think this system is needing to be addressing. As you said, as individual physicians, it’s about looking at a multifaceted approach. Understanding how to reconnect to why the work matters, and how to reconnect to where there is autonomy, and to taking control, and using empowerment where you can. There are a lot of different ways that we can talk about this. We could spend, I don’t know, what do you guys think about, 30 hours, in one podcast just talking about that. 

 

I think, it’s really important that you all understand that burnout, and in being able to help every individual physician to move through burnout to thriving is one of the foundational motivations behind everything that is being done at DocWorking, including something that we are extremely excited about that I’m going to take just a minute or two to tell you about now. It’s called DocWorking THRIVE. It is a subscription service for physicians exclusively. A 12-month membership to the subscription, which includes access to ongoing live, monthly small group coaching sessions. You get coached by, dare I say, a really great coaches like us to be able to work through some of the most challenging things that you’re facing. You get to have access to some excellent courses, including STAT, Quick Wins To Get Your Life Back, a virtual course that you can take on your own time. A new era of physician leadership, another virtual course that you can take at your own pace. And a final course on communication called communication for the win, designed specifically for physicians.

 

You also have access to a 24/7 Private Thrive Physician Facebook Community that is going to be facilitated by a physician coach to answer your questions, to give you resources, to be able to share best practices and ideas about whatever challenges and goals you’re facing. You also will get a weekly quick tip videos delivered straight to your inbox. So, all kinds of resources just designed specifically to support you in thriving at this work and calling that you were driven to. We’re really excited about this. To get all the information about this, to be first on the list to make sure that you get access to DocWorking THRIVE, don’t wait another minute. I mean it. Go right now to docworking.com. Until next time, this is Jill Farmer on DocWorking: The Whole Physician Podcast.

 

Gabriella: Hi, my name is Gabriella Dennery, MD. Life coach at DocWorking. Thank you so much for listening to this episode. If you are experiencing burnout to the extent that you’re having thoughts of suicide, please don’t delay and get help. Call the National Suicide Prevention Lifeline at 1800-273-8255 or call 911.

 

Amanda: Hello, and thank you for listening. This is Amanda Taran. I’m the producer of the DocWorking Podcast. If you enjoyed our podcast, please like and subscribe. We would also love it if you check out our website which is docworking.com. You can also find us on YouTube, Facebook, Twitter, and on Instagram. On Instagram, we are @docworking1 and that is with the number one. When you check us out on social, please let us know what you would like to hear on the podcast. Your feedback really means a lot to us. If you’re a physician with a story you’d like to tell, please reach out to me at [email protected] to apply to be on the podcast. Thank you again, and we look forward to talking with you on the next episode of DocWorking: The Whole Physician Podcast.

 

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