Emergency physician burnout and attrition

Emergency departments across Canada are seeing record patient volumes, bed shortages and overcrowding. A new longitudinal study in CMAJ, "Emergency physician burnout and attrition in Canada: a longitudinal study," finds physician burnout now above pandemic-era levels and driving reduced hours and departures from the specialty.

Dr. Kerstin de Wit, the study's lead author, an emergency physician and Tier 1 Canada Research Chair at Queen's University, reports that 65% of respondents to the January 2025 survey had high burnout levels, slightly higher than at the pandemic peak in December 2020, a  statistically significant difference. Participants described the health care system as broken, with chronic overcrowding forcing physicians to examine patients in corridors and waiting rooms as quality of care slips. Half the cohort had reduced shifts, 20% had stepped away from emergency medicine for a time, and 10% had left and not returned. She also describes physicians coping by detaching from responsibility for a situation they feel powerless to change.

Dr. Jillian Horton, associate chair of internal medicine at the University of Manitoba and author of We Are All Perfectly Fine, teaches an evidence-based program for physicians in distress. She argues that organizational factors drive 80% to 90% of burnout and individual factors closer to 10%, and that wellness efforts fail when they focus on individual-level solutions. Physicians now reject the language of resilience, she says, so she focuses on meaning, citing research that physicians who spend at least 20% of their time on the work they find most meaningful have half the burnout risk of physicians who spend less.

The study puts the cause in the system, which limits what any one physician can fix alone. Physicians can still protect the most meaningful parts of their work, which the research links to lower burnout risk.

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Transcript

Dr. Blair Bigham

I'm Blair Bigham.

Dr. Mojola Omole

I'm Mojola Omole. This is the CMAJ podcast.

Dr. Mojola Omole

So Blair, I'm going to start off today because this is about you. And your colleagues.

Dr. Blair Bigham

Is it about me, but I think it's also about all of us, Jola.

Dr. Mojola Omole

It is, but this article, by Kerstin, Dr. Kerstin de Wit, focused on emergency physician burnout and attrition in Canada, and it was a longitudinal study. So what are your thoughts?

Dr. Blair Bigham

And yes, it was, it was focused on emergency physicians. I don't think anyone would be surprised that emergency doctors have a shorter life expectancy than many specialties. They have a shorter career life expectancy than many specialties. And yes, we do burn out. Yes, we do quit at rates that are higher than the average doc.

But I think right now in Canada, the system is so crummy, it's so stressful that you don't have to be an emergency doc dealing with resuscitating a child to feel the heat. I think all of us are feeling this moral distress of working in a system that is failing the very people we got into business to help. And so I think it's very timely.

Dr. Mojola Omole

But I would say though, I think I would interject, I would say that there is like I do consider emergency physicians similar to family physicians as like our front line.

And, you know, when that, when our front line of protecting the public and protecting our patients fail, we feel the downstream effects and not necessarily the first effect of it. So, you know, it be we need to really this is an important study and an important conversation about what burnout is looking at at what burnout looks like, especially in this specialty where we all think you all are adrenaline junkies.

Dr. Blair Bigham

Yeah, and that's I think where the burnout discrepancy comes in, where people think that if an emerg doc is going to burn out, it's for the same reason a soldier might end up with PTSD. They think it's because of the high acuity. But I don't think that's why emergency doctors burn out. It's not because of the high acuity.

Dr. Mojola Omole

Well actually I think the opposite though. I think it's the opposite in the sense of you are the people who probably have more of an appetite to stand a system that is crumbling because of your nature to, you know, continue to keep on going. And if you're burning out and we have high rates of attrition, then we have to have a big conversation about that. So I think we should get into it.

Dr. Blair Bigham

Yeah, let's figure out what the data actually shows about emergency physician burnout and attrition. We'll start with Kirsten de Wit, the lead author of the study in CMAJ. And then we're going to speak to someone who teaches an evidence-based program for physicians who are facing distress. We'll talk to her after we talk to Dr. Kerstin de Wit about her study.

Dr. Mojola Omole

Dr. Kerstin de Wit is an emergency physician in Kingston, Ontario. She holds the Tier 1 Canada Research Chair in Emergency Venous Thromboembolism and is a professor in the Department of Emergency Medicine at Queen's University. She's the lead author on the article. Kerstin, thank you so much for joining us today.

Dr. Kerstin de Wit

Thanks so much for having me.

Dr. Mojola Omole

So, there's been a lot of coverage about the crisis in ERs across the country. Can you describe what the crisis looks like from the perspective of ER physicians, such as yourself and Blair? That also those included in your survey?

Dr. Kerstin de Wit

Yes. Yes.

So I'd say over the past eight years, we've seen a gradual increase in the number of attendances to the emergency department, and the complexity of the patients who present to the emergency department has increased dramatically as well.

And because of the crisis in the beds in the hospital, we're finding a lot of patients are attending the emergency maybe a day or two days after being discharged from the hospital, so we are seeing a lot of patients being admitted, discharged and then recycled back through.

The specifics that I've experienced, I'm sure Blair's experiencing, and we heard in the survey from our participants, was the lack of beds to see patients in the emergency department to the extent that they felt that they weren't really working in their own emergency departments. They were instead working in corridors and in the waiting room.

And the sentiment that the quality of care was deteriorating and that there was a trajectory where the deterioration was going to continue to worsen.

Dr. Mojola Omole

Now how does that affected you personally?

Dr. Kerstin de Wit

Personally, I feel exhausted when I'm in the emergency. I know a lot of my colleagues do too, and that also came through in the survey. By the end of my shift, I even find before the end of my eight hour shift, my brain's already deteriorating. My ability to make quick decisions has already deteriorated. My ability to make good decisions has deteriorated.

And that's partly because the environment has changed. There are just so many more people crammed into a small space. There are so many different interruptions. It's very, very noisy. We may have alarms going off all the time. We might have patients who are noisy. There might be 10 different conversations that I can hear at the same time and I'm trying to focus on the one conversation I have with my patient.

And if I'm having that in the corridor, then I really have no privacy. I'm trying to read between the lines when I ask patients questions because they have no privacy. I can't actually ask all the questions I need to ask and I can't expose them to examine them properly. So I'm actually not doing my job. I'm not conducting my everyday work the way I was trained to do that, and I know that comes with missing things. And I think that's an added stress.

Dr. Mojola Omole

And how many physicians in the survey report being burned out?

Dr. Kerstin de Wit

So in our most recent survey, 65% of all the people who responded qualified as having high burnout levels. So that's important to distinguish between being burnt out and actually having very, very excessive, high burnout levels. High burnout levels are associated with adverse mental health and suicide.

So 65% of the participants had high burnout levels, and those levels were higher than they were at the height of the pandemic in December 2020. Although only a tiny little bit higher, but statistically significantly higher.

Dr. Blair Bigham

Whoa.

Dr. Blair Bigham

So this whole idea that things have gotten better after the pandemic does not bear fruit.

Dr. Kerstin de Wit

No, absolutely not. And the burnout, it can no longer be blamed on the pandemic. It's really associated with the state of our healthcare system and the inadequacy of the resources that we have in the emergency department.

Dr. Mojola Omole

So you report a sentiment of almost kind of surrounding surrendering to the situation to the kind of the constant chaos and demoralization that's in emergency medicine currently. One quote from your article was, "Most of my patients cannot be helped. They spend 8 to 12 hours in the waiting room and I no longer see that as my fault. I just don't think about it anymore."

How common is this sentiment of sort of just shutting down from the crisis, you're checking in, doing your shift and checking out?

Dr. Kerstin de Wit

Yeah, great question. So what we learned in the most recent survey is that many physicians wanted to leave. They wanted to stop working in emergency medicine. And while some people had left, others either felt that they should stay because they owed their profession something, or they felt that they couldn't leave because that was their main training. They didn't have an alternative clinical specialty to move into.

And what we saw this time was a very different change towards resetting of the mental vision and the framework around responsibility for the situation. And it was as if they had tried the first two, three, four years to make a difference, and they had tried so much and they had got nowhere, that now they just had shut off. So they just would see it as a way to earn their living, to go in, see as many patients as they can, try and do a good job with that, but not to see themselves as personally responsible for the situation because they had tried everything they could within their power, and they felt powerless.

So it was almost like an approach to enabling them to go back in and go to emergency every day to keep working there. And that seemed to be very common. So this detachment, you might call it disassociation, no longer feeling that you're to blame, and part of that is actually not feeling responsible for the poor medicine that's being offered because it's not your fault.

Dr. Blair Bigham

I almost had an opposite reaction in a sense a couple of years ago, where I had that sort of depersonalization, numb feeling going to work, and I decided to sort of throw myself in the fire and like advocate as loud as I could, and got that, you know, brick wall in my face, and basically, I actually took two years off of emergency medicine because I said if I can't, and like, I mean like I'm a healthcare advocate, like if I can't make any change here, and I have a 98-year-old crawled up on the floor sleeping because their plastic chair is too uncomfortable, like I just couldn't do that job anymore. And, and I did burn out and had to walk away from it for a while.

Dr. Kerstin de Wit

And that's also a phenomenon that came through. So we have really a list of coping strategies, and one coping strategy is the distance and no longer feeling responsible. But actually 50% of our cohort had reduced their shifts, so to protect themselves, they had reduced the amount of time they were exposed to it, and 20% had actually taken time off emergency medicine altogether, just like you, Blair.

Dr. Blair Bigham

20%? Oh, I don't feel so weak anymore.

Dr. Kerstin de Wit

Yeah, one in five of physicians had had to step away for an amount of time to feel well enough to come back to work there again. But we do know in the survey, 10% of respondents had left altogether and they had not come back.

Dr. Mojola Omole

What do you think is the way out of this?

Dr. Kerstin de Wit

That's a very, very big question.

Dr. Mojola Omole

Well, let's okay, let me reframe it in the sense of if you had no constraints, I would say if you're queen for a day, what would you do?

Dr. Kerstin de Wit

Yeah, okay. I would spend a huge amount of money on the healthcare system. I would build I would increase the number of hospitals fourfold. I would build big hospitals with lots of beds. I would increase the number of long-term care beds tenfold. I would pay PSW workers a lot more money so that we had enough PSWs who could be actioned quickly when somebody's an older person's in an emergency to allow them to safely go home. There's no there's no answer that doesn't involve a lot of money.

Dr. Mojola Omole

I almost

Dr. Blair Bigham

Well, I almost feel like cutting

Dr. Blair Bigham

Well, I almost feel like cutting you off and being like, well, wait a minute, like we all know the answers. We don't have the agency to implement them. That's part of why we're all burned out. What is an actionable item that I can take, that you can take, that Jola can take, any one of our listeners, when they go to work, whether and let's face it, it's not just emerge docs, I think it's everybody who works in the healthcare system, like what is an actionable way to crawl out of a burned-out mindset?

Dr. Kerstin de Wit

Honestly, I think from everything we have collected over the years in this cohort, I think taking time to yourself, so reducing your shifts or taking time off is the number one thing you can do to help yourself. And that is very, very tough to do if you have a family who are relying on your income, or if you're self-employed, you know, we have no sickness pay. So some people I know feel very, very trapped.

But hospitals should be allowing physicians who want to, to step back for periods of time, and somehow allow them to do that so that they can come back to the specialty rather than leave the specialty. But, you know, another theme that came through was that, you know, the little things that people talk about wellness initiatives, people were so sick of hearing about wellness initiatives.

Dr. Mojola Omole

If I get one more person come around telling me how to stretch or giving me like a granola bar, I'm just like, honestly, shove it.

Dr. Kerstin de Wit

Yeah. I mean, in some of the quotes were just perfect, you know, no amount of wellness initiatives are going to get their patient to the operating room or to get them onto a bed in the ward, and that's what's causing our burnout.

Dr. Blair Bigham

Totally agree.

Dr. Kerstin de Wit

I do think there are small ways that hospitals and departments could try and help their physicians. So we do a lot of work in the emergency department that you might consider really work that an extender could do. So, you know, I was working last night and at 2:00 in the morning I was calling a son at home to find out about their parent's baseline function, what resources they have to help care for them at home. Those sorts of things don't necessarily need a physician to call.

We really need access to people who can provide communication with older patients who seldom feel that they're in the loop about what's happening and they can be left for 12 or 24 hours without understanding what's happening. People who could keep older patients company, who could, you know, when they're uncomfortable, they need more pillows, they could go and do those things. They need another blanket, they can go and get a blanket.

There's a lot of help that is missing, and at the moment, the people who provide that care are the physicians and the nurses. We don't even really have enough people to ensure that older adults can feed themselves when they're in emergency departments. So we have people who sit sometimes for days without a proper meal simply because they can't open the the apple juice container, you know, they can't get into the plastic knives and forks that are in the sealed bag to eat their their food tray.

Dr. Blair Bigham

Yeah. It just it is not a place you want to associate yourself with. It's just not a place worthy of of human, you know It's just it feels so wrong to feel like you're participating in a system that stoops that low.

Dr. Kerstin de Wit

Yeah.

Dr. Mojola Omole

Thank you so much for joining us today, Kerstin. Thank you.

Dr. Kerstin de Wit

Thank you so much for having me.

Dr. Mojola Omole

Dr. Kerstin de Wit is an emergency physician in Kingston, Ontario, and a professor in the Department of Emergency Medicine at Queen's University.

Dr. Blair Bigham

The participants in Kerstin de Wit's survey said that they were coping by cutting shifts, taking time off or just leaving medicine altogether. Dr. Jillian Horton got to that point, but stayed in the career. She's an associate chair of internal medicine at the University of Manitoba's Max Rady College of Medicine and the author of one of my favorite books, We Are All Perfectly Fine. And she teaches an evidence-based program for physicians who feel that they're in distress. Jillian, thank you so much for joining us today.

Dr. Jillian Horton

Oh, it's my pleasure to be here with you, Blair.

Dr. Blair Bigham

So Kerstin's respondents when she did this survey were sick and tired about hearing about wellness initiatives. I mean, Jola in the interview even said that if one more person comes around to help her do some stretching or hand her a granola bar, she's going to lose her mind even more.

Dr. Mojola Omole

I second it.

Dr. Blair Bigham

What is behind that reaction? Why have we become almost anti-wellness?

Dr. Jillian Horton

Well, I think it comes from an absolutely natural and appropriate place. And it's interesting, Blair, I had this unexpected experience about five years ago. I wrote a piece for the Los Angeles Times about a phenomenon that I called muffin rage. And I didn't really think anybody else was going to relate to this. It just sort of seemed like something I was writing to get it out of my system.

And what I described in that piece was the experience that I'd had when I was a resident, and one day I walked into my hospital, one of my hospitals, and there was a huge banner, and the banner said, Resident Appreciation Day, and under this banner was a big plate of muffins. And so, you know, 6:45 in the morning, walk by, pick up that muffin, and I just vividly have this like flashbulb memory of moving this muffin towards my face and instead of eating it, just having this overwhelming desire to use it to inflict maximum damage on everything around me.

And in that moment, you know, it was like the muffin just was this symbol for me of this, you know, what I actually didn't need. I didn't need a muffin. What did I need? I needed a workload I could actually do. I needed to be sleep restored. I needed a psychologically safe and healthy environment. I needed to see my family who I'd barely laid eyes on in months, it felt like. And instead of that, you know, you feel like, sorry, can't do that, but here's your muffin. Right.

So I think that reaction that you mentioned from Jola and kind of the visceral, almost like annihilating response that so often meets, you know, HR or hospital administration when they say today's wellness day, they really don't understand that when those things are being offered to us, what we're feeling in that moment is you actually don't understand anything about what we need. We've got the Grand Canyon here and you're offering a muffin to fill it up. And that's one of the reasons why I think wellness has really suffered from the way that often it has been handled and responded to at an organizational level.

Dr. Blair Bigham

What's your take on how we should all be using the word burnout, especially when we're trying to drive change?

Dr. Jillian Horton

Sometimes for me, it's flipping the script and saying, okay, we're all actually sick of talking about burnout, right? We all know burnout is a crisis. It's an existential crisis in our workplaces. I mean, the numbers in the study from the author that you just talked to, they're horrifying. Let me look at it from a different perspective. What do we want it to feel like to work where we work? What would it be like if it could, you know, if we had well-being at work, occupational well-being?

And for me, the Stanford model of occupational well-being is the one that I go back to again and again and again. And the first piece that it's encompassing is a culture of wellness. That's where sometimes people get it wrong, right? That's where they go, oh yeah, we have a culture of wellness. We've got Jola's yoga class and and the therapy dog that we bring in. And like that is not a culture of wellness. A culture of wellness is about leadership. A culture of wellness is about whether people feel appreciated in their workplace. It's about meaning in work.

And then there's the, you know, efficiency in work, workplace efficiency piece that is all the all these metastatic problems that we face with electronic medical records and workplace design and workflow and and incorporation of IT and everything else into that side of it.

And then the third piece, the piece where, unfortunately, the conversation so often begins and it therefore alienates us, the third piece are the individual factors. And that's another paradox, right? That the organization, the other two things are enormous. They're so big, right? They're The literature tells us 80% to 90% of the problem. Individual factors, maybe 10% approximately.

Dr. Blair Bigham

I want to dig in I want to dig in on that point specifically because, and I have to admit that eight or nine years ago I fell in love with the word resilience. I fell in love with the idea of resiliency training and that we could, you know, we can't control what's around us, but we can control the way we feel about it, right? This idea that resilience would get me out of this.

And and what I came across over time was this this negative sentiment towards the idea that wait a minute, this isn't my problem to solve. Why should I be stronger? I should have every right to fall apart after being awake for 30 hours. I'm wondering, how do you see the resiliency movement in Canadian medical education shifting and moving, and how can leaders learn from that?

Dr. Jillian Horton

Yeah. Um, I love how you framed that, Blair. So the first thing I totally agree with you. I mean, resiliency for medical learners overall and for most of us as staff is now experienced as a dirty word, you know. It's like don't you dare tell me to be more resilient. That is actually a completely appropriate response, as we know. What does the literature tell us? That we are really resilient people, that we are more resilient than age-matched controls. And guess what one of the things is, as we know, that allows us to function with high levels of burnout? High levels of resiliency. Both of those things often go hand in hand.

So to me, one of the challenges is because that is so often presented first, it's led with, it's that same emotional response as the muffin. Are you kidding me? You're starting with what I need to do. 10% of the problem is me. The other 90% of the problem are these system issues and workplace efficiency issues. Once we begin with that, and if we don't offer critical context for that, we have absolutely lost our audience. Nobody will ever come back and listen to us a second time, right?

So for me, I do believe those things are important, but they have to be framed in an honest way and and a a way that reflects the reality of everything else. So, you know, when I go to talk to groups, um, or when I'm teaching medical learners or speaking to anybody, I always start with three disclaimers. And the first disclaimer, I always say, these are things that I know they know them, but I need them to know that I know them, too, if they're going to take what I have to say seriously.

The first thing is what we've already touched on, organizational factors are the primary drivers of burnout, period, full stop. Not their lack of resiliency, that's not why we're there. Right.

The second thing is what we just said, we know they're resilient enough. The fact that they're still working after a pandemic, they have passed their physiologic stress test. They are all very resilient people. We know that, you know, the lovely study applying it to medical students that Canadian Chantal Brazeau did looking at, you know, the mental well-being of medical students before starting medical school and after. It was better than age-matched controls before and it was worse after they entered medical school and were matriculating. So, you know, again, getting that onto the open, we know that. That's not why we're talking about this. It's not because of a deficiency.

And then I think the third thing that has to happen before we can talk seriously about what we can do to help ourselves and why that still matters and is strategic, the third thing is, you know, I'm a big admirer of the work that underlies, undermines, under, pardon me, I made a few Freudian slips there, I think, of the work that underlies the joy in medicine movement. But I actually think a lot of people don't want to hear about joy in medicine right now. You know, you walk into our emergency departments, as you don't need me to tell you, they do not feel like very joyful places. So then you've got somebody coming saying work to find joy, it's another injury. Right.

Dr. Blair Bigham

They're shameful places. In many cases, it feels like things have slid even further towards disaster. And and Kerstin had mentioned that at some point many physicians are stepping back. They're leaving, they're working less, taking shift reductions. How effective of a strategy is that for the individual physician who says, "I'm like I've had it. I just cannot keep doing this. My family says I'm a disaster when I get home. I feel like a disaster." At what point do people have to step back?

Dr. Jillian Horton

Well, you know, the way I would frame that, Blair, is that the literature tells us that it does work in a general sense. And, you know, people sometimes hear that and they go, "Well, yeah, that's obvious." It's not necessarily obvious because a competing theory would be that the workplaces where we are, what if it's just true that they are so stressful and and the tipping point, we are so far past it, that the only way to mitigate burnout is actually leave those workplaces altogether.

Dr. Blair Bigham

I I I just want to leverage the the openness that you had in your book about the time or a time that you were struggling, and I want you to maybe help us connect that for physicians who do say "I'm going to take a shift reduction, I'm going to take three months off," what can they do in that time that they're buying themselves that maybe you can share some of your experience around how to bounce back and and stay in the game in the long run?

Dr. Jillian Horton

Yeah. Um, you know, great question, Blair, and I think it takes us back to so where we were a few minutes ago was this question about like individual factors. What can I do and why should I have to? You know, why should I have to when everything else is is the primary issue?

And I think what you're talking about, whatever it looks like for individuals, whether it's necessarily reducing, you know, FTE hours, whether it is necessarily taking time off and needing to step away to tend to other things in life, um, you know, within that time, what can a person do? And I think there are some things that, you know, definitely I really believe in that also correlate to evidence. And again, I'm very careful with my framing here, because to me, if anybody walks away from a conversation that I have with them thinking I said, "Well, if you do this, it will fix everything and you should have done this and it would have made things better," no way. These are just components, you know, small pieces of a puzzle, but they're important pieces because we have to find a locus of control wherever we can in, you know, in this landslide or we are just going to keep sliding down the hill.

So what do I see personally as as meaningful that's backed up by literature? Well, one thing is, you know, I'm sure you both know the work of the wonderful Colin West at the Mayo Clinic. He's a mentor and a friend of mine, and just has written some of the most important and thoughtful stuff about healthcare worker well-being that's out there. And a while ago, Colin gave Grand Rounds for us at U of M and he said something that I have never seen him say this exactly in print, so this is oral knowledge sharing, but he said basically every intervention that's ever been shown to help with burnout comes back to meaning and purpose.

And so, you know, you might pause and think about that and go, "Well, really? Like the EMR stuff, the IT stuff, like really?" But yes, because it all all those things, one of the things they have in common is giving back time, restoring relationships. And relationships, medicine, as Colin says, is a relational event and a relational experience and profession. That's what we signed up for, you know. We don't always feel like it's like that, but that is at its heart what it is that we're still, you know, longing for, I think, most of us.

So therefore, what can we do, you know, following on that, where do we see opportunities to hack into meaning and purpose in our work? We know that again going back to that culture of wellness, a culture where there is wellness is one where people are still able to connect to the deeper meaning in their work. So there's a nice study published in 2009 by Tait Shanafelt and Colin West and others, and they looked at academic physicians. And, you know, how much work they were doing of their kind of daily work that they felt was their most personally meaningful.

And, you know, hearing them talk about the study, Tait and Colin, when they first did this, the thinking was maybe that more would be better, you know, that Jill Horton, if she was spending 80% of her time doing her most meaningful work and Blair and Jola were at 60 and 40, that Jill would be much better off. That's not what they found. They found that 20% is a a beautiful sweet spot, and then there's no benefit after 20% in reductions in burnout. However, people who did not make it to 20%, so they were doing basically less than 20% of the work, their time spent in the work that they found the most meaningful, the people who made it to 20 had half the risk of burnout of those of their colleagues who didn't make it to 20.

So what I like about that number, it feels hopeful. It gives us something concrete. Now, again, medical students listening might be, "Well, I have no control over my life, so this is hopeless." What I would say to them is firstly, one day you will, and secondly, you are going to get to choose what you do, and this can be one of the, you know, breadcrumb trails that you follow to figure out what what, you know, fills me up, what what kind of makes my heart beat a little faster for that meaningful thing that is just aligned with who I am.

So, you know, looking at our work and saying, what is it that I find what's the most meaningful part of my week? Is it, you know, talking to families? Is it working with a particular patient population? Is it working in a particular setting? Is it teaching? Is it administration? Is it research? And then doing everything we can to make sure that we get to 20, and not being obsessed about going beyond it purely from a burnout point of view. One of the reasons that number may have that ceiling is for most of us, what we say is the most meaningful is our clinical work, and the clinical work is so hard that, you know, you can see that 100% of your time spent in clinical work is is also going to increase your your burnout proportionately, depending on the environment.

Dr. Blair Bigham

Jillian, all of this is fascinating. I think our listeners are intrigued and I wish we could go on, but we're going to have to leave it at that for now. Thank you so much for joining us.

Dr. Jillian Horton

Thank you so much. Lovely to be with you both.

Dr. Blair Bigham

Dr. Jillian Horton is associate chair of internal medicine at the University of Manitoba and author of the acclaimed We Are All Perfectly Fine.

Dr. Blair Bigham

So Jola, what's your take on this? How do we move forward?

Dr. Mojola Omole

Well, um, that's a tough one because it seemed pretty grim, um, in terms of all of us feeling the same way. We're like, you know, wellness is in a way has been weaponized and has in to just as a Band-Aid and a check mark of we care about wellness. However, throughout the conversation with Jillian, that 20% really resonated with me. That if you do 20% of what you find meaningful, that is protective against burnout.

I I am going to start using that when I'm mentoring, to say, maybe not in your training. In your training, if you can get 2 hours in a week where you loved it, keep on going. But as you build out what you want your future to look like, keep that 20%. Does my work life, and that includes things that you do outside of work, but are still part of medicine, am I getting to that 20% number? And how to get to that 20% number. So that to me was really powerful because that gave us back agency.

Dr. Blair Bigham

And it made me think that there's probably on the tail end of that spectrum another, I don't know, 10% or a 20%, it's a part of the job that you really get driven crazy by, that you really can't handle. And one of the things that I I read while I was looking through my own sort of burnout journey was Lisa Feldman Barrett's psychological work around this idea of having an emotional vocabulary.

So instead of saying I'm burned out, being able to take the word burnout and break it down: I'm tired, I'm feeling disrespected, I'm feeling like I'm not heard, I'm feeling sad, I'm feeling hungry. And when you can break down what exactly don't you like, instead of just saying, "Well, I'm burned out," and everyone goes, "Oh god, you need to take time off," you say, "No, no, no, I'm actually feeling XYZ." And then you can say, "Okay, we have a more precise category of burnout, a more precise reason for the way you're feeling what you're feeling. Maybe now we can start to address it."

Maybe it is a shift reduction, maybe it is a bit of time off, or maybe it's just kind of shifting how we view our current workload. So that that 20% where we have a positive valence sort of gets beefed up and that small percent on the other end that we just cannot handle, it makes us miserable, is somehow better understood.

Dr. Mojola Omole

It's interesting as I was listening, I'm like maybe the reason why everyone's like, "Oh well, you do so much. You do the podcast, you do this, you're a surgeon, you're a single mom." It's because I would say probably 70% of my job I love.

And that's not because it's just the job, it's I love my patient population, and I will always say this: I cannot work with better colleagues, from whether it's like my fellow surgeons in my department, to anesthesiology, to emergency physicians, to internists, everyone feels that we all I feel like we're all in this together, and I really find that being in a collegial environment where we just, you know, we talk about medicine, whether we talk about other things, has really improved just how much I love what I do.

Dr. Blair Bigham

And that's what Kerstin found, certainly, that culture is a huge part of this. And I think what Jillian was getting at when she talked about the relational nature of our work, sometimes colleagues are everything. And maybe that's one area where we can all try to bolster the circumstances we find ourselves in.

Dr. Mojola Omole

This has been a great conversation.

Dr. Blair Bigham

That's why I love doing the podcast with you, Jola.

Dr. Mojola Omole

Exactly. Like it honestly is a part of what prevents that exhaustion because we get the ability to be advocates and to do work that is within medicine, but fuels a bit of creativity and gives us a lane to amplify voices that often aren't amplified.

Dr. Blair Bigham

That's it for this episode of the CMAJ Podcast. I don't know, maybe that was my favorite episode, even though we're talking about burnout. Uh, if you're feeling burnt out or if you're not, do me a favor. If you can head out and like or share or subscribe to our podcast, it will help us widen our audience. We would really appreciate it.

Dr. Blair Bigham

The CMAJ podcast is produced by Podcraft Productions. Neil Morrison is our producer. Catherine Varner is a deputy editor at CMAJ and senior editor of the podcast. I'm Blair Bigham.

Dr. Mojola Omole

I'm Mojola Omole. Until next time, be well.