The Doctor Paradox is an increasingly popular series of podcasts dedicated to the topics of physician burnout, wellness and rediscovering a passion in medicine.
When I first came across The Doctor Paradox not too long ago, my excitement regarding the quality & diversity of the interviews led me to contact the person behind it all: Paddy Barrett.
Paddy is an Irish Physician based in San Diego who commenced this project in November 2015, quickly gaining a huge following on this previously taboo issue.
I was honoured to participate in a podcast interview on Alternative Careers, and even more so to discover what motivated him to set up The Doctor Paradox and the real truths behind Physician Burnout.
Why did you set up The Doctor Paradox?
From an objective perspective, as physicians, we have close to the ideal job: autonomy; mastery; purpose; respect; well paid; of service to others. Yet when you measure how satisfied physicians are with their jobs there is a large disparity.
This had piqued my interest for a long time but it wasn’t until 2 junior physicians committed suicide within a week of one another in the city that I was working in that I felt that this issue required so much more attention.
For me it was about the disappointment physicians felt when they looked at the physicians they currently were, and compared it to the physician they had hoped to be. I think there are a multitude of reasons that create this gap but addressing them can move us closer to the physician we wish to be.
What’s the difference between Burnout, Stress and Mental Health Conditions?
Stress is a normal part of life and being a physician is a stressful job.
The key is when the excess demands of stress accumulate to the point whereby you no longer have the resources or desire to manage it. The critical distinction to make is where your stress is coming from; the obvious target is long working hours but the source of your stress may well be very different to a colleagues.
You may find the long hours acceptable but if you feel that there is a major disconnect within your work environment with respect to your core values then that can be a major stressor.
For example, even working relatively normal hours, if you feel that the system that you are part of does not allow you to provide the type of care you wish to provide or the autonomy to do so; you will find that stressful. Burnout is when you exceed a threshold of your reserves and you find yourself on a regular basis feeling you have nothing left to give. You may feel disconnected or cynical toward your patients and that the work you do really doesn’t make a difference. You can have a stressful day and not feel any of these things, at least not daily, but when these are an everyday occurrence, you are likely burned out.
There is a lot of overlap in symptoms between burnout and say depression, and at times it can be difficult differentiate between them. The easiest way is if you remove the stimulus of work, do the depressive symptoms substantially reduce? If so, its more likely to be burnout. The challenge is that burnout can lead to and exist with depression but its more of a reactive response.
Why as doctors, are we so vulnerable to the above? How does it usually manifest?
The acid test of whether a physician is burned out is if they feel they just have nothing more to give at work, and if the first thought they have when they walk though the doors of work is ‘when can I leave?”. Furthermore, if every activity at work seems like an obstacle to you getting to walk out that door, then there is a good chance you are burned out.
Physicians have several vulnerabilities or blind spots when it comes to burnout. We are delayed gratification experts and will often push through challenging times – we tend to try work our way out. When it comes to burnout, this doesn’t work and each time we fail at it we feel worse. In general, those who are burned out are often last to know; we are very poor at recognizing it in ourselves.
More often than not we will recognize it in others long before we recognize it in ourselves. Additionally, when we are burned out, we think we are the only ones who are experiencing it, because everyone else is either hiding it or hasn’t yet recognized so we tend to experience it individually.
Have you ever suffered from Burnout?
Yes, but just like everyone else, I had no idea I was burned out for a long time.
For me it was classic, I felt I just didn’t have anything more to give and was totally wiped by work, I felt completely disconnected from my patients and thought the work I was doing really didn’t make a difference.
What was critical was recognizing it in myself and only then could I take steps toward addressing it. But without knowing you are burned out you will likely have no idea why you feel the way you do and more importantly not be able to fix the issue and get back to being engaged and energized by work.
What methods to you employ to protect yourself from Burnout?
There are lots of strategies to help you deal with environments that can lead to burn out and although useful, are often simply symptomatic relief. The main strategy has to be working in an environment which is more supportive of its staff and less likely to cause undue stress. This isn’t easy however, because to achieve that goal, substantial organizational and cultural change needs to happen.
You can meditate and eat healthy all day long but without parallel organizational change, physicians will continue to burnout.
So while I encourage physicians to consider a contemplative practice, get some exercise, make time for other things in your life and get more sleep, they are all likely to fail unless we as a community of physicians insist on effecting organizational change. This isn’t about, ‘us’ and ‘them’. We are the organization also, its on us to get involved and make the systematic changes that are required.
What have you learned from running The Doctor Paradox so far?
The key point I learned about burnout is that when individual physicians experience burnout, the primary strategy is directed a the individual – resiliency training, mindfulness etc.
This won’t work.
Physician burnout is the canary in the coal mine. This is an occupational hazard particular to the environments we are in. Without meaningful changes to the environments the issue of physician burnout will not be resolved.
Do you think burnout and doctors’ careers are linked? Why?
Absolutely, but it is by no means exclusive to physicians.
Burnout was originally described and is still most common in any job where people deal with people. Burnout has been extensively studied in the healthcare community but is equally as prevalent among nurses, teachers, police officers and other people orientated professions. The common theme to these roles is that the people who chose to go into them set out with a deep desire to make a difference in peoples lives, and when they find themselves unable to achieve that goal, they run the risk of burning out.
What do you think needs to be done to address Burnout amongst the medical profession?
Unless there is a meaningful acknowledgment by both the physician and healthcare organizational community that this is a problem that needs to be fixed with collaborative organizational and individual change we are unlikely to be successful in addressing this.
Without changing the ecosystem, the only solution many physicians see is leaving the health system entirely and in the UK we are seeing this in very obvious ways with the mass exodus of physicians from the NHS, who given the choice would rather stay but just feel like they can’t.
Until health systems realise that without organisational change, which we need to be a part of, I can’t see this issue being fixed. With that said, I believe we can and must make those changes. It will require an incredible amount of work but I believe we can create an environment that meets the needs of physicians and patients alike; to ultimately let doctors be the doctors they had set out to be.
For more on physician burnout, check out our article on Burnout Amongst Doctors – What can we do about it?