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Karen Hovav, MD
By Karen Hovav, MD on March 11, 2024

When the Flame Runs Low: Burnout in Pediatrics

As pediatricians, we’re trained to take care of everyone else. We care for our patients, their parents, our staff, specialists, and our community. Many of us were drawn to Pediatrics because we’re naturally empathic and enjoy solving problems. But it can be hard to maintain that core sense of mission and joy when we’re dealing with anxious parents, bureaucratic obstacles, clunky EHRs, sick children, and personal life stressors. 

So what happens when that empathy runs out? 

Despite all the talk about burnout, it can sneak up on you. You may not even notice the symptoms as they build up. After all, it’s normal to feel tired or stressed out. And feeling occasionally overwhelmed comes with the territory of medicine. So when does it cross the line? Burnout is defined by three elements: 

  • Emotional exhaustion: This can show up as lack of energy, feeling physically exhausted, or being irritable all the time. You might feel trapped, helpless, or just completely depleted.   
  • Detachment: You might find yourself more cynical than ever (gallows humor, anyone?). You might develop a negative attitude about patients, which can affect the quality of care. 
  • Lack of personal achievement: This can lead to feelings of inadequacy, which often creates a cycle of inefficiency.

If you’re going through burnout or had it in the past, you’re not alone. Over half of pediatricians reported experiencing burnout in 2022. While rates of burnout among pediatricians have returned to pre-pandemic rates, emotional exhaustion is higher than ever, affecting over 60% of us. And it’s not just physicians. Burnout is affecting everyone in the healthcare team.

On this month’s episode of Peds RAP, we interview Dr Kara Pepper, practicing internist and physician coach. She shares with us some common pitfalls that can lead to burnout and reviews systemic and personal factors that play a role.  

You might be wondering, so what exactly is a coach? Is it like having a personal cheerleader in your corner? Or a mentor to guide you in what you need to do? 

Not quite. It turns out that coaching is an evidence-based method for reducing burnout and improving the well-being of physicians. The International Coaching Federation (ICF) defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.”

So what does this mean? It means that coaching can help people identify thought patterns and beliefs that are not serving them well. For example, Perfectionism is common in medicine. We think it helps us be better physicians, but does that tendency harm us instead? Or consider that, despite our training and achievements, physicians are more likely than other US workers to experience Imposter Syndrome — a persistent feeling of self-doubt or unworthiness in high-achieving individuals. This can make it especially difficult to deal with the inherent uncertainty in medicine.  

But personal elements are only part of the puzzle. (And spoiler alert: they’re a much smaller part than the larger forces at play). A 2023 article by Dr Dhruv Khullar in JAMA describes three major forces that lead to burnout: 

  • Pressure to care for too many patients in too little time, with too few resources
  • Expectation to engage in activities that seem meaningless, rote, or counterproductive
  • An inability to meet the medical or social needs of patients

Sound familiar? If you’re feeling overwhelmed and burned out, you can take solace in the fact that systemic factors play a much larger role than personal ones when it comes to burnout. It’s not just you. And it’s not your fault. 

It’s critical that healthcare systems work to change these drivers of burnout. Not just because physicians should have a better quality of life (although that matters!). Burnout leads to increased turnover, reductions in work hours, and other factors estimated to cost the healthcare system a whopping $4.6 billion annually. 

On Peds RAP, Dr Pepper talks about the business case to be made for investing in physician wellness. Shanafelt, T. et al argue in JAMA Internal Medicine in 2017 that “improvement is possible, investment is justified, and return on investment is measurable”. There’s a growing awareness of the need for healthcare systems to invest in a culture of wellness, but change is slow.

So, where does this leave the physician among us struggling with burnout? We hope that this episode will leave you with hope. You don’t need to wait for system-wide changes if you’re feeling emotionally exhausted. Listen here to delve into this topic and hear some practical tips to help you recharge your batteries and reignite the spark of joy that drew you to Pediatrics. 

Published by Karen Hovav, MD March 11, 2024
Karen Hovav, MD