Burnout

Burnout Rate and Risk Factors Among Anesthesiologists in the United States:

  • Perceived lack of support at work and at home were most strongly associated with burnout syndrome on multivariable logistic regression modeling
  • Age was the only personal factor that was associated with burnout syndrome

I’ve felt my own burnout throughout the years. The earliest times I remember it was in my childhood. I would be in school activities and extracurricular activities until about 9pm and then come home and then start my school homework. That was my initial taste of burnout. Luckily, I was able to work on my time management skills. In college, burnout reared its ugly head again when I had a ridiculous idea of taking 21 hours in a semester with honors and research and made a 4.0 that sememster. Just for reference, 12 hours a semester was full-time. Then, there was medical school. Talk about hooking yourself up to a full throttle fire hydrant and devouring the info. Residency was more about lack of work-life balance. It was all work and occasional play. Fellowship was more relaxing, more focused, and less burnout. Finally, real-life job. The hours can be grueling as well as unpredictable. The only predictability is knowing you will be done early or working late. This became much harder when we had kids. It’s impossible to say with certainty that I will be home for dinner or for activities or be home in time to tuck in the kids. This is also burnout.

I’m not the only one. Clearly. Study after study are coming out looking at the toll of burnout on healthcare workers. One of my colleagues with kids has said she’s starting to feel the burnout as well. We’ve been in private practice for 10 years. It’s not like we’re new to understanding the nuances of our jobs. Throw in family life and being a mom and it really gets tough.

Best thing to do is knowing how you feel when you are burnt out. What will you do to get help? Who is your support system? What can you do to decrease the workload/burden of work/family? Know that you are not alone and that help is close by.

National Suicide Prevention Lifeline: 1-800-273-8255

TeamHealth.com

J of Business & Financial Affairs, 2018;7:4. Burnout and its Organizational Effects: A Study on Literature Review.

J of Graduate Medical Education. Dec 2009. Burnout During Residency Training: A Literature Review.

J Psychol Brain Stud. 2017, 1:1. Stress, Burnout and Coping in Health Professionals: A Literature Review.

Dealing with difficult colleagues

We’ve all been there. It starts early and young…. bullies. And then there’s arrogance and difficult attitudes and just overall uncompromising a$$holes. Life throws the full gambit of challenging personalities at us. After awhile, I learned that these people are everywhere. No matter where you go, you can never hide from them.

But what do you do when you come across a confronting/difficult/antagonistic/arrogant/etc colleague at work?


Image from Shuttershock.com

Business Insider, June 2011: 9 Useful Strategies to Dealing with Difficult People at Work

  1. Be calm.
  2. Understand the person’s intentions.
  3. Get some perspective from others.
  4. Let the person know where you are coming from.
  5. Build a rapport.
  6. Treat the person with respect.
  7. Focus on what can be actioned upon.
  8. Ignore.
  9. Escalate to a higher authority for resolution.

Continue reading “Dealing with difficult colleagues”

Worth Losing Friends Over — Doctor Enough

Today, I hurt. I’ve been talking about this pandemic for well over a month. My friend list is dwindling, and there are several people I don’t plan on catching up with when this pandemic is over—and now entire communities. America’s privilege is showing, in a terrible way. Rural areas that have been luckily unaffected are […]

via Worth Losing Friends Over — Doctor Enough

Leadership

From HBR:

People never forget how managers treated them when they were facing loss. And we will remember how our institutions, managers, and peers, held us through this crisis — or failed to. We also see the consequences of past failures of holding, in those institutions struggling to mobilize an already depleted pool of resources. It is tempting to resort to command and control in a crisis, but it is leaders who hold instead that help us work through it.  And it is to those leaders, I believe, that we’ll turn to when time comes to articulate a vision for the future.
When I ask managers to reflect a bit more on the leaders whose visions they find most compelling and enduring, they usually realize that none of those leaders started from a vision or stopped there. Instead the leader started with a sincere concern for a group of people, and as they held those people and their concerns, a vision emerged. They then held people through the change it took to realize that vision, together. Their vision may be how we remember leaders because it can hold us captive. But it is their hold that truly sets us free.

Protecting patient safety

Check out @ASAGrassroots’s Tweet: https://twitter.com/ASAGrassroots/status/981951115062337536?s=09

#NewYork budget excluded provision that would have undermined physician-led anesthesia care, opposed by @ASALifeline & @NYSSApga. #THANKYOU to New York lawmakers for protecting patient safety. #SafeAnesthesia4NY
https://t.co/3M5wQm0TK8

Responsibility for your own health

I was shocked to see that the NHS could ban surgery for the obese and smokers.  That’s socialized medicine.  You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare.  But in a way, it’s empowering patients to take responsibility for their own health.  Smoking, for sure — I agree 100% that surgery should be banned for this population.  Obesity is a bit trickier — there’s genetics and environmental factors at play in this one.  I don’t think anyone chooses to be obese.  But, people do have the power to change their eating and exercise habits.  Despite these efforts, there are some people who are still obese…. and these people should not be faulted.

Why single out the obese and smokers?

obesity-and-cv-disease-1ppt-44-728
From SlideShare

obesity-and-cv-disease-1ppt-43-728
From SlideShare

tobacco-health-statistics
From TobaccoFreeLife.org

Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.

150423sambydisease
From HealthStats

I think the NHS is on to something here.  They’re opening doors to moving the liability and responsibility away from physicians and towards patients.  This is a plus.  Outsiders may see it as separatism and elitist to only provide care for people who are healthy.  But look at the facts and the data…. obesity has a lot of co-morbidities associated.  Smoking has a lot of co-morbidities associated as well.  Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough?  In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness.  With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health.  I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation.  It’s not easy, but my health is 100% my responsibility.  I refuse to pass the buck to my husband, my family, my physician, etc.  I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.

Patients need to change their mindset re: health.  It is not your spouse’s responsibility to track your meds.  It is your responsibility to know your medical conditions and surgical history.  The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery.  This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care.  Please do not forget recreational drugs, smoking habit, and drinking habit in this list.  It is very important to know all of these things.  Also, your emotional history is very important.  Depression, anxiety, failure to cope, etc.  This all helps tie in your current living situation with stressors and your medical history.

Links for educating yourself in taking responsibility for your health:

obesity
From SilverStarUK.org

Work-Life Balance and taking care of yourself

Work-life balance and taking care of yourself #anes17 #meded #stress #medicine #burnout #administrators

The ASA 2017 had an interesting self-study module called Physician Wellness Beyond the Usual Suspects.  It was a great learning tool to focus on the importance of the anesthesiologist to consider their own stress levels and seeing how to best mitigate the issues that could be problematic.

meditation-reduces-stress-1

Check out these great articles from that self-study module:

Key points:

  • Understand your own stress levels.
  • Make changes: speak to your staff, your administrators, your hospital to see what’s available to help you cope
  • Get help
  • Sometimes you can’t fix everything… and ultimately that’s ok.

“It is obvious that we can no more explain a passion to a person who has never experienced it than we can explain light to the blind.”

-T. S. Eliot

Dr. Atul Gawande: “What are the outcomes that matter?” — A Penned Point

Dr. Atul Gawande: What are the outcomes that matter? From A Penned Point #ASA2017 #MedEd

The real surprise – to me, at least – came more than halfway through Dr. Atul Gawande’s keynote address at the opening session of the American Society of Anesthesiologists’ annual meeting in Boston. Much of his talk on October 21 celebrated the virtues of checklists and teamwork, topics that have turned into best-selling books for the…

via Dr. Atul Gawande: “What are the outcomes that matter?” — A Penned Point

The physician anesthesiologist vs. CRNA debate

Why is this even a debate?

It seems to me that the CRNA-led debate is financial… once you tease through all the fluff.

So here’s some literature I found:

As an anesthesiologist, I work in an MD-only anesthesia group. This is by choice: I prefer doing my own cases and being responsible for my own liabilities. The times I have required an anesthetic, I have requested a physician anesthesiologist. As a resident, I had very good insurance coverage, so I wanted a physician for my surgery. At that time, I was ok with having a resident anesthesiologist paired with an attending anesthesiologist for my case. My second surgery was done at my current hospital, and we only have MD anesthesiologists. Perhaps I’m biased? I know and I understand the path/journey/training it takes to get to become a physician anesthesiologist. I want someone who is well-trained, independently thinks, vigilant, and knowledgeable.

I’m sure there are great CRNAs out there… but when I was a resident… we used to supervise CRNAs in our final training year…. and it was scary some of things they would do. Who extubates from a trach R&R on 30% FiO2? Yeah, that particular CRNA told me they had 30 years experience. 30 years experience of doing something wrong doesn’t equate to 30 years of knowledgeable experience. And let’s not forget that CRNAs need a 15 minute morning break, 30 minute lunch break, and 15 minute afternoon break and they go home when their “shift” ends (even if it’s in the middle of a complex case). I take a break when I can… I eat lunch and take a bathroom break when I can…. and I choose to stay and finish complex cases for better continuity of care.

Would you want a nurse practitioner or physician assistant solely performing your surgery without a surgeon? I know I would NOT. I think there’s plenty of room for teamwork in healthcare. This is how to improve hospital efficiency and patient care. My fear is if CRNAs gain independence for purely financial reasons. But then, they will have to carry their own liability, cover their own breaks, take night call and discover that they had it so good in a healthcare team.

Opinions from other physician anesthesiologists:

 

Bottom line in my opinion:

  • Physicians endure years of grueling medical education that starts with the why, how, and treatment of disease. This is followed with years of residency training specifically in anesthesia. There’s also further training in the form of a fellowship for specialized fields.
  • Getting into medical school is an extremely competitive process. You take the top 1% of college graduates and high MCAT scores to get into medical school.  The board certification for becoming certified in anesthesiology is quite complex and difficult in both the written and oral board exams.
  • I will continue to be FOR team-based physician-led anesthesia care.