ADHD, Anxiety & More: Child Mental Health for Pediatrics
ADHD, Anxiety & More - formerly Child Mental Health for Pediatric Clinicians / PsychEd4Peds - is the podcast for pediatric primary care clinicians who want practical, evidence-based guidance for diagnosing and treating children and adolescents with mental health conditions.
Hosted by Elise Fallucco, MD, a nationally recognized child and adolescent psychiatrist and speaker whose educational programs have helped thousands of
pediatric clinicians improve their confidence in caring for children with mental health problems. This podcast is for pediatricians, pediatric nurse practitioners, physician assistants, family physicians, and other pediatric clinicians who want to confidently care for kids with ADHD, anxiety, depression, autism spectrum disorder, behavioral concerns, trauma, and other common pediatric mental health conditions.
Each episode translates the latest evidence into practical clinical pearls you can use in your office the very next day. Through conversations with leading experts in child psychiatry, psychology, pediatrics, and behavioral health, Dr. Fallucco shares real-world strategies, diagnostic tips, medication guidance, and communication tools designed specifically for busy primary care clinicians.
Are you looking for answers to questions like: • Which ADHD medication should I start first? • When should I use a non-stimulant? • How do I treat ADHD and anxiety together? • Could this be ADHD, anxiety, autism, bipolar disorder, trauma, or a learning disorder? • Which screening tools should I use? • When should I start an SSRI? • How do I manage common medication side effects? • When should I refer to child psychiatry? • How can I support children, teens, and families with confidence?
Whether you're evaluating ADHD, treating anxiety, managing behavioral challenges, prescribing stimulants or SSRIs, collaborating with schools, or navigating complex mental health presentations, ADHD, Anxiety & Beyond delivers practical, evidence-based clinical pearls to help you provide exceptional mental health care for children and adolescents.
Let's talk about clinician wellbeing and burnout...
In this episode, Dr. Elise Fallucco shares results from the recent AMA national survey about physician and APP burnout, and then shifts to talk about the portrayal of burnout and boundaries in a scene from HBO's "The Pitt".
She shared resources to address SYSTEMIC issues that contribute to burnout -
Welcome back to Child Mental Health for Pediatric Clinicians. I'm your host, Dr. Elise Fallucco, child psychiatrist and mom. So while we talk a lot about child mental health on the podcast, we also try to sprinkle in a couple of episodes that are really about your personal wellbeing as somebody who takes care of children. So in that vein, today we are gonna talk about clinician wellbeing and burnout. I'm gonna share some hot-off-the-press data from the latest national survey from the American Medical Association about job satisfaction and self-reported burnout. We're gonna take a brief quiz, we're gonna talk about the pit, and finally, we're gonna talk about how to maintain energy and joy in medicine, all in 15 minutes or less. We're talking about burnout in healthcare because, as we've talked about on previous episodes our profession is particularly prone to burnout. US physicians are about twice as likely to experience burnout when you compare with people working in other fields, even when you adjust for age, gender, relationship status, and hours worked per week. This is incredibly common, and sadly, is part of the reason why a number of us either leave the profession early, cut back hours, or even shift into another field. And given that there is already a national shortage of people who are specialized and trained to be able to take care of kids with mental health problems, we need to do all we possibly can for those of us who are trying to support kids and teenagers as they navigate their own emotional and mental health problems. So now for the quiz. What I'm gonna do is I'm gonna ask you a question that's the same question used by the American Medical Association when they sent out their national survey to assess self-reported burnout. So think about your answers to this, and then I'm gonna share data about what physicians and advanced practiced providers have reported about their own burnout. So here we go Using your own definition of burnout, please circle one of the answers below. Would you say, A, I enjoy my work. I have no symptoms of burnout. B, I'm under stress and don't always have as much energy as I did, but I don't feel burnt out. C, I am definitely burning out and have one or more symptoms of burnout, such as emotional exhaustion. D, the symptoms of burnout that I'm experiencing won't go away. I think about work frustrations a lot. Or E, I feel completely burned out. I'm at the point where I may need to seek help. So this survey and this particular question went out to about 19,000 physicians across the US, and what they found is that about 42% of physicians reported that they had at least one symptom of burnout. So basically, they chose either C, D, or E, and C was, quote, "I'm definitely burning out, and I have one or more symptoms of burnout." And then D and E were kind of more extreme, intense forms of burnout. While the AMA was very proud to report that these numbers are slightly better than they had been during the pandemic and in the previous couple of years, they're still pretty high. And you'd be curious to know which specialties have the highest rate of burnout. The highest rate of burnout was among emergency medicine physicians, with half of them reporting at least one symptom of burnout. But for those of you who are not peds ED docs, I wanna share the numbers for your groups potentially. So family medicine, the rate of burnout was 45%. Primary care was 43%. And In pediatrics, there were 40% of physicians who reported at least one symptom of burnout. The other thing that I wanted to share that I thought was really interesting is that in this survey, what they did is they compared physician rates with those rates reported by APPs. And I was kind of curious to see who's more burnt out or is it pretty much the same across the board? Well, here's what we found out. That overall, when compared with physicians, there were more APPs who reported burnout, as well as more APPs who said they intended to leave their current organization in the next two years. And fewer APPs compared to physicians reported that they felt valued which is bad news for all of us. And without taking a huge deep dive into the survey, there was a free response question at the end of the survey that said, "Tell us more about your stressors and what we, either the AMA or your healthcare organization, can do to optimize them." And what they found is that the most common theme is that documentation time and Inefficient issues with the EHR and their in baskets were the big systemic problem that they wanted help with to try to reduce their own stress and burnout. Okay. So as a brief recap, we've talked about how burnout is common in healthcare and shared the latest data from the AMA survey indicating that about 42% of physicians were reporting at least one symptom of burnout, saying they are definitely burning out. And I wanted to do a little tie-in with pop culture. Now, I don't know if you had had a chance to watch that HBO show called The Pitt," which is sort of like a modern reboot of "ER". I'm really into it because I think it tackles a lot of systemic issues in the healthcare system, and frankly, it's pretty entertaining. So I share this scene not only to let you in on my secret obsession with The Pit, but also to draw your attention to the fact that even pop culture is aware of our problems with burnout in healthcare. there was a particularly controversial scene, and that's caused a stir in the healthcare community. Basically, there's a third-year medical student named Joy Kwan who is at the end of her 12-hour shift in the emergency room, and she's getting ready to leave as the night shift is coming in when her supervising resident asks her if she's leaving and sort of sarcastically says, "Hey, I don't know if you've noticed, but we're sort of in disaster mode here and most people put in the extra time." So he's putting pressure on her to stay longer, to which the medical student replies Do you know that 62% of ED docs report suffering from burnout?" And then the ED doc says, I'm painfully aware." To which the med student replies, "Maybe you lunatics need to set some boundaries, like me. See you tomorrow, Doc." And she walks out of the ER. Jaw-dropping moment. And side note, I'm flashing back to any given point during my third and fourth-year clerkships where I would be at the end of a shift or post call going on hour 30, or I don't even know what hour, and my supervising resident would say, in kind of a passive-aggressive way, You know, if you really want, you could leave, but there's a really interesting case coming in." And being the people pleaser who I am, I would often reply, "Yeah, I'd love to stay," trying to sound sincere as much as I possibly could. And then, of course, I would stay. So it's particularly surprising to see this third-year medical student, in her first day in her clinical clerkship of the ER, has chosen to set a boundary and leave at the end of her shift. but we could go back and forth about what was great about setting that boundary, what was maybe not so great about this interaction. But what I do want to say is that setting boundaries is only a very, very, very small part of a way to promote our own wellbeing in healthcare. And really, we need to think more broadly and remind ourselves that there are whole system-level interventions that need to occur to be able to maintain our wellbeing as clinicians, as physicians, as APPs. Or as one of my colleagues once say, we cannot try to self-care our way out of this situation. And so to that end, I wanted to share a resource that I came across when I was preparing for this episode by the AMA. This resource is called The Saving Time Playbook: Build a Well-Run Ambulatory Practice by Optimizing Teamwork and Clinical Operations. And so this resource is really trying to give us tools in our individual practices, particularly in this case for outpatient care, to try to reduce some of the friction and eliminate some of the things that drive us crazy. And as an example, one of the strategies in this very brief playbook is called Stop the Unnecessary Work, and they have a de-implementation checklist that basically encourages practices to take a look at various processes or requirements or things that they're doing that add little value to patients and their care teams, and think about whether there's a way either to make them more efficient or to eliminate them entirely. And the example that they give was reduce mandatory trainings. which I love, especially on the tail end of our podcast a couple episodes ago with Dr. Nico Dosenbach, where we talked about how neither of us love to do these mandatory trainings for our healthcare organization. And then another suggestion they made was to consider allowing a test-out option for modules. I'm talking to you, hurricane preparedness module in Florida that we have to do every 12 months. So I'm gonna put a link to this saving time playbook because I thought it was pretty helpful, and at the very least, it can be a springboard for discussion with your colleagues, and your practice to think about what are the pain points what are things that we can do to reduce some of the issues around us that are contributing to our burnout or negatively affecting our wellbeing. And finally, before we go, while I'm acknowledging that we cannot self-care our way out of this, the reality is it's gonna take time for institutional changes to occur. And so I find it can be helpful to at least have some strategies or tools in the toolbox to help when I'm feeling overwhelmed, stressed, and in the middle of just an insane amount of end-of-year activities and concerts and last-minute schedule changes that has me pulling my hair out. I wanna give you a quick exercise that you can do now while you're listening, or potentially while you're driving or bopping around to reset your nervous system in the middle of the chaos. So this is a super simplified version and it centers around the number three. So right now, I want you to get in touch with your senses. Try to slow your mind down, if possible, from thinking about all of the to-do lists or challenging, tricky interactions that you just had. I want you to take a deep breath in and take a deep, breath out And I want you to notice three things that you can see and try to describe them. Now that you've seen those three things and paid attention to their color, to what's interesting about their texture, the way they're reflecting light, Now I want you to name three things you can hear. And get really quiet so you can hear even little soft noises. Finally, I want you to name three things that you can feel and that may even be the feeling of your legs on a chair or your feet on the ground. And by paying attention to these things around us, hopefully this is grounding us and kind of bringing us back into the present moment. So I'd encourage you to try doing this little exercise of three things you can see, hear, and feel and see if it can make a difference. And again, this is not the solution to burnout in healthcare, but just a little token of something you can do to help take care of kids and help take care of ourself. Okay. If you have any comments or response to the scene on the pit, I would love to hear it 'cause I'm so curious. Or if you wanna share any specific exercises or strategies that have helped you promote your own wellbeing and fight a battle against burnout, please let us know on our website, psyched, the number four, peds.com, where you can become a friend and colleague, sign up for our newsletter, and then we'd have the ability to email back and forth. Thanks so much for listening. I hope you found some part of this helpful or at least entertaining, and I wish you best of luck and gratitude for everything that you do every single day to help take care of kids. See you next time
