The PLA Podcast

Ep 2 - Part 1: Burnout and the Road Back: Rediscovering Purpose in Medicine

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In this episode of the Physicians Leadership Academy Podcast, hosts Dr. Stephanie Costa and Phil Cass are joined by transformation expert and coach Jim Marsden to explore burnout through a new lens. With deep experience across healthcare and corporate sectors, Jim introduces a powerful metaphor—the “left and right sides of the road”—to help leaders understand the inner tension behind burnout and how to reconnect with what truly matters.
 
This episode offers insight, reflection, and encouragement for physicians navigating exhaustion, cynicism, or disconnection in a high-demand system. Whether you're a current PLA participant or an alum seeking renewal, you'll gain meaningful tools and a fresh perspective to begin your journey back to purpose, vitality, and presence.
 
 🌱 Be sure to listen to Part 2, where we share practical strategies to move from burnout to transformation.
 🔗 Learn more at: physiciansleadershipacademy.org

Produced by the Columbus Medical Association

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UNKNOWN:

Thank you.

SPEAKER_02:

Welcome to the Physicians Leadership Academy podcast hosted by me, Stephanie Costa, and Phil Kass. Join us as we dive deep into the world of physician leadership, mindfulness, and rediscovering your purpose. Each episode features insightful interviews with inspiring guests who share their expertise and experiences, helping you become a more effective and fulfilled leader in healthcare. Tune in to reignite your passion and transform your practice. Welcome to the PLA Podcast. I'm excited to be joined with Jim Marsden and Phil Kast today. I'm Stephanie Costa and the PLA podcast. It's where we share all things PLA with people, connecting them to the mindset, the teachings, and community of PLA. Jim is joining us from Boulder, Colorado today, and most of us know Jim from when we were in the core part of PLA. Jim is an aficionado when it comes to Theory U, but some people don't remember that not only is he a coach and a facilitator, and has worked with organizations around the world in organizational development, leadership development. But he is this expert in transition and transformation and how we are in the world. The other thing I love about Jim is that he loves all thing wilderness. So we connect on that level an awful lot. Today, we're going to talk about burnout. And burnout is something that can kind of raise the hackles on physicians, but Jim has a little different approach that I think everyone is going to find incredibly helpful. So welcome to Jim and Phil, thanks for being here to co-facilitate this podcast today.

SPEAKER_01:

Thank you, Steph. Great to be with you both. Good to Good to see you. I get to see you both. So thank you.

SPEAKER_02:

Yeah, well, the great thing is Jim and Phil and I meet not infrequently by Zoom. And so we're expecting this conversation is really going to flow organically and we'll likely split this session up into two parts. So you'll be able to find a second part of that at some point. But let's jump in about this. And something that I've been noticing over the last 10 years, when we talk about burnout in the It can really cause some negative feelings in physicians. acknowledge that they may have burnout, let alone admit that they're not doing well. And we know that physicians are some of the most resilient people on the planet, but this increasingly demanding system of medicine plays a huge part in the development of burnout. And it's so complex. There's no easy solutions. And we can't really just leave it up to each individual physician to solve the whole problem. But Jim, you work with people from many different industries, not just medicine, who experience burnout. And I'm really intrigued by that personal approach that you take to it. Can you Tell us more about that.

SPEAKER_01:

Yeah. And let me start actually also by saying that I do work with physicians and doctors and folks in both medical and healthcare settings that span, you know, being on the front lines with patients and clients, but also in the world of academia. And then a lot of my experience also is informed by working with leaders in startup businesses and Fortune 50 and 100. I mean, there's the whole spectrum here. And there's something that I find that is super important about just being human in this dynamic. So when we start heading towards burnout, when I am with a client and it sounds like we're talking about something in the realm of burnout, whether that word's been used yet or not, I get super curious because in my experience working with folks, sometimes people are so exhausted that they will they'll start by saying, I'm afraid that I might be heading towards burnout. That might be the phrase, which is to say, I'm not in burnout yet, but I'm close and I might be knocking on the door. And so however it gets expressed, what I get super curious about are what's happening, what are they living, what is the lived experience at the moment? Because in my experience, burnout is, when it is with genuinely well-resourced people, it's when they are carrying unresolved competing commitments or the present of a tension that has become so constant that I'm now even almost taking it for granted and I'm trying to do the right thing, but I have not resolved the source of the tension of these things, which is importantly personal rather than obligational or organizational or something associated with the role. So if I continue with that, there's a lot of this that was coming up during the COVID time just because COVID shook up the context of so many different businesses and organizations where what people used to be able to count on within their organization or business or just getting things done wasn't the norm anymore. There's something different. And so it created all sorts of different challenges and people were exhausted. And so several things started to present themselves. One is that burnout isn't only about exhaustion. In fact, exhaustion may not even be the leading thing. It's just an important indicator. Exhaustion often is associated with too much work. So oftentimes burnout gets associated with I'm working too hard or working too much. And maybe there's an element of that, but that's not really the thing because we all might be able to relate to times in our lives where I worked a ton and it was really rewarding or I was really busy and it was really rewarding and flowed with the rest of my life. And so it's not about quantity. It's about unresolved tension. So I developed a metaphor that seemed to be general enough where it could cut across industries and situations, but specific enough where people could relate to it individually. And there's no judgment in this one at all. In fact, one of the things that I think that comes up when we start speaking about burnout is judgment is knocking on the door of burnout. You know, that judgment comes up when we start talking about burnout. And is it my fault? It's up to me. All the things around judgment. So here's the metaphor, just to hop right to it. What I invite people to do, and I invite listeners to do right this moment, is imagine that you're walking down the street of life. And it's the street of life. So all the things are there. Family, work, post office, the mundane, and the rich. Everything is right here. Imagine that you're on that street and you can see all the images of all of these things right here before you. It's all there. But the experience that you'll have on the left side of this road is very different from the right side experience. And so this road, like many others, it has these sidewalks. And so when we're on the left side of the road, we're walking down the sidewalk where it's the experience of being overwhelmed. There is a lot to do and there's an internal, your own obligation and genuine commitment and you're holding yourself responsible to do the things, whatever the things are. It's actually coming from a well-intended place. But in the way things are from the left side of the road, it's overwhelming. Your mission and purpose, the felt expressed mission and purpose on this side of the road is to keep it together. And sometimes I'll say it's to make it through the day. Or actually, it's to make sure bad things don't happen. And in many ways, that's the key thing over here when you're in that experience, is to do your best to make sure bad things aren't going to happen or aren't happening. And you're already likely in the context of some bad things happening. In this, the felt experience, just to continue, just to see if you can relate to having had these experiences, or maybe you're in this one now. There are several other things that are important here. you are carrying the sense that it is up to me. It's on my shoulders. And you're doing this again with best of intentions. But what this is leading to is you may feel at this time that you are disconnected from the people that really matter to you and from the things that actually bring you alive, bring you vitality. And if this continues, if you're not there already, it can lead to a sense of isolation and being in a dark pit or just, the worst of things. And even there, you will do your best from what you can do from this orientation to try to claw your way back up to the surface. And so at this point, you know, I'd be curious how many people can relate to having had this experience. I know I have. And it's when I am with a group of people and I share this and I ask how many people can relate, it's usually not just the lifting of hands, but hands shoot up. You know, it's Yes, I can relate to that. That can be me, or I'm going through it right now, or you just named da, da, da, da, da, da. So that's the first side. It's the left side of the road. Now it's the same street of life. So if we hop on over to the right side of the road, the right side of the road is having a very different experience. It's the same information, same data's in front of us, but I'm having a very different experience. And when I'm on the right side of the road, I'm actually connected with a different sense of purpose and mission. My sense of purpose when I'm on the right side of the road is that my role and my desire, my aspirations, my purpose is to bring forth more of what I love actually into the world. And that's what I'm doing. And I'm doing it by being with the world. It's not all up to me. It may feel from time to time that's on my shoulders, but I have support. I'm engaged. I'm connected. Sense of connection is quite different over here. This sense, this orientation on the right side of the road is a generative stance. Here, I'm clear. I'm grounded. I don't have to be right. It's not about being right or wrong. It's not about being forceful or defensive. I'm clear and grounded. And I'm working exactly with what is. I'm quite present to what is. So I want to make it super clear. This isn't about lollipops, unicorns, and rainbows. This is being quite clear with what is really here. But what makes the difference in the way of actually crossing the rope to get from the left to the right, is to remember actually what matters to you in this situation. Is to give yourself some elbow room to reflect and come back to this place of asking yourself, so what matters? What do I really care about? And what is mine to do in this place? It's a reconnection with your own personal sense of agency and your own personal sense of purpose. And even there, that might be too generalized, too conceptual. Let it be super personal. What do you really care about with what is actually happening at this moment? If you connect with that aspect first, even that connection, remembering what matters to you, can actually bring forth new choices, a sense of energy again, a bit of relief. And when I've been with clients and we're having these conversations, When they make that connection, I feel like my role is to get out of the way. Because it can happen really quickly that all of a sudden I see things I couldn't have seen before because I was really busy and entrenched on the left side of the road. So that's a quick flyby of the left and right side of the road and the kind of importance and simple sounding approach, which is very difficult to do in practice. of reconnecting with purpose and what matters to be able to go from the left to the right side of the road.

SPEAKER_02:

Well, and I feel like the left side of the road is so relatable and Phil, I feel like we're helping people connect and find that right side of the road through the PLA. So, you know, incorporating mindfulness and a sense of self and how we are in the world. Can you speak to that a little bit, Phil?

SPEAKER_00:

Yeah, I wanted to underline one of the things I think, Jim, you said was connecting to what is. Many, many years ago, I wrote a dissertation on this subject. And at the time, I was working with a lot of different populations of people. And one of them was farmers. And before I would work with groups of people, I would do a little research on where they were in the scale of of burnout and I discovered that farmers were some of the least burned out people in the research. So when I went to do a workshop with them, I said, I'm not sure why I'm here because you guys on the scale that I've looked at do pretty good. I said, how would you explain that? And one farmer spoke up and he said, I think it's because we don't fool ourselves. We know we don't have control of the weather. We know we don't have control of lots of stuff. We just got to be real with what is. And that was when you were talking about the right-hand side of the road, I was particularly struck by the notion of what is. And to your point, Steph, I think the meditation we do, that sort of thing, really is oriented toward helping people to be in touch with what is. Yeah.

UNKNOWN:

Yeah.

SPEAKER_02:

That's beautiful. And I totally get that mindset as well, because I grew up on a farm and yeah, people were pretty real. The relationships were really real and solid and such a sense of community. And Jim, when you were talking about that place of when someone is experiencing burnout and they're just so exhausted, inward and so disconnected and so isolated and it's such a lonely place and that's one of the things that I think I find really hard is being able to connect physicians who are really kind of struggling or hurting with resources or people that can really help them because you're relying on people to reach out for that help but they're in a place where reaching out for help just isn't even possible.

SPEAKER_01:

Yeah. Yeah, it's a really good point. Brings up a couple of things that might be practical and helpful here too. One thing is, again, from my experience, when people are in that left-hand side of the road experience, I think of that and the language I use is like, they're not well-resourced in that moment. And so to try to come up with healthy approaches, strategies that may be successful from that stance, from that orientation, really hard. And so what I like to do is to be with them in such a way where they can connect again with things that actually bring them into a place of vitality, something that helps them to experience Not strategize to, but experience something that is, this is me when I'm at my best, actually. Reconnecting with that. And sometimes it's even going out to the future. So for instance, one of the things that can be a helpful approach is to invite the person to share with you, the physician. So what's it like right now? Like, let it rip. I mean, just to not... not the leadership version of it, not what you're supposed to do with it, but what's it like for you right now, and just get it out. What that does, everything I'm going through, I'm able to put it out on the table and give it some names, and I can see it now in front of me rather than have this invisible cloud on my back. So even just that move alone can provide a bit of relief, and I'm starting to see things as they are, back to what Phil was sharing. And by the way, allowing yourself to have the experience to have you be the one to see what you're seeing. That's really hard. And I think this is actually something that's in play here too. And I'll get to that in a minute, but it's who I think I should be in the role that I have can be a very complicating thing at the moment. So what we're asking is just being the human being that you are and noticing you've got maybe a couple of letters in front of your name, um, But I'm talking to Sally or Sue or Steve, tell me what it's like and now just let it happen. So having the permission for it to be how it is and as it is, it can be actually a bit of relief right there. And it's just the start, but relief can start that quickly. The next thing might be to say, okay, I get it and share back and honor and recognize that that's actually really happening. To give no sense of judgment. The right thing, bad thing, your fault. Those things are like the tripwires that are in play already. But to invite them to say, okay, now imagine that it's two years from now and you are now in an experience where you're at your best. You're working with people that you love, that you care about, and they're supporting you and you're supporting them. It's a real rewarding experience and you're really... enjoying not just what you're doing, but you're looking back to see how you've gotten here. And you remember that there was this time where it was really hard. You remember that and you remember living that. If you look back right now and you touch base with that person who was going through it back then, but you're doing it two years from now, right? From the future, what words of advice or support would you have to offer? Or what is it that you might be able to see now that might be really challenging to have seen because you were so busy trying to be your best back then. What kind of perspective might you share? So even just letting them move to reorient fairly quickly to see new possibilities starts to bring some things up. What's not necessarily helpful is to move towards problem solving and strategizing from this other stance because I'm less than well-resourced And the thinking that's going on is coming from the places. You need to remember I'm in this pit trying to get out. And so it keeps me in this linear motion from being in yuck, trying to get to two or three stages better, let alone get to the surface. So some of those things kind of come up on what moves can be made to help them access a more resource place. It could be playing with your kids. It could be taking a walk in the park. You know, it could be start a gratitude practice because if you notice what really were moments in your life that brought you life in the last 24, 48 hours, you can't connect and appreciate that with actually acknowledging that that's something that matters to you. So, you know, there are some little things that can help them make the picture a little bit bigger and remember what it's like to be well-resourced, reconnect with that.

SPEAKER_02:

Yeah, I mean, just giving permission, right? to the doctor that you don't have to be this way all the time. Those societal and personal expectations that we place on ourself that can be so damaging and so just keep you in that space of isolation and what a relief it is when you're really allowed to just be your true self and that's celebrated and great.

SPEAKER_01:

Yeah. Yeah. Yeah. I find this one to be a pretty big deal of it's not conscious. It's less than conscious. And again, super well-intended, but it's trying to live up to the role and the image of that role that I'm carrying, who I think I should be. And so a lot of times on the left side of the road, I'm really busy with the shoulds and the need tos. And man, those things can get really weighty. And so being able to disconnect from the image I'm holding myself accountable to, often in these moments, others around may be even reaching out, trying to help, but I'm busy trying to be the best me, which means I'm trying to live up to these images that I've been carrying, sometimes for years and years before I even started this. And so that's a pretty big thing is if I disconnect from that image of who I think I should be as a physician, am I failing? The idea of fears, worries, and concerns and judgment and failure are big on this side. So a lot that can be done with sense, well, in some ways, the big work is sense of identity, but the more practical part is What is the dream I've been holding? And what is the real potential of what is being presented right now for me to step into and actually live rather than trying to continue to make the dream come true? So that's kind of a bigger idea, but I feel like that is a challenge that folks are working through on their own when they come to this place of burnout.

SPEAKER_00:

One of the things I wanted to kind of circle back to, Jim, that you said earlier, one of the things I've paid attention to when I see a physician or anybody that I'm working with, when I start to see cynicism start to increase, I'm almost, my antenna go up that we're either there at burnout or we're headed there.

SPEAKER_01:

Yeah.

SPEAKER_00:

And my way of operating with this notion of cynicism is that typically what breeds cynicism is fear, as you just said. And it's fear that my understanding of the world or what my belief is about the world is incongruous with how the world really is. And that sense of ideal, that sense of not being not only who I thought I was, but even some realistic things about who I think I am and how the practice of medicine is or whatever we're doing. The grounding of a reality is not just a

SPEAKER_01:

reality. I think that's a great catch. I think along with cynicism, I think of cynicism and practical expressions like sarcasm, a similar kind of thing. When that starts to show up, building on what you've just said, I too feel the same kind of thing. And sometimes I also think that it's a way of expressing anger without being angry and missing the resource that's actually in anger. But there's also kind of, to your point, I feel this, I'm disappointed or sad or frustrated, or maybe I'm in a moment that's knocking on the door of a loss of faith, that the way I thought the world would be if I did my part is actually playing out to not deliver when I feel like I've done everything I could. And that to me is kind of in that space of what I meant by the dream. For physicians, I'll generalize and have it be my own imagination. is that there's something I think of as like the deferred life plan, you know, where I'm going to do my part. I'm going to work really hard. I'm going to do all the things. And by age, I'll be in a place where I've got the, you know, all set and ready to go. And then I can breathe a little bit more and have a little extra space and enjoy life in a broader way. So I'm up for the, I'm up for the deal, you know, so to speak. It's almost like there was a commitment and a promise that's been made, but I'm the only one that seems to be living up to it in an overly amplified way and simplified way. So then here we are, we get to this place, and I feel like that's part of the unresolved competing commitments, is how come this isn't delivering in the way I thought? And the universe isn't holding up their end. That's right.

SPEAKER_00:

Yeah, exactly. It's like the universe is not holding up its end. So what do I count on?

SPEAKER_01:

Yeah, that's right. What can I trust? And so the cynicism kind of thing is like, well, I guess, you know, can't really trust that, you know, and then the sarcastic comments start coming in that are leaking, you know, a suffering of sorts. So another variation is I did all of it. I see I did all of it. And now I get here, is this really it? You know, I mean, wow. Now what? Should I be happy with this? You know, is another common thing as well. Folks in the realm that I'm often with is, you know, that can be, I sold the company. We did really well. I'm so happy with who bought it. And the people are going to be well taken care of. And I did really well. So why do I feel like I have a pit in my stomach on what's next and what I'm gonna be doing with my life? So bigger questions in play rather than just workload that's here. And so being able to head towards what matters and using this as an opportunity to bring about a shift towards alignment. is to actually come to be a better resourced individual working with the crisis or situation at hand. So there's an immediate benefit and to have a bit of integrity with who you are and who you're trying to become. But it's also you're doing your work in ways where you're not gonna be kicking a can down the road to just make it through this one only to bump into that can in the next situation. So it's an opportunity as well. It's a very rich opportunity you wouldn't wish on your best friend or an enemy.

SPEAKER_02:

That wraps up part one of our conversation on physician burnout with Jim Marsden. In part two, we'll dive into practical strategies for overcoming burnout, so be sure to tune in. This podcast is produced by the Columbus Medical Association. To learn more about the Physicians Leadership Academy, find resources, or apply, visit physiciansleadershipacademy.org.