Finding Resiliency in Residency

Reversing Cycle of Burnout Starts With Knowing Yourself

September 07, 2017 05:10 pm Jill Sederstrom

AAFP News recently spoke with Lauren Williams, M.D., a third-year family medicine resident at the North Memorial Family Medicine Residency Program in Minneapolis, about the stresses that face family medicine residents and the tools and strategies she's found to help her maintain a healthy work-life balance, even with a busy schedule.

[Third-year family medicine resident Lauren Williams, M.D., and her fellow residents enjoy yoga classes]

Although third-year family medicine resident Lauren Williams, M.D., (bottom, second from right) admits that practicing yoga may be "a super cliché form of wellness," she says it helps remind her of the connection between mind and body. Apparently, her fellow residents find it helpful, too.

Q: Can you share with me a bit about your practice setting?

A: We're at a clinic that has been in the middle of an urban, underserved neighborhood for about the past 40 years, so it's very well integrated into the community and the area. It's primarily Medicaid and Medicare patients. (There is) a lot of institutionalized racism and poverty in the neighborhood and a lot of challenges, but a lot of really awesome parts, as well.

Q: During your typical day-to-day routine, what are some of your biggest frustrations or challenges on the job?

A: My biggest challenge on a daily basis is feeling that my patients deserve better. They have so many challenges in their day-to-day lives with housing, food, family dynamics and violence, and seeing that and feeling pretty powerless to do much about it is probably the biggest struggle for me. Especially trying to navigate that (along) with treating their medical conditions and talking about how to manage their diabetes or blood pressure or even depression.

Q: As a resident, are there challenges related to the hours you work and the demands on your time?

A: Yes, definitely. As a resident, our schedules change constantly, so every couple of weeks I am on a new rotation.

One of my personal struggles, and one of the things that my husband and I have most had to work on, is that he's also in medicine and so he has a completely different call schedule, different hours and different nights that he's working. Trying to navigate that has been one of our biggest challenges in terms of how we make time for each other when we both have these chaotic schedules.

Q: How have the frustrations you face at work impacted your personal health and well-being?

A: I somaticize things. I tend to not be anxious about things in my head and can keep a pretty clear mind going through my day -- even when I am very stressed -- but I have issues with getting a full sensation in my throat, feeling like I can't swallow or feeling nauseated. I carry a lot of muscle tightness in my whole body. I've realized that even though I can go through my day without seeming stressed or noticing that I am stressed, I can feel when I have really difficult days or times that I am feeling overworked and overwhelmed in how I am carrying myself and how I feel overall as a person.

[Third-year family medicine resident Lauren Williams, M.D., with her fellow residents in the Minnesota State Capitol]

Williams joins her residency colleagues and faculty in a trek to the Minnesota State Capitol to lobby for increased family medicine residency funding.

Q: Do you feel you've ever reached the point of burnout?

A: I don't think I've ever gotten to a point where I felt "burnt out," but I feel that on a regular basis I cycle back and forth through feeling really excited and passionate and feeling a sense of joy and purpose in my job to (feeling) a sense of hopelessness, frustration and a lack of purpose or feeling that nothing I am doing matters. I think I oscillate back and forth through that on a pretty regular basis.

Q: What are some signs or triggers that indicate to you that these frustrations may be starting to impact your mood or job satisfaction?

A: I think just feeling that discomfort or tightness in my body. One of the best ways I cope is by staying active and moving my body, and so I do yoga really regularly. I know that's a super cliché form of wellness, but it really does reintegrate my body and my mind and reminds me how connected they are.

Often, I will get kind of irritable with friends and family, that's a trigger to me, for sure.

Another trigger I notice is that I stop caring about my patients. I care more about, "OK, how can I get done with this visit?" than I do about, "How can I connect with you and figure out what things you need, and how we can form a partnership?"

I think those are all triggers for me to say to myself, "You need to intervene and stop for a second and figure out how to get back on track."

Q: What have you found to be the most effective strategies and tools to help you maintain a healthy work-life balance?

A: I don't know that there is one thing that is most effective. I think it's a combination for me of finding joy where I work and where I am. A lot of times if I am feeling stressed, I get disconnected, and then I am not enjoying (the work I do), and so I have to remind myself of the reasons why I enjoy my work. Whether that's meditating or thinking (about) a certain patient that I connect with really well or thinking about an interaction that was positive during that day -- those are really important ways for me to reconnect with the joy in what I am doing.

I have also become active on an organizational and policy perspective, taking on leadership roles so I can help to shape my practice and community environments and address many of those systemic issues that affect my patients' care outside of the office.

At the same time, knowing when to say no and when to pull back from things (has been important). So, finding that balance. I tend to be a person who (says), "Yes, I'll do this and this," and in residency -- especially with my husband and I both having really crazy schedules -- there are a lot of times where there's an event in the evening or something where they need someone to cover, and my first instinct is to jump at that. But I've learned more and more the value of saying no and taking time for me and my family. That will actually let me be more effective in what I am doing.

Q: Where did you go to develop some of these tools and strategies? Did you have a mentor?

[Third-year family medicine resident Lauren Williams, M.D., with her residency classmates at brunch]

Williams raves about her "phenomenal" classmates, saying the differences in their respective personalities and interests have enabled her to learn new ways to manage stress.

A: I really rely on my residency classmates. I have a phenomenal class of peers. Our class just happens to be 10 women, and we are all very different -- like, drastically different in our personalities and our interests and everything. So it's really amazing to learn from them and their different personalities and their ways of managing stress.

I am very extroverted; I always want to be doing things, but I've seen in some of my colleagues who are more introverted or (who) value their time alone, I've seen them say -- even to an event that sounds really fun or wonderful -- "No, I really need this time for myself." And I am like, "Wow, I can do that? I am allowed to say that?"

Our faculty is really good at checking in with us regularly and seeing where we are, so that's been really helpful. I have also learned a lot about myself through residency. I have some friends who are very interested in different personality models that help you think about why you do some of the things that you do. That's been a huge learning (opportunity) for me -- to be able to think about myself a little more and the way that I am and why I may have a different response to different things.

Q: What has been the impact of incorporating these tools into your routine?

A: I think I feel a greater sense of well-being. I feel like it's -- again -- a cyclical thing where the more I focus on wellness and trying to cultivate resilience, the (better) my interactions are with my friends and my husband and my patients, which makes me feel more well.

The more that I do yoga, or that I go for a walk -- the more that I appreciate and understand the connections to the mind and the body and to the natural world, and the more that I am able to appreciate that -- the more resilient I feel.

Q: What tips or advice would you have for others who may be feeling work-related frustrations or burnout?

A: It really has to start with knowing yourself and trying to think about the things that you value and that bring you joy and (those) that bring you stress, and the way that you interact with the world, and then identifying how you might be able to reverse the cycle.

I think you get into this cycle of feeling burnt out, and then you don't do the things that you love, and then you don't have that enjoyment, and then you feel lower energy, and then you feel more burnt out.

If you are feeling really terrible and overwhelmed and stressed and burnt out and you are seeing that manifest however it does for you, then just take the time to be aware of it -- that has to be the first step.

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