Data Insights

Are you a candidate for burnout? If you are working in healthcare, you definitely are

MGMA Stat

Professional Development

Culture & Engagement

Frank F. Brabec MBA, CMPE
The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: “Looking at the past year, how is your burnout level?” The majority (43%) answered “Moderate,” 38% responded “High” and 19% remarked “Low”.  Respondents were then asked: “What are the major stressors in your position?”
  • On call. Tired during day. Squeezing in patients. Patient complaints of long waiting times. Not enough time to conduct important business developments.
  • Too much change to keep up with/execute.
  • Communication between departments.
  • Decreasing margins and increasing labor costs to support payer requirements.
 
This poll was conducted on October 15, 2019, during MGMA19 | The Annual Conference, with 316 applicable responses.
 
Before you continue reading this, take a long deep breath in and hold it for a count of 5. Now slowly release it. Do it a few more times — while you are at it, relax your muscles, starting from your face, down through your neck and shoulders, all the way down through your back and your hips, to your legs and feet.

How did that feel? I’m certain that you were carrying tension that you needed to release. We tend to carry tension with us for very long periods of time. We do not even realize it until we are prompted by something such as a massage or a moment of reflection to tune back into our bodies and recognize it.

This is not surprising given the extremely important nature of our work. We serve patients who are in their most vulnerable state, and we have the potential to impact their lives at these critical points. Everyone I encounter cares deeply about what they do and tends to take better care of those around them than themselves. They face monumental pressures in this age of doing more with less, constant change and increasing complexity.

Years ago, I experienced full-blown burnout, and it didn’t just happen all at once. Looking back, I see that it was a gradual process; most of the time I didn’t realize it was happening. At the time, I perceived the concept as something that happened to people who were weak. Little did I know the life lesson I was about to learn. I was much younger and had boundless energy, determination and goals. I expected a lot from myself and had a strong drive to be better than everyone else. All positive traits, right?

I was aware that I was pushing myself hard and that life was difficult, but my response was to push even harder. Then came the steep descent into what I will call despair. During this descent my motivation waned, excitement turned into feelings of fear and being overwhelmed. I felt physically tired, was prone to illness and had a very hard time sleeping. Worst of all, I felt as though I could no longer derive joy from my family time, recreation or my work. I realized I had become someone completely different and I felt as though I was in crisis mode.

Let’s look at Merriam-Webster’s definition of burnout: “Exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.”
 
Over the years I have been fortunate to have great people in my life to mentor and support me. My wife and I have spent a lot of time and effort working on ourselves, seeking counseling and helping others with the lessons we have learned in this area. I climbed out of that deep hole years ago, but since then I have developed a great talent for dancing around the edge of it — a dangerous game, indeed.

At the beginning of this year I sensed that I was right on the tipping point again. Faced with a wide variety of pressures from several high-priority projects I was juggling, along with finishing a two-year personal quest to obtain my private pilot certificate, I was in that high-pressure push mode again.

This time I was able to slay the dragon better than I ever had before. I experienced a lot of success from developing entirely new habits in my thought processes. I also changed my eating and exercise habits dramatically. At 52 years young, I gained most of the lessons I needed from where I least expected it: my flight instructor and guided runs via a run club mobile app. You can find extremely valuable people and sources to learn from if you look around your life. Here is what worked for me:
  • Learn to give yourself a break
    • We are all trying to be the best we can be, but we tend to be much harder on ourselves than we would ever be on someone else. We push ourselves to keep up an unsustainable pace. We think that because we don’t master something new right away, we are falling short. This can be particularly dangerous for us with the rules of the healthcare game changing continuously. We need to be patient with ourselves and regain the confidence we might lose by recalling experiences such as learning how to drive. All your nerves and muscles were aware but awkward in figuring out how to control that car. Now think of how you have mastered that skill and many others that have become second nature. Your potential is limitless if you allow yourself the time to learn first, then master and engrain new concepts and skills.
 
  • Nip those reactions (and resulting tensions) in the bud
    • This is a big one for me. How many times during the day do we react to things? The alarm clock, emails and texts piling up, and traffic! Our lives are filled with much more reaction than we realize. This does not support feelings of well-being and confidence. Wherever there is a gap between what we expect or desire and what’s currently happening, there is a directly proportional level of tension generated from it. Learning to quickly recognize the tension that comes from unexpected disruptions, and gradually replacing the habits of reacting with being more mindful of accepting what’s going on, allows us to approach the disruptions with much more aplomb.
 
  • Focus on the present
    • I learned that I have a tendency to live in the future most of the time. Projects, legislation, finances and various goals all pull me away from enjoying what is right in front me. I also discovered that it takes my focus away from my work and effectiveness or what is also known as “flow.” As I have learned to be better at cutting off thoughts of the future and what’s passed, I have been much better at concentrating on what is directly in front of me with less noise in my head. I also enjoy my work much more as I am better at sensing progress in real time and experiencing greater satisfaction, as opposed to waiting for it to come once the goal is met.
 
  • Learn to say “no” more often
    • It must be the part of us that wants to help and please people that compels us to agree to take on just about anything that comes our way. Warren Buffett is quoted as saying: "The difference between successful people and really successful people is that really successful people say no to almost everything." I have incorporated this in my life and found that I was able to eliminate a lot of distractions. As a result, I have been able to find more success and joy in the things that I decided to focus on. It has forced me to choose the best use of my time and effort.
 
  • Have release valves
    • For much of my life, running has been the way I get exercise and relieve stress, but at the beginning of this year I approached it completely wrong. I would go hard and fast to blow off steam and burn calories, only to injure myself and become more stressed because I used the time to ruminate over negative thoughts. Some negativity stemmed from feeling as though I was taking too much time away from important projects while out on the trail. Thanks to finding an excellent running (and life) coach in my phone, I learned that Olympic athletes usually train slow and easy. I think that is a powerful lesson for all of us. We aren’t built to run at full steam all the time. Find things that you enjoy and add value to your life and do them without letting anything else invade that space. You will return to your work projects recharged and better for it.
 
  • Improve nutrition habits
    • We have heard a lot about this in our profession, but it isn’t until recently that I took nutrition much more seriously. A friend of mine who is a highly respected gastroenterologist has been guiding me, and that has made a more profound effect on my energy and well-being than I ever expected. It is important to research and choose what is right for you. It does not have to feel like punishment, and it does not have to happen all at once, but changing eating habits over time can yield amazing results.
 
  • Have a (real) social network
    • My flight instructor gave me many words of wisdom about flying that resonated beyond flying. Slow down your thoughts, loosen up, don’t overreact, don’t overcorrect, focus, shake off your last bad maneuver and try again with your freshly learned lesson. Take it easy on yourself and keep it fun — success comes gradually. Always stay in command or you will become a passenger in your own airplane. Seek the guidance of people who are ahead of you in some way. As a member of MGMA, you can find mentors and friends that last for years as I have. Sometimes I derive large amounts of joy and energy from mentoring others, so I suggest seeking opportunities for that, as well. Of course, your family and friends are important, and opening up to them during difficult times will strengthen you and those relationships.
 
I am also a big fan of good professional counseling. To find a counselor that you sync well with can make a big difference in your well-being, especially if you are in crisis mode. I have seen too many people who have lost out on opportunities to dramatically improve their lives but felt a stigma about seeking counseling. There is never shame in seeking professional help, but there is honor.

I’m happy to report that I am so much better finishing this year as a result of the efforts I have mentioned above, and your mileage may vary trying the same things. There are many resources available and many ways to improve your well-being and avoid burnout. It’s still a challenge to overcome, but I’m building immunity by making new habits and engraining them. It worked for me; I sincerely hope you find ways to make it work for you.

Additional resources

 
Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat.

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About the Author

Frank F. Brabec
Frank F. Brabec MBA, CMPE
Brabec Healthcare Management, Inc.

Frank Brabec is a seasoned healthcare executive and consultant. His management and consulting career has spanned a variety of physician practices and hospitals, with a fifteen-year emphasis on OR and anesthesia management.
Frank has managed eight anesthesia groups in hospitals ranging in size from 107 to 527 beds.  He is highly experienced in conducting anesthesia coverage and cost analyses, as well as fair market value evaluations.
Currently he is advising a variety of hospitals and physician practices, and is actively managing an anesthesia practice. He helped Pioneers Memorial Healthcare District save $2,000,000 of expenses in their OR in the first year of providing anesthesia coverage.
Frank is a speaker at national conferences on anesthesia related topics and has been a Medical Group Management Association, (MGMA) Certified Medical Practice Executive, (CMPE) since 2009.

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