The Worthy Physician

Stop Working Yourself to Death: A New Path Beyond Burnout with Scott Anderson

• Dr. Sapna Shah-Haque MD

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Burnout recovery expert Scott Anderson shares counterintuitive approaches to overcome physician burnout and find a sustainable path to high achievement without sacrificing wellbeing.

• Burnout involves oscillating between hypervigilance and avoidance, similar to patterns seen in PTSD
• Traditional approaches like vacations and sabbaticals often worsen burnout rather than resolving it
• The R&R technique offers a simple 5-second practice to interrupt stress cycles by noticing physical sensations
• Most burned-out professionals spend 80% of their time on activities that generate only 20% of their value
• Complete disengagement—even for just minutes at a time—is essential for burnout recovery
• Community support helps combat the isolation that often accompanies burnout
• Life beyond burnout can lead to greater achievement with less strain and more fulfillment
• Recovery doesn't require abandoning medicine but rather recalibrating one's relationship to work

For a free burnout assessment and personalized interventions, visit fastfixcall.com. You can also find Scott's book "You're Not Toast" and more resources at burnoutbreakthrough.com.




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Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.


Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books

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https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker

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Battle of the Boxes

21 Day Self Focus Journal

Speaker 1:

Welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shah-Hawk, reigniting your humanity and passion for medicine. With each episode, we bring you inspiring stories, actionable insight and expert advice. Get ready for another engaging conversation that could change the way you think and live as a physician. Your income is your greatest asset, protected with Pattern Life. The easy, stress-free way to find the right disability insurance, with unbiased comparisons and no jargon. Pattern helps you to choose the best policy for your needs. Secure your future today at Pattern Life. The link is in the show notes. Let's dive in. Good morning, mr Anderson. How are you? I'm well, thank you. How?

Speaker 2:

are you? I'm doing well. Also, where are you located?

Speaker 1:

I'm located in southeast Kansas. How about yourself?

Speaker 2:

I'm in Omaha, nebraska. Very cool, pretty close.

Speaker 1:

Yes, I really enjoy Omaha. Every time I visit it, I always enjoy it. And tell me about your practice in southeast Kansas. I'm an internal medicine dog practicing in rural Kansas. I'm kind of fell into rural health in a roundabout way and I've fallen in love with it. It's a small town, 13,000 people, but we can do a lot of awesome things. We're about 45 minutes away from Wichita, kansas. We can do a lot of big city medicine with the small town feel. I love getting to know my patients on a more personal level.

Speaker 2:

Well, it's so important right now. My God, the pressure on rural health care is amazing.

Speaker 1:

Yes, we're definitely feeling some of that, not all of it. They are. That's a cool thing. We get great health care in a small town setting. It's so important. Tell me about your work.

Speaker 2:

I'm a serial entrepreneur, had lots of businesses and completely burned out myself. I'm also a licensed mental health therapist. What I found in trying to solve my own burnout was I couldn't find very much in the literature. There's a lot of discussion about burnout, but the people that have done the best work. There's actually a sociologist at Berkeley named Christina Maslow. You're probably aware of her and you know I mean she's still practicing, she's 80, I don't know what, four or something, but she's amazing. She coined the term in the 70s. Still, it's difficult to find anything in the literature that talks specifically about it.

Speaker 2:

I was trying to help myself and my mental health clients after I sold my tithing agent. I wasn't finding much in the literature, so I was really just sort of hunting and pecking and trying things myself on myself as sort of the guinea pig to see if it would work. And trying things myself on myself is sort of the guinea pig to see if it would work. Most of the things that I tried not only didn't work but made it worse. All of the things that intuitively came to me this ought to work didn't work. And so I mean taking a vacation you would think that would work or taking a long weekend, but what I discovered was just everything that came naturally made it worse, so I started to gravitate towards things that were very counterintuitive. It reminds me of George Costanza's opposite day on Seinfeld. I just started doing everything the opposite, and part of this came also.

Speaker 2:

I started a not-for-profit called At Ease USA, which is a post-traumatic stress disorder treatment nonprofit that treats both combatants and their families and a lot of people in rural communities, and we did a lot of research with Levine University, with the team of psychologists there, and discovered that there are a lot of parallels between PTSD and burnout, and one of the main ones is we developed an app, actually with Tel Aviv University. The main discovery was that people with PTSD toggle very quickly between avoidance and hypervigilant at a very high rate of speed. Those are the two poles they're bouncing between. We found that a lot of people with burnout have the same cool data to support it, but anecdotally and in our practice we've discovered that it's a very similar thing and we try to we soothe by hypervigilance or by avoidance and both make it worse. In career burnout, people who are perfectionists and have no boundaries tend to do very well in business, so there's a lot of incentive to continue to self-soothe by hypervigilance and avoidant.

Speaker 2:

We started to look at treatments that would and what we discovered, and we looked specifically at treatments that paralleled some of the treatments we were doing with post-traumatic stress disorder, which mainly revolves around a very gentle form of exposure therapy. That was at least our foot in the door. We started to realize that, for example, one of the first things we give to your listeners is a very simple process called the R&R technique, and the idea is to just very gently be with the overwhelm and stress you're feeling in real time, as you're feeling it. We call this a five-second vacation or a five-second sabbatical. We've had a lot of clients that have taken month-long sabbaticals. We've had several clients take 90-day and six-month sabbaticals and come back to work just as burned out, if not worse. You would think that something like that would work, but it really doesn't, and it's a form of avoiding and avoidance just doesn't, and it's a form of avoiding and avoidance just doesn't work. In fact, what happens with most people who are burned out is that the hypervigilance piece is really kicking in while you're trying to avoid. That's this cycle, this oscillation between avoidance and hypervigilance. So this R&R technique is a very simple way to just be with the overwhelm.

Speaker 2:

What we ask clients to do is when they notice that they're overwhelmed. The key, first of all, is to notice that they're overwhelmed. Most people with burnout will immediately go into how do I make this go away? How do I avoid this, how do I manage it, how do I work with it, how do I fix it? And instead of just allowing themselves to notice what's happening, what we ask our clients to do is not notice what's happening intellectually, but just notice what's happening in their body.

Speaker 2:

And what most people find is that they could very quickly detect some kind of tingling or tension or pain or warmth or cool or something typically between the jaw and the navel. I mean, it could be anywhere, but that's where it seems to be most often. We just ask them to just notice, spend five seconds to just notice and be with the physical sensation and notice what happened. We find that when people can focus on the physical sensation and not intellectualize or try to figure out how to fix it, it's the main go-to for most people the hypervigilant piece that it begins to dissipate. In my own recovery from burnout, that was all I had for a long time I was reading a book by Michael Singer called the Untethered Soul, which is a wonderful book, and I stumbled into this sentence. I just tried it in desperation and it really helped. The same kind of thing happened with PTSD. If we can allow ourselves to be present to what's happening in the gentlest way possible, that will gradually allow the energy to resolve and be released.

Speaker 1:

I think I, physicians and entrepreneurs, or even therapists we're a high performing individual and there's a very cerebral part of our job, our jobs, professions and existence. So how does one, when it's just like go, go, go, pedal to the metal, how does one slow down and start to bring their mind back into their body and start to reconnect? As a physician, I'm always trying to intellectualize or problem solve. How do we learn to take that step back?

Speaker 2:

We found that desperation is not something we wish in anybody, but it's very helpful and for overachieving people who tend to intellectualize things the idea of not doing something or not figuring it out, not solving it so we found that desperation really helps. That's what really helped me. When you wake up every morning with this sense of I've got to get out of bed, but maybe today is the day I can't get out of bed. You know, that's the kind of wall that I hit and that most of our clients hit, where you really begin to realize that trying and worrying and working harder is not working out, once people reach a point where they realize you know, everything I've tried doesn't work. The next point is that we just create some very simple practices. The R&R technique is a great example where we simply ask people to routinely allow themselves to step away from what they're doing and interrupt what they're doing. Oh, you're probably familiar with the Pomodoro method working for 20 minutes, setting a timer, working heads down for 20 minutes or 25 minutes, having an alarm go off or a bell go off and then intentionally taking a break.

Speaker 2:

The main thing with, ultimately burnout is a stress disorder. What's meant to happen with stress is that it has a beginning, a middle and an end in reaction to something that really happened, versus an idea that we keep conjuring up what really is kind of an addiction. We want to be in high-performance mode, so we keep conjuring up this idea of threat which keeps us in high performance until ultimately it doesn't and the wheels fall off. But you know, in real, in a really stressful event let's say a near missed car accident what happens is the adrenaline, cortisol, the whole stress cycle going to high gear very quickly and very powerfully, ideally for a short amount of time. If someone almost broadsides us but doesn't, time slows down our reflexes and our school abilities and our sense systems becomes totally acute. But 90 seconds after that event is over, the whole cycle begins to wind down and ultimately resolve. And that's what our stress systems are meant to do is to protect us.

Speaker 2:

But what overachievers have learned to do and some of us learned to do this at a very young age is to put ourselves in a state that resulted in high performance, that got rewards in whatever form. You know, most of us, we talk about illegal drugs a lot, but we're born with chemistry sets in our head and most of us, as a very young age, learn that we can kind of cook up the chemicals we need to get into a certain state. If you're wired the way burnout people tend to be. There is this intellectual curiosity and ambition, but there's also the rewards that come from being a perfectionist and from having poor boundaries, always saying yeah To keep up with that. We've learned to create the chemical state and it's like creating near-miss car accident energy, but it's not real. That's the problem. So anything that we can do to consciously interrupt that multiple times a day and allow the stress cycle to resolve, rather than do what we habitually do, which is stay in stress cycle so that we can soothe ourselves.

Speaker 1:

That makes perfect sense. You hit two things You're giving a new context to the Conjuring movie series, but it's also something that we live with, isn't it? This is a very real state, particularly in not just healthcare but, I think, most businesses, not just in a capitalistic society. But we know that burnout, moral injury, is not just isolated here to the United States but is a phenomenon worldwide and we don't really learn how to regulate, take it into gear and then disengage. We continually stay engaged in that high-performing go, go, go and where, in theory, think we have missed the opportunities to learn or to teach boundary setting.

Speaker 2:

Yeah, I think so often what happens is this whole cycle of revving up your own stress system to a perfectionistic hum works. If it didn't work, we probably wouldn't have this conversation. If you're wired this way and if you're ambitious and intellectually curious, it really works. Burnout wouldn't be such a problem, but it really works. This perfectionism and no boundaries really work until the wheels fall off, but for a while it can really work.

Speaker 2:

The thing that I find with most of my clients who are ambitious people not bloodthirsty ambitious people, people who want to do good things, want to contribute to the world it feels as though we've got two choices I can either succeed at work or succeed at home and have peace at home, but I have to pick one. The idea is that if I'm not this revved up super achiever, I will live a life of mediocrity, that it's a zero sum game. Superachiever, I will live a life of mediocrity, that it's a zero-sum game. And I think that's part of what can help people is to understand that other options exist, that it's possible to manage and harness the kind of intellectual gift that people have, the kind of trust that people have, in a positive way, but also to be able to shut it off when they don't need it. What we found with our clients is that and that's a lot of what our practice is all about I mean the first piece to recover from the overwhelming exhaustion of burnout. The second piece, which we call beyond burnout, is to understand how to use your intellectual ambition and competitiveness in a positive way. People achieve much more when they are intentional and conscious about their energy than when they allow their fears and perfectionism to run their line, to be bullied every day, essentially by our emotion. But when we become intentional and realize, boy, I really get to choose, then we stop wasting time on things that have marginal impact.

Speaker 2:

A lot of us soothe ourselves by working. Unfortunately, a lot of the tasks that we soothe ourselves with are not high value tasks. A lot of what we do with our clients is to ask them to go through a goal shedding exercise versus a goal setting exercise, ask them to think in terms of what they really want to achieve and to do a time audit for a week or so to determine how much of their day is spent in high value activity and how much is spent in habitual low value activity. What we find with most of our clients is that they spend a lot of time. In the 80-20 calculation, they're spending 80% of their time doing 20% value impact work. We work with them. To flip-flop you don't need as much energy.

Speaker 2:

In most people's professional lives, there are two or three or four things that will move the needle the farthest and the fastest for themselves and for the people they serve. When we ask our clients to do a time audit, they inevitably find that they spend almost no time in a given week doing these high value tasks. They spend 80% of their time doing low value. So we try to increase the percentage of time people spend in their genius zone doing things that really matter, and the whole idea is to make this intentional and conscious. So if your point is what do you do with boundaries and how do we bring those into our lives? It feels like we're dialing down our lives to kind of C plus achievement. The opposite is true. The only way to get to the level of achievement that most high achievement people want to use discretion about how we use our energy and time, and also to be very conscious about why we're doing what we're doing, versus allowing our emotions to bully us into working for the sake of soothing our anxiety.

Speaker 1:

No, you didn't over-answer it all. I love this conversation because the next question is probably not something that I haven't found in the literature. On average, from anecdotally in your clients, how long does it take to go from hypervigilance or avoidant and burned out or moral injury to where you're discussing being in the genius zone and starting to draw those boundaries, starting to bring the cerebral part of life back into the body and really reconnecting? How long does it take on average? Sure.

Speaker 2:

Our program is called Burnout Breakthrough. It's a 90-day program. It is a combination of online training and online coursework, and it's not coursework in the sense of academia. What we ask our clients to do is to reevaluate their values, what they really love about their lives, and compare that to the way they're actually living, along with learning some techniques that are very quick and easy to do. So burnout breakthrough is a 90-day process.

Speaker 2:

What we find within just a couple of weeks is that a light bulb goes on for most people. Where they realize, mainly by their own personal experience, is that there is another way to live. There is another way to approach work, and it's not to live in an ashram, which I definitely consider. Well, you could do that if you want, but you don't have to. Within just a couple of weeks, most of our clients will say something like wow, I woke up this morning and I don't have that 10,000 pound elephant on my back, but it really it's just kind of a subtle shift. It's not abandoning and this is the problem that a lot of high achievement people have is that they feel as though they have to abandon their superpowers and have to live in an ashram, for example. The reality is, all of those gifts and passions can actually come to light and reach a peak in a whole new way. It's just that we don't have to do it the way that we've been doing.

Speaker 1:

Thank you for bringing that up and no, I don't think that looking at going and living in an ashram or doing a silent retreat is far-fetched Lots and lots of them myself, and they were all great.

Speaker 2:

Yeah, burnout. Solution to burnout.

Speaker 1:

Because you have that piece, you've shut out the external world. But then what do you do when you go back to reality? How do you engage reality? Either you can go isolate, but yeah.

Speaker 2:

I was living in Krakow, poland, and, interestingly, during the beginning of the Russian invasion in Ukraine, a lot of Ukrainian people were coming to Krakow to escape and this woman had Ukrainian couple living in her house and most of the people in Krakow had Ukrainian people living in their home. The population of Krakow doubled overnight. Anyway, my client was going through a six-month sabbatical. At that, she's a data analyst person and she was coming to the end of her six-month sabbatical, expecting to be fully healed, and the reason we got into contact was that she realized that not only was she not healed, but that she was actually worse off than she was before she started the sabbatical. It seems like a sabbatical should work, but unless our frame of reference changed, it's only a couple of degrees, of course, correct, but it really is. It has a lot to do with moving from our head to our hearts and getting out of our heads and into our lives.

Speaker 1:

I think we forget how much a little tweak like that can change the course. I mean we think about it with a ship and navigation, or operating a vehicle or a plane, but we forget how much we disconnect and just bringing that connection back, getting back to who you are as a person, is really powerful. I think I know. For me I was very.

Speaker 2:

Lots of clients doctors, nurses, staff, et cetera in healthcare that felt like, well, I'm going to have to abandon my practice or my vocation in some case, you know, and in some cases they're working in scenarios that they had to move out of. But they didn't. We haven't had anybody who had to stop being a doctor, a nurse or a helper. We have people in the fire safety police, you know realm that felt as though they would just stop doing what they're doing, and it isn't necessarily true. What we hope to get people to is a place where they can make a decision based on their values rather than based on the overwhelm and the despair of burnout, so that they don't make bad decisions. We've had people sell businesses, get divorced, move away for a thinking this will help in desperation, only to find that it doesn't help. So again, just a couple of degrees of course direction can really cause a revolutionary change in your life.

Speaker 1:

And yet in the end, you have to identify your core values instead of these extrinsic values that society likes to pump us full of. There's a disconnect on multiple levels, and just reconnecting with the way you've said it is so important. I think as humans, we forget how to do that. I'm guilty of that myself. But now tell us about. You're Not Toast, because you have a really cool book behind you and I'm fascinated by the title.

Speaker 2:

Yeah, we finally got it printed. I'll send you a copy If you go to burnoutbreakthroughcom, there's a digital edition of it, but you can now get the paperback. I'll send it to you. Yeah, it's basically summarizes everything that we've learned over the last 12 years working with thousands of clients to recover from burnout. It goes through every detail of how to do it.

Speaker 2:

A lot of our clients like things to be intellectually complex, but the solutions are actually quite simple, disarmingly and sometimes disappointingly simple. Yeah, it's disappointing intellectually. To hear take five minutes away from your desk every hour is not satisfying intellectually, but it really really works. One of the things that we were talking about, dr Maslach at Berkeley, and one of the things that she discovered and again it seems so.

Speaker 2:

I don't know if it's obvious or too simple to be true, but it's incredibly powerful is that one of the keys to burnout recovery is to be able to completely disengage from what you're doing, and most of us don't disengage ever.

Speaker 2:

We've got our cell phones or our pagers, we're at the ready at all times and even if we don't, we still don't disengage completely.

Speaker 2:

Part of her findings, after almost 50 years of research to burnout, is that without this complete disconnection, without this disengagement and it can be as brief as five seconds, but without that we really can't begin to recover. We do actually experience, and know we're experiencing, a disengagement. For example, she says the best thing we can do and she advises once an hour, as we do is to get up from your desk If the weather allows, go outside and walk around the block, go to brisk pace and really focus on your feet hitting the ground. Most of our clients refuse to meditate or say they can't meditate. We've given up on trying to help our folks worth to meditate. What we can do is to physically get up from our desk, leave our phones, our Apple watches or whatever behind and disengage for even five minutes. And if we can do that even three times a day, it's incredible the difference that it and it's not very satisfying intellectually, but really really works with burnout.

Speaker 1:

So it's therapeutic to just be human and not necessarily being productive, be in the state of being for five minutes several times a day and just I'm oversimplifying the process, but this is a big part of it.

Speaker 2:

Yeah, this is beautiful. Well, it's a big part of it and it's just. You know, in the trade-off my thought was that I cannot stop working for even five seconds. The consequences are so dire to me and the people that I work, I can't relax for even five seconds. It felt like life and death. You know in retrospect that's insane, but at the time it really felt like the amygdala and fight or flight parts of my brain were super triggered and it really felt that if I didn't work every moment of every day, that something really bad would happen to me or the people I love.

Speaker 2:

And that's kind of the stage where we meet with people. Even when we suggest five seconds, they bristle because it feels invalidated. It feels like you must not understand what my life is about. If you think I can take five seconds off or five minutes off and walk around outside, you must be insane. That's the state that we get into in the worst. I certainly did. And it felt like when people would suggest normal today what seems normal to take care of yourself seemed like people just simply didn't understand my world.

Speaker 2:

A lot of what we do in the Breakthrough program is that not only do we do individual coaching with our clients, but we also have masterminds that meet on Zoom once a week over various lunch hours throughout the week, and the idea is we found and this started in the basement of my therapy office that when we can get people together and they can talk about it and realize with other high achievement people that they're not alone, that this is very common and sometimes when they hear other people say I came in and afford five seconds to relax, it begins to finally sink in how crazy that sounds.

Speaker 2:

But the other part of unity that really helps in our weekly Zoom groups is that people begin to hear people who are farther ahead in the process making improve and having the experience I mentioned earlier of saying to themselves oh my God, it's gone. Burnout, this 10,000 pound elephant, ruled my life and now it's gone. Community really helps. Isolation is I'll send you a link to an online burnout assessment a summary of the Maslach burnout inventory. One of the chief symptoms of burnout is isolation and the sense that no one understands that there's no point even trying to describe. Community is a big part of our program and maybe in some ways the most powerful part.

Speaker 1:

I love everything that you're saying in it, because Dr Maslach has done amazing work. I had the pleasure of listening to her speak and reading some of her work. These are just things we don't talk about, so I appreciate this conversation. Sorry, I get a little emotional when I discuss this, but we literally work ourselves to death, to the point of no return, and the reason why this platform was started was because I had a colleague that took her own life in her office and I don't want to see that happen again. It's not worth dying for. It got to the point of severe depression no-transcript.

Speaker 1:

I am thankful that there are platforms like yours for those to reach out and that we're having this conversation, because had it been 10 years ago, I really don't think it would have been as well received as it is now. So I'm very thankful that we're here in a space where we can have this conversation, particularly as healthcare professionals, because previously there could have been some serious backlash or credentialing questions. I'm happy that that veil is starting to lift. There's still much work to be done.

Speaker 1:

Having said that, I'm thankful for the solutions that are coming forward, like getting your head back into your body, really looking for things that are simple, and let's quit intellectualizing everything. Let's learn how to be human again. Let's revisit our core values, because I think it's so easy to get sucked into a society where I never thought I'd be. I didn't know what I really wanted to do past a certain point, but it's so easy to get sucked into. You need to continuously perform, perform, perform and get those accolades. But it really is okay to love having some days off and spending it with the kids on summer break, diving back into work midweek.

Speaker 2:

My experience has been. The program that we have for graduates of Our Breakthrough is called Beyond Burnout. What we've discovered I would have just loved to not wake up overwhelmed with exhaustion. I would have given anything for that. But what's happened, to my amazement? The amazement of the folks we work with is that so much more is possible. I figured that the best I could expect was just this trade-off of having a really blah life. I couldn't be the kind of person I wanted to be anymore, but what happens instead is that so much more is possible.

Speaker 2:

The mantra of our Beyond Burnout program is what else is possible? If it's possible to get past the exhaustion and despair of burnout, then what else is possible? In every area of our life, To my amazement, life gets infinitely more rewarding. I've achieved way more. I don't care nearly as much, but I've achieved way more than I ever thought possible, and at that critical moment it could have gone either way. So I'm totally grateful for the work that you're doing, but I guess that's the point I would want to leave with people is that there is a life beyond burnout that is infinitely better. It's one of those. The good is the enemy of the best kind of a thing, and the longer we stay trapped in the good, and ultimately we can't keep doing it, most of us. We're postponing what can be an incredibly beautiful life that's so much better than whatever accolades we ever got. There's a life beyond that that is indescribably more and better.

Speaker 1:

And if the listeners wanted to reach out and connect, or to learn more about your work. What are the best ways?

Speaker 2:

There's two ways. One is go to burnoutbreakthroughcom and get our book You're Not Toast and I think it's five bucks or something and the other is we've got a system or service called fastfixcallcom. The idea is to provide first aid for people suffering from burnout. If you go to fastfixcallcom you can schedule a quick 15-minute call and we'll give you a burnout assessment and help you understand how specifically it's and we can give you some first aid type intervention that can at least start your recovery. If people want to go to fastfixcallcom, it's a free call. We're not trying to sell you anything, but what we are interested in doing is to give you some interventions that you listen to. What we discussed today.

Speaker 1:

This conversation is to bring forth the fact that burnout is still real, While injury is still real. It's still occupational hazard and there are solutions. This is one platform that is very well connected to the human spirit. It is backed by Sir Drew Dr Maslach, who coined the term, but it's aligned with what we've discussed here at the Worthy Physician since its inception. So thank you so much, Mr Anderson, for your time and for your expertise.

Speaker 2:

Oh, my pleasure, so great to be with you. Thank you for everything you do.

Speaker 1:

Absolutely. It's a great thing to do. Thanks for tuning in to another episode from the Worthy Physician Podcast. If you enjoyed this episode, be sure to subscribe, leave a review and share it with someone who'd love it too. Don't forget to follow us on YouTube, linkedin, instagram for more updates and insights. Until next time, keep inspiring, learning, growing and living your best life.