Prioritizing physician wellness: Reducing burnout during the COVID-19 pandemic and beyond [PODCAST]

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“Ultimately, patients need doctors to help them be healthy, and need their doctors to be healthy to help them! Unless interventions are done now, our health care system risks a downward spiral. While the pandemic has brought increased levels of stress and burnout, it has prompted us to take action on mitigating this serious issue. Hospitals, practices, administrators, and physicians must realize that working together to combat burnout is essential for the health of our entire health care system.”

Lalitha Sundararaman is an anesthesiologist.

She shares her story and discusses her KevinMD article, “Prioritizing physician wellness: Reducing burnout during the COVID-19 pandemic and beyond.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Lalitha Sundararaman. She is an anesthesiologist, and she wrote the KevinMD article “Prioritizing physician wellness: Reducing burnout during the COVID-19 pandemic and beyond.” Lalitha, welcome to the show.

Lalitha Sundararaman: Thank you, Kevin. I’m so happy to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you just share your story and journey to where you are today?

Lalitha Sundararaman: Well, it’s no surprise, I guess, from my last name that I am from India, and I trained in India. I was working as an anesthesiologist, and just like so many of our immigrants, due to financial concerns, I came over to the U.S. I repeated my entire residency here, and I started out fresh again as an anesthesiologist. I’ve been an anesthesiologist at the Brigham in Boston for the last nine years.

Kevin Pho: So when you said that you had to repeat your residency after coming to the United States, tell me, what was it like?

Lalitha Sundararaman: To tell you the truth, we were left with a lot of family loans, which I was unable to pay in India, and I needed to come to the U.S. so that I was able to pay back my mom’s and dad’s loans much faster. And it did happen, so that was my chunk of the American dream. I came over here, and I was already in anesthesia, already practicing in India, and I decided that that’s the field for me and I want to continue my dream. So I came over here and I repeated my residency here.

To be honest, it’s really easy the second time. But that being said, it is a stress on family life, and it’s a choice which is always better if you make it as an informed choice, knowing what you’re getting into: the hours and the burden and the responsibilities which come with it. When I came to the U.S., it was a different scenario compared to the scenario in India, so that was a little bit of a different cultural change. And the responsibilities that you face as an anesthesiologist here are a little different from over in India, and that was all a change I adapted to.

I’m happy in my job, but it does come with certain responsibilities and burdens, which only accentuate when you have a family and you have children to take care of. And I’m sure that everybody is well aware that all our responsibilities and the emotional burden, as well as the physical burden, have really increased during this COVID pandemic. That’s what I hoped to elucidate when I was thinking about writing this article, because this is something which is very, very common, but nobody wants to express it first.

Kevin Pho: So let’s talk about that article, and it’s titled “Prioritizing physician wellness: Reducing burnout during the COVID-19 pandemic and beyond.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Lalitha Sundararaman: So physician, it’s a different sort of job. It’s not like IT, where if you make a mistake, you can just simply reboot the computer. I mean, I’m sorry, I’m kind of simplifying it, but you do have a chance. But if you make a mistake and it lands in really significant consequences, you’re probably scarred for life. Hence it’s a burden, it’s a responsibility, and it’s a joy. This profession serves to be all three, and what mixture it is depends on you. Hence sometimes it’s a real joy to do the job, and sometimes you come back home and you’re thinking, “Oh my God, what kind of a crappy day I had. Why did I even enter this job?”

When I was starting out, I was so excited. I was so happy with the job. And as the days meandered by, I must say that at certain times I was like, “Oh gosh, do I really have to go to work tomorrow?” Especially when the kids are yelling and screaming in the background and you have so many other family obligations, it becomes tedious. And the COVID pandemic actually brought a whole new layer to this problem.

There were days, just to be off the cuff and tell you, in the whole middle of the COVID pandemic, one Sunday night at nine o’clock, my nanny texted me saying that she doesn’t want to come to work again with me because she’s so scared of getting COVID from me. And I was like, “Really, guys? I go to work.” At that point, nobody was vaccinated, right? You take all the stress, you’re trying to help people, and then suddenly you land up with problems at home which you’re unable to face, and you’ve got to somehow face it and move on. So that really adds to your emotional burden.

And I was like, if I’m going through this, I’m sure a lot of other people are also going through similar situations, but they’re just not able to talk about it or think about what to do about it. So hey, why not talk about it, gather more opinions, and probably give some ideas on what can be done to tackle it? And that’s how the article was done.

Kevin Pho: So tell me, in the midst of the pandemic, that day that your nanny texted you saying that she didn’t want to come in because you were an anesthesiologist, walk us through that day and a few days afterward in terms of the emotions that were going on and what was going through your mind during that time.

Lalitha Sundararaman: So it was a Sunday night. The next day was a Monday morning. We had all the usual ideas about what kind of lunch to prepare for the kids, how to pack stuff, what kind of dress she’s going to wear tomorrow, Monday, and stuff like that. And suddenly, at nine o’clock at night, while I was reading up on my Epic docs and basically trying to think about what case is going to happen tomorrow and what the comorbid conditions are, suddenly I get this pop-up text message which says, “Sorry, can’t come from tomorrow. My son advises me not to go to work.”

And I was completely shocked. It’s like, “Are you OK? What’s happening?” And she said, “No, I’m fine. We are afraid of getting COVID from you.” There was this slight moment when I almost felt like a leper. Like, what am I? Am I carrying some disease? Why am I not entitled to help in these difficult times like everybody else, but expected to help from my side? Is it fair? There was that one moment of real frustration, because you’re expected to help as a doctor and you have no solution, you have no way out. It’s what you’re supposed to do, because you took the Hippocratic Oath, but then nobody else does that back to you.

So there was that moment of lingering frustration, and then my husband said, “Hey, jump out of it. Let’s see how we can tackle it. Maybe I can work from home tomorrow, and then we’ll see whether we have any backup options. We’ll call the Brigham backup service, we’ll call Care.com, we’ll check it, we’ll see what happens.” So he actually helped me get through that.

And then I also did a whole bunch of night shifts, so that during the days I could take care of my kids and family, and during the nights I was on the airway team, the lines team, the respiratory therapy team, and the ICU teams. That kind of helped us to get through the day. It was really tiring at points because of the nights and days, but we managed to get through it. And I’m sure the same situation happened for a whole bunch of my colleagues everywhere across the world. I’m probably being more vocal about it, while it’s probably simmering inside for them, and that’s it.

Kevin Pho: So as you were feeling burnt out because of family stresses, life stresses, and of course stresses with COVID in the hospital, what are some of the things that you did to address those feelings of burnout?

Lalitha Sundararaman: Thank you for the question. That’s a really important thing. For some reason, a lot of studies have come out saying that women anesthesiologists, and in fact women doctors during the COVID pandemic, have actually experienced greater rates of burnout compared to their male colleagues. But when they have supportive spouses, they actually experience less burnout, and that’s been quoted in my article along with references. And it’s actually been a very similar situation for me too, because if I was to experience all this alone, I would have been far more stressed. I’m really lucky to have a supportive husband who actually helped me through many of the family stresses. That’s actually where most of the core lies. Your family support is really core to getting you through these difficult times.

But hey, all of us don’t have supportive families, and the next step would be our friends and our immediate circle. So that’s one thing we actually did. From the group chat, we had group Zoom meetings to just kind of vent and find out, without any specific names, to kind of de-stress. Usually what people do is they meet up after work, like, “Hey, let’s grab a drink at the bar,” or, “Let’s meet up at the weekend with our kids at the playground.” Those are simple things, and I actually did quite a few of those. We met up at the playground because there was an open space, and while our kids could play and have some limited amount of socializing in the open space, we met with our masks on, at least at it, to kind of relieve our stress, which really helped.

And then the Brigham also and the ASA have many resources to help you with burnout. The most important thing is to recognize that this is happening inside you. Most people feel like, “Oh, this job no longer has any appeal for me,” or, “This is the same old, same old.” It’s not exactly like that. Maybe it’s not just a job. Maybe it’s what you’re feeling toward a job you started out with so many good intentions for, right? There’s a reason why you went into this field, because you really like it. So if you no longer like it, you should revisit the causes and consider what is happening inside you. If it’s stress, if it’s any other disappointment, a lack of promotions, or anything which is causing burnout, then that should be identified, and you should be ready to recognize the symptoms. That’s the first step.

And then the next step would be to manage it on a personal, social, and institutional basis, and those are the ideas that are given in my article. The personal basis would be meditation, using any apps like Headspace, listening to music, anything that you want to de-stress yourself, or social interactions, which can be any way you want: Zoom, FaceTime, or even just a walk outside. And then the second step would be social and limited social interactions on the outside, as well as exercise activities. It has been proven that even if you do 10 minutes of stretching and exercise every day, it actually helps to decrease burnout.

And when you consider that about 50 percent, 46 percent, of anesthesiologists even before the pandemic were experiencing at least one symptom of burnout, and that has risen to like 60 to 80 now, then that’s a pretty significant number, and if this can be reduced, we can really preserve our workforce. Fifty percent of anesthesiologists here and across the pond in Europe have actually decided to reduce their work hours after the COVID pandemic. So we’re going to lose a considerable number of our workforce, and any step that can be taken to decrease the stress and improve our work hours would probably be better. One step would be exercise, a simple exercise like 10 minutes of stretching every day, or 10 minutes of yoga, or 20 minutes of cardio, which can actually help to decrease burnout, release endorphins, and actually help you experience more pleasure in whatever you’re doing.

And then the last step would be institutional support. The institution also has to pave the way for you to have a streamlined method of working. What do I mean by that? All of us use Epic and many other methods of computational work, electronic medical records, right? And many times we go home and we do all the electronic medical record work at home, but that’s not what we’re paid for. That’s not what’s expected, that you’re doing that. Nobody even recognizes that you’re doing all this work at home. You’re answering emails, you’re answering patient messages, but sometimes it just spills over into your family life and personal time, and that adds to frustration.

So in some institutions, they’ve actually given you dedicated time during the day to answer telephone calls and take care of electronic medical records, and that could be something which is incorporated into the day as well. And another way to decrease the stress that you have from computational and other administrative work would be to have people like medical assistants or PAs who can take a part of that work, so that you can actually concentrate on what is important, namely clinical work. That’s what you were trained to do, that’s what you like to do, and hence it might actually be a better way to do things.

So those are the ideas that I’ve given in my article, along with some references to studies which have been done and what has worked. Just decreasing administrative work in one study decreased burnout from 58 to 13, and that’s a remarkable number by any standard. And there are many other methods which can also work on a personal level, but you have to be patient to try them. Give them time, and give yourself time for everything: for your personal life, for your own sense of self, and for your sense of being a doctor.

Kevin Pho: We’re talking to Lalitha Sundararaman. She is an anesthesiologist, and she wrote the KevinMD article “Prioritizing physician wellness: Reducing burnout during the COVID-19 pandemic and beyond.” Lalitha, I want to talk about institutional buy-in. You mentioned some of the ways institutions can help with physician burnout: by giving them dedicated administrative time, by providing resources, or by having medical assistants take a lot of the more nonclinical tasks. So as a physician, if their institution isn’t doing any of these things, how can they ask the institution or hospital to implement some of these ideas that you suggested?

Lalitha Sundararaman: That’s a very good question, because I think it’s going to be most pertinent. Everybody’s trying to reduce their number of health care personnel and make the existing personnel work more in these times. So the best way would be to present your C-suite, or whoever is in charge, with facts. See, these studies exist, and it’s going to end up in decreased productivity, and hence it’s going to end up in decreased efficiency, economic efficiency, and hence decreased return. That’s probably one thing which everybody in the C-suite will understand: Eventually, if you’re going to burn out the personnel which you have, more people are going to leave, and the people who remain are going to be less productive. Hence you’ve got to learn to take care of the people who you have so that they can produce and be more efficient.

The best way to do that would probably be to access some of the resources mentioned on the ASA site, as well as the article, about what the methods would be by which the institution can implement improved efficiency and streamlining of the resources to increase productivity. And if that can be mimicked in their own institution, this can result in fewer people leaving, because there are so many jobs out there now, and this can therefore result in their own improved productivity.

Kevin Pho: So you mentioned resources both at the Brigham in Boston as well as the ASA, the American Society of Anesthesiologists. Tell us about some of these resources that you mentioned.

Lalitha Sundararaman: Correct. So many of the apps for your own sense of personal improvement and decreasing your level of frustration, like Headspace and others, some other spaces like mine, are all sponsored by many institutions and also available. Some of these are also available through the ASA, and hence that could be a method of de-stressing yourself. As well, there are some resources which are available for one-to-one counseling in many institutions, and there’s a wellness initiative which is also being started by the ASA, and also by many institutions, whom you can contact if you have any personal issues, so that they can also work around that and basically help you to be more productive.

So one thing is that if you know that you’re being listened to and somebody’s out there who actually cares, that really helps in decreasing frustration and improving productivity, even if the solution is not yet in sight, if you know that somebody’s working on it. If you talk and improve relations with your manager, as well as the person who’s in charge of your own department, and make sure that they can help you personalize the track, like, “Hey, I want to work these four days a week. I’m willing to work extra hours, but the other two days I’ve got to go home and take care of the kids,” things like that. If there’s somebody to direct these wellness initiatives, which have been started in many institutions, for example, Johns Hopkins, Cleveland Clinic, and the Brigham, then that would really help to decrease frustration and improve productivity.

Kevin Pho: And my final question: What are some of the take-home messages that you want to leave with the KevinMD audience?

Lalitha Sundararaman: I think my main takeaway message is, don’t be afraid to recognize your burnout. It’s not a problem with you. It is sometimes a disease, and like any disease, we have to diagnose and treat it. Don’t be afraid to recognize it, don’t be afraid to ask for help, and don’t be afraid to try different methods of help till you feel better. And that’s it.

Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.

Lalitha Sundararaman: Thank you. Thank you for having me.

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