Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join Amna Shabbir, an internal medicine physician, as she shares her personal journey and reflections on physician burnout and its impact on family dynamics. Amna opens up about her early exposure to burnout through her mother’s experiences as a physician and the profound effects it had on her upbringing. We delve into the research on maternal burnout and its consequences for children’s well-being. Discover how Amna recognized and addressed her own burnout, paving the way for healing and a healthier work-life balance. Gain insights into the tools and strategies she learned to overcome burnout and create a more fulfilling life as both a physician and a mother. Join us as we explore the lasting effects of burnout on families and the steps we can take to break the cycle and foster well-being for ourselves and our loved ones.

Amna Shabbir is an internal medicine physician.

She discusses her KevinMD article, “From womb to burnout: a physician’s reflection on the impact of maternal burnout on her journey.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

With a growing physician shortage, increasing burnout, and declining patient satisfaction, a dramatic change is needed to make health care more efficient and effective and bring back the joy of practicing medicine. AI-driven ambient clinical intelligence promises to help by revolutionizing patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.

Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/8UpKOK

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Amna Shabbir. She is an internal medicine physician. Her KevinMD article is titled “From womb to burnout: a physician’s reflection on the impact of maternal burnout on her journey.” Welcome to the show.

Amna Shabbir: Thank you, Dr. Pho. I’m very excited to be here.

Kevin Pho: So we’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Amna Shabbir: Yes. I am an integrative wellness and life coach for health care workers. I’m also a practicing geriatrician and internist. I work in the post-acute long-term care space. Outside of medicine, I am mom to two young girls, and that is one of the most rewarding parts of my life.

Kevin Pho: Wonderful. So you mentioned that you’re a life coach and a geriatrician. So professionally, tell me how you manage everything. What does a typical day look like for you?

Amna Shabbir: Yes. So right now, in the post-acute long-term care space, I work in rehab medicine and nursing homes part time, as well as dedicating the rest of my week really to my coaching practice, which I started this year. It’s geared towards health care workers and their journeys of wellness, and that’s where I combine both integrative wellness and life coaching techniques.

This started as a result of my own personal journey through burnout. Between residency and fellowship, I practiced as a primary care physician full time, and during that time I suffered from severe burnout. I really wanted to pave the way for other physicians to start thinking about wellness conversations early on, so I work with medical trainees as well. This is where my passion lies these days.

Kevin Pho: All right. Let’s talk more about that in your KevinMD article, where we hear more about your story. It’s titled “From womb to burnout: a physician’s reflection on the impact of maternal burnout on her journey.” So tell us, how did your article come together?

Amna Shabbir: This was the culmination of a series of reflections as I undertook my healing journey. I wanted to pause and really think about how I could burnout-proof my life moving forward. What could I do? That’s really where I just paused, and it hit me all of a sudden that my exposure to burnout really didn’t happen when I started medical education. It started way before, because I am the daughter of an OB/GYN, and I was born during her training year. She was an intern at that time, and things were hard.

Kevin Pho: So tell us stories and examples. What made it so hard?

Amna Shabbir: So my mom is an amazing, amazing physician and surgeon. What would I say? I think I’m one-tenth the doctor that she is. She worked all the way up until the day I was born, the moment I was born, rather. And I saw the series of her journey kind of play out in front of me as time moved forward. She was in training. I am the product of a dual-physician household, so my dad is also a general practitioner.

After I was born, my mother really struggled with keeping and honoring her commitments as a medical trainee as well as to motherhood. So what ended up happening was that I moved in with my maternal grandparents. At that time I was an infant. They lived about a five-hour one-way drive away. I can only imagine how hard that was for my mother. That carried on all the way up until I was five years old, when my parents completed their training journeys and moved around, and finally I moved in with them formally when I was five years old.

Things really didn’t change a whole lot at that time either. When I moved in, I recognized how hard my mom worked, and the word burnout never came out of her mouth. The word stress never came out of her mouth. All she wanted to do was really care and give and work. So she gave at work, and she gave at home.

So when I was reflecting on what I could do, I really extracted that, OK, my exposure happened at that time. And then I started developing these internal feelings towards her. I feel like I have a more complicated relationship with her. And then the more I underwent my personal journey in medicine, and as I became a mom myself, I recognized and understood her struggles so much more. So the article was really me leaning back towards my mother and my younger self and saying that it’s OK as we navigate out of this burnout.

Kevin Pho: So with your mother as a busy obstetrician-gynecologist, and like you said, burnout wasn’t spoken about as widely or recognized back then, talk about the stress that had on your family when you were younger.

Amna Shabbir: So my mom loves her patients. It’s a nine-month journey with her patients, and at the end she always wanted to be there for them. So what I felt as a child was that she preferred them over me, basically, in a nutshell. And I feel like I innately developed this dislike for procedure-driven specialties. Although when I was going through medical training I loved procedures and surgeries, the lifestyle aspect of it really was a big turnoff for me. So I didn’t pursue any procedure-based specialties, and I wonder how much of that played into my decision of primary care. I loved being a general internist, but at that time I also wanted to have, quote-unquote, a nine-to-five job.

So I feel that it had a deep impact: me feeling disconnected from my mother, me not wanting to do a procedure-based specialty, and me later deciding to have a spouse who’s outside of medicine. My husband’s not a physician. So there was just a series of small changes that kept happening. And I feel that my guilt was way more magnified when I underwent burnout myself, because my internal dialogue was, “You should know better, Amna. You should know better, because you know exactly how your children are feeling right now, because you were them once.” So that really magnified my mom guilt.

Kevin Pho: So it sounds like during your own medical journey, at least you had the insight of not repeating what your mom did, and hopefully not replicating in your children how you felt. Is that right?

Amna Shabbir: That is correct. Oh, I tried, I tried. And yet I found, I would say, my own unique pit of burnout, because we can try to be as resilient as we can. Resilience almost sounds like a trigger word at this point. So we can try to do what we can do, but sometimes you just find yourself exhausted and tired in the middle of a pandemic, and you’re doing way more. Our primary care physicians work so hard.

So it was at that moment I really had to pause and ask myself, “Am I going to just keep going because my mom just kept going?” She tapered, or decreased, her work hours when I was finishing medical training. So she just kept going, and she’s still working. She’s working reduced hours now, but it was very difficult for her, culturally and otherwise, to have this conversation, because work was tied to morality, almost. So when you said you were going to rest, it almost sounded like you were attacking morality by taking a break.

Kevin Pho: Have you ever had these conversations with her, in terms of her reflecting on the choices that she made? I know work-life balance wasn’t spoken about as much back then as it is now. So did you ever have these conversations with her, in a more reflective phase now that she is towards the end of her career?

Amna Shabbir: I love the question, Kevin. So recently, actually a few weeks ago, I would say we had the breakthrough conversation. After the article was published, I sent the article to her. There were briefer conversations before, but when she saw it all in print, I think the impact that it had on her was very magnified. So she sat down with me, and I felt bad because she apologized, and then I had to have a different conversation, because I said, “I get it. You know, I get it, Mom. I get why you did what you did. How can we make things better?”

I think it was a very beautiful moment where she was able to acknowledge and share some of her struggles, which I did not know, and I was able to share my struggles. When I moved out of an academic institute and went part time, it was very difficult to share that with my parents. So she was able to recognize why I am doing what I’m doing and why I’m advocating for wellness the way I am right now.

Kevin Pho: So you said that when you moved from full time to part time, it was very difficult to share with your parents. Was it because of your parents’ viewpoint in terms of work equaling morality? Why was it so difficult?

Amna Shabbir: It was more everything that I had soaked in from the environment that I saw, which made me feel that this was not something, first of all, that I should say. So there was that internal narrative, and I had a bias against my parents. You know, this was my bias, that I will not tell them, that they will not understand, because of what I had seen. But the moment I was actually able to sit with them and share my struggle, they saw what I was going through and what it was doing to my family. And I think that the internal narrative that was there was my own, and in my case, the story played out better.

Now, yes, it was based in past conversations where grades and academia were very highly encouraged. They’re both physicians, and, you know, an academic physician is the best kind of physician, the most virtuous physician, for lack of a better word. So I think that that shift in perspective required time, and they saw with time what I’m doing and why it matters. But it was a process. I would say if we don’t open that conversation with our parents, we can never get to that.

Kevin Pho: Now, despite the observations that you made of your mother and the effect that it had on you growing up, you yourself had a journey into burnout as well, before you cut down and became part time. So tell us about your own journey. What kind of signs did you recognize that made you realize you were entering that phase of burnout as well?

Amna Shabbir: Yes. I honestly never thought that the word burnout or moral injury would be in the same sentence as me, because when I started primary care, and you can ask any of my colleagues from residency, I loved primary care, and I felt so passionate. In fact, I was the only person in my class who graduated and did full-time primary care at that time. But I recognized that within the first three or four months I was burnt out. As I reflect back, I recognize that at that time I didn’t know. I equated it to overwhelm and the fact that, you know, I’m new, I was a resident four months ago, and you just have to make this work.

So I think that the first sign that I had was the feeling that I don’t have any autonomy, and that was very resounding. I felt that I wanted to make changes and I couldn’t, and I wanted to make an impact in my patients’ lives and I could not, to the extent that I wanted to, which then started to eat into overwhelm. I think that I did hit a phase of depersonalization, where I felt that I was trying to get to the end of my day, and I was basically running through my patient appointments so I could get to that point. So it was very different.

And when did I realize that, yes, it’s burnout for sure? It was when I was consistently sitting in my car giving myself pep talks after listening to multiple positive podcasts and songs, and, you know, “You can do this. Just get through the door.” That was the moment where I realized, OK, something has to give. Something has to change. And I think the pandemic had a big role in that phase coming, and I had some personal health challenges as well, so it was all happening at the same time.

Kevin Pho: So you said that within the first three to four months you realized that you were burned out, and it was a lack of autonomy. So give us a specific example. Was it too many patients at work? Was it the work situation? What would be an example?

Amna Shabbir: I think in primary care as a whole, and it can be any institute, the expectations that we have of our primary care physicians are very unrealistic. We want them to see more, you know, in a 15-minute visit, a 20-minute visit. So an example would be, Kevin, a day where one patient shows up late, then another patient shows up late. There is no late-patient policy, and I’m expected to see all of them. And I see them, of course. I want to do justice by my patients. They cannot be seen in 20 minutes. They cannot be roomed, checked in at the front desk, fill in all the intake questionnaires, be seen by me with good medicine practiced, and then leave.

So then what would happen is, at the end of the day, the entire staff would have gone, and I would be in the office until about 8 or 9 p.m., answering all the MyChart messages and finishing up my notes. And that’s when I recognized, OK, this is a lot. This is a lot. And we talk about burnout in training, but what about burnout that happens in early-career physicians when they’re trying to navigate that bridge?

Kevin Pho: So now that you’ve had time to reflect, is there anything that you would have done differently, just knowing what you know now?

Amna Shabbir: I would have been less tolerant. I know that this is a word that can be phrased in many different ways, but there are lots of things that we tolerate in our lives, and we create tolerations for them. I think my toleration was that I said it’s OK that my internal feelings were not as valuable as the larger issues or the larger good. But all that did was suppress the issues that I was experiencing, and it just perpetuated and snowballed later on. There was a point where I felt that I had to leave medicine completely, so I am very glad that I did not.

I further had moments where I created and shifted my own narrative. I found coaching, and that was one of the things that allowed me to have that dialogue, and really, I stayed in medicine. I recognized that, for me, caring for older adults gave me much more joy and meaning. When I was looking at my patient panel, that’s when I realized, OK, that’s why I want to pivot and do fellowship. Fellowship had its own challenges. Becoming a trainee after being an attending was also interesting. But I think what I would have done differently was I would have been less tolerant.

Kevin Pho: So you mentioned that you’re now part-time clinical and you do coaching. How are you doing now?

Amna Shabbir: I am doing well overall. I think that burnout can be cyclical, so right now my reflections are all based around what I can do better and how I can be in a system where I can advocate for change. So my day-to-day looks like, you know, I’m working with my predominantly geriatric patient panel in the nursing homes a couple of times a week, and then I see patients for subacute rehab. I really thoroughly enjoy that work. It gives me a lot of satisfaction and meaning. And when I’m with my coaching clients, we’re working on systemic changes and all the issues that I had. So I feel that I’m addressing both the person who was burned out and the clinician in me, so it’s a very rewarding space to be in.

Recently, I’m involved with the American College of Physicians North Carolina Chapter well-being committee, and we’re launching the first ACP well-being town hall, so I’m very excited about that. Initiatives like this really give me purpose and drive to just keep moving.

Kevin Pho: And what do your parents think about your career situation?

Amna Shabbir: They have now come to recognize that I have made some really good choices. Initially, you know, they see it in multiple steps. I feel my mom especially was the one who was, you know, very career-driven, and she was very focused on outcomes and what I do in life. So she recognizes that maybe the way we define success needs to change a little bit. Maybe the definition of success is not just academic accolades. It’s also the amount of time that you spend with your children, the value that you bring at home, and how you see yourself in general, like how wholesome your life is.

So I feel that now they’re more accepting, and I am more accepting of the fact that they’re so accepting. Because again, I’ll bring it back to the point that being raised in a culture and family where everything is so academically charged, you know, just puts a lot of internal pressure on you. So I would say to anyone listening to this, please question. Maybe your parents don’t think the way that you think they’re thinking.

Kevin Pho: We’re talking to Amna Shabbir. She is an internal medicine physician. Her KevinMD article is titled “From womb to burnout: a physician’s reflection on the impact of maternal burnout on her journey.” Amna, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Amna Shabbir: I would say that if there’s anybody now thinking that they are burnt out, a clinician who’s feeling that way, please know that you probably burnt out a while ago and now you’re truly appreciating it. So this is the time to ask for help, and help can come in many different shapes and spaces. It could be talking to a friend. It could be reaching out to a colleague, a coach, a counselor, a therapist, or all of the above. But please ask for help.

My second piece of advice would be, please create some pause and white space in your schedule, even if it is 30 minutes, one hour, or half a day. And really ask yourself, “Can I get a sabbatical? Can I get a few weeks just off to myself, where I can allow the noise around me to die down, where I can maybe sleep and ask myself, when I’m refreshed and my basic physical needs are met, what am I doing with my life, and what do I want to do with my life?” So sabbatical, healing, and creating white space are so important.

Specifically, when we talk about women in medicine and mothers in medicine, I would urge all my colleagues to ask yourself and look around. Are you creating a good space and advocating for mothers in medicine? What does the maternity leave and paternity leave policy look like in your institute? How much postpartum support is present for those female physicians and surgeons when they come back? Are you allowing them to work part time if that is something that they’re interested in? Not everyone is interested in that. Are there options for emergency child care if that needs to be an issue? Especially for medical residents and trainees, if they need emergency child care, their training is impacted by that. Are there spaces for it?

And lastly, for any physician mom listening to this, I don’t have any advice for you, because you’re already doing a great job. So just know that, and please take time for self-care, because if you care for yourself, then you will parent better and you will doctor better.

Kevin Pho: I want to thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Amna Shabbir: Absolutely. Thank you, Dr. Pho.