Episode 1: Physician Burnout with Felicia Speed

In this episode, we talk to Felicia Speed, LMSW, Corporate Director of Social Work Services at Fresenius Medical Care North America, about Physician Burnout: the emotional and mental strain that comes with providing care in a time of crisis. 

Brad Puffer: Welcome everyone to this very first episode of our new series Field Notes. I'm Brad Puffer of the Medical Office Communications Team at Fresenius Medical Care North America and your host for this discussion today. We are incredibly fortunate to have access to many, many experts, researchers, physicians, and caregivers, who all bring experience, compassion, and insight into the work we do every day to deliver superior care to our patients.

We hope this series will get you to think about some new topics and issues and provide useful information that will help you in your work every day. Most importantly, I hope we can have some fun doing this as we learn and discuss these topics together. Yes, we'll be talking a lot about kidney disease, but also other topics that are timely and relevant.

Right now more than ever, we know the importance of physician partnerships and honor all our clinicians on the front lines as we mitigate and respond to the COVID-19 pandemic. The job can be stressful in normal circumstances. And now you add on a pandemic, and it can be even more challenging.

So we thought we would invite Felicia Speed onto the program today to discuss the real issue of physician burnout. Felicia is our Corporate Social Worker at Fresenius Medical Care and someone who's always able to stay positive, even in tough times like these.

Felicia, welcome to this very first edition of Field Notes.

Felicia Speed: Thank you. Thank you for inviting me. Glad to be here.

Yeah, it's great to have you. Let's just start with tell us a little bit in your experience how you define physician burnout? What are the signs? How do you know if you're burnt out?

Felicia Speed: Some of the signs that I have learned over my time of reading and having time with various physicians across the country, whether I'm dealing with patient provider conflicts or what have you, or just working with them directly on various projects or with just direct patient care, some of the things that I've identified is just-- seem to be a little bit more cynical, I guess you could say, a little bit more sarcastic. When you look at Maslach Burnout Inventory subscale, they have three components, which is depersonalization, emotional exhaustion, and lack of personal accomplishment.

So when I look at that and I think about some of the physicians that I've come in contact with, one big one is that emotional exhaustion and also depersonalization, where they just don't seem to have that same connection with our patients or looking for opportunities not to have contact or connection with the patient. They become very involved with the treatment and the procedure, but they lose sight of the person that's behind that.

Brad Puffer: So you lose that empathy that we need so much from our physicians?

Felicia Speed: Yes. And there's another term that's often used called compassion fatigue, where when you're dealing with very, I hate to say needy, but sometimes demanding patients-- it's one thing just to have an office visit where you may see them once every three months. But in a dialysis facility, sometimes our physicians can see our patients once a week. So you're having to see the same group of patients every week for sometimes years.

And that you get to a point where there's compassion fatigue when you don't see changes in behavior. You don't see improvement. The issues continue to be the same. And those are some of the things that can lead to some of the physician burnout, along with just simply the clinical practice, clinical medicine working with patients every day, lack of work-life balance, so their personal life, not having a balance with that.

And just physicians, they, I think, just learning medicine and going through all of the classes, and courses, and internships, and residencies, they've taught themselves to sort of be-- it's been drilled into them to be superheroes, right? So they have this, like, superhero syndrome, where they're not supposed to be weak. They're supposed to always be strong, work 20 hours out of 24 hours. And so they don't really know how to turn that off once they have accomplished all of their degrees and received their licensure and they're working in their offices or working with patients. And then they're at this place where they need to start to have some balance, and they have difficulty being able to do that.

Brad Puffer: And I imagine that's only compounded right now when not only are our physicians working long hours to begin with, but then you put on top of that what we're dealing with with this pandemic, all of the changes, all the new procedures, all the managing of patients, and then the patients who are actually COVID-19 positive or exhibiting symptoms. I can imagine that this is an incredibly stressful time for our physicians.

Felicia Speed: Oh, absolutely, especially when, I believe, everyone is really looking to them for all the answers. They're looking for them to be the experts, whether they're walking the floors or whether they're in those facilities. And we've even had to make changes where we've minimized the foot traffic of our physicians within our facilities by utilizing more telehealth to be able to communicate with us and the patients.

But even with that, just the overarching fear of the pandemic that is where we're exposed through the news. We're exposed through social media. And we would think, oh, physicians don't have time for that. People make time for that, right?

And so when you have all of that compounded with the numbers keep changing, the policies keep changing, there's so many changes that it's like trying to keep up with it-- so what you did two weeks ago may be different than what you do today, but still trying to maintain that level of calmness, of strength so that other people can feel more comfortable and secure. It is definitely a burden that I feel that our physicians carry at this time.

Brad Puffer: And I imagine it's hard to answer questions too. They're used to having all the answers when a patient asks them a question. And right now, there's a lot of unknowns out there.

Felicia Speed: Oh, absolutely, especially now, because now we understand that some people may be carriers and not even show any symptoms. So it's like, OK, well, what's going to happen to me? If they find out they are COVID positive, they want to know, OK, well, how long is this going to last? Is this going to be six days? Is this going to be 14 days?

They say 14 days, so what happens after 14 days? Am I going to end up in a hospital? And I'm sure they're bombarded with so many questions that they really don't have a lot of answers to. There's questions like, well, what if I'm pregnant or a staffer asking them?

And there's not enough evidence, research evidence right now, because it's still too new to really be able to identify and solidify any true answers to a lot of the various questions that people may have or how long can I be exposed to other people and be isolated from my family? And I'm sure them having-- even as physicians, having to go home knowing that they've been exposed to COVID patients and not wanting to put their families and their own personal families in danger can also add to that level of stress that they may have.

Brad Puffer: Well, let's say one of our physicians listening right now is in that situation and just feeling overwhelmed, feeling burnt out in their job, and perhaps especially because of trying to deal with the pandemic. What are some of the steps that they can take to manage that stress and to get that empathy and compassion back?

Felicia Speed: One thing that I learned as I was doing some research on-- there was one handout that I found about, who am I during COVID-19? And it's really self-awareness, identifying what zone you're in, whether you're in the fear zone, the learning zone, or the growth zone. The fear zone is where that's when we're running around trying to get tissue and all these type of things.

And when you in the fear zone, you're focusing a lot on what you can't control. And most of your conversations are about fear and anger, and you have a tendency to get mad easily. The goal should be for our physicians to at least try to get to that learning zone.

And that learning zone is accepting what you cannot control. I think that is key. And then, also, minimizing your exposure to a lot of the information that is available to us, minimizing that where you have some time that you unplug from that.

Also, just managing the relationships that you have personally and at work I think is very helpful for our physicians, where if you're working within that all day, you don't want to go home and talk about it for the next three hours. You really have to go find something else, whether it's bingeing on Netflix, or Hulu, or what have you, just find something else to do where you're focusing on a different hobby, woodwork, or fishing, or whatever it is, just finding something else to do where you can have that opportunity to unplug.

That growth zone is where you look at, what can I do to contribute? How can I put myself in someone else's shoes to understand where they're coming from so that we can have a little bit more tolerance for each other and have that compassion for each other that we're all doing the best we can? And so I think if we get to that acceptance of overcoming our own fear, then we can help others overcome theirs as well. And I think the key thing is don't ignore that you have fear. Be aware of it, but you just can't stay there.

Brad Puffer: And I know it's hard to do right now given the situation, but I've heard you talk also about the importance of unplugging. I think you said at one time you hope physicians can give an hour. You know that's not realistic, but give 15 minutes. How important is it just to unplug and focus on yourself for a few minutes each day?

Felicia Speed: It is absolutely essential. I believe that our bodies are not built-- and mentally and emotionally, we are not built to handle this level of stress for long periods of time. You have to give your body time to reset. You have to give your body time to replenish some of its energy, whether it's emotionally, mentally, because it's going to affect you.

You're going to sort of have memory problems. You may start to have panic attacks. And you just may find yourself being-- you might get to a place of suicidal thoughts or depressive thoughts. And so you want to be able to make sure that you're taking that time to just unplug completely, even if it's just 15 minutes.

And I know people are not big-- oftentimes physicians don't want to do mindfulness. They don't want to do breathing. But at least try to do some type of relaxation techniques. You can always order a massage chair or what have you.

Listen to some music that you like. Even if it's just, like, heavy metal, or hard rock, or country, or whatever it is, just get up and dance. Dance is a great way just to have that break, just to relax and give your body time just to release the endorphins that it needs to kind of replenish itself. There's even something called laughing yoga, where you just start laughing.

And your body doesn't know whether something's funny or not. It has no idea. It automatically is going to release the same hormones whether it was funny or not just by simply laughing. So it's just simple things that you can do throughout the day, whether-- I mean, we take time to go to the restroom eventually, so why not take the time to have that self-care, even if it's just five minutes.

Brad Puffer: Felicia, I was wondering if you could give us an example of a physician you've talked to that may have been dealing with some physician burnout and how did you manage that situation? How common is this?

Felicia Speed: Actually, some of the research that I read by Christina Maslach as well as Dike Drummond, they said about one out of three physicians experience physician burnout. And when I read that, I was like, well, I mean-- I used to work with three physicians for almost 10 years. So you're telling me one of them probably experienced physician burnout?

I can't necessarily say during that time I was really paying attention to their behavior. I mean, some of them I just thought they were mean and cranky all the time. I just thought that was just a part of their personality, and we always just made adjustments.

But as I look back, I can see how they were having to adjust to the demands. I think during that time, we were expanding our-- we worked and we had one clinic and we became three. So instead of them just always coming to one clinic, now they were going to three different locations, and trying to make rounds, and trying to handle all the care plan meetings and the QAI meetings. And then they became joint ventures, so then they had that business piece.

And so added all those additional responsibilities, I started to see some depersonalization, where they just really didn't-- they were just trying to sign all the documents. The long discussions that we used to have about patients started to get shorter and shorter, where they didn't really want to hear the detail. Or rounds that used to take two hours now was only taking an hour because we were spending less time with each patient.

But over time, one of them, their children got older, and they started participating with some of their children's activities. And then one of them, the children finally did get grown and leave the house, so I think that actually helped because then they had more time to dedicate and have some-- where they had that emptiness, and so they were really excited. I did notice that a lot of them started to do golf and things of that nature.

But you could tell over time, I started to see them evolve. And even as I go back now and I check in on those facilities that I used to work in, I can tell that they found that even balance. They seem happier then when I was working with them. And so I think it's just they learned the balance. They learned how to find things that they enjoyed, and they learned to start to appreciate the patients, and then realized that they couldn't control everything.

And so it's OK if I don't know all the answers. I'm going to do the best I can with the expertise that I have. And what I also started to see, which I thought was great is, I started to see them go to conferences. Like if there was a National Kidney Foundation conference or if we have our Medical Directors Symposiums, I started to see them participate more.

And I really believe that helped, just allowing them to get off their island and begin to participate with other physicians. And so that's my recommendation to other physicians is don't stay on your island. Realize that there are a lot more people that's doing what you're doing outside of your group. Stop looking at the same people and get to know other people so that you can learn from them, but also, you could just develop more of that community that I think is definitely needed now.

Brad Puffer: And I think that's probably part of the stress that everyone is feeling right now is we're all on our island, and we had to cancel our Medical Directors Symposium.

Felicia Speed: I know.

Brad Puffer: NKF had to go virtual for their clinical meeting. So everybody is in this together, but we are isolated. We're on our islands, and it adds just to that level of stress that everybody is dealing with.

Felicia Speed: Absolutely.

Brad Puffer: If you had two or three key takeaways that you would want to say to a physician who's feeling it right now, just feeling the stress from both the situation and regularly trying to manage their patient load, what would you say to them? And why is it so important to find a way to push through this so they can bring back that compassion and empathy?

Felicia Speed: I think the first thing is is that remember that we all have one thing in common right now. We all are exposed, in some capacity, to the pandemic, whether it's through family or through work. Whether you're a patient, whether you're a nurse, a CCHT, or a physician, we all have that common thread.

And so with that commonality, we also all have emotion. And so that's what makes us human. And don't be afraid of what makes you human. And we're not asking for people to be robots. I think now we have to be more intentional about showing our emotions because we're not seeing each other in person.

So take those opportunities to show your appreciation not only to yourself and say, hey, I really did good today, but also showing that appreciation to other people. I often tell people when you smile, the smile is not for you because you can't see it. It's really for other people.

Also, I think being grateful. That's the key thing I share in every presentation that I find myself doing, whether I'm talking to social workers, nurses, or physicians, because it's one thing I find that is lacking is looking for those opportunities to be grateful. I'm actually right now going through these 30 days of gratefulness during this time, and today it was simply what textures am I grateful for? I'm grateful for my fuzzy socks.

Or yesterday it was what's in nature that I'm grateful for? And mine was simply the breeze. Feeling the wind hit my skin is something that I'm grateful for. It's looking for those very simple things that you're grateful for every single day and that takes seconds to be able to do.

It doesn't take minutes. It doesn't take hours. It takes seconds to be able to ground yourself for that moment and be present in the moment. Allow yourself to feel what you feel, but also allow yourself to be grateful for, for some things that only you would truly understand completely. And don't hesitate to share that with somebody else.

Brad Puffer: Well, Felicia, that is a great message to end on. And I really want to thank you for taking time to discuss this important topic. Especially right now, physician burnout is a real thing, not just for physicians, but of course, for the clinicians, for all nurses who are dealing with patients right now. And I think the tips that you've given here apply across the board to how to manage that stress right now. So thank you so much for taking the time with us today.

And to our audience, we hope you'll come back and join us as we discuss more important issues in the coming days. A reminder that you can access our annual medical report and other in-depth feature articles on our website at FMCNA.com. And you will find our Field Notes series on the website there as well.

Until next time, I'm Brad Puffer, and you've been listening to Field Notes by Fresenius Medical Care. Take care everyone. Stay safe.