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Burnout. More than half of working physicians suffer this distressing condition today, according to the Canadian Medical Association’s 2021 National Physician Health Survey (NPHS). Among 4,121 physicians surveyed, 53% reported at least one of two burnout symptoms compared to 31% in the 2017 NPHS. Burnout is a spider that’s biting early- and mid-career doctors. Indeed, 34% of practising physicians under 35 years old, 44% aged 35 to 54 and 61% of physicians aged 55 and up reported they are likely to “reduce or modify” their clinical work hours in the next 24 months. What can physicians do to care for themselves and regain the passion that drew them to medicine? The Medical Post asked five physicians. Dr. John Chiasson, Antigonish, N.S.: 80% of the problem is systemic“Physicians only reach out when they’re really in dire straits,” Dr. John Chiasson, a peer support counsellor with Doctors Nova Scotia Professional Support Program, said in an interview. “I think the people who turn to our Professional Support Program are very important to Nova Scotians and Canadians. It’s important that they be well so they can stay and give good care.”Dr. Chiasson is a veteran of 43 years in family practice. “I’ve been in a spot myself where I felt all alone and disconnected and it was dark. Every single person is potentially vulnerable,” he said. “You feel all done when you’re in trouble. If someone asks how you are doing, and really cares about the answer, it changes everything.“My patients give me hope. They give me purpose. I’ve seen horrible things, but when people come and sit in front of me they know I care what happens to them.”Dr. Chiasson’s choice to work in a small town helps him to stay connected. Every morning, he walks a few blocks from his home to his clinic. He said it refreshes him, clears his mind for the day. He stops to buy a newspaper, chats with the shopkeeper. Calls people by name as he picks up a coffee.That connection and sense of belonging is key to staying mentally healthy and retaining passion for medicine, he believes. But “80% of what affects us in burnout is systemic things that are happening to healthcare.“I believe in advocacy for system change. If you’re willing to wait 10 years, things might be better. But if you can’t wait 10 years, let’s start to make some changes happen on the ground so we can endure the 10 years and get more from it, because we can’t control it all. What we can control is the narrative—what we’re going to say and do, and where we’re going to go tomorrow.”Dr. Irith Lebovich, Montreal: Leverage the patient-provider relationshipDr. Irith Lebovich, a nephrologist and founder of Yagrumo, a start-up specializing in training healthcare professionals in “human-centred care,” has been in practice for 20 years. She went through significant workplace stress in an earlier, hospital-based position. Now she has more control over her environment, working in an office she shares with several other physicians.“We’re living in very turbulent and uncertain times, with a greater number of responsibilities and obligations as human beings,” Dr Lebovich said. “Many physicians, especially over the last three years, have seen things that have affected them in profound ways, and they no longer feel they can continue to be a part of the profession.“It’s affecting us at a much deeper level than we think. We’re faced with so many changes in policy, processes and regulations.” Physicians feel “loss of purpose, loss of autonomy”—and loss of control, she said.“A loneliness has entered healthcare. We’re so focused on producing. Medicine has become so transactional that we’re missing out on what drew us to the healing professions in the first place.”Dr. Lebovich said “waiting for a miracle to happen—especially from the top down”—may take a long time. “We need to unite to create a culture where it’s safe for people to express their ideas and concerns; where people feel valued, relationships matter. The status quo is no longer tolerated and we need to affect change.”Dr. Lebovich suggested doctors start by “focusing on what we can control.She said, “We’re seeing patient-provider relationships as just another area where we’re losing energy and getting frustrated—in fact (medicine should feel like) a fountain of energy and path to fulfillment.“We should be leveraging the patient-provider relationship. My patients have saved me. They give back no less than I give.“Research has been clear that strong patient-provider relationships enhance patient experience and outcomes, and provider satisfaction as well,” Dr.Lebovich said.Dr. Alika Lafontaine, Grande Prairie, Alta.: Our stories remain hiddenDr. Alika Lafontaine, an anesthesiologist and past-president of the CMA, wrapped up his year as presidency in August and has gone back to seeing patients as an anesthesiologist. He spoke to the Medical Post just before his term ended.“Historically, doctors worked 80-hour weeks, and if you chat with people who used to work that way, they were a pillar of the community. They got a lot of love. They also were the centrepiece of their hospital and had a strong voice,” Dr. Lafontaine reflected.“There were doctors’ rooms in the hospitals back then where people interacted and maybe there’d be a birthday cake for one of your colleagues. Those doctors’ rooms are now administrators’ offices or closets where equipment is stored. I think health systems have been under so much pressure to maximize the productivity of every square foot, they cut the places where people gathered to create meaning.“Over the last 20 years, because of cost-cutting, and the shift to an extractive kind of management, where they try and maximize the amount of value people provide the system for the lowest cost, the question has shifted to how much worth you can get out of a physician, before they feel like they can’t tolerate it anymore and move on.“Shifting back to investing in people, really starting to humanize systems again, where people feel heard and are a valued part of decision-making . . . I think that needs to be done, moving forward.“You can be heroic in healthcare. But if (humanizing) changes don’t happen, parallel to that, you’re eventually going to hit a wall, with nothing else to give. For years we’ve tried, as frontline providers, to be that workaround to eliminate the crisis. But as a result, the system thought we could just do more of the same.“Health systems have still not realized that they can’t just implement solutions by making people work longer and harder, and expect to have a sustainable workforce. I have empathy for decisionmakers because I know they’re just part of a bigger system. We’re all workingdownstream from where decisions actually get made. But there has to come a point where people say, ‘This is just inhumane, what we’re doing.’“We’ve done a good job of suppressing the pain of physicians over the last few decades. And I think the actual reality is that we weren’t necessarily resilient. It’s just that we buried the stories of people that weren’t able to tolerate the conditions they were working in. And they kind of buried them within themselves too because of being stoic. We didn’t share our stories. We didn’t talk about our highs and lows, and as a result, our stories remain hidden. And that’s a healing thing when you start to share those stories.”Dr. Jennifer Williams, Nanaimo, B.C.: Reframe burnout as chronic workplace traumaAs a burnout survivor, “it became an opportunity for healing, growth and empowerment,” said Dr. Jennifer Williams, a gastroenterologist and a faculty member for the CMA Physician Leadership Institute.“Physicians are experiencing a loss of belonging and institutional betrayal,” she said, describing current healthcare systems as a work environment where bullying, harassment, microaggressions and racism are too often the norm. “We seek human connection from a person/institution we trust and instead experience gaslighting or inaction. Our voice is silenced and you can’t speak up for your colleagues or your patients.“I think what we call ‘burnout’ is a symptom-focused, downstream approach that does little to address the roots of survival behaviours,” she said. “We need to reframe burnout as chronic workplace trauma and build humanity-centred systems based on restorative principles.”Together with her colleague, traumatologist Jodi Ploquin, Dr. Williams facilitate courses through the CMA, sharing practical skills. In 2022, Dr. Williams also helped form Empowering H.O.P.E. (Humanizing to Optimize the Person Experience)—a fledgeling collaborative initiative aimed at creating “humanity-centred systems” that reimagine policies, procedures, protocols and leadership.“There’s been a shift, here in B.C., from ‘accepting the things we cannot change’ to ‘changing the things that are unacceptable,’” Dr. Williams observed. “Providers, patients and communities have begun to advocate for better healthcare together.“That momentum empowers grassroots movements, reaching a tipping point as the drivers of transformation outweigh the status quo.“Instead of just pulling people out of the river, let’s take an upstream approach and fix the bridge. Let’s transform the system by weaving humanity into our systems, one interaction and team at a time.”Dr. Maureen Mayhew, Vancouver: Foster a life outside of medicine“Every week I see physicians who have symptoms of burnout,” said Dr. Maureen Mayhew, an FP and a physician counsellor with Doctors of BC Physician Health Program. “Anxiety and stress represent another large number of people, and often these symptoms are related to experiences in their workplace. Lack of staffing is one of the big challenges.”Moral injury “by definition is related to a difference between my values as a physician and the institution I am working for,” Dr. Mayhew said. “And that discord feeds into the cynicism part, or the lack of engagement part, of the burnout triad. I see them as related, moral injury being a driver of burnout.” (53% of the 2021 CMA NPHS respondents reported experiencing moral distress at work.)“Burnout is really a system problem,” Dr. Mayhew said. “Physicians have been making up for deficits in the system for years. We do what it takes, to our own detriment.“It’s hard,” she said, “for physicians to step back and say, ‘No, I’m not going to continue to do this because it’s not good for me.’ It triggers a lot of guilt . . . but it’s possible to conquer guilt and get to a happier place, with more balance.”Physician leaders can play an important role, Dr. Mayhew said, but they’re often promoted by the system “without sufficient preparation or autonomy. I see leaders—medical doctors—who are burning out, because they straddle administration and medicine and may not have leadership training. Not knowing how to manage conflict gets to them, which is too bad because so many resources could be provided if organizations really wanted to set physician leaders up for success.”How can physicians create a healthier environment? To begin with, “You can shift your everyday culture—the culture of your team, of your clinic, even patient encounters, to a healthier, boundaried, supportive one,” Dr. Mayhew suggested. “Make your office a place you want to be, paint it a colour you like. Put in books and artwork you like. Get a comfy chair. Play nice music. These small actions can make a difference.“Foster a life outside of medicine. Even if it’s only 15 minutes every day. It does make a difference. Say ‘yes’ to the stuff that’s fulfilling and ‘no’ to the stuff that depletes your energy.”Dr. Mayhew has coached physicians who’ve reached the point of leaving medicine, including younger doctors who would be walking away from decades of practice. “When they have appropriate supports, many doctors who considered leaving decide to stay in practice. Most who think about leaving are driven by fears and anxieties, related to stressful situations which they don’t believe will change. With support and guidance, that doctor can learn skills that can transform their daily life.”

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