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Physician advocate and physical therapist Kim Downey and counselor Shari Morin-Degel discuss their article, “Why burnout prevention starts with leadership.” Shari shares her personal journey from a trauma-exposed mental health professional to a burned-out leader who initially expected her team to just “push through.” The conversation highlights how she reached a breaking point and realized that true recovery requires more than just individual resilience, it requires systemic support. Kim and Shari explore the data behind the “My Work BALANCE” initiative, revealing that employee engagement with wellness tools soars only when leaders actively model participation and provide paid time for it. They discuss critical research on behavior change and argue that tools alone are useless without a culture of visible norms and psychological safety. Learn how to shift from a culture of survival to one where teams can actually thrive.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Kim Downey, a physician advocate and physical therapist. She introduces me to Shari Morin-Degel, a counselor. Their KevinMD article is “Why burnout prevention starts with leadership.” Kim and Shari, welcome to the show.

Kim Downey: Thank you, Kevin.

Shari Morin-Degel: Thank you.

Kevin Pho: All right, Kim, I always ask you: How did you find Shari, and what about her writing and her resonated with you?

Kim Downey: Sure. So I am part of the Medicine Forward team, and they recently asked me to interview Shari for their new podcast. Shari sent me some information ahead of time, and I realized what an important, informed perspective she has about the responsibility that leadership shares in supporting employees. For Shari, it comes from a place of having been there. I am hoping to amplify the messages of health care leaders making a positive impact, and Shari is a great example of that.

Kevin Pho: All right, Shari, why don’t you briefly share your story and journey, and then talk about the KevinMD article for those who didn’t get a chance to read it yet.

Shari Morin-Degel: Okay, great. Thank you so much. Wonderful to be here. Thank you, Kim, for inviting me to collaborate, and thanks for accepting our article. I am a counselor by trade, and so that is how I started in my career. Then I spent a little over 15 years in executive leadership. I really got to understand burnout from both perspectives, having been in direct care and then having supervised direct care, and having experienced burnout myself. I also worked with hundreds of employees who have experienced burnout at one time or another.

For me, my journey was sort of having been burnt out but not knowing it. It was early enough in my career that we weren’t talking about that. There really wasn’t a mechanism for addressing it. Then I took it into my role and just expected others to carry it the same way that I had. Then, sort of hitting a wall eventually—enough stacked up that there was finally a straw. I wasn’t happy with who I was as a person. I wasn’t happy in my career. I was sort of running out of options. Leaving my career was not an option, so I was sort of forced to face it.

In the article, I share that I am a nature lover. I think you can see trees and a creek behind me. I have horses in my life. For me, I had great friends, and we took our horses every Saturday for three months and went out and rode in the woods. I didn’t take a sabbatical; I didn’t have to leave. I just took the time. We took a lunch and just got away. That refreshed me. It reminded me again of what it felt to feel good and that I needed to protect that. That was sort of the beginning. That wasn’t the end of my recovery; that was sort of the beginning of my recovery.

So now, that is what I do. That is where I focus: with individuals and organizations, helping them with burnout. I created an app to try to support that work because it is really about creating habits. You don’t get a one-time training and you’re fixed, or a one-time tool and you’re fixed. Preventing burnout is a long process. Getting there took a long time, so recovering takes a long time.

Kevin Pho: Shari, you mentioned earlier that you felt symptoms of burnout even before we started talking about it recently. So tell us exactly what you were feeling, and how did it affect the people around you and the work that you did?

Shari Morin-Degel: The work that I did, what I noticed is either over-identifying with clients or under-identifying with clients. That compromised my work with them. So I was either so fully invested that it was like, “Oh, this is terrible. I don’t know how there is hope for you. I can’t see a path forward.” Or it was, “Get over it. Just stop.” Finding that balance impacted the quality of my work with them.

For me personally, I was very irritable. I was very short-tempered, spontaneously angry, and emotionally eruptive. I was prickly, so I was not approachable. In my leadership, I was more defensive. So challenging the status quo was not safe with me. I was trying to push all of those things as far away as I could.

Kevin Pho: Kim, as you hear Shari’s story now, and as you talked to her before, what are some common threads from her story that you could relate to the other stories of burnout and moral injury that you’ve heard from other health professionals that you’ve interviewed?

Kim Downey: Well, one thing is she shared her specific symptoms, and that resonates. I have heard other doctors talk about the same things, even somatic symptoms—physical symptoms. Shari has gone through multiple periods of burnout, and other doctors have too. One thing they spotlight is that the symptoms could be different within themselves, even in their different periods of burnout. Shari might be able to speak to that a little bit more; her first period of burnout might not have looked like her second period of burnout.

Also, at first, I love that she is willing to talk about these things. That is another thread that other doctors relate to because, on one hand, you think, “Well, you’re a counselor. Shouldn’t you be aware of that?” Or doctors, you’re smart people. But that is so true when it is yourself. It also kind of relates to, say, you’re a parent and you’re a physician and you have to bring your kid to the emergency room. In that situation, you’re a parent, right? You don’t have your doctor brain on; you have your parent brain on.

So I just love the threads. So much of this is unique to each person, but there are so many similarities. Every time we share these stories, we are just chipping away at the stigma and saying: “You’re not alone, and it is okay to seek help. You’re not weak.” Just all of those messages are so important.

Kevin Pho: Kim, you highlight a certain irony here because Shari is a counselor who has to deal with burnout from people that she works with, but then she is burnt out herself. In the article, Shari, you mentioned a breaking point being an electronic medical record rollout. So tell us more about that.

Shari Morin-Degel: Yeah. So in my role, I was responsible for bringing in an EMR. It was really our first. So it required having to change everything and trying to fit it into this mold. EMRs were still fairly new at the time, so they weren’t really ideal. We had a combination of residential and community services, and it was really only designed for residential. So we were trying to make community fit. There was just a year solid of being forced to make this system work, and then the rollout, the training, and the complications—it was so challenging.

I was also doing my full-time job in addition to it. It was sort of like: “Just figure this out. Just add this once it gets implemented.” What we did not know was really the depth of what it took to do that. It is sort of like: “Oh, we are going to invest in this technology because it is going to save us from having to hire people, or it is going to save more time.” That is not the truth. I mean, it takes more manpower to do that.

So, we just didn’t know upfront what it would take. Just piling that on… In a lot of the work that I do, technology and workflow efficiencies are significant contributors to burnout—in addition to the secondary trauma. That is sort of its own piece. But we do not recognize the impact of what it takes to adapt to advances in technology.

Kevin Pho: And Shari, did you get any support from leadership during this rollout when they just added these administrative burdens to your plate?

Shari Morin-Degel: I got empathy in terms of, “I am sorry this is so challenging,” but I also got deadlines: “Sorry, it hurts, but get it done.” So that was also really frustrating. Then even with colleagues among other departments, getting feedback and dissatisfaction that I took personally—it was dissatisfaction with the technology and the limitations of that, but I felt like I wasn’t able to find those answers. So, yeah, that was challenging.

Kevin Pho: Kim, you’ve talked to a lot of health care professionals who undergo burnout, and sometimes leadership papers over these symptoms with empathy, but very rarely do they offer some structural change to fix their burnout. So, Kim, how common is that—that leadership fixes burnout with like pizza parties and yoga and kind of superficial responses to burnout rather than real structural change?

Kim Downey: That is very common, and that is why doctors tend to mock that on social media, right? That the answer isn’t a pizza party or doing more yoga. Again, which we might have talked about before but is so important to reiterate, that is why some doctors understandably hate the term “resilience.” They feel like, “You guys are some of the most resilient people on the planet,” and that makes it seem like an individual problem—if you could just be more resilient, you could fix this—when it is really the systems that are the problem.

However, some organizations are doing a very good job with this. Dr. Apo Gupta is working on this; he found what he calls a “loving organization.” He has found that there are some organizations around the country who are doing a very good job with this and that they are caring for their employees so their employees can care for the patients. So that is what I am really starting to focus on now: trying to amplify leaders who are doing it right and creating an impact to help all of us, which in the end helps doctors and patients.

Kevin Pho: So, Shari, tell us what happened next in the story. What were some of the things that you did to climb out of that pit of burnout, and some of the lessons that you’ve learned and could share with us today?

Shari Morin-Degel: I think some of the biggest lessons that I learned were (and I hate to bring back the word resilience, but this was again sort of the foundation of my story) learning what a healthy nervous system looks like. In returning to a healthy place, then I was able to impact the environment.

So sort of like, “Okay, what is health again?” Finding that, learning what a healthy nervous system is—that was not a part of my training at all. That came many years into my practice. But learning about that, and then once I found that, protecting that. Being able to build some self-awareness around the stress response so that then I was like: “Oh, wow, that is a trigger. Okay.”

Before, I would have just fought it, fled it, avoided it, or gone into people-pleasing mode. I would have had one of those reactions that in the moment feel completely justified, and that is why we are not aware of it. That is part of the mechanism: we feel justified in that response.

So being able to build awareness around that, and then I could recognize by my reaction what were those chronic stressors. Then be able to either advocate for myself or try to build real solutions around that. Whether it was just needing authenticity, needing autonomy, or whether it was way too complicated. Just being able to identify what those problems were, then I could actually implement something. But as long as I continued operating from that sort of triggered state, I wasn’t ever solving a problem.

You know what? I found that in that process, when I was not coming from a triggered state, I was getting more support from my leadership. I was getting more support from the people that I supervised, and I was able to be more supportive of them. I was able to role model how to just stay calm, how to feel safe, and how to talk about that.

So, I think it is not about taking breaks. I mean, yes, we have to take breaks; that is a part of it. But when you come back to what you are working with, you have to have a system. You have to have a way for solving the chronic stressors.

Kevin Pho: Kim, you’ve again talked to a lot and heard a lot of stories. You talked to a lot of clinicians about their burnout and how to get leaders to buy in. So Shari talked to us about one way that she did it. What are some other ways that you’ve heard other health care professionals share in terms of getting health care leaders to buy in and really implement that cultural change that is really needed?

Kim Downey: Well, I think you really have to show how it affects their bottom line. They need to deeply understand how supporting employees is less costly than turnover, health care expenses, and disengagement. Because I think a lot of it is they think, “Well, we don’t have the money to support our employees.” So I think that is what it has to come down to: show them.

I am sure you have shared the statistic before that every time a doctor leaves a system, it costs the hospital $500,000 to a million dollars to replace them. And then, of course, when you have doctors that go so far that they take their own life, the ripples that has on all of the patients that don’t get seen and their families—the replications are horrific.

Kevin Pho: We are talking to Kim Downey, physician advocate, and Shari Morin-Degel, counselor. Their KevinMD article is “Why burnout prevention starts with leadership.” Now I am going to ask each of you just to end with some take-home messages that you want to share with the KevinMD audience. Shari, why don’t you go first?

Shari Morin-Degel: I think the take-home message is that while we are still sorting out big system things—pay structures, systems—we still have to survive in the meantime. We can’t wait for those big system things to change. Absolutely, I don’t want to take away from the importance of having to figure those out, but we still have to survive in the meantime. So I think being able to know not just what works for you in your personal life, but what works for you at work—what works for you in your professional life—and protecting those things, being able to advocate for those things, and finding balance at work, not just in your personal life.

Kevin Pho: And Kim, as always, we end with you. Please share your take-home messages.

Kim Downey: So I liked what Shari shared today about what is a healthy nervous system and learning about that and figuring that out. Because when I went to PT school (we have some of the same stressors and burnout and moral injury), we didn’t have any classes on that. So I feel like for all health care professionals, that does need to be embedded in the curriculum. So I think that is really important.

And then also, I thought of the quote this morning (I think it is attributed to Maya Angelou): “When you know better, you do better.” That is not always the case. That is why I wanted to spotlight Shari because she is a good example of that. I feel like we need to amplify good leaders so what they are doing can be replicated.

Shari shared her important story of not understanding how her own unprocessed secondary trauma was affecting how she was showing up as a leader. Once she realized it, she acted on it. As I said before, she came to deeply understand that supporting employees is less costly than turnover, health care expenses, and disengagement. She transformed as a leader. Well-being is a shared responsibility between individuals, leaders, and teams. Leadership buy-in and support is the right thing to do and the sustainable thing to do for both individuals and organizations to thrive.

Kevin Pho: Shari and Kim, thank you so much for sharing your perspectives and insight. Thanks for coming on the show.

Kim Downey: Thank you, Kevin.

Shari Morin-Degel: Thank you. It is great to be here.