AAFP News recently spoke with Jamie Osborn, M.D., about her struggle with burnout and the tools she used to find joy once again in family medicine. Osborn, a married mother of two, relied on spirituality to help her regain a sense of balance after leaving her post as a fast-paced family medicine residency director. Osborn now works a 40-hour workweek providing employer-sponsored direct primary care.
Jamie Osborn, M.D., credits the same whole-person care she gives her patients with helping her overcome the burnout she experienced as director of a fast-paced family medicine residency and find joy again in her chosen specialty.
Q: Why don't you start by talking about when you first began feeling symptoms of burnout. Can you describe that time?
A: I think my experience of burnout was sort of a slow slide into it. I was in a very, very high-stress position as a university family medicine residency program director, which I had been in for seven or eight years already. I had always perceived rapid change, innovation, transition and growth as really good things, but they are also very stressful. One of the things that we learned in times of transition is that the whole team's dysfunction rises to the surface. So, one dysfunction that our team was experiencing was that I had been a very dramatic, charismatic, energetic leader … and while that had some great impact on our team, it also meant that I provided most of the energy, direction, motivation and correction.
When I started experiencing burnout, at first it just felt like change fatigue. I was feeling less optimistic that change was going to stick, being more able to see the problems than to celebrate solutions. That gradually then turned into feeling stuck, like nothing was ever going to change. And then blaming everything and everyone around me for how bad that felt.
I started noticing discouragement, negativity, blaming, procrastinating and compassion fatigue, first of all for myself, but also for patients and for colleagues and for my learners.
Q: What do you think was happening for you professionally, or even personally, during that time that was really contributing to your overall unhappiness?
A: Maintaining a healthy clinic and residency environment in a university program is hugely challenging because it's not the natural habitat for a family physician. An academic tertiary care medical center, with hundreds of other residents, is not where family doctors naturally thrive. It is a difficult environment during the best of circumstances … and we were not in the best of circumstances. That said, I was super passionate about family medicine and determined to create a place where we could thrive and even lead in excellence, compassion and education in whole-person care.
Personally, I am an incredibly resilient person, but I had been working 60 to 80 hours a week and doing maternity care, which meant I was on call 24/7/365. I had been doing that without a break since 1996. It was too many years without a break. There were some things going on personally that made home life a little bit stressful, as well. While I was learning how to adapt and cope with that, it meant that I didn't ever really get a break. Work demanded a lot of me and home wasn't a place where I could really rejuvenate fully either. I was too busy with work and family for "luxuries " like friendship and playtime and self-care.
Q: How did you know it was time to make a change?
A: This is super embarrassing. I went to have a mammogram done and when I came into the elevator to go back to my office, the thought occurred to me, "Ooh … maybe my mammogram will be abnormal and I'll be diagnosed with breast cancer and I can get six months off for chemo and radiation!" The moment that thought came into my head, I said out loud, "Am I really am having the thought that having breast cancer would be better than going to work today? I think I might have a problem."
Q: Once you determined something needed to change, how did you figure out what the best next steps were for you?
A: I live and I teach whole-person care. So when that thought came, I decided that I needed to step back and look at all areas of my life and do everything I could to get better. With whole-person care, I think about four areas: physical, emotional/mental, relational and spiritual dimensions of health.
I talked with my doctor and said I needed two weeks off. I started exercising. Emotionally and mentally, I got a therapist and worked on the home and work dysfunctions. Relationally, I called friends and said, "Hi, I am a mess, and now you have to take me out to lunch. "
Spiritually, I reached out to people for prayer and had healing prayer. I told people at my church what I was going through and got vulnerable. I set aside time for myself to just rejuvenate spiritually and relearn how beloved I am. At first for me, it was just time spent being quiet, to sit and listen to the wind blow, to watch a flower grow. Some of it was creativity time, giving myself permission to play, walk, paint, draw, sing, dance and journal. I had to do something so different than my normal grind of 200 emails a day and 17 RVUs (relative value units) per half-day and four resident crises a day. To be a human being instead of a human doing, or a superhero or a savior. Just be me, and be loved. I can't tell you how hard that was to do. I felt like a failure and a hypocrite to have taught it but never really done it for myself.
I met with four or five mentors I really admire in family medicine. It really helped me to hear them say, "Jamie, you are not weak. It happens. You will recover … you can, you must recover, doing whatever it takes. Just get better."
So that's what I set myself to do. I took six weeks off. I started medications for depression. I did everything I could to get better and after that was done and I had my feet back underneath me and I felt like my mood was normalizing again, then I started asking the questions like "Am I really stuck? What do I need professionally to regain my joy?" I began evaluating whether that was something I could achieve at my program or if it was something I would need to leave to find. I decided I needed to leave to find it because my workplace had changed in many ways, but it could not support the new boundaries that I needed to preserve my health and sanity.
So, I stepped out of the gerbil mill. I am working in employer-sponsored care, which is similar to direct primary care. Instead of having to see 17 RVUs every half-day, I am salaried with a team to take care of a population of patients and achieve fabulous outcomes for them. Insurance is not billed; I don't mess with CMS. I have longer appointments, open access (scheduling), and use the phone and email instead of appointments when my patients need to. I lead a small team in dozens of small changes every week until we feel that our patient care is where we want it. I can focus on the love that I have for my patients instead of the paperwork and the money. It's what family doctors were made for!
Q: You've referred to your recovery before as a rigorous spiritual cardiac rehab. What do you mean by that?
A: To me, the spiritual is about identity, destiny and belovedness. I had to think about my identity in a new way, that my identity wasn't defined by my provider dashboard or my RVU report or my evaluations or what improvements I made for the residency, but that my identity was something that I had settled within myself because of who God says I am. My identity doesn't hinge on what I do during my workday. So part of my spiritual rehab was rearticulating my identity statement that is about who I am inside rather than the roles of wife, mom, doctor, program director. Who am I? And why does that matter? The "What am I called to do with that?" is a destiny question. And then resting in the knowledge that I am loved fully and deeply, apart from everything I do.
Q: Now that spirituality is more intertwined in your daily life and practice and you've taken other steps to improve your physical and mental health and well-being, how do you feel your professional life has changed and your overall outlook on life has changed?
A: I don't feel annoyed by my patients anymore. That was one of my signals that I was not OK, because although everybody has some "special" patients that cause us some angst, when every patient does that to me that means I'm not OK.
Now, I really have regained the joy of practice -- enjoying my patients and enjoying who I get to be fully with them instead of feeling like, "Oh my gosh, you guys are just draining me dry!" I feel actually pretty relaxed and rejuvenated, even at the end of a busy day. That is my new definition of normal.
Q: I know burnout can manifest itself in different ways for different people, but what tips or advice would you have for other colleagues who might be battling burnout?
A: Be willing to give yourself a break. Family physicians are doing the hardest jobs on the planet, we really are. If you don't have the avenues already built into your system to allow for a decent break, then break the system to make it happen. Do for yourself what you would do for your patients in the same condition. Be as compassionate to yourself as you are to others.
Being trapped is a horrible feeling. If you are trapped, take action. If you can't help change the broken system, then get out and find a way to still bless the world with who you are as a family doctor. There are other ways to do what you love and not lose who you are in the process. You are worth it!