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In this episode, we delve into the critical issue of burnout among health care providers with our guest, Susan Landers, a retired neonatologist. We explore the alarming rates of burnout and depression among physicians and nurses, with a special focus on the unique challenges faced by female health care professionals. Susan shares her personal journey through burnout and discusses the transformative power of psychotherapy in her life. We’ll discuss the stigmas surrounding mental health care in the medical field, the importance of destigmatizing therapy, and the urgent need for systemic changes to support the well-being of health care workers.

Susan Landers is a retired neonatologist with 34 years of experience and has practiced both academic and private medicine. She can be reached on her website, Instagram @drsusanlanders, Facebook, and Substack.

She discusses the KevinMD article, “Beyond burnout: Normalizing psychotherapy for burned-out physicians and nurses.”

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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 Susan Landers. She’s a neonatologist, and today’s KevinMD article is “Beyond burnout: Normalizing psychotherapy for burned-out physicians and nurses.” Susan, welcome to the show.

Susan Landers: Thank you, Kevin. I appreciate the invitation.

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

Susan Landers: I am a retired neonatologist. I practiced for 34 years in various NICUs in the state of Texas, and most recently in Austin, Texas. And I raised three kids, married to a physician, had a very busy life, lots of stress from the NICU.

I experienced burnout late in my career when I was 60 years old. I did not intend to retire that soon, but I recognized my burnout, and I was working for a practice that allowed me to cut my hours back to part-time and go to a different location, a low-risk labor and delivery unit. And it took me about a year of concentrated effort to recover from my burnout. And so that experience taught me a lot about this issue for physicians.

Because I had never really experienced a full case of burnout until I was older. I think I had some working mother burnout issues in my 40s when my kids were little and I was chasing around three children and working full-time. But this was different. This was an emotional, overwhelmed sensation that was unlike any other. This was distancing myself from my patients and their parents and the nurses and other physicians. This was me walking around feeling like I no longer made a difference, and I had never felt that way before.

So I got psychotherapy. I have had psychotherapy off and on in my career, and that’s for a number of different reasons and some intermittent depression. But the psychotherapy helped me during my burnout because I was able to isolate the issues that really kind of tipped me over the edge.

And what I mean by that is the ethical issues with the difficult patient, when the doctor and other physicians and the parents wanted something different, palliative care versus pulling out all the stops. Babies who had lethal congenital malformations whose parents wanted everything done and all the surgery. And then the tiniest preemies, who have so many complications and don’t do well, and they stay in the hospital for six or eight months and then they go to the PICU, pediatric ICU, and live there with their trachs for another year or so and may never go home. And so those kinds of things began to feel like burdens to me, and those ethical issues contributed to my burnout. Not just working a lot, not just being up at night running to deliveries.

So I ratcheted down my hours, I got psychotherapy, I exercised a lot and did meditation practices and some journaling. I found a lot of help in visiting with old friends, and laughing and joking and telling stories, and that was wonderful. I did a lot of reading. But basically I just sort of cocooned myself and took care of myself. And so I recovered from burnout within a year, maybe 18 months. And by then I thought, well, I’ve really had it, and I retired when I was 64.

Now I’m 72 and I wish I had not retired so early. After I retired I was bored, like a lot of active, energetic physicians feel, I’m sure. I felt like I didn’t matter, I wasn’t doing anything important. I had recovered from burnout and I was in a good place mentally.

So I sat down and I wrote a memoir. I have a memoir called So Many Babies, and it is about my life in the NICU, and it’s true stories, it’s favorite patients, their parents, and some of the ethical issues. And it’s also me being a mom, a working mom, and all the mistakes I made.

So writing that memoir and talking to folks about that book, I discovered that women physicians were all in terrible shape. They were all burned out, they were all having mom overload and physician burnout issues, and nobody helps me take care of the kids in the household.

And so I started writing a blog on my website, I started writing a newsletter, and I started talking to working mothers on podcasts to discuss this issue of burnout, not only among physicians but also among working mothers. And so that’s what I’ve been doing the last four or five years, is being an advocate for women who work and get burned out, and for physicians who work and get burned out. So that’s my long story short.

Kevin Pho: So I want to talk about your article in a little bit, but one question I wanted to ask was, when you felt that burnout towards the later stages of your career, and you said it was unlike any other feeling that you had previously, was it a sudden event that precipitated it, or do you feel like it was a more gradual thing coming on?

Susan Landers: It was a gradual thing coming on. I had recognized particular cases that were bugging me. And you know, you talk within a practice, and what’s the other guy think about this particular case, and I was beginning to feel a little bit like an outlier.

I remember telling my husband that I dreaded going to work, and he said, what is going on, you’ve never said that, you’ve always liked working. And I said, I don’t like it anymore, it doesn’t feel good, I don’t feel like I’m making a difference. I said that to him too.

And so in retrospect it was a gradual process. It snuck up on me. I thought I knew how to take care of myself. There I was, 60 years old, I had been doing this for over 30 years, and I knew how to keep my head above water and stay sane. And my husband and I were great advocates for one another through both of our careers. But it really did kind of sneak up on me.

It was startling when I finally felt that I wasn’t making a difference. I mean, it was terrible hiding in the call room. Nobody wants to do that. That’s just an awful feeling, when you’re used to interacting with nurses and parents and patients and other physicians, and all of a sudden all you want to do is detach yourself from your work. That is huge. It was huge for me. It scared me. I had never felt that way in my whole career.

Kevin Pho: Let’s talk now about your KevinMD article, “Beyond burnout: Normalizing psychotherapy for burned-out physicians and nurses.” For those who didn’t get a chance to read your article, tell us what it’s about.

Susan Landers: It tells a little bit about the current figures for physicians and nurses. We know that burnout is still epidemic, and it is occurring more often among women physicians than men. It’s a little more prevalent among nurses. My daughter is a PICU nurse, and she and I talk about this all the time, because nurses are getting less support than physicians are, believe it or not.

And so my article gives statistics about where we are currently. It talks about what physicians and nurses take advantage of for burnout and for support. And it’s really sad, because it describes a minority of physicians and nurses who are getting any kind of help, either psychotherapy or coaching.

We know that physicians are reluctant to get help because of the stigma around mental health care, and we know that we’ve been plagued with intrusive questions about mental health conditions and care on our licensing applications, our credentialing applications.

And so I did some research and looked at what the Lorna Breen Foundation has been doing, a huge amount of work advocating training and therapy for physicians and nurses and all health care givers about burnout and about the importance of mental health care. And I talk a little bit about that in the article.

And I was pleasantly surprised to find that 25 states now have removed from their state board licensure applications questions about mental health care, therapy. And that is huge, because all of us look at those little questions, have you ever had depression or any condition that affects your ability to practice. And of course, even if you’ve had depression you can still practice if you’re being treated and you’re recovering. And we all have looked at those questions on application forms and credentialing forms, and we sit there and we go, I don’t want to answer those questions, it’s not their business, you don’t ask if somebody’s a diabetic or an asthmatic.

And so I talk a little bit about my feelings about those questions, and how I’m glad that state medical boards are changing. Hospital credentialing, not so much, not yet, but hopefully that’s coming in the future.

I also tell my own personal story of what I learned from psychotherapy and how it helped me manage conflicts, ethical issues with parents and colleagues, conflicts with colleagues, conflicts in my marriage. It helped me solidify what I knew about taking care of myself, the importance of exercise, sleep, connections, friends, doing things. So I learned so much from psychotherapy.

And for some reason I wasn’t embarrassed to tell people that I see a therapist. Maybe in Austin, Texas all the liberals are always talking about what they tell their therapists. But I decided to fess up and tell people that I had benefited from psychotherapy, and that I hope other people, especially younger physicians, will go that route.

The other good thing that’s happening that the Lorna Breen Foundation is doing is they’re actually trying to get the act passed to re-fund programs to teach hospital systems how to train residents and hospital staff and nurses in self-care and preventing burnout and treating burnout. That’s not, I’m not talking about resilience programs, everybody’s doing a little bit of that. I’m talking about really programs that help physicians and nurses.

And so my article just summarizes my view of all this, and my admission that therapy is helpful if you have burnout. We know it’s helpful if you have depression, and since burnout leads to anxiety and depression, it’s equally as helpful if you have burnout.

Kevin Pho: So when it comes to physician burnout, we’ve been talking about this on my podcast and site for what seems to be years now. There’s a lot of coaches that address physician burnout. So contrast psychotherapy with coaching. How is it different, and what exactly was it like when you talk to that psychotherapist as it specifically related to your burnout?

Susan Landers: I’ve never had a coach, but I’ve read that what they do is helpful in setting priorities and goals, and looking at boundaries, and our ability to choose where we want to focus, our ability to affect our attitudes about our goals and our focus. And so coaches are more goal oriented, is my belief.

Having said that, I have a friend who was a perinatal social worker, she’s now a counselor and works for various companies in their employee assistance program, and she counsels employees who are burned out. And she tells me that within eight to 10 sessions, by doing some therapy things and some coaching things, she can help people figure out what their issues are, what pushed them over the edge, where they need to focus to try to get better. And she says she can tell people when they need additional therapy. I said, you can do all that in six or eight sessions? She said, no, it’s usually more like eight to 10. And you know, most employers give you 10 to 12 sessions as part of EAP.

Now, therapy for me was different, because we talked about issues from my childhood, from my marriage, from my trying to be a full-time mother and a full-time neonatologist, and all the guilt that comes with that, all the missed opportunities to be the best mom in the world, but plenty of opportunities to be a great neonatologist.

So therapy was more personal for me. It was more deep seated, deeper rooted. It identified issues about accomplishments and self-esteem and interpersonal relationships. And I don’t think coaching gets into those areas.

So coaching may be great for some people, and short therapy like EAP programs offer may be great for some people, to just say, I don’t know what happened, was it the hours, was it the pay, was it my boss, was it my colleagues, was it my kids, was it my relationship with my husband? You know, a coach can help you answer those questions. But I think a therapist forces you to really dig a little deeper into your own personal, and how you let yourself get into that position.

I’m a perfectionist. A lot of physicians, especially intensive care physicians, are perfectionistic. And my therapist helped me figure out that my love of saying yes and doing everything well and doing everything perfectly is a weakness. It’s a terrible weakness. I always thought it was a strength, but it’s not. I had to teach myself how to set boundaries and say no, not just in my work but also in my personal relationships.

So I think the short answer is, therapy is more personal, more intuitive, more about your current life and your past life that contributed to who you are. And coaching is more based on what’s going on, where you want to go, and how do you want to get there.

Kevin Pho: So you mentioned earlier that about half of states still require physicians to disclose behavioral health treatments, and the majority of hospital credentialing questions still ask physicians to disclose that. So how can physicians overcome that obstacle to seeking psychotherapy?

Susan Landers: I think we should answer the question no, and happily say to ourselves, it’s really none of your business. I think we should talk to each other when we get therapy. Women do this a little more freely than men do, but I told my supervisor I was getting therapy. My medical director was an old friend of mine, and he said, well, that makes sense, is it helpful? I said, yeah, it’s really helpful.

If we don’t talk to each other about how bad we’re feeling and what we can do to feel better, we’re not going to get better. Hiding because of the stigma is no answer. It is just not going to make a difference.

We all know that psychotherapy for depression or for anxiety is beneficial. We all know that antidepressants are beneficial. Why should that be singled out by these organizations when our treatment for diabetes or asthma is not? And I think physicians ought to be brave and just say, I’m not going to answer those questions. Just answer them no.

And as we progress along in dealing with the burnout epidemic in our country, maybe physicians will loosen up and not be so scared of what others think of them. Maybe when leaders, people like you and me, admit that psychotherapy was necessary, that it was helpful, maybe more younger physicians would be willing to get the help they need.

Kevin Pho: We’re talking to Susan Landers. She is a neonatologist, and today’s KevinMD article is “Beyond burnout: Normalizing psychotherapy for burned-out physicians and nurses.” Susan, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Susan Landers: If there is a program offered in your hospital, in your clinic, to either provide group support or to provide resilience training, or to just be a support, or to meet with some sort of counselor that has any experience, please take advantage of it.

I’ve read that 40 percent of health care organizations are offering these services now, and it’s not perfect, and it may not be individual psychotherapy, but I can guarantee you it’s helpful to sit with others and talk about what you’re going through. That is therapy in a way.

And so almost half the time there are going to be things in our organizations that we can take advantage of. So I really beseech people to meet with others, to talk with others, to try to take advantage of whatever your organization offers for care of this problem.

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

Susan Landers: Oh, you’re welcome, Kevin. Thank you.