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10 Tips to Stay on Fire

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Don’t let burnout extinguish your drive to succeed.

By Scott McAfee, PT, DPT

Too many people wear “workaholism” like a badge of honor. Our society accepts busyness as a constant state of life, esteems lack of sleep as a sign of success, and likens relaxation to laziness. In our work-centered culture, we’re constantly pressured to keep working harder, making it better, or doing it faster. But we forget that burning through our fuel faster than we can replenish it can only last so long. At this unbalanced pace, our strong fire for success in the clinic, classroom, or business may ultimately burn out.

Burnout is a massive problem, especially in health care. A recent survey of over 1,300 physical therapists in the US found that 29 percent experience high emotional exhaustion and 13 percent are experiencing burnout.1 In medicine, the figures are much higher: Over 50 percent of U.S. physicians are experiencing burnout.2,3 This has been shown to be linked with more patient safety errors, less engagement in the workplace, and lower levels of empathy toward patients.4,5,6 Interestingly, a 2014 Annals of Family Medicine article even called for a fourth aim—improving the work life of health care providers—if we are to achieve successful implementation of the Triple Aim (care, health, and cost).7 So although social media makes it appear as though everyone out there “has it all together,” this couldn’t be further from the truth.

Much of what our workhorse culture considers “lazy” or “unproductive” are the very things we need to keep our fires from burning out. Even if we want to take a break, get more sleep, or catch up with friends, we may avoid making these positive changes in our lives out of pressure or fear that we won’t be working hard enough. In his book The Path of Least Resistance, Robert Fritz writes about the two parts of the creative cycle: Stretch (engaging in dedicated work) and Consolidation (taking a step back and assimilating the results of that work). When the cycle is balanced, we burn bright with passion, creativity, and positive momentum. The problem is that our fast-paced society keeps too many of us in the stretch phase. If you are stretching and not consolidating, you are headed straight for burnout.

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A lot of people confuse burnout with stress. Although the two share similar characteristics, there are very distinct differences. For one thing, stress is unavoidable; burnout is not if care is taken to avoid it. Stress is a problem of too much at one time—too many physical or emotional pressures that demand too much of you. Everyone has times like this when pressures converge and mount. In the short term, this may emerge as that out-of-control feeling that arises from long weeks, large projects with no end in sight, or tight deadlines. However, once the situation changes (hopefully soon), the stress often lessens or disappears entirely and tasks seem more manageable. Burnout, on the other hand, is a problem of not enough—a feeling of emptiness, exhaustion, underappreciation, self-doubt, or lacking motivation. Problems seem insurmountable, positive change appears hopeless, and it’s difficult to amass the energy to even care. Most importantly, there’s often disconnect between what you’re currently doing and what you truly want to be doing, which results in feeling deprived.

This is a 10-step guide to ensure burnout never extinguishes your drive to succeed as a clinician, student, or business owner. No matter where you are in your career, I hope you’ll appreciate how tremendously hard you’ve worked to get there, that you’re never alone in what you’re feeling or experiencing, and that it takes a special kind of person to do what we do. Above all, I hope you’ll appreciate that in such a selfless profession of caring for others, we cannot forget about ourselves. So read it, share it, and implement it. Let’s do this.

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Define Your Massively Transformative Purpose (MTP). This one’s listed first for a reason. As described in the book Exponential Organizations, your MTP is the highly aspirational reason behind why you do what you do. It goes beyond merely earning a paycheck or making a living: It’s what makes you jump (gently, mind your back) out of bed in the morning and keeps you going strong through tough times. Burnout is virtually impossible when you’re working for a larger purpose. So think about what internally drives you and write it down. Define it. Reread and recite it often. This will turn into an influential exercise, so spend time thinking deeply about your MTP. For example, mine is “Building the next Apple/Nike/Google of Health Care.”

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Complete a Personality Assessment. Whether you’re a clinician, student, or business owner, the next step in changing your mentality is understanding it and using it to your advantage. With a simple Google search, you will find many free resources. The standard Myers-Briggs Type Indicator (MBTI) assessment, for instance, can help you identify your emotional tendencies and how you typically respond to stress. Don’t let your patients be the first ones who recognize you’re burnt out. You must be able to recognize when you’re not your strongest self. This critical step sets you up for those that follow.

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Change Your Perceptions. This one may be the most challenging on the list, but it is critical to successfully implementing change in your life. You can’t always choose what happens to you, but you can always choose how you feel about it. Practical tips for this one include: keeping a daily/weekly gratitude list, redirecting your daily focus toward enjoyable aspects of your work, or editing your vocabulary to your emotional advantage. Take out the negative and frame it as positive. For instance, try saying “Today, I get to do . . .” instead of “Today, I have to do . . .” when running through your daily tasks. These simple changes place a positive spin on mundane tasks and offer encouraging reminders that you are working toward your MTP. Personally, I try to never use the word “busy” in daily conversations. Starting small can make big changes in your mood.

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Invest in Close Relationships. Time spent with loved ones refuels your fire and reminds you of what really matters. Whether it’s with your partner, children, colleagues, family, or friends, consistent face-to-face social interaction with supportive people is arguably the strongest antidote to burnout. This may sound simple and obvious, but take a brief moment right now and assess how much time you’ve truly spent in the last week with those closest to you. When you had the time, did you maximize these opportunities or was that time spent thinking about the work you haven’t completed? Don’t be too hard on yourself, but realize that just when you think you’re over your head in problems and responsibilities, a talk with a close friend may be exactly what you need to reset and solve the next problem. Additionally, forming strong friendships in the workplace may help fill your otherwise stressful workday with laughter and enriching conversation.

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Prioritize Basic Needs. High-powered individuals often let sleep, exercise, and diet fall by the wayside in order to get more things done—a blatantly illogical habit. Although we all know this one to be common sense, it doesn’t always translate into common practice. One day, I hope society looks back on today’s tendency to avoid basic necessities for life in the same way we currently look back on the days when smoking was deemed healthy. If we were to recommend healthy lifestyles to our patients, why would we not value them ourselves? Once again, start with small changes—evaluate which needs you may have been pushing aside and set a small and achievable goal.

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Take Relaxation Time Seriously. Relaxation does not equal laziness. Whether it’s through meditation, yoga, sports, reading a book, listening to music, or taking a leisurely walk, plan for “refueling” time. In business, don’t promote a workhorse culture without promoting a healthy lifestyle. In practice, don’t underestimate the power of a few deep breaths between patients. If you’re a student, don’t start the next day of brain-filling lectures without ending that night with brain-clearing relaxation. Remember the old Zen adage, “You should sit in meditation for 20 minutes every day—unless you’re too busy; then you should sit for an hour.” Take time for yourself and your productivity will surely benefit.

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Say No. When first starting out in any venture, I believe it’s imperative to say yes to opportunities that help you grow and gain experience. However, at a certain point, you must actively protect the things you love to do by saying no to the things you don’t. I’ve recently found the philosophy of Derek Sivers and Tim Ferriss to be extremely valuable: Unless a new opportunity is a “Hell yeah!” it’s a “No.” After all, optimal work-life balance is a never-ending, active pursuit, not an ultimate nirvana you eventually reach. If it’s truly an opportunity and not a requirement, saying “No” may benefit your life far more than negatively affect it.

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Perform a Workload Analysis. It’s easy to drown in responsibilities, but a workload analysis can be your lifeline. The best kind of analysis runs all the tasks expected of you through a three-tiered filter of elimination, automation, and delegation. Is this task absolutely necessary or can it be eliminated? If it’s necessary and oftentimes repetitive, can it be solved by an automated system put into place? If not, can somebody else do it? Only if a task survives all three steps in the analysis and is necessary for you to complete independently, does it earn the right to be on your to do list. Creating systems for automation and/or educating your staff on repetitive tasks may be time consuming initially but has the upside of paying off tenfold in free time later on.

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Nourish Your Creative Side. The happiest people on earth are those who are constantly learning new things that intrigue them. What personal projects are you working on? What hobby do you have that is completely unrelated to your regular job? What are you known for outside of work? Sometimes a change of pace, plans, or circumstance can be exactly what you need to rekindle your creativity and relight your motivation.

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Overcome Imposter Syndrome. Imposter syndrome is the persistent fear of being exposed as a fraud. Extremely common among high-achieving individuals, imposter syndrome can make you wrongfully complacent with being burnt out. You’ll think, “I’m not really any good at this,” “I’m not qualified enough,” or “Who am I to be doing this?” I was plagued by these same thoughts before writing this article. However, the truth is that people aren’t always 100 percent qualified to be doing what they are doing. How many times do you see “orthopedic expert” or “so-and-so modality guru” on social media? They’re everywhere. While some of these individuals are good at what they do, these titles are largely self-proclaimed in attempts to reach a larger audience. Plain and simple: These are the individuals who have overcome imposter syndrome or are faking it. Don’t let self-doubt stop you from pursuing your own dreams. Compete with yourself, not everyone around you, to increase your self-efficacy. If you’re unsure how to break this barrier: Fake it until you make it.

References

1. Zambo Anderson E, Gould-Fogerite S, Pratt C, Perlman A. Identifying stress and burnout in physical therapists. Platform Presentation at World Confederation for Physical Therapy Congress; May 2015; Singapore.

2. Penson DF. Re: Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. J Urol. 2016;195(5):1568.

3. Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E. Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care. 2007;13(5):482-488.

4. Shanafelt TD, Balch CM, Bechamps G et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.

5. Salyers MP, Flanagan ME, Firmin R, Rollins AL. Clinicians’ perceptions of how burnout affects their work. Psychiatr Serv. 2015;66(2):204-207.

6. Thomas MR, Dyrbye LN, Huntington JL et al. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med. 2007;22(2):177-183.

7. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576.

Scott McAfee, PT, DPT, is a recent graduate from the University of Southern California, former board member of the APTA Student Assembly, and current orthopedic resident at Adventist Health in Los Angeles. He can be reached at mcafee.scott@gmail.com or on Twitter at @McAfeePT.