Beat Down Burnout

Are There Any Real Resources for Burnout?

In the early 2000s, I hit a wall. I was working as a traditional Pediatrician in a large multidisciplinary clinic. Pediatrics was the only department that had clinic hours 7 days a week. I was working 90 to 110 hours every week, just like residency. I had 2 school-aged children at home and a husband who was applying for disability. My husband couldn’t do several things around the house. My children were both struggling in school, and I felt unable to help them. I felt I was failing them.


My patients adored me. However, I was carrying 25% public aid patients in a private clinic where most of my Pediatric peers were carrying less than 20%. Most of the docs who weren’t Pediatrics carried 10% or less, like a tithe. I wasn’t making it financially by the BOD’s standards. They considered me a failure and found ways to let me know.


As more and more responsibilities were placed on the Peds Department, I lobbied against them, and found myself the new Head of Pediatrics. I thought this was a good thing, an opportunity to be a champion for my colleagues and my patients. Then, I was squarely informed that communication would be a one-way channel from Administration down to my department. It was not a good day.


One day I was driving home from the hospital, after rounding on my patients after working for 36 hours. I stopped at a four-way stop and waited for the sign to turn green. A stop sign, not a traffic signal. I didn’t even realize my mistake until the pickup behind me honked. I hadn’t had a day off in 23 days. I might be able to take off the upcoming weekend, if I could discharge all my inpatients and not have anyone else from my own practice admitted. I got myself the 6 blocks home and slept until dinner. Was up 2 hours and slept until morning. I found my way to the CMO’s office the very next day.


I told him what was happening, “I think I’m burnt out.”

“What are you going to do about that?” was his immediate response without skipping a beat. He didn’t offer me any time off. He didn’t offer any counseling. Nothing. No suggestions. He put all the responsibility back on me.


As I drove home that evening, I thought about that. This was the same physician who would call me for procedures an hour before my call stint would start. I would remind him that I was not yet on call. “Well, you’re here,” he would say. “Yes,” I would respond, “that’s part of my time management. I’m not on call. Call the person on call or delay your procedure until I am on call.”

His response was always, “You should consider this a compliment that I have such trust in your abilities.”

No. This was bullying. 95% of those procedures could have waited until I was officially on duty. He just wanted to throw is weight around. Just like the BOD wanted to throw their weight around and tell me how to run my department, instead of listening to our needs, or learning what systems changes we needed to best serve our patients.

You see, we had no resources for burnout, and our own physicians were creating, or adding to burnout. We weren’t corporate. We were physician owned. And we were eating our own.


Yes, physicians eat their own. We hear about nurses doing this, and physicians are often the first to point a finger at it. However, physicians do it as well. This is the bullying that I’ve spoken of so many times. Often the recipient is female, or a person of color. It gets swept under the rug and called ‘the politics of Medicine.’ It is a huge driver of burnout. There are no real resources for this for most providers.


In the early 2000s, my CMO asked me what I was going to do about it. He washed his hands of the whole thing and put the responsibility for my burnout back on me. Many people told me to quit on the spot. I found out shortly after that there were extenuating circumstances. That this gentleman had just received devastating news. I cut him some slack. I didn’t quit right away, but I did start looking for an exit strategy. When he was replaced and I had a similar experience with the new CMO, I tendered my resignation.


That was my first experience with burnout. Burnout can be a chronic, recurrent disorder. After leaving that clinic, I had the opportunity to work in several different scenarios. I’ve now been a professional locum physician for over 10 years, and I’ve loved it. That hasn’t kept me from being placed in situations where the workload has been overwhelming, or the administration has taken advantage of the locum physicians. I’ve been in places where DEI meant that being Caucasian was a disadvantage and being female in addition made you a target. Everywhere I went, I heard, “That’s just the politics of Medicine.” I saw colleagues being bullied for the color of their skin, their gender, or their sexual preference. When I asked about burnout prevention, mental health, or any kind of support for my colleagues, all I would get were odd looks and uncomfortable questions. There were no real resources for burnout prevention or burnout treatment.


Let’s fast forward to today. We’ve made a lot of progress in the last couple of years. Or have we? The AMA came out with a statement in 2021 that bullying in healthcare actually exists. They came out in support of programs for prevention of bullying and burnout. However, these programs were limited in scope and relied heavily on mindfulness. At that time, it was already known that only 20% of the drivers of burnout could be affected by mindfulness. The other 80% were organizational and would require organizational change. Many organizations went ahead and instituted these programs anyway. What did we learn from this? We learned that mindfulness programs, when applied to people who aren’t ready and/or don’t want it, can make the problem of burnout worse. Therefore, it is not a real resource for burnout, unless you are looking for mindfulness. Most people who are already looking for mindfulness, have already found a mindfulness program. They don’t need one rolled out by their employer.


What programs were not offering, and what many are requesting, are effective ways to communicate with administrators and break down barriers. They are requesting ways to set up systems that allow physicians and other staff to voice their concerns and negotiate for their needs without fear of retaliation. Physicians and nurses are seeking a comprehensive plan for their teams to set boundaries, in terms of hours and duties, to prevent morale injury. They are asking for a system that ensures that narcissistic leaders will be sent through emotional intelligence courses, and their progress followed, or that they be replaced based on staff satisfaction reports. Leadership can no longer be based upon the financial bottom line, or you’ll never have decent staff retention. If you can’t retain staff, you can’t retain patients. What I’m outlining here isn’t pie-in-the-sky. It’s a structured plan of effective communication that is easily attainable and implementable. I’ve seen it done, and I’ve done it. It’s far cheaper than replacing your staff, and has positive, lasting effects. In other words, it’s a real resource for burnout. What is it that we do? We make people matter. So, contact me for more information for you and your team. Jump on this opportunity now, before you lose more staff.

Nanette Nuessle