How burnout sneaks up on health care professionals [PODCAST]

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Devina Wadhwa, a psychiatrist, shares her personal journey through burnout and the challenges of navigating systemic pressures in health care. From recognizing subtle signs of burnout to setting boundaries and redefining resilience, she offers valuable insights on reconnecting with purpose and advocating for meaningful change in the medical field.

Devina Wadhwa is a psychiatrist.

She discusses the KevinMD article, “How physician burnout silently creeps in and takes over.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Devina Wadhwa. She’s a psychiatrist, and today’s KevinMD article is “How physician burnout silently creeps in and takes over.” Devina, welcome to the show.

Devina Wadhwa: Thank you.

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

Devina Wadhwa: So I’m a psychiatrist, and I work up in Northern Ontario in a smaller town called Thunder Bay. I also do a bit of work up in Northern Canada, in the Arctic, in Nunavut, and in some smaller northern communities as well. I was trained previously as a pharmacist at the University of British Columbia, and my journey sort of moved me to Toronto, where I completed a residency in psychiatry and then was very interested in rural psychiatry, essentially in underserviced areas, and that’s how I ended up here in Northern Ontario.

Kevin Pho: So tell me about some of the things that you see in those rural areas, in those Indigenous areas, from a psychiatry standpoint. What are some typical things that you’re seeing?

Devina Wadhwa: So, you know, working in a place like Thunder Bay, and we call it underserviced, there is so much mental health need, and oftentimes not enough psychiatrists or mental health clinicians overall. So you end up seeing lots of clients on a day-to-day basis, and you essentially come across individuals that struggle with significant amounts of trauma. Intertwined in that trauma history comes mental illness, substance use, and then the overarching psychosocial difficulties that a lot of individuals struggle with: homelessness and living in low socioeconomic statuses. I think it’s very similar in many parts of the country, but really, the more rural you are, the more people struggle to get services that they need, and they often wait a lot longer, you know, than they should.

Kevin Pho: You wrote the KevinMD article “How physician burnout silently creeps in and takes over.” Before talking about that article itself, what led you to write this one in the first place?

Devina Wadhwa: I had a good, I call it, dose of burnout that really sort of changed and shifted my perspective and crept in probably two years ago in my own life. Coming out of that, I have really reflected on just creating some more awareness, in a very vocal way, around how it’s a real thing. You know, we use this word a lot, and that’s where the article sort of struck me. I hear burnout all over the place, burnout, burnout, burnout, and actually stopping to think about what it feels like was quite profound for me.

I struggled with this sort of sense of hopelessness around the work, this sense of not achieving and making a difference in the world. That’s what I set out to do in medicine and in mental health, and that’s sort of the inspiration of the article, and wanting to write and share with clinicians, with learners. You know, I teach a lot of medical students and residents through NOSM University, and I’m quite open about my own journey and my struggles. I find it de-layers a layer of shame that we all have as clinicians, where we need to kind of push and work hard and almost feel like nothing affects us. And really, burnout’s real.

Kevin Pho: So tell us your story. Tell us about some of the challenges that you faced.

Devina Wadhwa: So, you know, I think as a new grad (I’m seven years into practice now), my first, I’d say, five years, I was very keen to sort of help, for lack of a more sophisticated way of describing it. And I think the last few years, that feeling started to degrade a lot more. I felt like I wasn’t making a difference. I felt really bad about myself, about my work. I didn’t feel fulfilled. I didn’t feel like I was helping anybody. It started to creep into my home life, where, you know, I was more irritable in my home life. My partner was the first person that picked it up, being like, “Do you think work’s really affecting you?” And my first defensive answer was like, “No, I’m fine. Everything’s good. I’m fine.”

I think just really reflecting, you know, going back into psychotherapy for myself (I had a psychotherapy course in residency for myself) was really eye-opening. Because I thought, as a staff clinician, you’re immune to anything sort of difficult happening, because that’s what you trained for, and you can do anything that is put in front of you. And I really realized quickly that actually I couldn’t, you know. I was more anxious. I was doubting myself. When a bad outcome would happen, I would berate myself about it. I lost quite a bit of confidence as a clinician.

And just stopping and thinking about, “OK, what can I do differently? I know I love the work, but I need to love it in a different way,” you know: working less, becoming a little bit more creative in what I did, and mixing my work up, so not just acute care psychiatry and emergency room psychiatry. This mindfulness piece has sort of started to become part of my toolbox. Teaching has been really important for me. Wellness has been really important. So I’ve started to branch out a little bit.

And in my article, I do mention, right, what does get sacrificed. You know, you think about, OK, how much, in terms of remuneration, gets affected when you work a job that maybe provides more remuneration than others. It’s a sacrifice, and it’s a real one that sometimes is taboo to talk about. And at the same time, I think my health and my wellness and my outlook on the work as a clinician have improved significantly. So I think for me, that sacrifice and the compromise have been well worth it.

Kevin Pho: So what kind of changes specifically did you make? Did you work less? You said that you worked in other settings, so tell me the specific changes that you made.

Devina Wadhwa: So definitely, you know, from sort of this intensive environment of working in an acute care setting, I halved the time that I was doing that. So instead of working in a setting like this for ten months, I scaled back to working in a setting like this just for six months. I started to travel a bit more. I started to also engage as a speaker in continuing medical education conferences away, so there was a bit of travel and sort of psychiatry teaching with that. Teaching more yoga, teaching more mindfulness courses, has been part of that. And then sort of working in even more rural areas has somehow become part of the mix of the work, which actually feels really fulfilling, but I’m not doing it all the time. So, you know, a bit of play, much more play in a way, but still lots of work, but just a good mix of work for me.

And honestly, talking about the struggles with burnout, and, you know, to jump with moral distress, where you sometimes feel like it’s you as the clinician, but our system, our health care system in general, and I’ll talk about the province of Ontario, there’s a lot of pressures from all directions. And, you know, I think as clinicians we do feel that, and that can aggravate that sense of hopelessness and helplessness we feel towards not being able to do the best that we can for our patients sometimes.

Kevin Pho: So just to be clear, this was intentional on your part in order to address some of the burnout symptoms that you’re feeling. The job itself, did they make any accommodations in terms of helping and addressing your burnout at the job?

Devina Wadhwa: So, you know, in terms of the actual job, being able to work less, I would say that was an accommodation, where it was like, “I can’t do this all the time, so this is what I can do, and I will do it well if I’m able to do it this way.” So that was an accommodation, right? Because scaling back is always challenging for a team that’s already quite strapped from a human resource perspective.

But the environment per se and the system per se, I think that’s where a lot of us clinicians are trying to navigate around. You know, there’s not enough family doctors out there, right? There’s just not enough. Hallway medicine is becoming sort of routine standard now. And those are the things I think we need: top-level changes. But, right, I don’t know what it’s going to take to change at a system level, so clinicians on the ground like myself are able to work in more conducive settings.

Kevin Pho: Talk more about what you mean by hallway medicine.

Devina Wadhwa: Oh, my goodness. So, you know, I mean, and transparently, I have not worked in Southern Ontario since I finished my residency. But I know when I started in Northern Ontario, you know, there were spaces to see patients. Patients would get into rooms in twenty-four hours. And now, you know, we see patients in emergency room hallways waiting for a bed for three, four days. You’re trying to squeeze and find a little private corner to speak to your patient, and being mindful that these are patients that are suffering from emotional distress and mental illness, and there’s no space. It’s a constant sort of negotiation about needing to have people discharged, right? And hallway medicine is really, there’s so much need, and our infrastructure feels like, not to be pessimistic, but it’s crumbling to a certain extent at some moments, to be able to serve the needs of our patients and do the job well that we were trained to do.

Kevin Pho: So in your case, you cut down your work schedule, and you’re able to pursue passions sometimes outside of medicine. So talk to me about a commentary in terms of our health care system. One implication is that it is very difficult for physicians to practice full time. I’m a primary care physician. I do internal medicine, and I’m half time as well. And I’m seeing that it’s very difficult for physicians to practice a full-time patient care load. Is that what you’re seeing as well? Physicians who do practice full time, they’re going to be more prone, of course, to burnout.

Devina Wadhwa: One hundred percent. And I’m a prime example of that. I set out, when I graduated, to, you know, want to be a clinician, teacher, educator, researcher. And I think that’s where I reflected, and those were the biggest feelings I struggled with, of failure, being like, “My goodness, I can’t, let alone do clinical work full time. How am I going to try and achieve all these other hats?” Because we’re always sort of told, or subtly trained, that these are the things we need to do in order to become a successful physician.

But I see a lot of clinicians around me that, you know, are choosing not to do full-time work, because it’s just not sustainable and it’s just not possible. And we’re seeing, I know in psychiatry, a lot more new grads that are coming out and becoming locum physicians and are managing to sustain practices as locum doctors, because a lot of us that set out to work full time are not able to do that anymore.

Kevin Pho: So how long did it take you to accept that, hey, you couldn’t practice in your ideal way because it was burning you out? Was that difficult to accept, and if so, how long did it take you to come to terms with that?

Devina Wadhwa: I’d say two years. I reflect back now, and, you know, my article highlights how it slowly engulfs you. It took me a while, because there was this sense of, “That’s not possible. I cannot burn out. It’s just not possible. I do all the right checkbox things for wellness.” And then that acceptance happened, and this new liberation and freedom came with it. And now I don’t feel ashamed to share. Even with my junior colleagues, it’s an open dialog: It’s OK. It’s OK not to be able to practice at a certain intensity for a long time. It does not mean that we are not good or we are failures in the clinical sense.

Kevin Pho: So are you starting to see that trend shift? Are you seeing some of your colleagues come to terms with a less-than-full schedule in order to prevent burnout?

Devina Wadhwa: Absolutely, absolutely. And, you know, is it a good thing for medicine? You know, I think about me and our future generation, where we have a lot of us working less. I don’t know the answer to that. And yet I think it’s a good thing that we’re able to check ourselves, and when we’re at work, we’re good and 100 percent well, emotionally, physically, and mentally. So that’s a good thing. We just may need to train more physicians to be able to accommodate for the need that our society has.

Kevin Pho: So you mentioned that you have medical students, and you have resident interns sometimes rotate with you. So given your own experience with burnout, what kind of things are you advising these future physicians?

Devina Wadhwa: So at NOSM, the psychiatry rotation, medical students actually come in their fourth year. They’re a little bit different from other schools, and by that time, they’ve already sort of made their choices as to where they’re essentially headed. And it’s always like, you know, in medical school and residency, we are waiting. It’s this delayed gratification: “When I’m a staff, I’m going to have a balanced life. It’s coming. And, you know, it doesn’t matter now. I’m going to work. I’m going to do one in four. It doesn’t matter. But when I’m a staff, I’m going to be a balanced physician.” And we graduate, and we actually realize we don’t have the tools to know what balance is, because our entire decade, we’ve spent completely living lives where we’re not balanced.

So I think it’s always a reminder, you know: Look after yourself. And it’s the checkbox-y stuff. So, for example, when I start a call shift, I’ll say, “Make sure you take thirty minutes, an hour, go do a wellness thing, and then we’re going to meet and divide our night and do call together,” right? So these little subtle things, I think, really matter, because they’re our next generation that’s going to do the same for the next generation. And I’m not saying that patients should wait five hours longer because the clinician needs to go and practice yoga, right? But the clinician needs to be well and 100 percent ready to be a complete listener for them. So it’s this fine balance we strike around looking after our patients but being well ourselves to do it well.

Kevin Pho: We’re talking to Devina Wadhwa. She’s a psychiatrist, and today’s KevinMD article is “How physician burnout silently creeps in and takes over.” Devina, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Devina Wadhwa: Thank you. I would say, look after yourself, because that’s how we can then look after each other, and then that moves on to looking after our patients or our clients. Medicine is such a beautiful profession, where we learn how to look after others at the cost of sometimes looking after ourselves. So look after yourself.

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

Devina Wadhwa: Thank you very much.

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