Ep 2 - Part 2: Reframing Burnout: Small Shifts, Big Change for Physician Leaders

In Part 2 of the Physicians Leadership Academy (PLA) Podcast’s conversation with transformation expert Jim Marsden, hosts Dr. Stephanie Costa and Phil Cass continue their deep and compassionate exploration of physician burnout. 
 
Part 1 focused on practical strategies for overcoming burnout. This episode offers a refreshing, non-judgmental approach to stepping off the "hamster wheel" through small, intentional actions that reconnect you with purpose, creativity, and community. Jim introduces his "three Cs"—connection, creativity, and contribution—as accessible pathways to healing, while also unpacking how reframing daily routines and acknowledging external stressors can help restore agency and clarity.
 
Whether you’re overwhelmed by mounting responsibilities or paralyzed by forces outside your control, this episode provides real, human-centered strategies to move from exhaustion to empowerment—and reminds you that you're not alone.
 
 🎧 Produced by the Columbus Medical Association. Learn more at physiciansleadershipacademy.org

Produced by the Columbus Medical Association

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Transcript

UNKNOWN: 0:00

So,

SPEAKER_01: 0:08

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.

SPEAKER_03: 0:39

One of the things that I think Steph and I run into, I'm sure you do too, Jim, is people saying, I'm on this hamster wheel. It's a hamster wheel I don't want to be on. The job requirements keep me on the hamster wheel. How do I even step off for a few minutes?

SPEAKER_04: 0:57

Well, a couple of things come to mind there. Kind of goes back to what I was saying earlier about move towards vitality. It's move towards a more resource self So then when you can work even harder at getting off the hamster wheel, you're doing it from that orientation rather than I'm exhausted. Now, how do I make a move here? So in this one, how to get off the hamster field, I also think of start close in and that there are no steps that are too small to be taken. So Actually naming that you feel like, and the words can vary, but that idea of naming that, I feel like I really, it's time for me to get off the hamster wheel, something of that sort. Naming, that's a big step. It's a big, huge move. There's, for people who have done that, I'll offer, you probably felt what it's like to cross the threshold. You actually became aware of something you couldn't be unaware of anymore. You know, so... Big, huge step. And yet you still might be on the hamster wheel, but it's a different thing now. The next thing that I feel is in here is remember and connect with those things that matter to you at any level. And what I found is that there are three categories that you might look towards that can be helpful for you. They're general categories, but looking under the hood for what matters to you might be helpful. So the three categories are, It's how are you doing with connections? The three C's, by the way. So connections. So it's like your relationships. Spending more time with the people that matter with you. It's not needing to take a week off and go on vacation with so-and-so. It's like maybe a cup of coffee, maybe a phone call, maybe a text message. It's anything you might do. There's no step that is too small. And it's part of what... In this move, I think of getting the reps in. It's like working out. There's no rep that is too small. You just need the quantity of the reps over the magnitude of them. So send a text message to somebody you care about and let them know that you care about them. Super easy, one and done. How long is that going to take you? Not that long, less than a minute. But the commitment and the act of it actually happening, huge. Connection is the first C. The next C is creativity. Oftentimes when people are burning out, you come into this place of, I don't feel like I've got a lot that's new and creative that brings things alive. And creativity can take many, many forms. But checking out, do you have channels for creative expression? What would that look like for you? You don't need to join a world-class choir. but you might start singing as you walk to your car. So it could be whipping out your phone and taking a picture of something that captures your attention and knowing that that's what matters to you. You may not share that with anybody, you might, but it's letting yourself head towards creative expression. And the last C is meaningful contribution. Do you feel that what you're doing is actually making a difference in a way that you would have your own yardstick for whatever makes a difference to you, to your family, to the community, to the people you work with, customers and clients who are at the receiving end of that meaningful contribution. So if you start looking close in for things that might start to move that needle a little bit for you, it really is small steps that start to matter. And the other thing that's really valuable to know is it's the experience that matters rather than the outcome or conclusions. So in this period of moving off the treadmill, the hamster wheel, what matters is that you feel a sense of progress. Progress is what you recognize to be progress. But you need to let yourself recognize it's progress. Because here again, there can be that trap of, Well, the first world-class golden certified physician wouldn't count that as whatever. No, it's let you be you here. You hold the yardstick. You're the one that is deciding what matters to you. What constitutes as progress forward? Maybe the last thing I'll share is you don't need to have the final picture of whatever you're moving to next before you start moving off the treadmill, getting off the hamster wheel. If you start moving off the hamster wheel and moving more towards what's mattering to in your life, you're already moving towards whatever is next and you're actually helping whatever's next find you so that it can be more you that stands out in the world. So those are some of the things, I mean, it's a bunch in there, but some of the things that stand out for me there, hopping off the hamster wheel.

SPEAKER_03: 6:09

One of the things I try to do with people I'm coaching who are struggling with this is have them do a little bit of an inventory of their day. What are some of the things that you routinely do? It might be just driving to work. It might be walking the dog. It might be watering the plants. And I'll ask them, so what's the frame, the mental frame you take to that? Is walking the dog a chore? Is watering the plants a chore? Or could we actually reframe walking the dog into your moment? Could we reframe the watering of the plants into your moment? Could we reframe the driving to work as less of a chore in your moment? And so there is this cognition, cognitive aspect of definition of my behavior that also plays into never being off the hamster wheel. I come home, I got to walk the dog, I got to feed the plant. That's a reframing.

SPEAKER_04: 7:09

Yeah. Yeah. I think that's critical. I think the whole thing here is a movement of reorienting. So where you were mentioning framing, I think of it as just, what's my orientation? And we can get lost believing that my current orientation is the only orientation, is the truth of the way it is. But there are many other perspectives, vantage points, and orientations. So how do we move towards more of a preferred orientation that is of alignment for us?

SPEAKER_01: 7:48

Well, and I think too, just that deliberate nature of getting off the hamster wheel. And I always talk to people about, you know, you have your day and on your drive home in that commute, use that time to drop the heaviness of the day, you know, inhale some freshness, exhale the heaviness of the day or the worry of the day. And that would be a great way to jump off the hamster wheel so that when you do get home and that fog is wagging its tail at the front door right you get to go spend time walking the dog and reconnecting and it's it's that whole entry into mindfulness that also really shouldn't be compartmentalized necessarily you know sprinkled throughout your day whether you're at work or home

SPEAKER_04: 8:47

yeah you bring up another um both of you have been mentioning the time element too. And so another thing that I think is right here in the beginning stages of someone who's trying to move from wherever they might be to a better place is, well, where do I find the time? It shows up in, I'm sure, physicians with, well, that's going to take effort. Effort takes time. Have you looked at my calendar? And that's number one. Number two is financials. It's like, but I need to make so much money and that's gonna keep me here and there's all the thinking that goes around that. And from its orientation, it's all valid. So I don't wanna get into an argument about that. I wanna recognize and affirm, yeah, from that orientation, it's true. And there's another approach. It just turns out that you actually don't need to take more time It's actually weaving into the time that you have and how you approach and see these different things that starts to make the difference. And I'll say this now, that when you start heading towards more of the things that actually matter to you, you will find that time does weird things. It's, I have done this with my clients, I've experienced personally, but it's like, when I start prioritizing to actually head more towards the things that make a difference and matter for me, and start to let go of some of the other things, things start to switch. And I didn't have to do calendar math to make it happen. But it starts from making the commitment to be in the orientation, to cross on over and give it a go, rather than I'm trying this from where I am right now to manage risk really is what's happening. But man, it's a letting go and now letting it happen kind of move to get there. And you can start with time and that starts to bring up those things. But head more towards what matters. And if you start like really letting your connection thrive there, time's going to start moving differently and you will see it and appreciate it in ways that you couldn't have seen it from where things are right now.

SPEAKER_01: 10:59

yeah i mean you talk about the power of the calendar and time yeah and using that as an excuse and the thing that i see in people and i think particularly in women is the darn to-do lists and they'll have a to-do list is a page and a half long and once i get these things done Then I can take a break. Then I can allow myself to work on myself. You know, like it's just so compartmentalized and utilizing. It's like the most important thing on your to-do list is, and not just a to-do list. It's that way of life, that whole mindset shift.

SPEAKER_03: 11:46

Yeah. You know, we always refer to this world of burnout in the context of stress being our human response to conditions, stressors, that are environmental. And being able to distinguish, we have more control of our stress response than we have to controlling the stressors in our lives. And so it's to your point, Jim, the reorientation. I think it's also important, and we haven't talked about this yet, to note that the external stressors aren't getting any easier. And not that, I guess everybody thinks they've lived in the tough times, and probably people have lived in tougher times, but things are pretty stressful out there right now. And that's in the environment, that's in the ether that's affecting us that we really many, we don't have a lot of control over and sometimes don't even recognize that that's going on, that there's ether out there that's affecting us as well. And I think it's important to note that when you're dealing with yourself is that there's stuff out there that has impacted me. Even the things that aren't political, aren't social and so on and so forth. But I keep thinking if I'm a physician, I'm sitting there going, there's this thing called AI that's screaming down the path at me. I don't even know how to approach thinking about that yet.

SPEAKER_01: 13:23

Yeah, how do you approach all those stressors that are beyond your control and are terrifying? You know, they can almost, you know, there's such an epidemic of anxiety right now too. So yeah, Jim, I'm all ears if you've got some suggestions on an approach to how do you try to align with what matters to you when there's all these external powerful forces that are really out of our control?

SPEAKER_04: 13:52

Yeah, well, it seems like we could spend a lot of time in here and have it be quite valuable. So I feel like there are paradoxes in this one because on the one hand, being able to do our best and discover because it might take in each situation or in each moment, there might be an element to actually discover what is beyond my control and what is within my agency to do something that I feel like that is the path that is a lifelong learning navigation course there. But it does include coming to see a name, but also in a way that's kind of honoring. This is really here. Because to be able to see it for what it is, is to actually really see it for what it is, rather than to give it a name that people might recognize, but then talk about something that actually marginalizes it. I think that was one of the things... I think AI is a really good example. I think the pandemic was another one where it cuts across, it doesn't care what industry you're in. It doesn't care what your role is, what your position of power is. So to come to terms with what's really here is super challenging and dynamic, I believe. But to leave open a space of there are aspects here that are beyond my control, is to help to then come to see, well, what is really within my agency? So then this brings in my work here and also thinking about burnout. I think we're knocking on the door of things like judgment in this space of like, shouldn't I have known? Shouldn't I be smart enough? Shouldn't I be able to figure it out? What do I really think? And how come I can't get there? So there's this pressure as well that sometimes that pressure actually can lead to big breakthroughs. So the one aspect that I feel like is important with much of this work is to not make something wrong so something else can be the savior or something. It's actually trying to do your best to see everything for what it can be and what it is, including myself. You know, where am I right now with all of this? And so I think the judgment thing, like Phil, you're bringing up the AI example has me thinking about things presently, but then also imagining a future where it didn't go as I thought. And something happened that I couldn't anticipate or I didn't anticipate. But now that I see it, Should I have anticipated that? And couldn't I have done something with that? And then there I am. And so that I feel is incredibly common. What I find to be helpful and it's not, it's compassionate, but it's not leading with, it's not meant to just be about compassion. But what I think is super important at the realm of being a human being is a phrase that you can bring up for yourself in these times, because I've, kind of learned it to be something like this. So imagine that AI is now more fully in our worlds. I am that physician who is trying to figure out how to really make sense of things and put this to the best work. And now I'm, instead of that, I'm on the receiving end of having this not be a good deal for me or the office or the clients that I'm working with. And here I am in this place of I'm smart. I should have known, I'm feeling guilty. And so I'm feeling the judgment, the shame and the blame from all of this. But the phrase is, if you can come to this place and look back in time and say, I was doing the best that I could with the amount of experience and wisdom and access to support that I had at the time. And if you can hang out with that phrase, then often, um, you can come to a place of arrival, of seeing that I really did the best that I could. And so I feel like there's a move towards forgiveness. And I believe that in those spaces, you arrive at forgiveness. It's not a place where you say, I forgive myself, like a light switch. You can arrive at something that feels more like forgiveness. And that movement helps to support you, that you were in the act always of trying to do your best. with the level of wisdom and experience and access to support that you have. And there are things that you can learn from what has happened with the benefit of hindsight that you didn't have at the time. And you were who you were back then, and here you are today. So all of those things we're kind of coming up with, how do you work with the things that are out of our control? And one, I guess, is like recognizing your relationship with those. and exploring your relationship with the things that may be beyond your control. I

SPEAKER_03: 19:29

think also that we underestimate our own power. There's tons and tons and tons, most stressors, outside influences, we don't have control over. But we sometimes underestimate the fact that we can do little things. It won't necessarily change the whole dynamic. But to your point, Jim, it makes me at least feel like I was talking to somebody recently who was going on and on about the political circumstance. I get that. I can go down that

SPEAKER_02: 20:01

path

SPEAKER_03: 20:01

pretty easy. But I said to the person, have you written a check? They had the wherewithal to do that. Have you put a yard sign up in your yard? I said, it's not going to solve the world, but you can say, I wrote my

SPEAKER_02: 20:18

check.

SPEAKER_03: 20:19

I put my yard sign up.

SPEAKER_02: 20:21

I

SPEAKER_03: 20:22

took that one hour little seminar online about AI. I've done something to take leadership of my life. And in doing that, I've also provided some leadership to the larger questions that are impacting our lives. So I go back to your statement earlier about there's nothing too small.

SPEAKER_04: 20:43

That's

SPEAKER_03: 20:43

right. Not only a little too small to get off the hamster wheel, but there's nothing too small that a contribution toward helping the larger issue isn't important.

SPEAKER_04: 20:53

Right. Yeah. I see that act too. I mean, that can also be an example of moving from the left side of the road to the right side of the road. It's like, remember what matters and then bring your agency to what matters. And same thing with, it brings up another example of that and also to the things that are beyond control. I'll try to keep it super short, but it's, I have a client who, because of a variety of things that were beyond the company's control, he found himself in a situation where a third of the company was needing to go to be let go in order for the company to have a chance of continuing. And all of the information was there in front of him. The spreadsheets and the calculations and the financial implications were all laid out and he and the leadership team could see what was needing to be done, but it meant laying off a third of the workforce there. And when we were talking, we were having this conversation and it felt to me that I was talking to someone who is just trying to go through the script of what was now in play and that he, he was in that place heading towards burnout of there's something that's out of alignment here, even though there's something that clearly needs to be done. And so if I fast forward here, we had that conversation of, hold on for a second, let all of this be true the way that you see it. It is what it is, although not everything is what it is. But the detail and the facts of all this are right here in front of you. Now, take three steps back. Let's have a conversation of what actually matters to you. So tell me about what you really care about with this being the way it is. Just tell me the story. It doesn't have to be coherent. Just what matters? What do you care about? What do you think is really important for this thing to happen? And what he came to was he saw that what was happening really important is that people be treated as people and that people be recognized for the contribution that they had made to help the company get to where it was in that place. And to find a way of laying people off, yes, but doing it in an incredibly respectful way and to have it be something that would be recognized that here's how we do it, not here's what needs to be done. And At that point, he was just sharing, and I was just his scribe in a way, just mirroring things back. And as soon as he could see that that's what was there for him, it was like, get out of the way. Now he's more connected. And what matters and his agency to what matters made a big difference in what happened next for the company, everybody. Because even where the folks were staying are, of course, deeply impacted, too. And the ones who are leaving can feel like they may be leaving their jobs and it's super important, but they are not leaving friends and important relationships and a lot of things that came from there being a part of this.

SPEAKER_01: 24:22

Well, Jim, I think the thing that you were able to get him to a place where he just humanized himself

SPEAKER_02: 24:29

the

SPEAKER_01: 24:30

problem, even though it was difficult for those humans. And just as you said, a few moments ago, even with ourselves, just treating situations with compassion and forgiveness to ourselves. And, you know, really just when you get to that place, all of a sudden there's this clarity and, you know, it's going to help move you over to that right side of the road. So,

SPEAKER_02: 24:58

yeah.

SPEAKER_01: 24:58

that ability to just hit the pause button and really humanize the struggle, the, the, the, the fear, the, you know, bring it back to wait, what's really going on here can just really break that cycle of chaos, fears, worries, concerns of the left side of the road. So.

SPEAKER_04: 25:21

Yeah. In, in hindsight, I think he would speak to this too, is Or that moment there, he stopped trying to live up to being the CEO he thought he should be in the moment. And instead leaned into the human being he was and wanted to be more of. And then brought that back into being the CEO. But now it's his expression of CEO and being incredibly responsible all along the way too. So he resolved that competing commitment.

SPEAKER_03: 25:54

a principal of the Physicians Leadership Academy, is trying to figure out how I actually come to love myself as a prerequisite for all this stuff. And we help people get there. Jim helps us get there. That is part of the deal that we're talking about here.

SPEAKER_01: 26:14

Yeah, and too, Phil, you know, I know we've been making a big effort push, you know, recognizing the importance of community in our PLA alumni. And, you know, Jim, when you were talking about kind of that place of isolation, when you're feeling so burned out and alone, that place isn't good. And so, you know, just knowing that there's a place, not just for our PLA graduates, but you know, physicians in central Ohio, you know, within the CMA, the PLA and doc to doc and, and made for medicine and the free clinic and, um, you know, advocacy, um, through the public policy committee, there is community, there is a lot of, of support here. And, um, you know, bit by bit we can, uh, help guide each other over to that right side of the road, but such a wonderful approach toward burnout. I mean, I've been reading and, and attending conferences in this space, at least in the medical arena for about a decade now. And you know, just this, this whole approach of, of reorienting and that metaphor of the right and left side of the road and, and not having judgment in that. It's just a path, you know, and normalizing it, which is really what needs to happen with a lot of the work around physicians, you know, kind of acknowledging, hey, I'd like something better, and I'm going to be open to help. So Jim, thanks so much for this unique approach.

SPEAKER_04: 28:02

You bet. Great to be with you both. And So much ahead too. I'm really appreciating more and learning more as we continue to talk and think about things for the future. So thank you for that. Thanks, Jim. Thanks, Steph.

SPEAKER_01: 28:19

So wonderful. Take care.

SPEAKER_00: 28:24

Thank you for tuning in to the Physicians Leadership Academy podcast. This podcast is produced by the Columbus Medical Association. We hope today's conversation has inspired and equipped you on your journey as a physician leader. For more resources and to learn about applying to the PLA, visit us at physiciansleadershipacademy.org.