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We delve into the critical issue of physician burnout with Jillian Bybee, a pediatric intensive care physician. Jillian shares her firsthand experiences from the front lines of health care, discussing the unique challenges faced by pediatric intensivists and the broader implications for medical professionals. Tune in as we explore strategies for managing stress, the importance of support systems, and innovative approaches to maintaining well-being in the high-pressure world of critical care.

Jillian Bybee is a pediatric intensive care physician.

She discusses the KevinMD article, “5 lessons for a better life: observations from a front row seat for the highs and lows.”

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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 Jillian Bybee. She’s a pediatric intensive care physician. Today’s KevinMD article is “5 lessons for a better life: observations from a front row seat for the highs and lows.” Jillian, welcome to the show.

Jillian Bybee: Thank you so much for having me. I’m really excited to be here.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Jillian Bybee: Sure. So I told my parents I wanted to be a physician when I was five years old. They told me I couldn’t be my pediatrician, but they told me I could be one like him. So I decided that was what I would do, and I never looked back.

I never thought I would be a pediatric intensive care physician. That really came for me when I was a second year resident. I really love learning how things work, putting things together, teaching other people, and certainly in the pediatric ICU I get to do all of those things.

The way I came to be writing is, unfortunately I experienced both burnout and depression when I was a fellow in pediatric critical care medicine, and it took a while to recover from that. I experienced another episode of burnout when I was an early career physician, and I really had to figure out a different way to do life. And as I figured that out, other people wanted to learn about it, so I sort of started teaching about it. And that was five years ago, and never looked back from that.

Kevin Pho: All right. So before we get into that and your article as well, regarding pediatric intensive care medicine, just tell us some of the rewards and challenges of the field today.

Jillian Bybee: So it’s a busy time. I think what we’re experiencing in my hospital here in Grand Rapids, Michigan is that our space doesn’t fit all the people. So a lot more children need care, complexity of care is going up, especially as more children are born prematurely, and so we take care of children with a lot of chronic medical issues. I think that can be both a beautiful thing, because I actually get some continuity in my job, but certainly in a place where we don’t always have the outcomes that we want and we deal with sometimes death of children, can be a really difficult place to work.

I think we’ll get into it, but I wrote this article mostly because there are really great things. I get to learn to appreciate my life better because of the work that I do. I learn not to take things for granted. And so I think it’s an all-around great specialty. People often just see the bad parts about it.

Kevin Pho: All right. So let’s talk about some of those challenges in your KevinMD article, “5 lessons for a better life: observations from a front row seat for the highs and lows.” For those who didn’t get a chance to read your article, tell us what it’s about.

Jillian Bybee: So this article was inspired by an interaction I had with a medical student. She thinks she wants to do pediatrics, and then also told me that she thinks she wants to do pediatric ICU, which I think is an amazing thing to know when you’re a medical student. But she came to shadow me one day when we were having a particularly hard day. We had an end-of-life situation happening, we had a lot of other very difficult situations happening. And she asked me to tell her about the job, like, what’s your job like?

And I sort of panicked, because I think when we interact with medical students we want to give them all the good answers. But it didn’t seem fair, especially on a day where everybody around her was sad, that I left out the bad parts, because it’s certainly part of it. So that’s really where this came from.

And I write my own blog, I have a podcast, and I originally thought about this article just for that audience. But I thought, I think a lot of these things are applicable to the broader medical audience, not just those of us who work in pediatric critical care medicine. So I shared it with you, and you graciously published it, and here we are.

Kevin Pho: All right. So tell us about that interaction, and when you’re talking to medical students, or you talk to people going through that medical school path in general, tell us some of the challenges about the field.

Jillian Bybee: So as I mentioned, we sometimes have end-of-life situations, and certainly that is less frequent than in adult medicine. So I think it’s one of the great parts, is that most of our patients actually get better. I think people think that all of our patients die, but the mortality is only 2 percent for all comers in the PICU. So it’s not that they’re dying, it’s just that it is very difficult to see not only children but also their families kind of suffering.

And so one of the things I’ve learned is that there can be both joy and hardship at the end of life. So I’ve learned to see what love is through other people’s eyes. I can’t believe the amount of love and joy and comfort that happens between families, family friends, when children are dying. And then also the fact that those people then send me letters thanking me for the care that I provide their children at that time. I think that always really strikes me, it sort of takes my breath away, because I never expected to get thank you letters when children die. And certainly it says something to be able to be there and be present with people in a way I never knew possible.

It’s also fun. I think pediatrics is great. All of you out there doing adult medicine are missing out, because we throw birthday parties, we have child life specialists who help us, we have therapy dogs. We have a lot of fun in our unit, and not everybody gets to see that.

Kevin Pho: I was talking to another guest the other day about the power of a thank you letter from a patient or their family. So go into more detail. Like you mentioned that sometimes you get thank you letters after a child passes away. Tell us your reaction, your emotions, as you read a letter like that.

Jillian Bybee: I think it’s an amazing thing. It’s such a gracious thing for someone to take time out of their day to send people letters.

I think the one that I got that took me the most by surprise was, it was during the pandemic, and this patient that was well known to our unit had been admitted. I had never met her, and she sort of quickly progressed to a place that it was no longer a survivable condition, and it wasn’t in line with what her parents wanted for her. So we managed to get 12 or 13 of her family members into the hospital during the pandemic, which I think speaks to how amazing our hospital is, to allow people in at the end of life.

But after that, you know, I was experiencing the difficulty of that, but not even close to what this family is going through. And a few weeks after that I received a letter in my mailbox, my physical mailbox at work, and it had a different physician’s name on it. And I of course thought, oh no, what have I done, you know, the thing that people think. And it was from her grandpa, who is also a physician, and I didn’t know that.

And he was saying that his family has this faith background that people come into your lives for a reason because God puts them there, and that I and the other team members were that for him that night. And not only did we bring them comfort in that moment, it had comfort for them for the rest of their lives, to know that the patient touched all of us so much.

And then I think the thing that was the most touching for me is, you know, this is a senior physician saying to me, a junior physician, that he teaches medical students and he wants to teach them to be like me. And I just started crying. So I think it was really touching in that moment for me.

Kevin Pho: You mentioned as part of your journey that you had several episodes of burnout during your pediatric intensive care career. So tell us more about that.

Jillian Bybee: So when I was a fellow, there were times, you know, we had work hours, but there were times when I was working 100 hours a week, working every other night overnight, and a lot of really traumatic things happened. So end-of-life codes, putting people on ECMO. And we didn’t learn to process that, we just sort of shoved down those feelings and kept going.

And there was a time during the end of my second year when we had probably one of the most difficult patient situations of my career, and I couldn’t function afterwards. Like, I could still go to work, I could take care of patients, I could get motivated for that, but I couldn’t do my research anymore, I couldn’t make progress on things. And it took a little while to admit it to myself, but I finally diagnosed myself with depression, and then I realized I’d also been experiencing burnout for quite a while.

The next time was when I was two and a half years into my career here in my current job, and I think the same things that I had been doing, the not processing my feelings, the overworking, the trying to do too much and sacrificing myself in the process, really led to that.

And I think the hardest part about being a physician is we all know that those behaviors are rewarded. It’s good to be efficient. Hospitals don’t reward you for taking time off, which I will soon be doing. But I think there are things that we have to learn to do, and we also have to let go of some of the perfectionism that drives those behaviors in the first place.

Kevin Pho: So how did you go about doing that? And did you have a coach, did you have a mentor that helped guide you through that process?

Jillian Bybee: Yes to both of those. And then also of course, through my depression I had not only a psychiatrist but a therapist who helped me with that, and that really took care of the depression part. I’ve been in remission ever since then, which I’m grateful for.

But it was really, like you said, a coach and a mentor who helped me start to look at some of those behaviors, some of the rules that I had for myself about what a good doctor does. So previously a good doctor for me didn’t take breaks, self-sacrificed, worked hard, helped everybody else above myself. And I think that eventually led to me getting so exhausted that I wasn’t able to do anything else, and I was actually useless to the people around me and useless to myself.

And so it’s taken the five years since then for me to get better at it. I don’t think I’m perfect at it, but that’s really why I write, podcast, teach about it, I speak nationally about it, is I have to learn these things for myself. And I think they’re not the things that we get taught when we’re in medical education or residency. And they’re starting to be touted as important, but I find that even the trainees that I lead, as the wellness director for my organization, don’t know how to do these things.

Like, people say it’s really important to take breaks, but then when they see us as leaders not taking them, that doesn’t really set the tone where they’re able to do that. And I think especially this generation feels like it’s being called lazy, just like mine was for other things, for having work hour restrictions.

So I see it as part of my role not only to do the things for myself, so I can be there for me, my family, everybody else, but really as a leader in my organization to be setting a precedent that these are things that are important. Because I think we know that people are starting to leave their jobs even earlier. It used to be three to five years, now it’s one to two years people are leaving their first jobs.

Kevin Pho: So tell us some examples or stories of how you set the tone as a wellness leader at your institution.

Jillian Bybee: So last year in June I worked 18 out of 19 days, not by choice but just by having the end of an academic year and going into the next year. And while I was doing that, of course I was getting exhausted. It was not all clinical work, some of it was administrative. But I found myself getting more frustrated, having more difficulty being patient with people. And you can imagine, as an intensivist I’m not a patient person at baseline, so it was getting even worse than that.

And instead of just continuing on with that behavior and knowing that one day I might snap at somebody, I told them. So I told my team when I was the attending in the ICU, hey, I’m working a lot right now, I’m not feeling quite like myself, feeling a little bit short. So if it feels like I’m being short with you, it’s probably more about me than it is about you.

And I think it’s such an important thing to share with those who are leading, and especially trainees, because they make it all about them. If you snap at them, they create a story in their own head that it’s about them, you must not like them, something like that. And it really negatively impacts their own wellness. And we know from the data that our behaviors as leaders are the things that make our team well.

And so it’s just something as small as saying, hey, I’m having a sort of difficult time right now. And you don’t have to say why. If you’re having a loss in your family or a family illness or something else, you don’t have to give everybody your story, I don’t think you owe it to them. But it is OK to say, I’m having a bit of a hard time right now. Which I know are hard words. Like, I work with surgeons, I work with other people, they don’t like to talk about feelings, neither do I. You don’t have to get into it. But I think we do as leaders owe other people a bit of an explanation about why something might be happening, or at least some context, so that they don’t internalize it and then work even harder to prove themselves to us.

Kevin Pho: So sometimes when it comes to the steps to reduce burnout, it isn’t necessarily all in the hands of physicians and physician leaders. Of course the administrators and system issues need to be improved as well. And you don’t have to talk about your institution specifically, but in general, what are you seeing from the administrators in terms of their buy-in to alleviate the potential causes of burnout?

Jillian Bybee: Well, I’m glad you brought this up. I think it’s a really crucial part of every discussion about wellness and burnout for physicians, is that we know that 80 percent of what drives burnout for physicians is a system issue. I also remind people that we’re part of the systems, especially as we’re leaders.

But I am happy to work at an organization that really takes it seriously. We have an office of physician well-being and fulfillment at our organization, and our job, I’m one of those members, is to be looking at the drivers of burnout and to be looking at the three domains of professional fulfillment, which is the Stanford model: professional fulfillment, culture of wellness, so that includes our leadership behaviors, how we bring ourselves to work, how we create that culture on our teams, and then practice efficiency.

I think some of the cool things that have been happening here at my organization is the use of an inboxologist, so someone to be helping with inbox messages for outpatient physicians, to be making sure that they’re not burdened by that clerical work. They’re also piloting some AI in some spaces for note taking. I think because we have people from different areas thinking about it, and we also have invested leaders.

I think I’m luckier than other people in other spaces, because I talk to a lot of my friends and colleagues across the country who don’t have that. And so for that I would say a lot of this culture change really starts locally, and a lot of it is already embedded in the quality improvement processes that we do. And so I think the more that we can talk about it in a way that ties professional fulfillment and improvement together, and sort of not leave out the wellness conversation but really talk about how it benefits not only the organization but also ourselves, that starts to get people’s attention.

And we did have to go through a process of making a business case for this, and there’s a lot of data out there. Tait Shanafelt from Stanford is publishing a lot of it, and I think it’s nice to have that data, because there’s really a case that’s out there, we just have to start taking it.

Because I think what I tell other people, including the trainees that I lead, is no one’s coming to save us. It’s not like people are going to give us more PTO or do things if we don’t make a case for it. And certainly there will be places where people don’t listen, and those are the places where people leave a lot of the time. And I almost left here, not because of those things, but we were working a lot and I didn’t know how to stand up for myself, have boundaries, block off time on my calendar.

And so now, through our system changing and also me changing myself, we’ve really been able to make improvements. And I think if anyone listening to or watching this is at my organization, they will remind me that it’s not perfect here. And I don’t think perfection is the goal, but I think pivoting towards something more sustainable is the goal, or we’re all going to leave health care.

Kevin Pho: So for those resident physicians, fellows, early career physicians who may be listening to you and are now in that place of burnout that you were years ago, you’ve given so many great pieces of advice, but what would be the single most important thing that they should do next?

Jillian Bybee: So I love that you asked this question. I just wrote a blog about this on my own blog. But there are two parts of it.

So the first one is, don’t be like me. Which means don’t do it by yourself. So I waited for a long time when I was trying to figure out, is this depression, is it burnout, which we didn’t know that much about back when I was a trainee. I kept it to myself, I didn’t tell anyone I was struggling. And I think that everyone around me could see it in some way or another, and they didn’t know what was wrong either. But no one can help you if nobody knows.

So I promise you that there is someone in your life, whether it’s a family member, a mentor, one of your co-trainees, somebody who cares about how you’re doing, and you should tell that person that you’re struggling. And that can be hard, it can be difficult for our egos to admit that we need help, because we’re often the helpers. But don’t do it alone.

And then really find ten minutes, which is 1 percent of our day, to do something that brings you joy. And I get a lot of eye rolls when I talk about this, but it’s only 1 percent of your day. And if you can’t spend 1 percent of your day on yourself, I’m sorry, but you won’t be able to make progress forward.

And that’s really where that other supportive person can come in. I think that those are the people who help us stay accountable. And I’m really happy to have a lot of those people in my own life. They’re the people who, when we’ve had a death on the unit, or something else that’s happening, they send me a text and say, hey, I heard you’re having a hard time, or there’s hard stuff going on, are you taking care of yourself, do you need anything, you know, how can I help support you?

And I think that’s how we build culture, one team member at a time, is by slowly accumulating those people around us. So don’t do it by yourself, take 1 percent of your day to do something that brings you joy.

Kevin Pho: We’re talking to Jillian Bybee. She’s a pediatric intensive care physician. Today’s KevinMD article is “5 lessons for a better life: observations from a front row seat for the highs and lows.” Jillian, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Jillian Bybee: Yeah, I think I just said one of them, so I love that we’re ending on this. But the other one is, don’t put off your happiness for the future. Because I think a lot of us live in the land of the arrival fallacy. I’ll be happy when I finish medical education, or training, or when I’m an attending, or when I retire. And honestly we miss our entire lives living for a future that never comes, because we just move forward into the next thing.

So my biggest takeaway is for you to start to look at your life today as the thing that’s actually happening to you right now, and figure out how you can find some satisfaction, or at least be OK with today. Because we’re not promised tomorrow. And I think that’s what’s in this article, is things can happen every day that change our lives immediately, and you might never get the thing that you’re waiting for.

Kevin Pho: Jillian, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Jillian Bybee: Thank you for having me.