Nurture Your Resilience and You'll Avoid Burnout
Abstract
Jodi Lofchy, M.D., an associate professor of psychiatry at the University of Toronto, was scheduled to give a talk on resilience at 9 a.m. on Sunday, September 26, at the Canadian Psychiatric Association's annual meeting in Toronto.
Jody Lofchy, M.D., tells psychiatrists that setting priorities and firm limits will help them avoid burnout.
The day and hour she had been assigned were most unfavorable, she thought, as she drove toward the downtown convention center where the meeting was being held. Who would want to get up to hear a talk at 9 a.m. on a Sunday? To make matters worse, she encountered a marathon taking place in downtown Toronto that morning, which meant that many streets were blocked off to traffic. She parked her car as close to the convention center as possible, then walked many blocks in high heels while lugging her computer.
By the time she got to the convention center, she was tired and frazzled, but in a position to practice what she was going to be talking about, which was developing resilience in psychiatry. And what better way to practice resilience than to show a sense of humor? she thought. “I got mixed up in a marathon coming here this morning,” she commented. “But at least I got some exercise!”
She also got an audience: she was relieved to see at least 30 psychiatrists in the room—mostly residents and early-career psychiatrists, and some seasoned ones as well.
Certain Physicians Especially Vulnerable
Although medicine is inherently stressful as a profession, research has shown that certain types of physicians are especially vulnerable to such stress, Lofchy reported—those who have poor self-esteem, an avoidant coping style, have a type A personality, score high on the personality trait of neuroticism, and cannot say “no.”
Residency can be an especially stressful period for psychiatrists, just as it is for other types of physicians, Lofchy pointed out. Residents arrive directly from medical school, so are still in a student role, but are expected to be “real” physicians and supervisors as well. “So you have a number of roles and identities. You doubt yourself and are anxious. You may also keep negative emotions about certain patients or experiences inside yourselves, and that can be stressful. High-risk patients can also create stress, especially when you are alone in the night with them. Then there is all that fatigue. . . .”
Although the stress usually eases by the final years of residency, it certainly does not end when residency ends, she continued. “I was once at a conference in another country, and when I returned, I found that my office had been moved and my secretary was somewhere else. It was incredibly stressful.”
On another occasion, she assumed new duties, yet did not receive the necessary clerical help. “Such a situation was more stressful for me than working as an emergency room psychiatrist or working with high-risk patients.”
When psychiatrists or other physicians are faced with too much stress, it can lead to burnout, Lofchy said. “Burnout is an erosion of the soul—emotional exhaustion, depersonalization, a form of mild depression.” She surveyed psychiatrists at various stages of their careers to learn more about burnout. The survey responses revealed that it can be characterized by stupor, irritability, dreading to go to work, a loss of a sense of humor, and taking longer to perform tasks than would usually be the case.
“Burnout in turn can lead to impaired job performance, poor mental and physical health, and substance abuse problems,” she said.
Lofchy told her audience that one way to deal with stress and avoid burnout is to develop resilience. “The concept of resilience, not just in psychiatric patients, but in psychiatrists, is getting a lot more attention than it used to,” she opined.
How to Become More Resilient
Here's the advice she shared with her audience:
| •. | “If you can do only one thing to successfully deal with stress and prevent burnout, it is not to work less, but to do work that you love. If you work a lot and love it and feel valued, it will not lead to burnout, but if you do not love it and do not feel valued, it may. Early on in your career try on different hats, but always fine-tune the process so that you learn what you love and what you don't, what fits.” | ||||
| •. | “Do what you love not just professionally, but nonprofessionally as well. And don't be driven by money. You are going to be a psychiatrist for a long time, and you'll earn a good income eventually.” | ||||
| •. | “If you are good at what you do, people will recognize it and give you more work, but that may not be good for you. Set priorities and learn to say no.” | ||||
| •. | “If you are a resident, seek out faculty whom you like and whom you want to hang out with. Pick their brains about how they've handled stress in their careers. These should not be faculty members who evaluate you, though.” | ||||
| •. | Time management is essential. Some residency programs are starting to address this issue. But a reduction in work hours, as is happening in American residency programs, is not the answer to stress management. If there are fewer hours, but with the same expectations, it can lead to stress. | ||||
| •. | A sense of humor with colleagues can be a useful way of coping with stress and preventing burnout. | ||||
| •. | “Aerobic exercise can be incredibly helpful. I once took six months off from psychiatry and cycled across China to deal with burnout. I also climbed to the top of Mount Kilimanjaro this year.” | ||||
| •. | “Variety in your practice is healthy—for example, a little teaching along with a clinical practice. Psychiatry offers an amazing number of opportunities.” | ||||
| •. | “Keep in mind that what you do is not forever. Keep your options open to new opportunities.” | ||||
“Nurturing resilience is not only the way to deal with stress and burnout, but is the key to professional success and satisfaction,” Lofchy emphasized. 
