MGMA · Mindful Medicine: Beating Burnout for More Effective Leadership
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Burnout is running rampant throughout the healthcare industry, especially in recent years, as 80% of healthcare leaders in 2022 reported that their level of stress and burnout increased. To provide listeners with the tools and resources necessary to combat these often-overwhelming feelings, MGMA is offering a new podcast series called Mindful Medicine which will feature interviews with mental health experts in the fields of psychology, neurology, leadership and mindfulness.
In the first episode of this series, we speak with Dr. Jeff Comer, PhD, MHA, FACHE about burnout – why it happens and how we can control it. Dr. Comer has over 20 years of experience as an interim and permanent acute and behavioral hospital CEO in both rural hospitals and urban facilities.
Editor’s note: The following Q&A has been edited for length and clarity.
Q: Burnout has been a huge challenge for practice leaders well before the pandemic, but it’s been exacerbated by the pandemic. You and I were looking at a 2018 MGMA survey on stress and burnout and it found that even before the pandemic that 73% of practice leaders said they’re burned out. Why is that? What are the biggest factors causing the burnout in healthcare?
A: We are all 24/7, 365. We’ve all gotten the calls at two in the morning on Christmas Day, that just goes with our jobs. And that makes it very difficult with our families because you never really are away from the job, you always have that phone with you. … I think we all know that practice managers and leaders have some of the highest divorce rates, high substance abuse rates, high behavioral health rates. All of these things come together, and to cap all this, as leaders, as managers, we don’t get a lot of attention. All of the attention goes to our clinicians, our doctors, our nurses - and they need it. I’m not saying our doctors and nurses and clinicians don’t deserve that, they absolutely do, but so do we. I think a lot of us feel neglected, we feel like we’re alone. The statistic you just shared shows we’re not alone. We’re actually all very burned out.
In fact, the rates of burnout for leaders are actually higher than the rates for clinicians, which is very interesting to me. There’s a lot of reasons for that, but I think when it comes down to it, you look at all these factors I’ve been talking about, and at the same time as a leader we’re supposed to be strong. We’re supposed to be confident. We’re always supposed to have the answers. We’re supposed to know what to do. We’re supposed to be there to take care of the organization, to take care of our employees, our doctors, our staff. So this is kind of hardwired into our mindset. It’s how we’re trained in our educational system and processes. It’s how we enter these jobs. It’s how we get rewarded and promoted, because we do have this knowledge, we do know what to do. But unfortunately, that leads us to not really focus enough on ourselves.
We’re focused on everybody else in the world in our organization, our employees, doctors, performance, all those different aspects, but we tend to neglect ourselves. Then we feel weak, we feel that we are not strong anymore. We don’t have all the answers because we’re hurting, we’re having some issues, we don’t have that motivation, our productivity drops a little bit. So, all of these things come together, and they produce almost a lack of control, and from a psychological perspective, anytime we have a lack of control it leads to psychological challenges and issues and problems in our lives. Particularly for leaders who are so used to being in control or at least having the perception of control. The final thing that I will mention, this is a really interesting one - it is what I call the badge of honor of stress. … It’s like this competition, like I’ve got to be more stressed than him, I’ve got to work harder than him. And so its like we wear stress as a badge of honor. All these factors … lead us to having long term, what I call, chronic unmitigated stress. And that’s what leads to burnout.
Q: What is burnout and how does it differ from stress?
A: We do complicate this way too much. Stress is essentially a physiological response to a stressor of some sort. It is there to protect us, to keep us as a species, alive. Our brains are still hardwired to be on the plains of Africa, the grasslands of Africa - that tiger comes running at you, your brain goes into a freeze mode, your amygdala takes over, you get all these hormones, these neurotransmitters, the immune system kicks in, and the fight or flight response kicks in. It’s there to keep you alive and save you. That is really what stress is supposed to be. The problem is, in human society, we have all these technology changes, we’re quote more civilized, society has evolved faster than the brain. So what happens is, the normal stress response: you get really stressed, you deal with the situation and the stress goes away. It’s a very short time period that that response occurs. With that, there’s no damage to your body, the immune system calms down, you don’t have cytokines causing all kinds of damage internally, you don’t have a psychological condition as a result. Burnout is a stress induced disorder, but is a chronic unmitigated stress induced disorder. Chronic meaning it stays with you over time, it doesn’t have that short window that acute stress should have. It’s there with you for months, for years, its unmitigated, you haven’t managed it. … So burnout is just long-term stress, it happens at work, it happens at home.
Q: So now what do we do about it?
A: You have to take control of your own stress, your own burnout. Suppression never ever works, suppression is where you consciously say, I don’t want to deal with this right now, I’m too busy, I’ll deal with this next week, next month. That doesn’t go away, it stays in your body. There are thousands of different techniques that you can use but you must understand that burnout is unmitigated long term chronic stress. So take control of it, don’t let it become unmitigated.
Now the next thing I always like to tell people to do is to break the chronic portion down. So if you have a really toxic work environment, you’ve got this boss who is horrible to work for – it’s overwhelming, I totally get that. But instead of thinking (negatively), think about breaking it down. … If your boss gave you feedback on a project you just did, instead of taking it and blowing it out of proportion, think about that feedback, just that isolated incident, that one single project you got feedback on. Listen to what the feedback was and then determine how you want to incorporate that feedback into your next project. Now what I’ve done is I’ve taken control of that toxic work environment and I’m trying to focus on a much smaller segment. What I’m trying to do is get you away from that long-term chronic burnout and deal with it on a short-term acute stress basis. I’m not saying that will solve your toxic work environment … but it can help you to deal with those individual events a lot better.
Essentially what you’re trying to do, and I use public speaking as an example – it’s always amazing to me when you ask people what their greatest fears in life are, and a lot of people say they fear public speaking over death. … Here’s the thing, from a physiological standpoint – your psychological response to the public speaking event, you’re labeling it as nervousness, but if you contrast that with an event that is very exciting to you, something you really love to do. The physiological and psychological response is identical, it’s how you’re labeling it, it’s how you’re interpreting it. … Just changing that mindset is really important. So first take control. Second, break the overall, overwhelming feeling into manageable chunks, and third try to change your mindset to how you’re dealing with it.
Q: What’s going on in the brain to get you to fake it ‘til you make it?
A: Just by putting a smile on your face, the research is overwhelming, your mood will follow, it will start to improve. You can trick your brain into being happier and more upbeat. And here’s the other thing, when you walk down the hallway at your practice, let’s just say you had a horrible board meeting and your doctors are mad at you, you’re not getting payment from your payers, and your nursing staff is upset, and you have all this turnover - all this stress of these jobs we have. Walking down the hallway putting a smile on your face, it makes you feel better but also you will have a way different response from all these people, when you’re smiling instead of grimacing and having that mean look on your face. They will respond to your differently. Now from a chemical standpoint, a neurochemical standpoint, that momentary bond you have with those people in the hallways increases your oxytocin, a very powerful hormone in your body, its what we call the love hormone. … That’s what gives you those warm, connected feelings, that will also help you reduce your testosterone – get the anger, the irritability, the aggression to come down so from a chemical standpoint you’ve got a lot of things that are taking place internally by just putting a smile on your face and walking down the hallway. Makes a huge difference.
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The MGMA Insights podcasts are produced by Daniel Williams, Rob Ketcham and Decklan McGee.
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