Following a keynote lecture on her personal and professional understanding of physician burnout earlier this year at the annual meeting of the Society of Interventional Radiology (SIR; 23–28 March, Austin, USA), Sasha Shillcutt here details the changes physicians can make to best achieve “work/life integration”, emphasising the importance of not compartmentalising yourself.
I was approaching 24 hours in the hospital and waiting for my partner to come into my operating room so we could do “hand-off”, where I spend 15 minutes going over all of the events of the surgical case and explain my patient’s health history, his current status, my current treatment strategies, the echocardiography findings, and our plan for the rest of the case. As I was awaiting my colleague’s arrival, I received a text from my son, AP.
AP: We need to make lunches, when will you be home? Are you taking us to school?
Me: Please make sure everyone is awake and make lunches.
AP: S2 is still asleep. He’s refusing to wake up.
Me: Can you PLEASE wake him up and make lunches. Also, get the papers on the island ready to hand in—they were there two nights ago.
Two nights ago, the last time I was awake in my house.
In comes my partner, and we chat. I tell him about my last 24 hours and the patient in my care. We review the anaesthesia record and the current surgical state. I say goodbye to the surgeon, the third one I have worked within 24 hours. He thanks me for my help throughout the night and wishes me a good day.
I do a five-minute change and rush home, transitioning into mum mode. I call home on the way and put out sibling fires and rally the sleepy preteen over the phone. When I arrive, AP has delivered: everyone is dressed, breakfasted, and lunches are thrown in backpacks. I kiss everyone hello and tell them I have missed them. I drive them to school and hear about yesterday’s events and today’s plans. They exit the car and I kiss them again. A little pang goes off in my heart; I just said hello, and now I am saying goodbye.
When I finally get home, I try and decide: sleep, shower, or coffee? And in what order? Should I empty the dishwasher, go through the mail, or just ignore it until later? Should I catch up on emails, or crash into a few hours of sleep? Should I run errands? After all, I am awake.
This is a very typical day in my life, and in most physicians’ lives. I recognise this does not just happen to doctors, it happens to many of us who work in areas such as healthcare, emergency service personnel, military, and law enforcement. We feel honoured to care for other’s sisters and dads and brothers and friends, yet we are all of those things to others, and find it a difficult balance.
In the last two years, out of complete necessity, I have studied professional burnout. Five years ago, I experienced clinical burnout myself and nearly quit the practice of medicine. Despite years of training and experience, I did not want to be a cardiac anaesthesiologist anymore. I knew I was in danger.
I needed to get a handle of my work/life integration. I do not use the term “work/life balance” anymore; I recognise that the 10-year quest for “balance” left me empty, defeated and more stressed than ever. So this is what I did: I embraced the suck.
Literally and figuratively. I stopped trying to be a “doctor” at work and a “mother” at home. I am both, all the time, and they are integrated. I stopped worrying that if I talked to my son about his homework over the phone at work and someone heard me they would not think I was serious about my job because I am a woman “mumming” at work. I stopped trying to hide in my bedroom to answer a consult at home. I just embraced that I was both of those things, and people who respected me would have to as well.
Burnout, in any profession, will steal your empathy and your innovation and, well, YOU. You will feel less engaged, less motivated, physically and emotionally exhausted, and start to withdraw. It is a dangerous path and can lead to very costly problems for individuals, institutions, and your family. Over 50% of physicians report burnout, and the suicide rate is 1.5–2.3x higher in male and female physicians than the general population. This is a real problem.
For me, when I started embracing that my work would flow into the home and my home would flow into work, suddenly my work became much more manageable. Now, do I answer questions about homework during an emergency at work? Of course not. Do I answer phone calls from work when my son is about to take a penalty kick? Heck no, I am cheering on the sidelines and it can wait 10 minutes. Do I have best friends who I also work with that I meet and have coffee with and decompress about a case that I am struggling to let go of? Absolutely. Do I invite my mother to hear me speak professionally, so she can understand what I do? Absolutely. Do I write manuscripts on the sidelines of my son’s football practice when I have downtime? Of course.
I am both doctor and mother.
It is important to leave work and be a sister, a friend and a dad. It is important to shut down devices and decompress and connect with your loved ones. I am not promoting a 24/7 work life. I am promoting embracing the fact you are ONE. One person, who is many things. And it is OK to be all of yourself, at all times. My patients and my work colleagues deserve my BEST self; that person is a mum, a wife, and a friend. And what I have found is that I have developed resilience and respect from my colleagues by being fully ME.
When I speak professionally on burnout and overcoming professional failure, I encourage physicians and leaders to make these changes:
- Set boundaries. When we are burned out, we must pull back from what we are being asked to do (or over-asked to do) and have frank conversations with leadership and say enough. There are limits to what we can do in a day, and we need leaders who listen to our requests for support; whether it is clerical, administrative, or procedural.
- Start with one efficiency fix. Identify the area of your workflow that is most problematic and requires you to do things inefficiency or takes your time and steals your joy. If you can recruit stakeholders to make changes, and fix one problem at a time, you will immediately see improvements.
- Stop judging yourself for being burned out. Start allowing yourself space to work on your own wellbeing. This is often hard for us as we care for others, we work incredibly long hours, and we feel guilty saying no to extra work. Here is the thing: the hardest working people burnout the most. Give yourself grace to recognise this, and empower yourself to say yes to your own health. Only you know what you need to be mentally and physically healthy—it is different for each individual.
- Plan your wellbeing. Wellbeing must be intentional. Wellness is not doing yoga, it is living within healthy boundaries you set for yourself and finding joy in your personal and professional life. Allow yourself to be a whole person—both at work and at home, and understand that requires saying no, thank you. And it may require change.
Let us stop judging one another in healthcare; rather, let us encourage each other to be our whole selves; not half and half. Whole. It is where freedom lives.
Sasha Shillcutt is a professor and the vice chair of Strategy and Innovation in the Department of Anesthesiology at the University of Nebraska Medical Center (UNMC; Omaha, USA). She leads conferences and retreats for women through her organisation, Brave Enough.