Keep Out From Burnout

August 01, 2019

Dermatology is a perfect combination of technology, medicine and surgery. Science and skin care are among top passions. In your day to day schedule, there’s never a dull moment.

As a Dermatologist, You:

  • See an assortment of patients all with different needs and conditions.
  • Conduct a variety of multiple procedures and you’re always on the move.
  • No two days are the same.
  • The chance to hone your artistic abilities and creative skills every day is an added bonus.
  • Relationships are important to you. The daily human connection with your employees and your continuous care to patients makes being a dermatologist worth it.

But the most rewarding thing about being a dermatologist is you make a difference in your patients’ lives. Often times, you even save their lives. You help patients reflect who they are on the outside based on what they feel like on the inside.

With every reward comes risk. Like most high-demand jobs, the highest risk for physicians is burnout.

While studies have shown that specialty physicians are especially prone to burnout. Thankfully, burnout in Dermatology is on the lower end of the scale, with ophthalmology and plastics closely behind! Dermatologists and pathologists reported low rates of burnout (32%), while plastic surgeons reported 23% and ophthalmologists reported 33%. Women are more likely to burn out before their male counterparts while every five in ten physicians will burn out between the ages of 45-54. Though these percentages are low among these specialties, it still occurs in 1/3 of our colleagues!

In this article, get a peek at the transparency you’ll see in all of our sessions as, in their own words, CSF contributors and faculty share how they avoid burnout and stay ahead of the stats!

Featured Contributors: Drs. S. Manjula Jegasothy, Joe Niamtu and Joel Schlessinger

 

Have you or anyone you know been affected by burnout?

 

Joe Niamtu, DMD: Burnout is a relative word as it can imply either a bad day, a bad week, or a bad career. I think that every doctor is a victim of some type of burnout probably on a regular basis and they write it off as a challenging day at the office. On the other hand, there are people that become overwhelmed with the responsibilities of doing what we do and combined with the stress of life, family, health insurance, etc., they literally get dragged down and hate going to work.

To me, that is the true definition of burnout.  I think that any physician that doesn’t say they’ve never been burned out does not have a busy practice because there are weeks when I do feel that I really need that weekend for my sanity. However, by Sunday night I’m always excited about coming to work and doing a facelift on Monday, so I’m in a good place in my practice and still love operating.

Manjula Jegasothy, MD: I’m definitely not burnt out and take on new responsibilities all the time. I’ve been fortunate to foresee EMR, billing and all the things that contribute to burnout. I chose not to commit to that. I still do paper charges and have a scribe write for me so I have less than 20 min of paper work a day. I participate in Medicare. Patients like that I don’t bill them or do any insurance work anymore. That’s been a big burnout savior for me.

What has also been really helpful for me is having a small staff and high overhead. I’m able to manage my schedule and take vacation without losing money. I’m able to spend more time with my patients and do more procedures with them which continue a more ever increasing revenue stream with those patients. This helps with reducing marketing cost so I don’t have to worry about that.

Taking really good care of your staff creates a good vibe in your office. I buy lunch every Friday for my staff and we sit, talk and spend time together. It makes me happy. We love to post things like our Friday lunches to our social media pages. Social media also sets a tone to the patients and creates this image of your practice to your patients.

Burnout is basically unhappiness. If you promote happiness, you’re less likely to burn out.

Joel Schlessinger, MD: I have seen many colleagues who suffered from burnout over times in their career.  Burnout can be the result of a bad group of patients in a limited period of time or staff that are challenging or simply a difficult home dynamic.

The key in dealing with burnout is realizing that you are suffering from it.  Whenever I have had issues that seemed to be ‘getting me down’, I have been extremely fortunate to have had staff members who told me I was not myself and got me back to reality.  I can’t stress the importance of having individuals who are willing to take the time to let you know!

 

Do you believe burnout is something aesthetic dermatologists/dermatologists should be concerned about?

 

Joe Niamtu, DMD: The only physicians that do not need to worry about burnout are those that are retired. So to answer your question, of course burnout is something that aesthetic dermatologists, dermatologists or physicians should be concerned about. One of the main reasons is because a lot of people experience burnout and don’t realize what it is. They can’t figure out why their practices are stressful. The key to improving burnout is to figure out why one is becoming burnt out. This frequently has to do with patient load, staff relations, billing and insurance, physical work place or general health.

Manjula Jegasothy, MD: In my opinion, the burnout in aesthetic dermatology is more related to managing expectations with your patients rather than what the causes of burnout are for a medical dermatologist. Aesthetic dermatologists don’t have to deal with paperwork or billing. We have to play at a much higher level to make our practice and services exceptional. The standard is much higher; our techniques have to be perfect. Managing expectations for aesthetic patients has to be trickier than medical patients. These aspects are challenging but in this arena, the best of the best really rise to the top. And I love that challenge. It could be something that burns out if you aren’t the best, but you have to be perfect. I like to be the best. If you don’t want to be the best, it could be frustrating and lead to burnout.

Joel Schlessinger, MD: I absolutely think this is a concern for aesthetic physicians!  Anyone can suffer burnout and it doesn’t just come to those who are struggling to start a practice.  In fact, the time that it seems to happen most is when things are going well for many physicians and they have less to worry about.  This may correlate specifically with the time that an aesthetic practice has finally ‘made it’ as the achievement of a goal can lead to a loss of purpose for some.

The important thing to do is to recognize that burnout is happening and adjust schedules to allow more ‘me’ time or discuss new goals or expectations with staff and loved ones.  This alone can lead to a successful outcome.  If this isn’t possible (and I suspect that ‘possible’ is variable from practitioner to practitioner), then other methods should be employed to make life more positive.  This is harder to accomplish but is important to consider.


Are there any programs/processes you have implemented to improve your overall well-being or the environment of your practice? Some examples from the American Medical Association include interventions, workflow and teamwork enhancements, policy changes and technology improvements.

Joe Niamtu, DMD: Yes! There was a time where my practice seemed so stressful and I literally had to sit down and look at why this was. The first problem was that I had some incompetent staff that were very nice and kind people, but they simply were not up to the responsibilities of doing their job and brought everyone else down a notch. If somebody is not working out, you need to get rid of them and that’s very hard for some doctors to do. I also felt that I needed to see every patient that called my office and I was literally running up and down the halls all day so at the end of the day I was pretty worn out. I sat down and figured out what procedures I really like doing, what procedures have the best remuneration and what procedures are the safest with the lowest risk of complications and I began cutting out other types of procedures.

I try to redecorate our office every 5 years. Little things like that truly bring up the morale. Finally, after doing cosmetic facial surgery for 3 decades, I decided to stop working on Fridays and it has made a huge difference in my disposition and in my practice. I am actually more profitable and my bottom line is bigger than it was when I was working 5 days.

If somebody is under a lot of stress, the first thing they have to do is sit down and identify the stressors and work towards improving each one of them. The biggest problem is that some people can’t figure out how to sit down and enumerate what is making their practice and life miserable.

Manjula Jegasothy, MD: I have New Year’s resolutions every year. For the first 10 years, my goals were related to my practice. In the last 10 years, my New Year’s resolutions have been related to my overall well-being. For me, it is reading one non-medical related book, exercising (different forms of exercising like yoga and stretching) and tailoring it to what my body needs more.

I think having a stressful practice environment can lead to burnout. However, there are many things a “burnout doctor” can work on to get things back in order and actually enjoy their practice.

Some practices have treatment rooms with bright lights and medical white walls which, to me, do not create a relaxing environment. In my practice, the walls are dark, the lights are dim and the windows are panoramic view of the Miami skyline. We pipe aroma through the air ducts, without being a diffuser or perfume spray. Fresh cut flowers are better than fake flowers. These are things that are really beneficial to my patient’s experience which improves the overall practice atmosphere.

Joel Schlessinger, MD: We had a rough patch in my practice about 14 years after the start when a group of nurses, en masse, decided to leave.  Initially, this might have been identified as a ‘burnout’ point for me.  I was devastated.  While this could have been a disaster, it turned out to be one of the best things to happen.  We found out that there was a toxic member of our staff who was making life miserable for the nurses (and others!) and that individual was terminated.  After this, we took classes at Gallup (located in our town) on ways for managers to manage better, including myself.

This was a turning point for us as an organization.  Since this time, we have had a cohesive, but incredibly respectful and delightful group of nurses who make my life and the life of everyone else much better for their presence.  Had we not experienced this terrible event; we wouldn’t have ever had this renaissance.

Burnout can be addressed in many ways, ranging from despair to resolute determination to fix inherent problems.  Dermatologists need to know that each approach leads to a significantly different outcome.

What are ways you improve your overall well-being to avoid burnout?

 

Joe Niamtu, DMD: I feel that wellbeing is all about balance and that has to do with home life, health, staff and work. One of the biggest things that have helped me maintain my sanity throughout my life has been physical fitness. I work out every day either before or after work and that really helps me get rid of my stress. For some people, it may be playing a musical instrument, playing golf, yoga or simply meditating. Whatever it is, you have to find activities that you enjoy to offset some of the stress that we have.

Manjula Jegasothy, MD: Completely compartmentalizing my life has been a good way for me to avoid burnout. I schedule time with my husband, family and friends and to travel. If I’m behind with office work and have to bring it home with me, I make sure I do it in the same room as my husband. It’s important that we are together. So many people have a study or an area sectioned off dedicated to work and it’s like they might as well be at the office. I don’t have studies at my house. Family matters so much, so it makes your family feel like you’re with them more even if it means spending time together in the same room.

Joel Schlessinger, MD: Me time and family time is essential.  There are times that things are incredibly busy at the office and I make time for a ‘date’ with my wife or time to see a TV show or movie at home.  These are so very helpful to keeping a positive attitude.

 

 

Want to learn more about ways to prevent burnout?

The American Medical Association has put together an easy seven-step process in order to prevent burnout.

  1. Establish wellness as a quality indicator for your practice
  • Encourage your organization to recognize the impact of burnout on providers as well as patients. The quality of their care and finances reflects on your practice. Establish a wellness provider that is regularly measured in your practice.
  1. Start a wellness committee and/or choose a wellness champion
  • For a large practice: committee should be made up of providers (MD, NPs, and PA’s) and administrators (finance, management). This group should meet once a month to brainstorm solutions, challenges and review progress.
  • For a small practice: designate a wellness champion. This individual promotes use of wellness resources, models behavior and encourages employees to complete an annual wellness survey.
  1. Distribute an annual wellness survey
  • AMA offers a burnout survey online you can download for free. It’s a ten item burnout program survey with questions that cover overall satisfaction, stress, workload, atmosphere, values, care team and EHR.
  • Your wellness committee or wellness champion can create an annual wellness survey in-house depending on the data you’re aiming for.
  1. Meet regularly with leaders and/or staff to discuss data and interventions to promote wellness
  • Your team will identify the areas of greatest concern (practice or organization or department) and decide as a collective group the best way to address the situation with the appropriate intervention.
  • Surveys should not be shared among staff and kept confidential.
  1. Initiate selected interventions
  • The interventions your practice needs likely fall under one of the three categories: workflow redesign, better communication between providers and quality improvement projects/programs targeted to clinician concerns.
  • OR simply develop a resource list to how practitioners can reduce burnout through time management, delegation, exercise, sleep and mindfulness.
  1. Repeat the survey within the year to re-evaluate wellness
  • Surveys should be assessed before and after interventions. It’s important to celebrate what works and evaluate weak points.
  1. Seek answers within the data, refine the interventions and continue to make improvements

Resource: Preventing Physician Burnout, M. Linzer, MD, L. Guzman-Corrales, MPH,  S. Poplau: June 1, 2015 https://edhub.ama-assn.org/steps-forward/module/2702509

Those AMA tips were really helpful, but I work in a small office/single-provider practice. How can I enjoy engaging in similar activities?

  • Join an online group
    • RxDerm is a discussion group created for dermatologists. This open forum allows discussion on a free flow of topics related to dermatology.
  • Quarterly dinner with a group of colleagues
    • Casual environment to reflect on practice values, brainstorm new wellness ideas and implement action plans
  • Host a webinar viewing party
    • Cater in some delicious bites and stream a webinar focused on company health and wellness
    • WELCOA and We Are Wellness
  • Create a wellness bulletin
    • Designate 1-2 employees (depending on the size of your practice) to decorate a bulletin with healthy lunch recipes, tips on living stress free and mood enhancers in a designated office space
  • Start a Wellness Program
    • Recognize and reward employees who practice healthy and mindful lifestyle habits
  • Designate a health hero(eos)
    • Elect an employee who’s passionate about health and wellness to present to your whole practice each month with new topics

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