**This post was written in collaboration with content from Margaret Leddy, PA-C**   Before I give you tips on how to prevent burnout as a Physician Assistant, I need to flashback to 2005. I had just received my long white coat graduating from Yale University Physician Assistant Program. I felt so accomplished and official, but also a little like a babe in the woods. I had a job lined up at Yale New Haven Hospital in hospitalist medicine, I was excited, nervous, eager and hungry to become skilled at my new position. I was also just plain hungry from eating like crap as a student..but I digress.     Fast forward to 2014, 9 years into my career. I was working my third job as a PA at MD Anderson Cancer Center in Houston, TX.  I saw 20 plus patients a day with my physician, I was the supervisor of 13 nurse practitioners and PAs in my division. I was the President of the Association of PAs in Oncology. I was published in journals, speaking at conferences, you name it I was doing it. But the day to day drama and bureaucracy began to wear me down. How much was I billing compared to my doctor, how many RVUs I generated, endless documentation, insurance paperwork, peer to peers, prior authorizations, and on and on and on. Oh and don’t forget the drama that comes with managing people and different personalities. The complaints are endless! This person does nothing yet she gets away with it, this person works with only one doctor and I work with three, this one always calls out sick, I can’t work with this doctor anymore, you get the point. I was at work at 7:30am and often didnt get home til 7 at night. I would miss dinners with friends or just make excuses not to go because I was so tired. I had to start paying my dog walker to come twice a day to take out my poor pups and I hardly ever saw my husband.

As the years in Houston came to a close I was completely BURNED OUT.

I remember waking up, getting dressed, and then getting back into bed with my dogs. I could not bear the thought of going to work. I was anxious and depressed. I did not think I even wanted to be a PA anymore. Then came the guilt..how could I even say that after all I had done and worked for??? Just as I started having a pity party..SURPRISE! I’m pregnant and moving to Charleston.  

After I had my daughter in 2014 I suffered from post-partum anxiety and depression (hear about that here). As I began to feel better, I contemplated what I would do. I still wasn’t sure I wanted to go back to work as a PA, but I sure as hell was not stay at home mom material, so I had to figure it out. Luckily, I found a position that was willing to work with me starting part-time, and I was introduced to coaching (read what the hell is a health coach) by my bestie.

That was when it all turned around for me.

Exercising, eating healthy, feeding my mind with positive thoughts every single day changed everything for me. I started to have a renewed energy for my job as a PA and started again to feel that passion I once had as a new graduate. I started doing more non-clinical work like lecturing to students, becoming a preceptor, & reviewing personal statements for pre-PAs which I found rewarding in a totally different way (& still do so contact me if you need help with your personal statement). As I turned 40 this year, I have a new passion for helping pre-PAs, PA students and practicing PAs prevent the BURNOUT I experienced and that has become prevalent in the medical community.   The highest rates of burnout are in emergency medicine at 72.6%, but this specialty also has the highest level of job fulfillment. One in 8 PAs will quit their job due to burnout, and a PA leaving their position can cause employers over $100K in lost productivity.

So what the hell is Burnout?

Christina Maslach, PhD is best known as one of the pioneering researchers on job burnout, and the author of the Maslach Burnout Inventory (MBI), the most widely used research measure in the burnout field. She describes the 3 pillars of burnout: 1-Emotional Exhaustion (overwhelmed, drained, unable to meet demands) 2-Depersonalization (callousness, seeing others as objects) 3-Inefficacy (diminishes sense of accomplishment) High levels of burnout amongst nurses and other healthcare providers have been directly associated with increased hospital-associated infections, worse patient outcomes, and decrease in patient satisfaction.  It is also associated with increased medical errors, malpractice suits and even Medical Malpractice Syndrome which is a condition severe anxiousness, restlessness and excessive worry more than 50% of waking hours.  If that isn’t bad enough..it is also associated with: Lower quality of relationships….. #yourpartnerwantstokillyou Lower mental satisfaction…. #butyouwanttokillthemtoo Shorter lifespan…. #youdiesooner Depressed immune system.. #yougetsick Depression/PTSD/Suicide… #yousad Traffic violations and accidents… #youdangerous Personal injury… #youhurtyourdamnself    

I know, this all sounds pretty crappy right?? Here are some tools you can use NOW to help prevent and overcome provider burnout.  Researchers call this “resiliency”, I call it taking care of YOU.

Frame of Reference: Retrain your brain to be more positive. Something goes wrong and life gets in the way. You get rejected from PA school, you miss a critical lab value, you call the wrong patient, a family member gets sick..any unexpected life event. Instead of allowing this to take over your mind, create anxiety, create negative self-talk..think what can I learn from this experience? What is one positive that I can take away from this? Fail forward. Over time, this positivity will re-wire neurons in your brain to see the positive in a not so positive situation. You are human. You will make mistakes, it is how you rebound from them that makes a lasting impact.     Three Good Things: There has been a lot of research done on how writing down 3 good things that happened in your day can increase happiness levels over time and reduce depressive symptoms. Investigated by Sheldon and Lyubomirsky in 2004 and Martin Seligman and others in 2005. After 1 week, participants were only 2% happier. But the magic happened when they began checking happiness levels week by week. Happiness levels rose to 5% by one month and 9% at 6 months. The caveat here is..you actually have to WRITE..like with a pen, either every night for 1 week or weekly for 6 weeks. You need to reflect on what you did as this is essential for perceived control and well being. Give it a try..if you can find a pen. Gratitude Letter: A gentleman named Robert Evans created a gratitude journal that he wrote in for 20 minutes for 21 days and had others do the same. He found that other people were less depressed, happier, slept better, and had better marital satisfaction. Later, Martin Seligman who dealt with really depressed patients found he couldn’t have them do 20 minutes a day for 21 days, so changed this to having gratitude towards one person, not a thank you note, this acknowledges this person that did something that impacted you and you are grateful. Just as three good things, this exercise was found to not only improve happiness and reduce depressive symptoms initially, but had lasting effects over time. Can you think of one person you could say thank you to today?? A text, email or phone call would do. Trust me, it feels damn good.     Exercise: There is extensive data to suggest exercise causes improvement in brain function & makes you feel better. In people who are depressed, neuroscientists have noticed that the hippocampus in the brain—the region that helps regulate mood—is smaller. Exercise supports nerve cell growth in the hippocampus, improving nerve cell connections, which helps relieve depression. High intensity releases endorphins that make you feel happy, but low intensity or consistent effort over a long period of time spurs the release of growth factors that allows new nerve cells to grow and make new connections. Weight based exercise 4 days a week has been shown to be as effective as an SSRI is some studies. Turns out I do both, so I am SUPER happy 🙂  

I never want any medical provider to feel like I did. Ready to quit on a career I worked so hard for.  My husband, a surgeon, has experienced this as well. We both have had to learn the importance of positive emotions, living in the moment, and exercise on our well-being as individuals and as healthcare providers.

You cannot take adequate care of your patients unless you take care of YOU first.  

If you have struggled or are currently struggling with burnout, feel free to leave a comment. We need to support each other.

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