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Catherine Kuhn, MD, knows there are some in the medical community who still view “burnout” as a sign that certain physicians just can’t cut it. In this Member Spotlight, she tells ASA Community how she’s working to counteract the old thinking both personally and professionally, using her position in the graduate medical education community to help reframe the issue in terms of physician well-being, not weakness.

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Research shows that burnout poses a real threat to physicians, their patients, and their practices, but some physicians – even in conversation here in ASA Community – still consider “burnout” to be a sign of weakness. What do you tell colleagues who may still be skeptical about addressing burnout at the institutional level?

I know anesthesiologists and surgeons (among other specialties) who feel that acknowledging burnout could be perceived as a sign of weakness. For years, physicians have put the needs of their patients and colleagues ahead of their own needs. Taken to an extreme, this over-exuberant altruism becomes exhausting, and physicians can lose their compassion and empathy for their patients and each other. We know from institutional surveys that clinical areas with higher burnout scores in their staff have more turnover and staff with less career satisfaction. Equally important, though, is that patient outcomes in areas where there is a high degree of burnout are worse.  For these reasons, it’s important to address burnout.

In the graduate medical education community, there is increasing accreditation emphasis on ensuring the well-being of our residents and fellows, as well as for faculty, who are role models for trainees. That emphasis is starting to make conversations about caring for oneself a little easier. Removing barriers at work so that physicians spend their time doing skilled patient care, rather than administrative work, is critical. It’s not about how hard we work—physicians work very hard to get through medical school and residency—and the vast majority of physicians are highly dedicated to their patients and ensuring they get good care.  Burnout happens when people are no longer finding meaning or joy in their work.

The COVID-19 pandemic has sent physicians’ stress level through the roof. What are you seeing and hearing anecdotally about the effects on physician well-being, and how does that inform your approach to promoting healthy strategies and perspectives?

From an institutional perspective, as the Associate Dean and Director of GME, I have been concerned about residents and fellows who have matriculated this year.  They have moved to our area, potentially without friends and family nearby, and we have had such limitations on being together in community. There are limits to what can be accomplished virtually, either for social reasons, or in patient care. All physicians have had fears about their own health and that of their families, in addition to the challenges of child care and schooling. Early in the pandemic, hearing about events in other parts of the country (e.g. scarce PPE and other resources) created anguish for our team members even though our area was not similarly impacted.  I have been impressed with how physicians, including residents, fellows and program directors have been juggling their family obligations and career demands during the pandemic, and I worry about the toll that all of this takes, which will endure beyond the pandemic.  Being apart from each other makes it harder to check in with each other and to partake of activities that normally sustain us.

When COVID vaccination started here a few months ago, there was a palpable lift in the mood. I have been volunteering at one of our patient-facing vaccine clinics, and seeing the joy and excitement of the patients is a boost to my own well-being. It feels good to be a part of the solution.

Additionally, we have mild weather here, so safe outdoor gatherings, and exercise options are easier than in some parts of the country. Our anesthesiology department has done a great job of providing resources for faculty and staff well-being. Our institutional GME Office just celebrated our residents, fellows, and program leaders by sponsoring a GME Week. We have converted to a socially-distanced model for sharing appreciation for our colleagues—Grubhub coupons instead of group meals, apps to express appreciation to each other, etc.  We’re trying to do what we can safely, until we get back to being together.

What do you think is the role of exercise in mitigating stress? What are your recommendations for prioritizing physical activity in an already overloaded work schedule?

Exercise is an important way to help manage stress.  When I exercise, (usually in the early morning) I feel a sense of accomplishment, even before work starts. It boosts my energy and my spirit. Anesthesiologists are superior multi-taskers, and that skill helps me fit exercise into a busy life. I like to listen to podcasts, and so I combine podcasting and exercising. Taking my dogs for a long walk or a hike with my husband is a way to multitask my exercise activity with family time.

What’s your go-to strategy for self-care to deal with work-related stress?

I try to find time to do something for myself every day and dedicate it to myself intentionally. On a crazy day the “gift to self” might be something as simple as savoring a cup of tea, but on less busy days, it might be my time at the gym, or a phone call or a meal with a friend, or planning a vacation. The intentionality of this exercise is what makes it work. It’s a subtle reminder to pay attention to how I’m coping. I am trying to cultivate more formal meditation as a skill, and find that when I practice it consistently, I am more patient, and can assume positive intent in others!

Is there anything you’d like to talk about that we haven’t touched on here?

I’m very grateful to have had a long and satisfying career as an anesthesiologist. I love the yin and yang of academic anesthesiology—busy patient care days mixed with academic and administrative days and trying to make a difference for my patients and for our future doctors!

Catherine Kuhn, MD, is Professor of Anesthesiology, as well as Director and Associate Dean of Graduate Medical Education for Duke University Health System and School of Medicine. She also serves on ASA’s Committee for Physician Well-Being.