About The Books
Naim El Aswad is an emergency and internal medicine physician who is a national and international speaker, researcher and educator on physician and nurse Burnout. He has an amazing book that we're going to talk about as far as that is concerned, you can find out more about him at www.VitalSignsVitalSkills.com.
Thank you for having me. It's a pleasure and a privilege to be here.
Well, I am really enjoying your book on physician burnout. It's called Physician Burnout: An Emotionally Malignant Disease.
And I'd love to just start there. I know what we’ll talk a little bit about the ER.
But in this book, which you co-authored with two other professionals is really heavy in emotional intelligence, really heavy on a lot of things that really need to be talked about in hospitals and other health care environments.
And what I really love about it is you use the very principles of medicine to diagnose the pathology of it. If I'm using these words correctly, what's wrong, as well as how to diagnose and to treat this epidemic of physician burnout, where almost two thirds of female doctors and generally half of male doctors are in a state of burn out. So please correct me if I'm wrong, but I love to hear more about what prompted you to author that book.
1:50 Naim El Aswad MD >
Well, Nathan, this is a podcast about stories. So all physicians have stories and I'll tell you where this one started.
I was working in the emergency room One night. I was exhausted. It was three o'Clock in the morning, and I had just sat down in my room who kind of tried to rest a little.
When the nurse calls me, she says, you know, there’s someone who's checking in for belly pain for six months, and so at that point I'm exhausted, and I'm thankful that the distance between my room to the E. R. is a long, Long hallway - because I immediately got upset and curious and mad that this person has a problem for six months and they're showing up a three o'clock in the morning and I’m exhausted.
So my initial thoughts were - I became angry. And I'm going to show that person how, you know, egregious if you will this act - to show up at Three o'Clock after having pain for six months. And as I was walking, it's like steam coming out of my ears and then halfway through the whole way, I just stopped.
It's moments like, Okay, why am I here? Why did I become a physician? And why am I angry at the patient? And why am I thinking that I'm going to yell at the patient or scream at the patient? Or tell the patient this or that and, you know, dictate the patient's life and you're not supposed to show up at three o'Clock in the morning?
And it was like a screeching halt of everything. And then I went back to I kept asking myself, Why am I here? What did I do this? Why am I here?
Until I reconnected with the purpose of medicine of my purpose of medicine I signed up for which is to help people.
3:44 Nathan >
I know this from reading your book. You call that experience mastering the moment, and it's really, really critical. I mean, we don't have to be physicians to master the moment. We all have moments in our own lives. But I remember reading that in your book and thinking, man, that must take a lot of practice to be able to master the moment completely internally, but that was the first time that you had ever had the opportunity to master the moment, I guess. As you said the long hallway and long mini commute within the department really saved you from having a negative interaction with your patient and with other people at three in the morning.
4:30 Naim El Aswad MD >
Absolutely - through this kind of saved my interaction, and it put me back into the position which I am supposed to be as the professional and to honor the oath that I took as a professional. And so my whole thing just shifted and I went and saw the patient and so on and so forth. So it's mastering the moment. I'm glad you brought it up.
We described it as the point of impact. When two persons meet. Where are you with respect to the patient to your family, to your children, to your friends, to your coworkers at that point of interaction? Where are you mentally? Where are you emotionally? And what's going to come out of you? And that's mastering the moment. And this is something that we have to always be cognizant of.
Absolutely. And if we could just talk about the emergency room environment. I’m born to medicine. As I mentioned in the intro, I'm also married to medicine. So I hear the stories. I see the other side of things, and I know in medicine it's so difficult.
It's very much a double standard, but it's a double standard that I believe every physician, at least earlier in their career. They sign up for the double standard and the double standard - my words, not Naim’s. The double standard is that you're signing up for something that's going to take every ounce of willpower, brainpower, financial power, disciplined everything else.
And then on the flip side, you have a margin of error of pretty much zero, and we're at a point right now with our technology and with the polarization of our society and the class warfare and the political warfare, and you know all of the different things that are really a tearing our society apart.
Everything is really coming to a head. So here's a name in the doing. His work he's working is part of a team. My point with all of this is there is a really culture still where, even though the effects of physician burnout are just screaming and not just the symptoms but the results, and we've got a good five or six years of study evidence coming in, there is still kind of a I'LL just call it my words a macho culture where I think in some ways it might be good because you don't want to wear your feelings on your sleeve. They're there to serve other people save lives.
But on the other hand, there's gotta be a way to acknowledge this, not just privately, individually, anonymously behind closed doors. But there's gotta be a way for maybe the higher ups the administration department heads chief medical officer’s… Maybe people like that to take some steps to systemically change the system. Now, this is really, really deep stuff but Naim, I would love to hear your thoughts on this.
How do we change this system? Not just from the bottom up or the middle, but from the top down. Where does it start? In your opinion?
7:50 Naim El Aswad MD >
All of what you said is tremendously true and where it starts first is awareness. People have to understand that the problem exists.
And, like you said slowly, if I mentioned burnout ten years ago, it would be like a scarlet letter. And now it's gaining such attraction. Such momentum. It’s saying, you know what? This problem does exist and let me give you a simple example in the medical field. And it's following the same model.
In our book we talked about the burden of being an emotionally malignant disease because of text time. It's a cumulative effect, and then when it shows up, it shows up with a plan stage. But I'm gonna give you a different model, also, that people might relate to.
In 1984 we discovered two diseases: Kaposi’s Sarcoma and Pneumocystis Carinii, which showed up in people. But nobody knew why. They just knew that these were there.
It took us about four, five years to finally figure out that this is related to AIDS or because of AIDS and HIV. And when we did, there was a period of ten, fifteen years of the dark ages where you don't talk about this. And if you have this disease, then you are labeled, as you know, gay or you're a drug addict and that's it.
So you were looked at found out by the society and the same thing that's happening now. So we finally acknowledge that there’s burnout because we're seeing it every day and now it's moving from the awareness of it to finally say, Okay, you know what? Let's try to understand more, acknowledge its existence, to take finally some action against it - towards it.
And we are in the stages of the awareness / acknowledgment both on the institutional governmental levels and on the group individual levels. Moving forward and to try to take action, one of the things that need to happen is we have to speak the same language.
And burnout, it has its own language, you know, the profession of medicine, the relationship between physicians and patients is the most scrutinized relationship in the history of mankind. Everybody wants to know everything about it, and everybody wants to control it. And it is a sacred relationship, you know. So with all the pressures that are on it and with our teaching, So now what we're looking at is OK.
The very fabric of medicine has to change. The way our profession is thought because they're still the cultural extent of much. Well, if you can't take it, you're out. You know if you can take the pressure, you need to leave because you're not cut out for it.
And that's why you have about a four hundred physicians killing themselves every year because of burnout. That's why you have the statistics that you said about people being burned out, positions being burned out and the patients suffer. So do the physicians, and it's not the patient's fault that we are under tremendous stress, but they're the ones suffering also.
10:51 Nathan >
Well, we've been enjoying this conversation with Dr. Naim El Aswad. He is the co author of the book Physician Burnout: a Emotionally Malignant Disease, and we're just scratching the surface in this introvert view. Today we want to go beyond the surface, maybe at a future time, but I'm going to pivot right back to Naim for the for the final word.
Thank you for bringing this to the surface. Thank you for shedding light on it and thank you for humanizing medicine. This is what, exactly what we need in a world where it's becoming less and less human and more and more mechanical
in its expectations and unrealistic in its expectations. So thank you for bringing it back to where it started.
Well, Dr Naim El Aswad Thank you so much for coming on the talk and sharing your wisdom with us. If you want to find out more, just go to www.VitalSignsVitalSkills.com
Dr. Christopher Burton MD is a board-certified Physical Medicine and Rehabilitation (PM&R) physician and author of multiple books, including Putting Out the Fire, How to Prevent Physician Burnout, Personal Finance for Physicians, Marketing Your Medical Practice and more. Contact Dr. Burton for a coaching discovery call or to speak to your organization at www.ChristopherBurtonMD.com .
[0:00:55] Christopher Burton MD >Thanks so much, Nathan, glad to be here.
So I wanted to just jump in here and just get the back story. I mean, we go in and we see our physician, or we see our specialists and we get are usually three and a half minutes like I do with my Ear Nose & Throat (ENT) doctor the other month. We usually don't have a whole lot of time to find out who they are as a person, much less an emerging thought leader in the field. So how did you get in tow medicine? What was the first time that you knew that you wanted to become a doctor?
[0:01:50] Christopher Burton MD >
Well, that goes way back to junior high playing sports. I'd always been very active person, but I always ended up with visits to the emergency room as a part of that. And I knew that after interacting with the sports medicine doctors and learning about the musculoskeletal system that really interested me. And that's why I went into physical medicine rehab because I really wanted to help people get better, get back to doing the things that they were doing beforehand and function at their best possible level.
[0:02:18] Nathan >
So you've started as a physician, but you've got a broad range of experience. Your speaker. You're an author. You’re an international trainer. You are an adjunct faculty member. You've done a whole lot of things and wore a lot of hats. So what point was that not enough for you? Or is this simply an extension of what you already feel called to do?
I come by it honestly. My mom's a teacher, so teaching others has been a big part of everything, so that the coaching, the training, I think that probably comes naturally to me. The one thing that really led me down the path
I’m on now though, is when I started out, I went into private practice. My partner, the guy was brilliant. He still is. He knows medicine, our specialty inside it out.
But he struggles with the business side
of it and, you know, for a young guy coming out, I knew that I didn't know anything about the business of medicine. You know, a few faculty I know, jotting down numbers here and there. And you sent those codes to somebody
else who handled everything. But they never took the time to really teach us what we needed to do for coding and billing and let alone hiring a team to communicate effectively with your staff how to get them on board and
buy into the program. And so those sorts of things got me thinking I need more leadership training more communication training. And as they got further and further down that road, you know, I really enjoyed it.
But I realized other physicians are now coming to me asking me, “Hey, what do I do in this situation?” “Hey, can you help me do the things that I need to do to run my practice efficiently?” So it got me thinking, “Hey, you know that there's a lot of physicians out there who were in the same boat I was. We just don't know these things. So what can we do if we don't have somebody we can turn to get that information?”
And so I guess, kind of by default. I became that guy to go to guy for information on, you know, managing the practice. You know, the books, the marketing, your practice, you know, how to lead and communicate effectively with your staff. And so I really enjoyed it. I'm glad I got into that down that road, but it certainly wasn't intentional.
[0:07:17] Nathan >
So we're going to pivot over your latest book, which I love because, like I mentioned, I've been around healthcare providers my entire life.
So I love it when somebody writes a book about a pink elephant or gorilla in the room that nobody else is willing to talk about, and we all know that pink gorilla is right there in the room. Now this is not the title of your latest book, but that's good that you didn't talk to me before you published it. Instead, it's probably better titled Putting Out the Fire. How to Prevent Physician Burnout.
And what i really love about the book - you're not just talking to individual physicians. You're also talking about the CEOs, operations officers, financial officers and anyone involved in the management or administration. A you have plenty of real juicy anecdotes, unfortunately.
I cringed reading some of these stories of what happens when people burn out and let me think of a way to set you up with that. What was the most interesting anecdote from the book that you, can tease us with here?
[0:08:29] Christopher Burton MD >One of them is a story that I heard pretty much as soon as I started practicing, I've been out maybe a year or 2. And was at one of the hospitals locally and just getting involved. And one of the long-term was telling me of a general surgeon who was known for his temperament, to put it mildly.
Nathan >
Aren't they all? I thought they all were. I thought that was a condition of certification!
[0:08:54] Christopher Burton MD >
Unfortunately, they're there for a reason in some cases. Luckily, though, I think we're getting better. We're getting that E. Q. If you will talk to us in Med school now, which is good,
[0:09:06] Nathan >
You mean emotional intelligence. (EQ)
Emotional Intelligence is very important. And what caught me completely off guard was how this surgeon it was so used to bullying everyone that he didn't think twice about it, and he threw a live cauterizing device that a nurse who handed him the wrong instrument and it’s not that he hit her. It’s that he actually caught the operating room on fire.
So, to me, this is why I also talk in my book to administrators - is because you know when you have your operating room on fire, it's not just a physician's problem at that point. It's a patient safety problem. It's an H R problem. It's a liability problem.
[0:09:42] Nathan >
I mean, the whole place is literally burning down at that point. Pretty hard and pawn that off or minimize it.
[0:09:49] Christopher Burton MD >
This is not a mild oops / slap on the wrist sort of incident.
[0:09:55] Nathan >
The HR department was working overtime that day.
Alright, so that's a little extreme example. And of course, we are talking about surgeons, so I don't know if I'm allowed to make surgeon jokes. Probably not.
We don't want you to get to that point. And whether you are a physician listening this, whether you are in administration, whether you're in nursing or some other provider or practitioner or administrator or manager, what are some things that we can do to not get that way in the first place. One of the things I love about your book is that you talk about all kinds of reasons why we got this way.
How do we not get this way, even though we are this way?
[0:10:37] Christopher Burton MD >
Absolutely. Then the fact is, this guy didn't wake up that way from Day One once you graduate from med school. He did not become that way that the day he walked into his first operating room. Now this was building up over years. People just ignored him until they couldn't any longer. And that's unfortunately, the problem with burnout all along is that we just keep ignoring it both as physicians and hospital administrators and as a society until it's reached this crisis. We're now you've got physicians at a rate of 400 physicians a year, taking their own life, which is higher than any other profession.
You've got physicians who are divorcing at a higher rate than any other group of people in the US. There's obviously a problem.
[0:11:22] Nathan >
We can no longer hide in the corner. Stick your head in the proverbial sand just because we don't want to talk about our attitudes changing in terms of the administration.
From what you see in terms of what's going on in the industry, because I hear the stories.
Occasionally I hear of a colleague of one of my family members who jumped off a bridge or took their own life. It is horrific.
[0:11:42] Christopher Burton MD >
It really is. I think that people are starting to wake up to it. The fact that we can't just ignore it any longer. The problem is it's still either one of two things in my experience.
And I've been around a lot of people who talk about burnout and bend of presentations, probably like many of your physician listeners have.
The problem is it's a big institution. And nothing against them, but they're looking at it from a purely academic standpoint. To them these 400 physicians are just a number, and they survey and find out. Okay, well, 67.3% of physicians are burned out their organization. They publish all this research trying to elucidate why that might be theorized.
But there's not a lot of depth on what they're going to do to change it. You can't just keep serving us and expect the same problems suddenly going to go away. That's kind of like telling your patient. Hey, you just keep filling out those intake forms. And by the time the doctor gets to see you, you'll be all better. It doesn't work that way.
So while there is more awareness. I still think that it's either that problem where it's too cerebral and not practical enough. Or we still have people, you know, on the administrative side, thinking it's still just an individual physician problem and not realize how it impacts patient care about, you know, let’s face it. Liability is a huge issue the PR issues of burning down your operating room. There's a lot of those factors that they don't realize it impacts them. It's not just a physician problem anymore.
[0:13:05] Nathan >Christopher. What do you think it's gonna take? This is such an important issue. It's becoming more and more documented, like you say. What's it going to take for this to transcend measurement and get into culture change as well as policy change. So that we actually start to enjoy a not necessarily better standard of living, but some empathy toward real people who are working these jobs?
[0:13:34] Christopher Burton MD >
Absolutely. And as a physiatrist, you know, quality of life is what we talked to our patients about all the time. But now I'm talking to more physicians about the quality of their life. Do they have the career they want, the family life they want, the relationships they want because those are things all play into burnout.
It’s not just, Yeah. I don't like my electronic medical record. I don't like my staff for my administrator, our quality of life entails so much more. And it's not just one thing. So we've gotta address it from many points. So we look, at that whole person, if you will. Until we see physicians as a whole person. I think that's kind of the start of that.
The other problem that we face is [having to] become the squeaky wheel when something goes wrong. The hospital administrators are busy, too, and they're not necessarily thinking about your quality of life as they're going through their busy day. “Do we have everything we need? Are we fully staffed we have enough equipment? Do we have enough people that it's their job?” It’s stressful, too! And I understand that.
Since more and more physicians are employed, [we need to] find a few key movers and shakers at that top level, these large institutions who are willing to say, “You know what? I want to invest in my physicians because I know that satisfied and happy physicians are going to make for better cared for and more satisfied patients down the road.” So, you know, even if they look at, is a purely bottom-line issue. They still come out ahead by taking care of their physicians.
[0:15:04] Nathan >
One of the things I like about your book. I mean, we're talking about the pain. We're talking about the systemic-ness of the problem. But you also have several things that you can do whether you are an individual provider physician, whether you are in administration and you have, a hand in policy. And you advocate a lot for things like options such as locum tenens that most physicians in institutions and hospitalists don't even necessarily have a whole lot of familiarity with.
Just like I tell my patients. We as physicians have to take responsibility for our own care – our own wellness. And that comes to doing things like exercise, and eating right. And I fall into the same habits. So I'm busy today. The first thing that goes is my own time for me. I've got other things that I needed to take care of. But if we don't take care of ourselves, we're not gonna be any good to anyone else down the road. So in the book, we talk a lot about that.
You know, when I do coaching, obviously one on one, I spend time talking about “What are the real goals that you want out of your career out of your life?” And we all went into medicine to help people in some way or other. But there's more to it than that.
What specifically do you want from your career? Do you want to teach? Do you want to be a thought leader in your specialty? Do you want to do medicine and work part time and be home with your kids every afternoon when they get out of school?
There's a lot of goals that we can all have and work towards, but we've got to figure out what those are first. So I definitely advocate for a time for not only take care of yourself physically but mentally, spiritually, emotionally. Engage. Set aside time to look at your gauges. Look at your gauges regularly, Just like a fuel gauge. You've got to know, you know, if you're almost empty in that tank, whether it's physical, mental, emotional, spiritual. Where are you at on that tank? And if you're getting low, set aside some time.
Whether it's a vacation, whether it's something I need to talk to my family about. Maybe we need to change some things around or work – maybe we need to change our time and our schedule around.
One example is a single mom physician. If they would have just moved her shift forward by a couple of hours, she could have taken off, picked up a kid from daycare school and continue to work there. But because they weren't want to work with her and give her some flexibility, she said “I can't work here anymore.”
[0:17:28] Nathan >
What was the cost of that? You mention in the book at least $150,000 to find a replacement up until up into seven figures in some cases.
[0:17:37] Christopher Burton MD >
Definitely. Depending on the specialty, it can even get into couple of million dollars easily.
Just to recruit somebody to replace that person who was perfectly happy otherwise.
And I think there's some of those things that we can do. But unfortunately you mentioned, there's some times where there's just no working
with some situations. Unfortunately, not everybody's on board with working with physicians through burnout. And sometimes you do have to step away or find them a new job.
And like you mentioned the locum tenens, this was a great opportunity, temporarily, while you're transitioning to a new position. I've enjoyed doing it myself. In addition to speaking and doing it are working around, you know, my book-writing schedule and doing that to keep the clinical skills going. But have the flexibility I need to do the things I want to do.
[0:18:21] Nathan >
I'm going to ask a personal question. Really intrusive question. We know that there are always things that happen. We have Murphy's Law going on.
You're in an environment that is emergency driven. That's the nature of health. It's not preemptive as much as it is treating the symptoms and the crisis. When you are trying to put together a little bit of an action plan, a self-protection plan, where do you know that the line has been crossed?
You've already taken steps to protect your time, you know you need to be super flexible, and you know you're going to default to serving other people.
How do you still hold on to your own time? And what criteria do you use to know when it's a “Christopher, put the air mask on for yourself first” moment? Versus a “serve the other people” moment?
[0:19:19] Christopher Burton MD >
It's true. No matter what you do in medicine, your patients are depending on you. Your staff, depending on your family's, depending on you. Sometimes you feel like you've got the weight of the world on your shoulders. But first we've got to remember to set aside the time to regularly do a mental checkup of where you are.
Physically, it’s easy to say OK, the scrubs are getting a little bit tighter than that. I could see the step on a scale. Those things are very objective. But when it comes time to look at your relationships with my children, am I still patient with them? Or am getting a little bit edgy and getting too demanding of them.
Now, when you've got a toddler, you can't really demand that she's perfect all the time. But we do the same thing to ourselves. Physicians feel like we have to be perfect all the time. And unfortunately, we project that onto those around us. That's one example of relationally.
And from a communications standpoint, how am I talking to my family? How am I talking to the people around me? Sometimes I do this to where you kind of feel like, so overwhelmed you want, just draw into yourself. But that's not healthy, either.
We talk to our patients all time, “you’ve got to tell us what's wrong. We can't help you if you don't share all of your symptoms.” If you're trying to hide things.
It's the same for us as physicians. We can't just hide all of it in the corner and expect that someday the pressure won’t build up and explode all over everyone else. And we gotta make sure we find little cues that work, whether it's our interactions with other people, or objective measures such as the scale or our waist size. Have something that you’re measuring.
[0:20:50] Nathan >
So another way to say, all this is like everything else in medicine and health care, there are very few easy answers. And that, in effect is a leading reason why coaching especially for physicians, is beginning to take off. It’s very unlikely that you're going to be able to crack open a book and be able to find something - “Oh - I didn't think of that.”
But with coaching you can actually go in, have somebody that's going to partner with you, get in your head space, not judge you and actually help you determine solutions that match up to your capabilities and your values and your constraints.
Would you say that there's a growing physician awareness of coaching? Because I know growing up, that was something that I had absolutely never heard of It all.
[0:21:44] Christopher Burton MD >
There is. It's coming around slowly, just like anything else. Medicine's always slow to adapt and adopt. We've had people who funny stories from back in med school about the guy discovered that washing your hands would save the lives of babies and moms between deliveries.
But it wasn't for your generations before that kind of became common practice.
Other people in other industries have been using coaching for decades because they know that helps them achieve their goals, get where they
want to be faster and more efficiently than trying to figure out on our own.
As physicians we are slow to adopt. Just because that's our nature, we tend to be cautious. But we're also telling ourselves we have to be perfect all the time. We can't ever show any signs of weakness. But the beauty of coaching is - that coach is there to work with you. They don't owe anything to the institution, to your family, to anyone else. They just are there confidentially to hear what you have to say. To look at where you're at now, where you want to go. To look at what roadblocks or obstacles might be in the way. And then you come up with strategies together to do that effectively and efficiently.
Now you know, you mentioned books. Obviously, I wrote a book on that topic. I hope everyone enjoys it, but there's no way it's going to be the “end-all-be-all” for everybody. There's just too many nuances and our different situations. Or the culture we're in, our family situations. So we have to be mindful that as well.
The same thing with going onto YouTube and watching a video. Or attending a lecture or workshop at your state medical society or your national organization meetings. So having that coach is kind of next best to “Okay, I've learned all this stuff, but how do I put it in a practice? how do I implement it, and how can they get me where I want to be more quickly?”
With burnout, let's face it, you're a ticking time bomb. It's not a matter of if you're going to explode, it's when you're going to explode. And what's it worth?
The risk of your life, the risk of your marriage, that risk of your career, the cost of those things is immeasurable. So investing in coaching or in a program is obviously a much better option than losing everything you've worked so hard for in life.
[0:23:50] Nathan >
Look at the big picture. And again you lay it out in the book. There are a lot of people with half a million dollars in student loans from medical school and then basically feeling like they're in a rat race or hamster wheel in being micromanaged. All the other things that you mentioned in there. Certainly getting into the practice of setting aside not just savings, which is a good idea. You want to absolutely set aside savings money, even in addition to what's already been taken out for retirement.
But it's also a great idea, as you have done, to invest in your own personal development. And a coach could be a great way to do that. And for those people that aren't ready to take that step [of coaching], I understand that you are creating a video course that's going to be out at the time of this interview. Going live. Tell us a little bit about the companion course.
[0:24:47] Christopher Burton MD >
Yes, a lot of things that I talk to my colleagues about when I'm coaching them.
Let's face it. We all face a lot of similar problems. You know time's an issue. How do we set our goals and achieve those goals? Those things. We're going to be the same.
We change our mind set from “I have to be perfect all the time. I have to be the best at everything”. To, “I can get help here. I can ask somebody to get me to that next level.”
So a lot of the things that I repeat over and over again as I go around speaking to different groups or even one on one. Why not package that into a short interview or a short course where somebody who's looking to take that next step instead of just reading a book? They've got the information, but how do they apply it? And so that course is going to go a little more in depth and unlock the tools that we brush up on in the burnout book.
Well, I can't speak highly enough of getting an investing in a course like that. If you are committed to getting that one on one valuable coaching from whatever coach that you would have out there.
So much of it is going to be already covered in a group course that is based on group coaching or the themes that come up. So you can actually fast track in many ways even deeper into that. You can find out more about Christopher at his website, which is www.ChristopherBurtonMD.com.
Christopher, back to You for the final word of advice.
[0:26:36] Christopher Burton MD >
Oh, thank you, Nathan. I appreciate the time that I got to reach out to your listeners.
I just want to encourage anyone who's struggling with burn out. There is a problem, you know. There's no getting around it. So at this stage, the options are you can either ignore it and it’ll get worse, or you could do something about it. You know, no matter what you do, whether it's reading a book or going to a workshop or a course or a coaching program, just make sure you do something.
You got to do this for you and not just for you, but for your family, your career, your patients. This burnout is not just something that we deal with personally is something that affects everyone around us. So do what you can on your own, but also, if you need help, don't be afraid to reach out, whether it's to me or someone else in your organization or your specialty society. There are resources out there, and there's no reason to go through this by yourself.
[0:27:25] Nathan >Christopher Burton, thank you so much for coming on the talk and sharing your wisdom with us.
[0:27:30] Christopher Burton MD >Thanks, Nathan. There's been a lot of fun.
Ruthann Russo is the founder and CEO of SOHL where she and her team create Sustainable Self-Care Initiatives to help individuals
and organizations prosper.
Ruthann has over 20 years of experience leading health care consulting and software development firms. In all of this work, she and her teams have created new services for healthcare
systems while successfully integrating change management processes to ensure sustainability.
She has worked with over 200 healthcare systems and Fortune 100 firms implementing clinical documentation improvement,
compliance, self-care, and lifestyle medicine initiatives.
Ruthann has earned 4 doctoral and 2 master’s degrees and is double board certified in Lifestyle Medicine and Acupuncture and Chinese Medicine.
[0:00:00] Nathan Eckel >
We are live with Dr. Ruthann Russo. I should probably say Dr Dr Dr Dr Ruthann Russo, because you are the first person that I've interviewed with terminal degrees in four different fields.
So if you are in healthcare or leadership, or someone you know or love is dealing with these very same issues of burnout or systemic stress…
Or if you were a little disturbed the last few times you've gone to your primary healthcare provider, and maybe you only had three or four minutes with that person and you wanted to ask a couple of questions.
We're trying to enact positive change. To other people that are really trying inside the [healthcare] system who are really doing their best to do what they can, even though their hands are very much tied.
I don't think anybody is going to say that the health care system is is perfect or even all that functional these days. And we're really trying to arm people with the resource is that they need to make a difference.
Ruthann any corrections or clarifications on that?
[0:02:02] Ruthann Russo, PhD, JD, DAc, MPH >I absolutely agree with you. It is pervasive what is going on in terms of burnout and overwhelm. But to the extent that we can all just do our own part. That can start with just taking care of ourselves and knowing what we can do to take care of ourselves. It's a good place to start.
[0:02:23] Nathan >
So Ruthann Russo, thank you so much for this bonus session with you. I know you have four different doctorate degrees. You have healthcare doctorate degrees. You have an MBA which is a “business doctorate” degree. You started with your (J.D.) law degree, and I'm forgetting another one. I think an Acupuncture and an alternative medicine degree. Please clarify any of those as well as tell us about the three health care information companies that you founded and grew.
[0:03:33] Ruthann Russo, PhD, JD, DAc, MPH >Sure, and the the one particular degree I think that you were searching for was on Mind-Body Medicine. So it's, you know, evidence based solid science, on Mind-Body Medicine, and the three companies that I actually founded were information tech start ups that eventually were acquired. I did this the 1st 20 years of my professional career because I had a love and I still do have a significant love for health information.
[0:04:00] Nathan >Sorry to cut you off, but I got I got to say I've never met anybody else who has ever told me that they're in love with health / Electronic Medical Records! I have heard of the scourge of these time consuming programs. So I just love that that you love this this challenge. That's very special.
[0:04:29] Ruthann Russo, PhD, JD, DAc, MPH >
The very first time that I actually ever opens up a medical record - Right after I graduated from college. I was working in a hospital. It was the first time I had seen one, and all I could think to myself was, “Well, this is the story of somebody's life from a perspective of health care.”
And from that moment on, I've followed it through all paper records (though I'm giving away my age) but through digitized and then eventually that the EHR the Electronic Health Records.
And it's still continues to be a wonderful thing.
[0:04:59] Nathan >So we're going to get into the promised topic of overcoming physician and healthcare leadership burnout. But before we do that, just because I've never interviewed you before, I really want to hear the backstory.
So if you could just take us to where it all started and I know you've got all of these different journeys I know you gave a recent Ted X talk which people can look up.
And they can find out a lot of the backstory talk about some of the health challenges in your immediate family and the drastic and amazing changes your entire family went through with amazing results. Except you changed so many factors, you couldn't actually go back and pinpoint what what actually made the changes.
But if it's possible for you to Just in about 60 seconds somehow encapsulate all that, I'd love to hear the backstory.
[0:05:49] Ruthann Russo, PhD, JD, DAc, MPH >
I was actually still working in health information. I was a CEO of an organization and my daughter was a teenager. Through my husband, I have a son, and, he was always the one that had every sickness in the book.
[My daughter] was the healthy one, and she was diagnosed with epilepsy with juvenile epilepsy with uncontrollable seizures and we could not find a conventional medicine solution. And in fact, her physician at NYU Dr D. whom I call Doctor D. so as not to give away his name. Wonderful man. He still is her conventional medicine physician. At one point, after about a year and a half of treatment, said, Well, there's nothing left.
But he handed us a book that was entitled Complementary and Alternative Therapies for Epilepsy, which, by the way he wrote.
And said, You know, there's nothing left but see what you can do with this book. And she had been having seizures. Sometimes, every other week, that kind of thing. Always without we couldn't tell when they were coming, and they were the Grand Mal type that ended up in the hospital.
And from the time that we began experimenting with these, what I now call Mind-Body Medicine or self care practices, she did not have a seizure for almost five years.
We just literally descended upon this book and we tried everything in that book all at once.
And when we went back, we were so excited to tell him and he said, Well, you know, you were only supposed to try one thing at a time. How are we supposed to know which one [worked - we] didn't care? Because, you know, she was healthy. Our whole family, I had literally transformed as a result of this.
And that's when I decided to go back to school and focus on how could we could actually use this to go back into health care, because at the time when she became ill, I left in the company and spend all the time with her.
Now how can I go back into health care with this information that I have and use it to help patients to help providers? And at this point, where it’s really led to is helping the folks at the top - the leaders.
[0:07:50] Nathan >That's where we want to take it from here. So you know if if you want to hear the backstory of the TEDx talk as well as some of the therapies and and practices you can, What what's the name of the the TED talk. I don't have that right in front of me. Ruthann.
[0:08:07] Ruthann Russo, PhD, JD, DAc, MPH >
Sure, it's “your vital role in reimagining health care.” And if you just Google [Ruthann Russo + TEDx], it'll come right up.
[0:08:13] Nathan >
We want to speak to the top because I have a mentor who's written over 100 books on leadership, and he says “Everything rises and falls on leadership. “
And in a related segment today, with another guest, we were talking about the whole challenge of physician burnout and how that there is not even time to carve out a lunch for yourself sometimes.
But the real solution to that is to realize that you're not just a physician or a nurse or a nurse practitioner or whatever your job title is you are a leader, and leaders do what needs to be done, including setting boundaries and carving out time, and even setting physical distance between oneself and others.
So if you are a physician, - especially if you are a physician who is on a board of directors for a medical body or entity, we're talking to you. Because I love what Ruthann is embodying here. She's had real struggles in her family. She's overcome them, She has done the hard work, and she has gone back to school to begin in a way that that has credence with academia and peer reviews and all of the best practices.
She is compiling evidence based evidence and data and metrics for things that work.
So we're talking to you because we want to resource you with the hard conversations that we know that you're really longing to have in the board room, behind the board room, before the board room.
We really want to resource you with some ways that you you can think about overcoming change. We know health care does not change quickly. We know it's systemic. We know it's not going to be a quick fix. And we want to expose you to ideas and people and their white papers and evidences that are going to make a difference for you.
Ruthann Thanks for indulging me that very, very long little diatribe right there. But that's really the purpose here.
We were talking before we went live that we really want to talk to the leaders.
We want to talk to healthcare leadership in this bonus segment that can include doctors, nurse practitioners, everybody all the way down and up the organization. But we want to talk to leaders because they're the ones that can eventually create new cultures and impact cultures through influence.
So, Ruthann back to you. You've been in the C suite. You've taken companies and grown them and you've been right there in that boardroom. You've been in the top seat.
How do you begin to impact change when your hands are tied, when there's no margin, when everybody's naysaying, And when you're pretty fried yourself?
How did you be able to get results for your companies?
[0:11:24] Ruthann Russo, PhD, JD, DAc, MPH >
Great question and short answer is one step at a time.
And the other piece of that is by being an example, and that's where it does lead us right back to the leadership, right?
Because we do know from the research that's out there is that leadership is essentially contagious. What the leader does the rest of the organization does as well.
And so when I began looking at this issue around health care, and knowing that there were so many physicians and other clinicians that were burned out, and you look at the research that's out there, it's about half of all health care professionals are burned out.
[0:12:10] Ruthann Russo, PhD, JD, DAc, MPH >
So there is a lot of research that shows that about half of all health care professionals are burned out.
[0:12:16] Nathan >
HALF!
[0:12:17] Ruthann Russo, PhD, JD, DAc, MPH >
Half. That's a big number, right?
So we know this is a problem, and then the first response by health care systems has been, “look, you need to figure out as a physician or other clinician how to take care of yourself. “
Oh, it's, you know, “go learn mindfulness. “
Or at least I'm not saying these things don't have their role, but it's a piece.
And now the recent research, a Stanford University medical system, which who actually has the first Chief Wellness Officer for their physician group, has come out.
They've literally shared a workable model, which says, yes, this is a piece of it. Physicians need to care for themselves. They need to build resilience. They need to know whether it's [to] meditate or, you know, go running or whatever it might be. Yes, that's important, and it's a piece of it.
But we also need to recognize that there is an issue around the physician workflow.
We don't give them enough time to do what they need to do. We expect too much around the Electronic Health Record.
So we as health care systems, need to actually put something into place to help physicians with that, Whether it's hire a scribe to document for the physician or any other literally innumerable number of interventions.
That's the organization's responsibility.
But here's the third piece and probably the biggest piece of this. It's literally the organization and having a culture of wellness that starts at the top. It starts with the executive team.
And I will tell you that in the research that I did when I interviewed about 50 CEOs and other C Level individuals and health care organizations, one of the biggest findings was the fact that 84% of them said, “I believe that what I do in terms of my own self care and wellness practices impact the staff in this hospital..“
But almost 70% of them said, “I also believe that what I do impacts my patients.” In some cases, these systems are quite large. We know they might have 12, 13, 20 or more hospitals.
One individual is literally, directly or indirectly impacting hundreds of thousands of lives based upon what they themselves were doing.
Now, when you ask them what that is, is there a structure? Is there a measurement?
There's nothing that is consistent. It's kind of every man out for themselves, and there's a way that there’s science out there.
There's evidence out there. We can pull this together and we can create systems to help them help themselves and literally everybody else that they impact.
[0:14:57] Nathan >
I love that Stanford has new Stanford-certified research about all this but the new thing to me. I've never heard of a CWO - a Chief Wellness Officer. So you had me at “Chief Wellness Officer.”
Is the job of the Chief Wellness Officer is? Is that her job to track the data and track the soft metrics that go into a hard system and comprise actual outcomes? What would you say is the job of a CWO?
[0:15:35] Ruthann Russo, PhD, JD, DAc, MPH >That's a great question, and I will tell you that this is also a sticking point in health care systems because even who the CWO is responsible for actually focusing on (in terms of their own wellness) varies.
So at Stanford right now, the focus is physicians. Because physicians the cost to replace a physician could be anywhere up to about $2,000,000 based upon who that physician is. And we know that the turnover can be quite high.
That number Stanford again in the research shows that it could be somewhere over the course of two years - to the tune of about $30,000,000 to $40,000,000.
[0:16:11] Nathan >
Say that again? I just I blanked out on that!
[0:16:16] Ruthann Russo, PhD, JD, DAc, MPH >
Again 30 to $40,000,000 over the course of two years to replace physicians who they are losing due to burn out.
[0:16:29] Nathan >
$40 Million in 2 years - Wow!
[0:16:32] Ruthann Russo, PhD, JD, DAc, MPH >So at Stanford, the focuses on physicians. Now I will tell you that in other health care systems, what they're doing is saying, Hey, it's all clinicians. That may eventually be what's being done in Stanford. Who knows? But each system, based on their own culture and leadership, will define what that actually looks like.
And what the Chief Wellness Officer is responsible for - again, It will vary, but I can't believe that you would hire somebody at this level and not make them accountable for some level of metrics.
To literally say, “Hey, what are the key metrics we're tracking?” Everybody wants to know Return On Investment when you're looking at something like this, right?
It's costing us 1,000,000. We want to know that we're going to get at least 1,000,000 plus back. Otherwise we won't do this. And it's a tricky thing.
You know, one of the most interesting things - I worked with a Fortune 100 company last year around creating a prevention of burnout program. And one of the things that they would say over and over again their leadership team around the metrics was, “Look, you can't prove a negative.” We were able to show that. “Hey, your health care costs have actually decreased.” But what they would say is, “Well, how do we know it was your program that actually caused that?”
That's the challenge around trying to prove a negative, as the old saying goes.
[0:17:53] Nathan >
Some of you know that I used to adjunct professor in the field of instructional design. So really, what we're talking about right now is the difficulty of doing what we we call a Phillips evaluation a Level Five evaluation.
Which is not just measuring the the impact of a learning innovation -a training, program or whatever. When you get to level five, that's when you have to be able to have access within a system to whatever metrics.
And very rarely do you get that level of access because it takes a long time to be able to get the data, test the data, roll out a new plan you know, go back and are the same people working at the facility?
Are the stakeholders still even there? Or does that get the whole project get shelved?
That's what we're talking about right now. And that's why it's so elusive and, you know, kind of kind of loose-y goose-y a little bit.
And I love that this Chief Wellness Officer is going to be, you know, the queen bee or the king bee that that is going to start sifting through this stuff. That's really what we're talking about. So that's a little bit of Instructional Design/ tech-speak to my other learning professionals out there, but I just want to put this in perspective.
And I also want to commend to you, Ruthann Russo's White Papers. One that got my attention because I love the infographics in The New Prescription for Burnout. It's all about physician burnout.
Some very, very well produced, really good visuals. Very good infographics. Really easy to read. It's all available on her Web site. The other one is Leader Led Care, and her website is S O H L the number seven - www.SOHL7.com
Ruthann What was the S O HL? I know that that stood for something and I just can't quite remember it.
It stands for sources of health, leadership so and the sources of health.
And the number seven is used because there are seven sources of health. So, you know, knowing your life purpose, attending to your mind, body emotions, creativity, community and your environment.
So we address all of those from a self care perspective, and we got some good stuff going on.
[0:20:24] Nathan >
Well, it sounds like a really good stuff, so I'm going to come right back to you. Go to www.SOHL7.com To get access to this stuff, I'm going to give you the final word of advice for everybody.
[0:20:37] Ruthann Russo, PhD, JD, DAc, MPH >
The final word of advice is look to the top.
And for those of you who are already at the top and don't know where to turn, look to your boards.
We had talked about this earlier, but the boards are really ultimately the decision makers for the organization. And in this day and age, we need this focus on self care that's going to start with you, as the leader. And trickle down throughout the organization out to the patient base.
Because here's the thing. We're not that far away from global payment, which literally means health care systems will be paid one fee in order to care for patients, and their patient population.
So while healthcare has in the past, been incentivized to, I hate to say, keep patients sick, (but that's literally the way the health insurance system worked in the past). In the future, that won't be the case. In the future it will be “How do we keep people as healthy as possible.”
So that's a great thing for all of us.
Ruthann Russo, thank you so much for coming on the talk and giving us your wisdom today.
[0:22:14] Ruthann Russo, PhD, JD, DAc, MPH >Thank you, Nathan. Appreciate the opportunity.
ABOUT NATHAN ECKEL
Nathan Eckel connects high performing physicians to their patients through media production.
In 2018 Nathan interviewed 365 TED speakers for BeTheTalk podcast – giving him proof that
the medium of audio worked, and that after interviewing experts from all walks of life – Nathan realized he was effective at taking the pressure of producing a show off his guests so that they could simply share their solutions.
Prior to this Nathan had significant experience producing, speaking, and emceeing
at TEDx.
After completing the year of interviews – Nathan took time to think through the highest and best use of his skills at media production and interviewing SMEs.
Perhaps it was his father closing his solo medical practice after 39 years of faithful service.
Perhaps it was another related medical professional who realized as fewer patients vaccinate their children, that
she is a non-responder.
Perhaps it was seeing one too many pseudo-science memes foolishly spread on social by well-meaning, but tragically misinformed consumers.
Nathan realized the real modern crisis is the thousands of diligent physicians whose influence with their patients slips away for the other 364 days of the year.
Nathan has seen the dedication of physicians in his family who see dozens of patients daily, care for their staff, stay current with their CME and board studies, only to bear the brunt of society’s ignorance and mistrust.
-
Frivolous lawsuits and their lingering threat.
- Escalating malpractice insurance.
- Unexpected staff turnover.
- MicroManaged care from HMOs and politicians.
- Tropes about doctors
tanning themselves on cruises paid for by Big Pharma, deceiving patients, and other wholesale accusations.
