“I don’t know how much longer I can keep doing this.”

“I used to care so deeply but now I barely care at all.”

“By the end of work, I’m so depleted I can’t even enjoy my time off.”

Study after study tells us there is an epidemic of burnout in our profession. As an emergency physician I have experienced it personally, and as a coach who works with physicians I see it every day in my clients.

The reasons for burnout are increasingly well understood. Rapid changes in healthcare have brought a loss of physician autonomy, increased administrative minutiae, and unreasonable performance expectations. These compound the more traditional challenges of constantly dealing with death and suffering, high-stakes decision making, and long, irregular work hours.

As a physician, these hurdles can seem insurmountable. However, as a coach I know that physicians with burnout can recover and even thrive. When I begin to coach a physician, I often start with thought exercises to pinpoint the areas of their life that need immediate attention and have real potential for improvement. The exercises below are two of my favorites:

What is your ideal day?
When someone is burned out, it is natural for them to ruminate over external causes, vent frustrations, and assign blame. It is far more difficult to shift into a positive mindset and visualize an ideal work day, from wake to sleep, in minute detail. Making a deliberate effort to do this forces them to see the large and small areas of joy and difficulty both at work and at home. I ask clients to log their actual workdays for a week. After completing this exercise, physicians are often shocked at just how much of their day is unintentional. There are almost always several clear areas ripe for relatively easy improvements.This question, “What is your ideal day?” is also powerful simply because most physicians I work with have never thought about this before. Once individuals identify the things that are important to them, it is much easier to address barriers and begin taking specific steps to achieve their ideals.

If you could wake up tomorrow and find that miraculously one part of your job could be permanently changed, what would it be?
This question forces physicians to zero in on where they are struggling the most. The Pareto Principle tells us that 80% of our job dissatisfaction is caused by only 20% of our work activities. Therefore, making even small improvements in the most frustrating activities can drive enormous increases in our work satisfaction. This exercise is about identifying concrete stressors so that the individual has the opportunity to take specific actions to improve his or her situation.

The real power of these coaching questions is that they begin the process of reclaiming an internal locus of control. They help physicians shift from a state of passive frustration and victimization to a mindset of engagement and change. Physicians who recover from burnout do so not because they discover a single silver bullet for the problem, but because they ask themselves what they truly want in each area of their lives, and then act to bring about change to that effect. Being burned out is a lonely and even desperate place to be. I find it reassures physicians to understand that even a small positive first step can lead to meaningful and lasting change for the better.

About the Author
Dr. Ryan Bayley is a board certified emergency physician and a professional development coach. Through his coaching practice he works with physicians on a wide range of career and leadership issues, with a particular interest in burnout and work-life balance. He can be reached at rb@ryanbayleymd.com.