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Jim Young

Jim Young says the first steps in defeating burnout are admitting there’s a problem and seeking help.

“I had a major problem, and I needed a solution. Fast. So I decided to use the best strategy I had: outworking the problem on my own until either it was resolved or I collapsed. It was an easy choice, really. Up until this point, I had a 100 percent success rate in winning those battles. Besides, failure wasn’t an option. I’m a man. We don’t fail, and we don’t need help.

This time I was different. I knew that because of the carpeting.

Until that point in my life, I had never spent time inspecting the nuances of the flooring of my tiny, two-bedroom condo. But there I was, planted face down in the middle of my living room floor, drenched in sweat, tears streaking down my face, anguished groans occasionally escaping my writhing body. The abrasiveness of the matted Berber carpet felt harsh on my nose, forehead, and cheeks. Its aroma, stale and slightly chemical in nature, reeked of atrophy. It was not a pretty scene.

As I lay there uncontrollably sobbing, shaking from waves of stress pulsing through my depleted body, it was clear that I wasn’t OK.”

That’s a very powerful, and poignant, passage from the introduction to Jim Young’s recently released book, titled Expansive Intimacy: How “Tough Guys” Defeat Burnout.

Young, a Northampton-based coach who calls himself the “Centered Coach,” and before that an IT executive, has become an expert on the subject at hand — burnout — and defeating it. He’s been there and done that, as we can discern from his introduction, in which he talks about an assignment to revive a major client’s IT system, one that, coupled with other factors ranging from his grandmother lying on her deathbed to being six months into divorce, sent him nosediving into that aforementioned Berber carpet.

He’s also helped others defeat burnout, but only after they managed to find the strength to do what most men strenuously resist doing — first admitting that they need help, and then getting that help.

“I often describe myself as a men’s and organizational burnout coach,” he told BusinessWest. “Because that’s who keeps finding me; that’s the work I’m most compelled to do, to help men deal with this condition we call burnout.”

“The term has gained a lot of buzz over the past few years — the pandemic has pulled the curtains back on this topic, which has really been there for a long time. I think we conflate it oftentimes with being tired or exhausted. People say, ‘I’m burned out today’ … it’s a bigger issue than that.”

In a wide-ranging conversation about his book and the broad subject of burnout, Young said this term gets thrown out almost daily in the workplace, usually with little regard for its true meaning and symptoms.

Indeed, burnout is, in most respects, a technical term. It doesn’t mean tired, or exhausted, or exasperated, he said, adding that there are several symptoms, and also what he called the “burnout spectrum” in which individuals experience some but perhaps not all of these symptoms.

Expansive Intimacy

“The term has gained a lot of buzz over the past few years — the pandemic has pulled the curtains back on this topic, which has really been there for a long time,” he explained. “I think we conflate it oftentimes with being tired or exhausted. People say, ‘I’m burned out today’ … it’s a bigger issue than that.

“The World Health Organization finally, in 2019, recognized that burnout was a workplace condition of unmanaged stress with three components,” he went on. “Exhaustion, for sure, whether we’re physically, mentally, or emotionally exhausted, but also cynicism and a lack of effectiveness; we don’t feel like we can get things done anymore, and we can start taking a cynical approach that things are never going to get better — a mentality of ‘it is what it is.’ A true case of burnout involves all three of those symptoms, and there are people all across the burnout spectrum who might be dealing with one or two of those symptoms, but not all three.”

With that broad definition, and that list of symptoms, which a great many individuals in business can relate to, how does one go about defeating burnout and put it behind them?

It starts, as Young said, with admitting that there is a problem, something he finally did, and then doing something about it rather than trying (almost always unsuccessfully) to tough it out, which is what ‘tough’ guys usually try to do.

For this issue, BusinessWest talked with Young about burnout, his new book, and that concept of expansive intimacy, which, in his view, is the only way to get at the root of this problem.

 

When the Heat Is On

When asked how people know, or should know, if they are burned out, Young said that he — and probably many others — don’t actually know in the moment.

“I lived on the burnout spectrum for five to seven years, and I floated through different aspects of it,” he explained. “I didn’t know it when I was in it until I looked back at it and remember not wanting to get out of bed and go to work in the morning. I felt like I was moving in wet cement as I was trying to get things done.

“To me, a lot of it is the felt sense of it, but also, how are people around me responding to me?” he went on. “And if I could be honest with myself, I would ask people, ‘hey, was I difficult to be around? Was I less effective than I was before? Did I come across as someone who never had something positive to say?’ We’re feeling like we’re not getting things done that we’re capable of. That’s the best answer for me when it comes to knowing when we’re burned out. There are assessments we can take, but I always come back to how we’re feeling and getting some perspective from other people on how I am compared to when I’m at my best.”

Elaborating, Young said people and can and often do have bad days, bad weeks, and bad months. But burnout is longer-term. It’s a persistent feeling of simply not feeling like yourself, accompanied by some physical symptoms.

“There’s a ton of practical advice that you can Google; it will talk about exercise, it will talk about diet, it will talk about shifting your work schedule and maybe even changing jobs. Those are all valid things to do; however, they’re just putting Band-Aids on symptoms. They’re not actually getting to the root cause.”

These can include indigestion, lower back pain, and other ailments that cannot be easily explained, he said, adding that these problems equate to stress building up in the body — stress that, if not relieved, will lead to deeper issues.

It’s incumbent upon individuals, and especially men, because often, they don’t listen to what their body is telling them, Young went on, adding that, if they listen hard enough — and he eventually did — they will come to understand that the problem might be burnout.

And this brings us to the next step in this assignment — deciding what to do about it, be it taking time off, finding a new job or career, seeking counseling or coaching, or some mix of the above.

“And that often depends on how crispy you are,” said Young. “Some people, when they’ve had an extreme case of burnout, really need to decompress; I’ve dealt with people who have had to take long-term leave and just not do anything for a while, but that’s not something that a lot of people can do.

“For me, when I started looking at how I defeated burnout and what I wanted to share with others, there’s a ton of practical advice that you can Google; it will talk about exercise, it will talk about diet, it will talk about shifting your work schedule and maybe even changing jobs. Those are all valid things to do; however, they’re just putting Band-Aids on symptoms. They’re not actually getting to the root cause.”

Elaborating, he said the biggest problem he had with burnout — and the problem that most people have — is the isolation and the feeling that he had to deal with it alone.

“When I pulled back all he covers, when I rewound the story, I realized that the thing that got me out of burnout was to stop isolating myself and create intimate connections in all areas of my life so I always had a place to go when my stress was built up,” he told BusinessWest, adding that this is a difficult assignment for many men.

How do they get over that hurdle?

“I think the answer to that is to look at our shame, which is not a word that guys want to talk about, but it’s there,” said Young, who related his own experiences to drive home that point. “If the reason I got into burnout was because I kept comparing myself to the men around me, to my peers, to the people who were a few steps ahead of me on the path, and feeling that I don’t measure up, then I have to double down; I have to outwork everyone. I definitely can’t ask for help; I can’t reveal any of that to anyone because then I’m going to really hear it from the guys. And that’s not OK.

“So I suffered in silence and tried to tough it out,” he went on. “The problem is, the hole kept getting deeper, and so, when I wrote the book, I knew I wanted to write about burnout, because it was a horrible experience for me, but I also knew I wanted to write about intimacy and intimate connections in every area of my life, which was actually the real antidote that got to the root cause. But I didn’t realize that I was going to see shame come up so prominently; as I interviewed dozens of men about it, I got the same story — the fear of being called out by other guys because we’re not man enough to deal with our business and we got burned out is a huge obstacle.”

 

Bottom Line

Clearing this obstacle is difficult, Young said in conclusion, but it is the first big step toward defeating burnout and moving on from it.

It’s the first step toward picking oneself up off the floor — figuratively, or, as we saw in Young’s own case, and probably many others, quite literally.

 

George O’Brien can be reached at [email protected]

Features

Work After the Pandemic

By John Graham

It’s been a year now since we came under the relentless domination of the coronavirus. After all this time, the picture isn’t pleasant. The end is uncertain, and the implications for the future are far from clear.

McKinsey reports that “75% of employees in the United States and close to a third in the Asia-Pacific region report symptoms of burnout. European nations are reporting increasing levels of pandemic fatigue in their populations. The number of those who rate their mental health as ‘very poor’ is more than three times higher than before the crisis, and mental-health issues are still likely to rise.” In spite of their severity, such figures should get our attention, but do they?

Perhaps the most dangerous part of the coronavirus is its divisiveness. More often than not, outside attacks — wars, famines, and natural disasters — bring us together to slay the dragon. But the pandemic has driven us further apart. Who would have thought life could take such a painful turn?

Overnight, workers were told to leave their jobs and work from home. Not only did they do it, they liked it. Now, many are ready to refuse to go back to claustrophobic cubicles or vacuous open spaces where they lacked privacy. To express their pleasure at working from home, they remodeled their bedrooms, kitchens, and basements; upgraded their internet connection; purchased all sorts of digital devices and office equipment; and didn’t miss a beat.

They’re choosy, too. “You want me in the office? I don’t think so.” Some moved to Boise or some other place in the middle of nowhere that welcomed them with open arms and lower living costs. They donned their sweats, popped open a laptop, jumped on virtual meetings, adjusted the lighting, turned on a monitor or two, and went to work in their new, $999 office chair, or decided to stay in bed and make it their office that day. To the utter surprise to everyone, productivity went up.

That’s just the first chapter. The McKinsey report also notes that “there is a veritable flood of new small businesses. In the third quarter of 2020 alone, there were more than 1.5 million new-business applications in the United States — almost double the figure for the same period in 2019.” That’s not all. The fourth quarter found Apple ripe for success with the highest revenue in its history — and the company wasn’t alone.

 

Four Lessons

All this adds up to an amazing, but totally counter-intuitive, story. But what does it mean to all of us who must live it? Literally, what in the world is going on? Even more to the point, what’s the message about the future — our future? Here are four thoughts about that.

“Overnight, workers were told to leave their jobs and work from home. Not only did they do it, they liked it. Now, many are ready to refuse to go back to claustrophobic cubicles or vacuous open spaces where they lacked privacy.”

The genie is out of the bottle. It’s finally happened. To put it another way, like no other phenomenon in modern history (perhaps in all of history), the pandemic released a level of momentum sufficient to turn the world and everything in it upside down in an instant. It may also be the catalyst that changes everything, from politics, government, and public policy to health and medicine, education, work-life balance, business, entertainment, culture, industry, and science. When Jeff Bezos, the CEO of Amazon, steps back, we can be sure profound change is in the air.

 

Far more people have seats at the table. We talked for so long, but nothing changed. Then, suddenly, we became keenly aware of those who had long been invisible to us. We raised our hands and called them ‘heroes’ but never raised their wages. Now, all of a sudden, we’ve finally figured out that when everyone has a seat, we have better healthcare, better jobs, stronger families, and happier communities. Could it possibly be that it took a painful pandemic to make more room at the table?

 

Everything is under a microscope. Again, counter-intuitive but nevertheless true: the number of applications for fall 2021 at the University of California are breaking all records. It’s happening at the same moment when millions of young Americans are questioning the value of a college education, particularly if it will take decades to free themselves from the sobering shackles of student debt. Those who went before them, the Millennials, are dogged in determining their own way in the world. Don’t be surprised. The lens of the microscope may never rest.

 

Don’t drink the Kool-Aid. There are dangers in the tension-filled, stressful times in which we find ourselves. Someone has aptly described it as “hitting the pandemic wall,” and it’s felt at home and at work. It’s when we reach out for relief so we can get our lives on a better path. Simple, quick, and easy answers are what sell in turbulent times: “buy this or do that, and your problems vanish, and your dreams come true.” We’re too resilient to do that to ourselves.

 

Bottom Line

Now, go back to where we started, the original question: “Who will have the upper hand after the pandemic: employers or employees?

All this leads to the final question. Through the pandemic frenzy, who will come out ahead, the workers or employers? The way it looks at the moment, it just may be the workers. But, as we all know, things can change. u

 

John Graham of GrahamComm is a marketing and sales strategy consultant and business writer. He is the creator of Magnet Marketing and publishes a free monthly e-bulletin, “No Nonsense Marketing & Sales Ideas”; [email protected]

 

Health Care

Under Pressure

A changing healthcare landscape has doctors feeling stressed, unsatisfied, and burned out like never before — and that could have dire effects on patient care. That’s why the industry is focused on diagnosing the problem and prescribing remedies.

Every day, patients rely on doctors to tackle their chronic health and wellness issues and make them feel better.

But what if it’s the doctors feeling miserable? Or stressed-out, anxious, and overwhelmed? Unfortunately, that’s happening constantly.

Burnout among physicians has become so pervasive that a new paper recently published by the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Mass. Medical Society, and the Mass. Health and Hospital Assoc. deems the situation no less than a public health crisis.

“A Crisis in Health Care: A Call to Action on Physician Burnout,” as the document is titled, includes a number of strategies aimed at curbing the prevalence of burnout among physicians and other care providers, including improvements to the efficiency of electronic health records (EHRs), proactive mental-health treatment and support for caregivers experiencing burnout, and the appointment of an executive-level chief wellness officer at every major healthcare organization (much more on all of these later).

But the report also details just how extensive the problem is, and why it should be a concern for patients. In a 2018 survey conducted by Merritt-Hawkins, 78% of physicians said they experience some symptoms of professional burnout — loosely described in the survey as feelings of emotional exhaustion, depersonalization, and/or diminished sense of personal accomplishment.

Physicians experiencing burnout are more likely than their peers to reduce their work hours or exit their profession. And that’s concerning in itself; the U.S. Department of Health and Human Services predicts a coming nationwide shortage of nearly 90,000 physicians, many driven out of practice due to burnout.

“The issue of burnout is something we take incredibly seriously because physician well-being is linked to providing quality care and favorable outcomes for our patients,” said Dr. Alain Chaoui, a practicing family physician and president of the Massachusetts Medical Society. “We need our healthcare institutions to recognize burnout at the highest level, and to take active steps to survey physicians for burnout and then identify and implement solutions. We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.”

Dr. Alain Chaoui

Dr. Alain Chaoui

 “We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.”

While some have pointed to the passage of the Affordable Care Act (ACA) in 2010 — the most significant recent change in the American healthcare landscape — as a stressor, the roots of the crisis date further back, the report notes. For example, EHRs, mandated as part of the 2009 Reinvestment and Recovery Act, have dramatically changed the way doctors allot time to their jobs. And the 1999 publication of the Institute of Medicine’s “To Err is Human” report, highlighting the prevalence of medical errors, directed new attention to the need for quality improvement, physician reporting, and accountability — and brought heightened pressure.

In the past, the report notes, some have proposed ‘self-care strategies’ — such as mindfulness or yoga — as a response to burnout and presented some evidence of limited success with such approaches. However, physicians typically don’t have time to fit such coping strategies into their routine. They also don’t really address root problems.

“Such an approach inaccurately suggests that the experience and consequences of burnout are the responsibility of individual physicians,” it continues. “This is akin to asking drivers to avoid car accidents without investing in repairing and improving hazardous roads. Simply asking physicians to work harder to manage their own burnout will not work.”

Digital Dilemma

As the report noted, a broad consensus has formed that a major contributor to physician burnout is dissatisfaction and frustration with EHRs, which have become ubiquitous in recent years. While the goal of transitioning to electronic records has been to improve quality of care and patient communication, the results have been mixed at best.

“The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” said Dr. Ashish Jha, a VA physician and Harvard faculty member. “There is simply no way to achieve the goal of improving healthcare while those on the front lines — our physicians — are experiencing an epidemic of burnout due to the conflicting demands of their work. We need to identify and share innovative best practices to support doctors in fulfilling their mission to care for patients.”

As Dr. Atul Gawande, a Massachusetts surgeon, writer, researcher, and CEO of the nonprofit healthcare venture formed by Amazon, Berkshire Hathaway, and JP Morgan Chase, recently described it, “a system that promised to increase physicians’ mastery over their work has, instead, increased their work’s mastery over them.”

That’s because the patient encounter is now dominated by the demands of the EHR, undermining the crucial face-to-face interaction that has long been at the core of a satisfying doctor-patient encounter, the report notes, adding that, “for many physicians, EHRs impose a frustrating and non-intuitive workflow that makes excessive cognitive demands and detracts from, rather than reinforces, the goals of good patient care.”

Dr. Ashish Jha

Dr. Ashish Jha

 “The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients.”

In addition, the quantity of mandatory documentation imposed by EHRs — due to regulatory and payer requirements — means physicians typically spend two hours doing computer work for every hour spent face to face with a patient, including numerous hours after work. And they’re frustrated by spending so much time on administrative tasks they feel have little to do with actual patient care.

One promising solution, according to the report, would be to encourage software developers to develop a range of apps that can operate with most, if not all, certified EHR systems.

Improved EHR usability is, in fact, required by law. The 21st Century Cures Act of 2016 mandates the use of open health care APIs (application programming interfaces), which standardize programming interactions, allowing third parties to develop apps that can work with any EHR. This would allow physicians, clinics, and hospitals to customize their workflow and interfaces according to their needs and preferences, promoting rapid innovation and improvements in design.

Another promising but less-developed approach to reducing the HER burden on physicians, the report notes, is the development of artificial intelligence (AI) technologies to support clinical documentation and quality measurements.

Mind Matters

The report spends plenty of time on mental health, and for good reason.

“It is clear that one can’t have a high-performing healthcare system if physicians working within it are not well,” it notes. “Therefore, the true impact of burnout is the impact it will have on the health and well-being of the American public.”

To that end, it calls on hospitals and other healthcare organizations to improve access to, and expand, health services for physicians, including mental-health services — while reaching out to doctors and encouraging them to take advantage of such services in order to prevent and manage the symptoms of burnout.

That’s easier said than done, of course, as a stigma still exists around seeking help for mental-health issues.

“Physician institutions — including physician associations, hospitals, and licensing bodies — should take deliberate steps to facilitate appropriate treatment and support without stigma or unnecessary constraints on physicians’ ability to practice,” the report argues.

Last year, the Federation of State Medical Boards (FSMB) adopted a policy reconsidering ‘probing questions’ about a physician’s mental health, addiction, or substance use on applications for medical licensure or renewal, as the existence of such questions may discourage physicians from seeking treatment. “To the extent that such questions are included,” the report says, “those questions should focus on the presence or absence of current impairments that impact physician practice and competence, in the same manner as questions about physical health.”

The FSMB is also calling for state medical boards to offer ‘safe-haven’ non-reporting to applicants for licensure who are receiving appropriate treatment for mental health or substance use. Such non-reporting would be based on monitoring and good standing with the recommendations of the state physician health program (PHP).

Speaking of which, Physician Health Services Inc. (PHS) — a charitable subsidiary of the Massachusetts Medical Society that serves as the PHP for Massachusetts physicians — intends to reach out in a broader way to physicians and hospitals to encourage doctors dealing with burnout and behavioral-health issues to seek appropriate and confidential care.

“Many PHPs in other states have expanded their outreach,” the report notes. “Hospitals and other healthcare institutions should complement and support this effort by acknowledging physicians’ concerns with seeking mental healthcare and clearly identifying avenues and opportunities to receive confidential care, particularly for residents and trainees, who are at a vulnerable stage of their careers.

Finally, the report calls for the appointment of executive-level chief wellness officers (CWOs) at all healthcare organizations. “CWOs must be tasked with studying and assessing physician burnout at their institutions, and with consulting physicians to design, implement, and continually improve interventions to reduce burnout.”

“Patients do not like being cared for by physicians who are experiencing symptoms of burnout, which is significantly correlated with reduced patient satisfaction in the primary-care context. Evidence further suggests that burnout is associated with increasing medical errors.”

The key responsibilities of the chief wellness officer, in addition to acting as an advocate and organizational focal point, may include studying the scope and severity of burnout across the institution; reporting findings on wellness and physician satisfaction as part of institutional quality-improvement goals; presenting findings, trends, and strategies to CEOs and boards of directors; and exploring technological and staffing interventions like scribes, voice-recognition technology, workflow improvements, and EHR customization to reduce the administrative burden on doctors, just to name a few.

CWOs could benefit physicians not just in hospitals, the report continues, but across health systems, and in affiliated practices. “Departments, units, and practices can survey for burnout, begin to identify their areas of focus and barriers to success, and collectively develop solutions. The CWO can help lead this process and provide best practices and other supports.”

Lives in the Balance

In the end, physician burnout is a problem with many triggers, which is why the authors of “A Crisis in Health Care” encourage a multi-pronged approach to counter it. But it’s also an issue with many potential consequences, not just for doctors and their employers.

“Patients do not like being cared for by physicians who are experiencing symptoms of burnout, which is significantly correlated with reduced patient satisfaction in the primary-care context,” the report notes. “Evidence further suggests that burnout is associated with increasing medical errors.”

Dr. Steven Defossez, a practicing radiologist and vice president for Clinical Integration at the Massachusetts Health and Hospital Assoc., said hospitals in the Commonwealth place a high priority on the safety and well-being of patients, so combating burnout will continue to be an area of focus.

“In particular, we recognize the need to further empower healthcare providers and support their emotional, physical, social, and intellectual health,” he said. “This report and its recommendations offer an important advance toward ensuring that physicians are able to bring their best selves to their life-saving work.”

Joseph Bednar can be reached at [email protected]

Opinion

Opinion

By Tom Flanagan

Burnout among the nation’s physicians has become so pervasive that a new paper published by the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society, and the Massachusetts Health and Hospital Assoc. has deemed the condition a public health crisis.

In a 2018 survey conducted by Merritt-Hawkins, 78% of physicians surveyed said they experience some symptoms of professional burnout.

The paper includes directives aimed at curbing the prevalence of burnout among physicians and other care providers, including the appointment of an executive-level chief wellness officer at every major healthcare organization, proactive mental-health treatment and support for caregivers experiencing burnout, and improvements to the efficiency of electronic health records. 

In a 2018 survey conducted by Merritt-Hawkins, 78% of physicians surveyed said they experience some symptoms of professional burnout. Burnout is a syndrome involving one or more of emotional exhaustion, depersonalization, and diminished sense of personal accomplishment. Physicians experiencing burnout are more likely than their peers to reduce their work hours or exit their profession. 

“The issue of burnout is something we take incredibly seriously because physician wellbeing is linked to providing quality care and favorable outcomes for our patients,” said Dr. Alain Chaoui, a practicing family physician and president of the Massachusetts Medical Society.  “We need our healthcare institutions to recognize burnout at the highest level and to take active steps to survey physicians for burnout and then identify and implement solutions. We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.” 

By 2025, the U.S. Department of Health and Human Services predicts that there will be a nationwide shortage of nearly 90,000 physicians, many driven away from medicine or out of practice because of the effects of burnout. Further complicating matters is the cost an employer must incur to recruit and replace a physician, estimated at between $500,000 and $1,000.000.

The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” said Dr. Ashish Jha, a Veterans Affairs physician and Harvard faculty member. “There is simply no way to achieve the goal of improving healthcare while those on the front lines — our physicians — are experiencing an epidemic of burnout due to the conflicting demands of their work. We need to identify and share innovative best practices to support doctors in fulfilling their mission to care for patients.” 

The full report is available at www.massmed.org.

Tom Flanagan is Media Relations manager for the Massachusetts Medical Society.

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