What if You Don’t Know What You Want Next: A Physician’s Guide to Finding Direction

An earlier version of this article appeared on this website in March 2024.

As a physician, you've poured years of your life into your profession. You spend the better part of your waking hours staying current on the latest research, honing your skills, serving your patients with compassion and care, and being a supportive teammate to your colleagues and staff.

But, like many doctors, there may come a time in your professional trajectory when you feel a need for change and a yearning for something different. Maybe you feel stuck, unfulfilled, or underappreciated. Or perhaps you simply crave a change of scenery.

In this article, I’ll give you some strategies that will help you to gain clarity and direction when you’re not sure what you want next.

Why Uncertainty Feels So Hard

Even when your current trajectory feels all wrong, it may be difficult to envision what change should or could look like. From medical school to residency and beyond, your path up to this point has probably been clearly marked. As you reached one milestone, the next was likely in view. That’s one reason that making your own way can feel like such a steep climb.

There’s a certain comfort and predictability in following the well-worn trail, no matter how strenuous. For many people that is the right choice. But at some point you may find yourself longing to choose your own direction, or set your own pace. Whether you're considering changing the way you practice, adjusting your working hours, exploring opportunities outside of clinical medicine, or even contemplating retirement, the uncertainty can be daunting.

It’s very easy to get stuck at this point, instead of recognizing that this period of unease is often the first step in a new direction.

Seven Strategies to Move Forward

Although it’s important to think things through, I’m a firm believer in the adage that action creates clarity. Action however, does not have to mean commitment or a big shift. Sometimes that can even be dangerous, especially when you haven’t planned for the obstacles ahead. Giving yourself time and space to actively explore what is possible can make your next steps more clear.

If you’re feeling like you’ve come to a standstill, here are some ideas that can help pull you out of the rut and find some serious traction that will move you forward.

🥾Reconnect with Your Core Values

Take some time to reflect on what truly matters to you, both personally and professionally. What are your core values? What values do you want your career and life to reflect?

Understanding what drives you and what you hope to achieve can provide valuable insight into the direction you should take. If you’re unclear on how to express your personal values, my Values Workbook can help.

🥾Inventory Your Strengths and Interests

Think about what energizes you in your current work. Which skills do you enjoy using most? Are there interests outside of medicine that you’d like to explore more deeply?

Sometimes asking yourself “What lights me up?” is enough to spark new ideas. Don’t be afraid to consider possibilities that may not obviously relate to the practice of medicine. At this point in the process, curious inquiry does not mean commitment.

Mind mapping or journaling can often help connect your passions with new possibilities.

🥾Seek Guidance and Perspective

Reach out to mentors and trusted colleagues. Each one of us has our own story, but a mentor can give you valuable insight and may even open doors to new opportunities.

You might also choose to work with a coach. A coach will give you a safe space to explore and reflect, and the process can provide valuable insights that can help you get out of your own way. While a coach will not tell you what to do next, coaching will support you as you uncover your own answers.

🥾Explore and Experiment

If you're unsure of the direction you want to take, allow yourself to try out new experiences. Attend a conference, volunteer for something meaningful to you, take a course, or explore an interest that excites you. These experiences don’t have to directly connect to medicine. Exploration itself often reveals what truly resonates.

🥾Stay Flexible

Your path doesn't have to follow a straight line. It's okay to pivot or investigate new opportunities at any stage of your life. Be true to yourself, but keep in mind that it’s always a good idea not to burn any bridges along the way.

When you embrace flexibility, you’ll often find unexpected and even surprising opportunities.

🥾Take Small Steps

Thinking about a major change can feel overwhelming, especially for physicians. More than most other professions, we often feel defined by the work that we do.

You don't have to have all the answers right away. Break down your goals into smaller, manageable steps, and focus on consistent and purposeful action. If your goals change through the process, all the better.

🥾 Practice Self-Compassion

Be kind to yourself as you navigate change. It's normal to feel uncertain or indecisive during big transitions. Practice self-compassion and remind yourself that it's okay not to have all the answers.

Moving Ahead

As a physician, you already embody resilience, dedication, and resourcefulness. Those same qualities will serve you as you explore what comes next. By aligning with your values, experimenting with new possibilities, and giving yourself grace in the process, you’ll create space for clarity, renewal, and purposeful action.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Managing Uncertainty as a Physician

An earlier version of this article appeared on this website in July, 2022

Uncertainty is woven into the life of every physician. Patients don’t always get better, there is not always one best choice or right answer, and sometimes your decisions are affected by factors that are completely out of your control.

For most physicians, managing uncertainty doesn’t come naturally. Perfectionism may be an ever-present companion. In many ways it can be a strength. The drive to excel benefits your patients and fuels your professional growth. But when you set unrealistic standards, perfectionism can shift from being an asset to becoming a barrier, undermining both patient care and your own well-being.

Layered on top of that is the responsibility you carry. Every decision can directly affect another person’s health, and that weight can make uncertainty feel almost unbearable.

And then there’s medical culture, which often rewards confidence and conviction, even when doubt is inevitable.

Add the natural physician desire for control—to fix problems, to restore order—and it’s no surprise that “not knowing” can feel like failure. Together, these forces make it difficult for physicians to acknowledge, much less embrace, uncertainty.

The Cost of Intolerance for Uncertainty

A recent study of over 2,000 faculty physicians found that intolerance of uncertainty was associated with a three-fold higher risk of burnout. Physicians who struggled with uncertainty were also less likely to feel satisfied in their careers and more likely to be disengaged at work.

As you might expect, those who struggled with uncertainty were much less likely to be satisfied with their career, and tended to be less engaged at work. Factors that correlated with a greater intolerance of uncertainty were

• Female gender

• Primary care

• Earlier stage of practice

• Lack of a trusted advisor.

Yet intolerance of uncertainty was not limited to these groups. The study found that many male physicians, specialists, and senior clinicians also struggle with its impact.

Burnout and physician unhappiness are crucial pain points in our current healthcare environment. Not surprisingly, stress from uncertainty correlates with depression and low levels of resilience. Intolerance of uncertainty has been linked to poorer outcomes and even to increased healthcare costs. And burned out physicians are more likely to leave the practice of medicine.

Naming the Challenge

Medicine rewards precision and stoicism. From training onward, physicians are expected to project confidence—even when the answers aren’t clear.

That’s why it’s especially powerful when senior colleagues and mentors acknowledge that uncertainty is part of the work. Simply hearing “I don’t always know either” can normalize the experience and help younger physicians feel less isolated.

Building Skills to Navigate the Unknown

Although becoming comfortable with uncertainty may always be a challenge, managing your response to uncertainty can open up opportunities to react to life’s curve balls in ways that are both positive and beneficial to all involved.

In their thorough analysis of the issue, Samuel Reis-Dennis and colleagues describe “three corrective virtues” that might help physicians navigate the challenges that uncertainty creates. These include:

• Courage: avoiding the tendency to run away from threats by developing strategies to cope with new challenges

• Diligence: seeking guidance from trusted colleagues and staying current on the medical literature

• Curiosity: addressing uncertainty by viewing it as an opportunity to learn and grow

These virtues remind us that uncertainty isn’t a personal failing but a natural element of the constantly shifting world of medical practice.

Finding Support

Recognizing the impact of uncertainty is one thing—navigating it is another. Medical schools are beginning to teach these skills, but once in practice, many physicians find they still need additional support.

Working with a coach or trusted advisor can provide space to process uncertainty, identify strengths, and discover practical strategies tailored to your unique needs. Building these skills doesn’t just benefit you—it also enhances your care for patients, strengthens your resilience, and can help to restore meaning in your professional life.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Allison, J. J., Kiefe, C. I., Cook, E. F., Gerrity, M. S., Orav, E. J., & Centor, R. (1998). The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Medical decision making : an international journal of the Society for Medical Decision Making

Begin, A. S., Hidrue, M., Lehrhoff, S., Del Carmen, M. G., Armstrong, K., & Wasfy, J. H. (2022). Factors associated with physician tolerance of uncertainty: an observational study. Journal of general internal medicine

Berg, S. (2020). Feeling burned out? Try picking up the phone to call your coach. American Medical Association

Cook, J. (2022). Forget resilience, improve your uncertainty tolerance. Forbes

Iannello, P., Mottini, A., Tirelli, S., Riva, S., & Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Medical education online

Reis-Dennis, S., Gerrity, M. S., & Geller, G. (2021). Tolerance for uncertainty and professional development: a normative analysis. Journal of general internal medicine

Simpkin, A. L., Khan, A., West, D. C., Garcia, B. M., Sectish, T. C., Spector, N. D., & Landrigan, C. P. (2018). Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Academic pediatrics

Sinsky, C. A., Brown, R.L., Stillman, M. J., & Linzer, M. (2021) COVID-related stress and work intentions is a sample of US health care workers. Mayo Clinic proceedings

HALT: A Self-Coaching Stress Management Tool for Physicians

An earlier version of this article appeared on this website in January, 2024

As a retired cardiologist and a physician coach, I've seen firsthand how the current state of healthcare can push even the most resilient doctors to their limits. On some days, it might feel like one more disrespectful message, incomplete handoff, or chaotic clinic day could push you over the edge.

In these tough moments, HALT can help. It’s a quick and powerful prompt that helps you to check in with yourself, pause, recalibrate, and respond with intention.

HALT stands for Hungry, Angry, Lonely, Tired. Originally developed by psychiatrist and addiction specialist Dr. David Streem, HALT was designed to help people recognize the triggers that might lead to a relapse.  But for physicians, the acronym serves as an intuitive tool that can remind you to mindfully take a pause and acknowledge what you need, instead of lashing out with a reaction that you might later regret.

Why HALT Matters for Physicians

Burnout is recognized as a natural human response to a dysfunctional workplace. Key features include emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. Most physicians experience one or more of these aspects of the syndrome. Burnout is not your fault. Nor is it a mental health diagnosis. But when left unchecked, burnout can fuel emotional outbursts and reactive behavior that may jeopardize your professional standing, strain your personal relationships, and leave you feeling even more overwhelmed.

Whether or not you’re experiencing full-blown burnout, it’s likely that you encounter frustration on the regular. How you navigate these challenges can have ripple effects. When you’re running on empty—emotionally or physically—you're more likely to lash out, shut down, or say something you’ll regret when you’re triggered. These reactions don’t just affect patient care and team dynamics; they can also have serious consequences for your career.

That’s where HALT comes in. Ask yourself if you feel:

❓Hungry

❓Angry

❓Lonely

❓Tired

If the answer to any of the above is yes, take a breath, slow your roll, and give yourself a moment of self-compassion and grace.

Here's how HALT works:

Hungry

When you're hungry, even small problems can feel overwhelming. Hunger can wear down your patience and trash your tolerance for stress and difficult interactions.

If you’re like many physicians, hunger may be your default mode. Although it shouldn’t be the norm, it’s painfully common for physicians to skip meals or eat irregularly due to hectic and overbooked schedules.

Junk food from the snack machine or physician’s lounge might fill you up, but it can often make you feel even worse. One easy strategy to counter the “hangries” is to take a few minutes each evening to pack something nourishing for the next day. Nuts, a piece of fruit, or a protein bar can go a long way.

But hunger isn't just about food. It's often about other unmet needs, whether emotional, physical, or intellectual.

Take action on all kinds of hunger by building in a 10–15-minute break to reset your mind and body once or twice daily whenever possible.  When you fill up the tank, stabilize your blood sugar and slow down your sympathetic nervous system, you’ll likely find it easier to maintain a steady mood and energy level.

In the long run, the few minutes you carve out to care for yourself will pay off in more respectful relationships, improved productivity, and better health.

Angry

Anger is a natural emotion, but how you handle it in the workplace is crucial. Unchecked anger can lead to conflicts with colleagues, write-ups from staff, and unpleasant meetings with administrators. When it carries over to the bedside or operating room, it may impact the doctor-patient relationship, undermine teamwork, and even affect patient care.

Often the first warning sign of anger is your physical reaction. Become aware of this emotion, and notice how it feels in your body. When you find yourself getting angry, take a moment to pause and step back. Give yourself time to process and reflect, so that you can move forward with intention instead of reaction.

Deep breathing, a short walk, or even bluntly but respectfully discussing your feelings with a trusted colleague can open up a fresh perspective and prevent words and actions that you’ll regret later.

Lonely

Even if you’re surrounded by people all day, the medical profession can be isolating. The weight of responsibility, the fear of making mistakes, a constant pressure to perform, and the need for confidentiality can all leave physicians feeling emotionally disconnected.

When you’re feeling lonely, your stress response may be more intense—reactivity, irritability, or emotional withdrawal can all be signs that you’re running low on connection.

Acknowledging loneliness is the first step toward countering it. Even brief yet meaningful interactions with friends, family, or trusted colleagues can help restore a sense of belonging. Get outside of the boundaries of the clinic or hospital, even if it feels a little uncomfortable at first. Finding a hobby or activity that gets you out of the “doctor” mindset can offer much-needed connection and perspective.

Tired

When you’re tired, everything just feels harder. It’s no surprise that fatigue is a common issue among physicians. Long hours, high stress, and fractured sleep while on call mean that more than 40 percent of doctors surveyed report that their work schedule simply doesn’t allow for adequate sleep.

Chronic tiredness can impair your judgment and your empathy. Although it can be hard to feel compassion for your staff and others though the fog of fatigue, noticing what’s driving your irritation can soften your reaction to stress.

While you may not always be able to control your schedule, small changes can still make a meaningful difference. Prioritize consistent sleep when possible, even if it means saying no to non-essential obligations. When you’re sleep deprived, use short breaks during the day, even if it’s just five to ten minutes, to stretch, breathe deeply, or take a quick walk. Even modest improvements in rest and recovery can help restore your clarity and replenish your emotional reserves.

How to Use HALT in Your Daily Practice

✅ Check In: Before reacting, take a breath and run through your HALT checklist. This simple pause can reset your frame of reference.

✅ Be Proactive: Make time for healthy meals, use brief but effective stress-relief practices like mindfulness, get regular exercise, cultivate a life outside of work, and do your best to get restful sleep.

✅ Seek Support: If you're struggling with anger, loneliness, or fatigue, professional support can be a lifeline. Therapy, coaching, or peer support groups may offer the perspective and tools you need, depending on your circumstances.

✅ Communicate with Colleagues: Foster an environment where it's safe to respectfully express what you’re feeling. This kind of openness can build stronger, more supportive team dynamics.

Simply recognizing your internal state is often enough to shift your response. It’s also a powerful reminder that caring for yourself is neither selfish nor optional.

When you meet your needs with intention and care, you’ll create the capacity to show up more fully for your patients, your team, and yourself.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Maximize Your Time: Essential Toolkit for Physician Time Management

An earlier version of this article appeared on this website in December, 2023

Physicians aren’t magicians, but the demands of the job often make it feel like you’re expected to conjure time out of thin air. It’s not your imagination. A recent study found that in order for a primary care physician to provide guideline-recommended care and communication, they would have to work nearly 27 hours every single day.

With burnout impacting more than half of US physicians, much of it related to these unrealistic demands, some healthcare systems and many medical associations are beginning to take note. System-wide commitments to streamline tasks and automate simple processes are beginning to take hold. But true reform is likely to be several years away.

In the meantime, when every minute of your day feels like it belongs to someone else, managing your own time isn’t a luxury. It’s essential. Yet time management is rarely taught in medical training, leaving many of us to figure it out the hard way.

During my years as a busy cardiologist, I became fascinated by productivity strategies. I learned from the best in the field, and I discovered that with the right tools, I could work more efficiently and create space for what mattered most outside of my practice. That included time with friends and family, creative pursuits, and re-energizing with physical pursuits like riding my horse and practicing yoga. That extra space in my life helped me to stay energized and focused so I could keep showing up fully for my patients.

As a physician coach, I enjoy sharing these simple techniques and insights with my clients. For some, they can be transformative. By optimizing your personal time, you may find that the more rigid pressures of work feel like less of a burden.

Start a Bullet Journal

A bullet journal is one of my favorite time savers. This analog notebook is far more than a traditional planner. It’s a personalized system that blends task management, reflection, and goal tracking. Here’s how it can work for you.

✅Customizable Layout: Design your bullet journal to fit your needs, whether that’s jotting daily to-dos, tracking long-term projects, or creating space for self-reflection. Don’t worry about making it look pretty, unless that’s something you enjoy. Mine is simple: a basic checklist and scattered notes throughout the day. No artistry required.

✅Mindfulness Practice: The act of writing by hand boosts memory and mindfulness. It can also help you to prioritize tasks. I like to take 10 minutes every evening to set up my plans for the next day. Even if I don’t check off every box, simply writing them down creates an intention and makes it more likely that I’ll eventually follow through.

✅Bonus Tip: Use color coding for the win. Assign different colors to specific types of tasks or appointments—like blue for meetings, green for personal time, and red for urgent deadlines. It’s a quick way to visually organize your schedule and makes it easier to remember what’s important at a glance.

If you want a deeper dive into bullet journaling, check out The Bullet Journal Method, by Ryder Carroll. There’s no rush to get through it. For me, ten minutes a day was enough to build lasting momentum.

Commute with Audiobooks

Multitasking is generally overrated. That’s because most people tend to do both things halfway. And multitasking can make you more vulnerable to distractions. But listening to a good podcast or audiobook on your commute or while exercising can be a great way to safely and efficiently feed two birds at the same time. That could be CME, a good story, or personal development.

Here’s a brief list of some of my favorite productivity audiobooks:

✅Four Thousand Weeks by Oliver Burkeman is a thought-provoking exploration of time, productivity, and the modern obsession with getting everything done. Rather than offering hacks to do more, Burkeman challenges us to embrace the limitations of the human lifespan, roughly 4,000 weeks, and focus on what truly matters. It’s a refreshing, philosophical take on time management that encourages purpose over perfection and presence over productivity.

✅Atomic Habits by James Clear focuses on the development of small, incremental habits to achieve significant life changes. The book emphasizes the compound effects of your small daily decisions and the importance of establishing systems rather than focusing solely on goals.

✅Stolen Focus by Johann Hari delves into the modern crisis of attention, exploring how various factors in our environment and daily lives erode our ability to concentrate. Hari argues that the decrease in attention spans is not an individual failing, but rather a systemic issue influenced by technology, diet, sleep patterns, and societal structures. Although Hari advises systemic change, simply being aware of these forces can help you to push back.              

✅Deep Work: Rules for Focused Success in a Distracted World by Cal Newport advocates for a practice of deep, focused work as opposed to the more common shallow, multitasking approach. The book offers practical advice on how to cultivate a deep work habit, minimize distractions, and maximize your cognitive capabilities. Although the ideas in the book are not always applicable to the reality of a physician’s practice, you will come away with a greater understanding of the importance of focus and the negative impact of constant distractions.

Recharge with App-Based Yoga and Fitness

Taking care of your physical and mental well-being is one of the most powerful ways to clear your head, enhancing your ability to manage time. As a registered yoga teacher, I’m a big fan of online yoga classes—not just for the practice itself, but for the flexibility they offer.

✅Flexibility: Yoga apps let you practice at your convenience, fitting sessions into a busy schedule. . Whether you have 10 minutes or a full hour, there’s something that fits your schedule. I like DownDog, AloMoves, and YogaWorks. All three also offer options besides yoga, including strength training and meditation. And some offer live options as well.

✅Stress Relief: : Yoga, like many forms of movement, is a way to reset both body and mind. If you're just starting out, or if your time is limited, keep it simple. Commit to just 10 minutes twice a week and build from there. Sometimes the hardest part is simply beginning.

✅One quick tip: If you’re new to yoga, Pilates, weight training, or any other form of movement, consider a few in-person sessions or private lessons. Learning the basics from a skilled teacher helps prevent injury, boosts confidence, and makes the experience more enjoyable.

 Save Time with a Time Tracking App 

Understanding where your time goes is the first step to better time management. My favorite easy-to-use option is Toggl. Time tracking apps can help you to:

✅Identify Time Drains: Tracking your time online can help you spot activities that sneakily eat up more time than you realize. That doesn’t mean you need to give up email or social media altogether—but when you see where your time is going, it becomes easier to make intentional choices that align with your priorities and values.

✅Create Structured Work Intervals: I especially like the Pomodoro Technique. It goes like this: Work for 25 minutes, then take a 5-minute break. This structured and repeatable process can enhance focus and prevent burnout. You can also use time tracking to break larger projects (as well as tasks like charting) into smaller intervals. That way you’ll maintain your focus and create a more manageable and efficient process.

✅Batch Your Tasks: By committing to focus on one type of task at a time, your efficiency will surge. For example, use a dedicated block of time for phone calls, charting, or emails. You’ll find that when you’re not skipping from one modality to another, you’re able to get more done, even if all you have is 10 minutes.

Click on “Do Not Disturb” Mode

Your attention is one of your most valuable resources. Pre-scheduling Do Not Disturb mode on your phone, computer, or both can protect your focus during critical windows of the day. Of course, being unavailable isn’t always practical, so be strategic in how you use this function. Here’s how it can help:

✅Fewer Interruptions: Silencing notifications during focus blocks helps reduce distractions and boost efficiency.

✅Protects Your Boundaries: Sending calls to voicemail or messages to “later” mode gives you breathing room for deep work, rest, or patient care.

✅Easy to Set Up: Most smartphones and operating systems allow you to automate DND based on time, location, or calendar events.

Pro tip: Let colleagues or assistants know when you’ll be in DND mode, so they can support your boundaries rather than bypass them.

Free Yourself with App Limits

Many apps, especially social media, are designed to control your attention. When you set a time limit (available in your phone’s settings), you can begin to take charge of this most valuable resource. Here’s why it works:

✅Raises Awareness: You may not realize how often you scroll until you get a daily report or hit a time limit.

✅Encourages Intentional Use: Setting a 15-minute cap on apps like Instagram, TikTok, or news sites helps you check in without falling down a rabbit hole.

✅Built Into Your Phone: Most smartphones include screen time settings where you can create limits for individual apps or categories (like entertainment or social media).

Take One Simple Step

You don’t need to overhaul your entire routine in order to optimize your time. Instead, pick and choose what works best for you, or let these ideas spark some options of your own. The important thing is to commit to making at least one change. When you invest a little time and energy to get started, you may be surprised by how much you get back.

What time management tricks and tools have you found that keep you organized and on task? Drop me a line. I’d love to hear from you!

DISCLAIMER: As an Amazon Associate I may earn from qualifying purchases, which means that if you click on one of the product links, I’ll receive a small commission. This helps support the website, for which I am grateful! Please do your own research before making any important decisions.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Using Tension as a Tool: Turning Discomfort into Strength

What do you feel when you think of the word tension? Maybe it’s a furrowed brow, a tightening in the shoulders, or a clenching of the jaw? Why wouldn’t you want to avoid such an uncomfortable feeling?

The Miriam Webster Dictionary defines tension as “inner striving, unrest, or imbalance, often with physiologic indication of emotion”, but also as “a balance maintained in an artistic work between opposing forces or elements.”

It’s normal to try to smooth over any sense of discomfort as soon as it arises. But what if you reframed tension as a tool—something to be explored and used to your advantage? Something that might even help you to create balance in your life and greater satisfaction in your medical practice. In this article, we’ll explore the ways that you can make tension work for you.

Tension as a Stimulus

Tension is a natural part of growth. In the body, muscles strengthen when they are challenged with resistance.

In the mind, as with problem solving, scientific research or even art, breakthroughs happen when we hold space for competing ideas and perspectives. And in personal and professional development, tension often signals the moments where change is possible.

Tension as a Signal

As a physician, you may experience tension as a pull between the demands of patient care and personal well-being, or between your role as a trusted healer and the bureaucratic realities of modern healthcare. Instead of always seeing this as a burden, what if you used it as a signal to reassess, reprioritize, and innovate? 

As a coach, I work with physicians who may yearn for immediate relief from career dissatisfaction, burnout, or decision fatigue. But sustainable change doesn’t usually come from escaping tension—it comes from staying with it long enough to understand what it’s trying to reveal.

The tension between wanting stability and craving change, between honoring commitments and protecting personal boundaries, can become the catalyst for transformation when approached with curiosity instead of resistance.

Tension as a Creative Tool

Tension in a work of art—whether through contrast, unexpected juxtapositions, or asymmetry—creates interest. A perfectly balanced, symmetrical photograph might be beautiful, but it can also be forgettable, lost in a sea of similar work. It’s the unexpected tension in a frame that pulls the viewer in, making them linger and engage. 

The same is true in problem-solving. Whether you are navigating career decisions, leadership dynamics, or personal dilemmas, the most creative and impactful solutions often emerge from the friction between opposing forces. This idea can also be applied to patient care, for instance when trying to devise a complex treatment plan for a patient with competing health and personal issues.

When you try to escape tension, it can be tempting to settle for the easiest answer instead of the best one. Instead, if you stay with the discomfort a little longer, you may allow space for deeper insight and more creative approaches.

Using Tension Intentionally

Just as yoga can teach you to breathe through physical tension rather than fight it, we can apply the same principle to mental and professional challenges. By leaning into discomfort with awareness, you allow yourself room to experience growth.

Pause Instead of Reacting

When you feel tension -- whether in a difficult conversation, a contentious committee meeting, or an internal conflict—take a moment to pause. Instead of immediately resolving the discomfort by taking the path of least resistance, ask yourself “What is this tension telling me?”

Reframe Tension as Information

Instead of trying to scape it, view tension as a source of data. If a decision is difficult, what values or priorities are in conflict? If a conversation is uncomfortable, what truths might need to be acknowledged? 

Use Tension to Expand Possibilities

In my coaching practice, I often ask my clients “What if you didn’t have to choose one or the other? What if both things could be true?” Tension can lead to a binary mindset, an either/or perspective, but staying with it can reveal more nuanced, integrated, and interesting solutions. 

Apply Tension to Leadership and Communication

Great leaders use tension productively. Instead of avoiding difficult conversations or suppressing dissent, they recognize that discomfort can lead to clarity, deeper alignment, and stronger teams. Productive tension—when handled with respect—can push individuals and teams toward innovation and better decision-making that makes room for everyone’s perspective.

Let Tension Strengthen Your Work

Whether you’re navigating a career transition, leading a team, or developing a new project, tension signals that something important is at stake. Instead of smoothing things over too soon, ask yourself: How can I use this tension to create something better?

Leaning into Tension

When used mindfully, tension can deepen your thinking, sharpen your skills, and lead to better outcomes in virtually any aspect of your life. 

Instead of asking, How do I get rid of this tension? try asking yourself, What can this tension teach me? That shift in perspective might be the key to unlocking your next breakthrough.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery meeting, click the button below.

Creating Boundaries and Reclaiming Values: My Podcast Appearance on Dr. Bill Lombardi’s Journey to Better

I recently had the great privilege to be invited back to trail-blazing cardiologist Dr. Bill Lombardi's Journey to Better podcast. This is truly one of the best physician-focused podcasts out there.

Bill is a fantastic and thought-provoking interviewer! We discussed a wide range of issues facing physicians today, including

⚕️The importance of setting boundaries

⚕️How to integrate the experience of the arts into medical practice

⚕️The crucial role of effective and engaged leadership

⚕️Why defining your personal values can help you to make better decisions for yourself and your practice

⚕️How coaching can work for physicians dealing with challenges of transitions, time management, and leadership opportunities.

You can find our conversation wherever you get your podcasts, including Spotify and Apple Podcasts, or take a listen below. And if you want to listen to my first podcast appearance on the show, you can find it here.

My second podcast appearance on The Journey to Better with Dr. Bill Lombardi

Physician Stress and Burnout: How Mindful Coaching Can Help

An earlier version of this article appeared on this website in December, 2023

Although physician burnout has probably existed for decades, it’s only recently that it has taken on the notoriety of an epidemic. A visit to PubMed.gov tells the story. In 2024 alone, 872 academic papers were published on physician burnout. Compare that to just 129 in 2011—or 4, the year I entered medical school in 1984.

Many factors have contributed to the rise in burnout, both inside and outside the institution of healthcare. Some are relatively new, such as the rapid rise of disinformation and disrespect, while others, including diminishing reimbursement for services and corporate takeover of practices, have been slowly gathering momentum. For years no one talked about it. Today burnout is out in the open, yet a clear path to meaningful prevention remains elusive.

What Burnout Really Means

The term “burnout” itself may sound a little nebulous, but there are methods to measure and define it.

The Maslach Burnout Inventory defines burnout as “a psychological syndrome” that occurs among people who work with others—particularly in high-demand environments such as healthcare.

The key symptoms?

🩻 Emotional exhaustion – feeling like you’ve got nothing left to give

🩻 Depersonalization – distancing yourself from patients, often with growing cynicism

🩻 Reduced personal accomplishment – feeling ineffective, even hopeless

Although it can give you the blues, burnout isn’t a psychiatric disorder. It’s a normal human response to an abnormal, high-stress environment.

We all have tough days, so how can you recognize burnout? One important clue is that when these symptoms become persistent and all-consuming, burnout is likely at play.

The Data Behind the Epidemic

A 2023 Mayo Clinic survey of over 7000 US physicians found that more than 45% reported symptoms of burnout. That’s down from the pandemic high of nearly 63% in 2021—but still higher than pre-pandemic levels.

Burnout rates were highest in:

🤕 Emergency Medicine

🤕 Internal Medicine

🤕 Neurology

Other studies have shown elevated burnout in

🤕Critical Care

🤕Ob-Gyn

🤕Infectious Disease

🤕Family Medicine

It was notable that in the Mayo study, subspecialty surgeons reported lower-than-average rates.

Risk factors: Not Just About Workload

The biggest contributors to burnout will sound familiar to anyone in healthcare.

⭕ Bureaucratic tasks

⭕ Lack of respect

⭕ Long hours

⭕ Lack of autonomy

These align closely with the six factors associated with workplace stress identified by the British workplace health and safety regulatory agency:

⭕High work demands

⭕Low control over workload and process

⭕Inadequate support from management and colleagues

⭕Poor workplace relationships

⭕Lack of clarity regarding professional role and responsibilities

⭕Poor management of change within the organization

Personal factors matter too. The Mayo Clinic study found that women physicians are about 30% more likely to report burnout. And those with strong support at home—often reflected in marriage status—tend to report lower burnout rates.

Why This Matters: Beyond the Statistics

Burnout doesn’t just make you miserable. It affects your confidence, your relationships, your clinical decision-making, and your ability to experience meaning at work.

And while it feels like everyone is talking about burnout, it often seems like nothing is being done about it.

Which brings us to the next question: What can we do?

Beyond Bubble Baths—Real Tools to Tackle Physician Burnout

We’re not going to yoga or om our way out of this mess. It’s a far more tangled web than that.

And let’s be clear: the responsibility to fix burnout should not rest on the shoulders of burned-out physicians. We wouldn’t expect that of our patients. The source of suffering needs to be addressed before meaningful change can happen.

To ensure sustainable and high quality care for patients, including an engaged and committed medical staff, healthcare systems must lead the charge in addressing root causes. But while we wait for structural change, there are tools that can make a meaningful difference. Among the most promising? Mindfulness and coaching.

Mindfulness: More Than a Buzzword

Mindfulness is often dismissed as fluff—but it’s more than the popular notions of deep breaths and apps.

As a certified mindfulness meditation teacher, I define mindfulness the way my mentor Sean Fargo does:

“Paying attention to the present moment with curiosity and non-judgment.”

It’s not about escaping stress, but building awareness of how we relate to it. In other words, it’s about simply being present.

This sounds nice, but how can it possibly help you overcome the powerful forces that lead to stress and burnout?

In a 2020 meta-analysis of randomized controlled trials involving medical students, mindfulness programs led to significantly lower stress scores—even months later. Techniques included:

🌻Body scans

🌻Awareness of thoughts and emotions

🌻Breathing exercises

🌻Walking and sitting meditation

🌻Group sessions and mobile apps

Most programs were once weekly group sessions, while one used a mobile app.

Mindfulness isn’t magic. You won’t suddenly be living in a blissed-out state of ease. But mindfulness can create a powerful shift in your patterns of thought and open possibilities for new and supportive ways to navigate stressful environments.

Coaching: A Practical, Personalized Intervention

Coaching offers another evidence-based path forward—one that’s personalized, practical, and action-oriented.

In a 2019 randomized trial from the Mayo Clinic, physicians who received six coaching sessions by phone experienced:

📞17% drop in burnout (vs. an increase in controls)

📞20% drop in emotional exhaustion

📞Improvements in job satisfaction, engagement, and meaning at work

Other studies, including one from Duke University, have shown benefits for physicians at all stages—from residents to senior leaders.

Coaching gives you a supportive structure to clarify your values, reset your goals, and regain agency. Sometimes, that means discovering a way to achieve a better balance in your current role. Other times, it means exploring new positions. For some, it means leaving clinical practice altogether.

Mindful Coaching: Where Awareness Meets Action

When mindfulness and coaching intersect, physicians get the best of both worlds:

❇️ Awareness of what's depleting your energy

❇️ Clarity around what matters most

❇️ Practical tools for taking aligned, meaningful action

This is not about telling physicians to fix themselves. It’s about providing a safe space to reflect, reset, and reconnect with purpose..

A Call for Change

Although mindful coaching can help you rediscover your own strengths, burnout is not a failure of individual resilience. It is a consequence of a system that demands too much and gives too little. But within that system, you can still reclaim clarity, agency, and connection through personalized support that connects with your own value system and aspirations.

Systemic change is essential, but it begins with the individual. When you advocate for your own well-being, you’re also shaping a more humane and sustainable future for healthcare.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Berg, S. (2021). Q&A: Clearing up confusion on physician burnout and depression. American Medical Association

Christensen, A. J. et al. (2023). Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Military medicine, 189(Suppl 1), 64–70. https://doi.org/10.1093/milmed/usad277

“Death by 1000 Cuts”: Medscape National Physician Burnout & Suicide Report 2021. (n.d.). Medscape. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#3

Drybye, L.N. et al. (2019). Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. Journal of the American Medical Association Internal Medicine

Garcia, C. L. et al. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina

Hathaisaard, C. et al. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: a systematic review and meta-analysis. Asian Journal of Psychiatry

Health and Safety Executive. (2019). Tackling work-related stress using the management standards approach

Kane, L. (2022). Physician burnout and depression report 2022: stress, anxiety, and anger. Medscape

Maslach, C. et al. (1997). The Maslach Burnout Inventory Manual

Schneider, S. et al. (2014). Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention. Explore

Shanafelt, T. D., West, C. P., Sinsky, C., Trockel, M., Tutty, M., Wang, H., Carlasare, L. E., & Dyrbye, L. N. (n.d.). Changes in burnout and satisfaction with Work–Life integration in physicians and the general US working population between 2011 and 2023. Mayo Clinic Proceedings. https://doi.org/10.1016/j.mayocp.2024.11.031

Compassion Without Burnout: How Physicians Can Balance Empathy and Sustainable Practice

Balancing deep compassion with professional distance in the face of suffering and death can be challenging for newer physicians. Learning to care deeply while maintaining emotional boundaries is a skill that takes time to develop. This is the practice of equanimity. For many seasoned physicians, sustaining this balance is a lifelong point of tension.  

Whether you work in a high-intensity surgical or critical care specialty or an outpatient practice in which you nurture long-term relationships with your patients, you are likely to face this challenge many times through your professional life.

Detachment as a Survival Mechanism

Intense suffering, tragedy, and death are circumstances that most people only experience a handful of times in their lives. For many physicians, this is the reality of a normal day at work.

When your job is to make strategic decisions and take decisive action, creating separation from another’s anguish is not a flaw; it is a necessary adaptation. It allows you to effectively care for your patients, alleviating the source of their distress without taking on the burden of every painful story. And it protects your patients, because it means that your decisions come from a place of wisdom and expertise.

At the same time, maintaining an emotional distance can often come across as distant and unfeeling. When it becomes habitual, you may even begin to believe that you’ve lost your ability to experience compassion. It’s a fine line to walk, and it’s something that is rarely taught.

If taken too far, suppressing your inherent pull of empathy can erode patient trust and increase your risk of professional burnout. It may also spill over into your personal life, impacting your ability to connect with those you love and risking your present and future well-being.

One Doctor’s Struggle: When Emotional Armor Becomes a Burden

A highly skilled interventional cardiologist I know recently reflected on the ways that his years of exposure to suffering created a powerful emotional detachment that threatened his health and his marriage.

Early in his career, the heavy weight of each patient’s experience felt overwhelming, as if every tragedy could pull him underwater. He often cared for people who sought him out knowing that their advanced heart disease left them with few remaining options. Many times, the procedures he could offer carried great risk. And while most patients benefited, some did not. There was a high risk of complications, and he knew that a few would die despite his best efforts.

Attempting to protect himself, he grew a thick, protective, rational shell which numbed him emotionally and created an aura of impassiveness that was often perceived as indifference and even coldness. Over time, this self-protection extended into his personal life, putting his marriage and family at risk.

His case-hardened persona was at odds with his personal values and created a feeling of disunity and distress. He was often tempted to numb himself to exhaustion with extreme exercise before going home, even when it was very late in the evening. He eventually realized that change was necessary—not only to sustain his career in interventional cardiology but also to repair and preserve his relationships with his wife and family.

When it became clear that he was about to lose the people who mattered most to him, he reached out for help. Over time, through a practice of mindfulness and self-care, he became able to extend compassion to his patients without becoming emotionally engulfed in each case. As a result, he could nurture his personal relationships without fear that this vulnerability would bleed into his professional role.

Finding a Sustainable Path Forward

How can you begin to find the balance between maintaining compassion and protecting yourself? It can be helpful to remember that detachment doesn’t mean not caring—it means setting boundaries to ensure longevity in a profession that demands so much of you.

Your emotional capacity is rarely infinite. It may help to think of it as an energy bank account that requires careful management. When you worry endlessly about outcomes beyond your control, you’re spending your energy recklessly, draining your account without benefiting yourself or your patients.

Just like a bank account, emotional capacity is not only about withdrawals, but also about strategic savings and interest. This comes through self-care. This might mean practicing mindfulness, connecting with colleagues who understand the emotional toll and have found healthy ways to manage the distress, or engaging in fulfilling activities outside of medicine.

Studies of surgeons engaging in a surgeon-focused mindfulness-based stress reduction program known as Enhanced Resilience Stress Training have shown important benefits. Similar programs are likely to help others who deal with high-stakes situations on a daily basis.

Coaching can also be a meaningful tool, providing a supportive space to reflect, gain clarity, and develop your own path forward.  If the weight of it all feels too heavy, working with a therapist who understands the unique challenges physicians face can provide valuable support.

Compassionate Boundaries

If you’ve ever felt guilty for not feeling deeply every time you witness a patient suffering, you are not alone. This is not a failure of empathy; it is a recalibration that allows you to keep showing up, day after day, for the people who need you. Compassion and detachment are not mutually exclusive, and compassion is not measured by how much suffering you absorb,

By setting boundaries, recognizing your own limits of emotional energy, and applying mindful detachment with care, you will find your way to practice compassionately while protecting your own well-being. You’ll create a meaningful separation between work and home. And you’ll be present and effective for your patients in their time of need.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery meeting, click the button below.

When Physicians are Disrespected: My Guest Appearance on the Podcast by KevinMD

If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.

Not only does he offer a curated selection of articles tailored to physicians and others in healthcare, Dr. Pho also hosts a podcast for thought leaders in the medical field. I was honored to be invited back as a guest.

In this episode, which originally aired in October 2023, we talk about the epidemic of disrespect faced by physicians today, and clear steps you can take to advocate for yourself and reclaim your dignity.

This is a topic I wrote about in Preventing Physician Burnout: Reclaiming Your Dignity. An earlier version of the article also appeared on the KevinMD website.

When physicians and others in healthcare are treated respectfully, the practice of medicine becomes more sustainable and more inclusive.

My podcast appearance discussing disrespect on the Podcast by Kevin MD.

Thriving Amidst Chaos: Prioritizing Health, Self-Care, and Mindfulness

An earlier version of this article appeared on this website in October 2023

When your days are busy and your evenings are full, making time for your own well-being can sometimes feel like just another thing to check off your endless to-do list. If you’re like many physicians, self-care often falls by the wayside.

The truth is that you need to recharge and refresh in order to be the best version of yourself. And, as important as it is to care for your own health and happiness, it’s not just about you. When you care for yourself, you’ll be better equipped to care for those who depend on you.

In this article, we’ll explore why self-care matters, including the impact of self-care on stress management. Next, I’ll give you some simple steps that will help you to put these ideas into motion. By caring for yourself, you’ll be empowered to thrive amidst the daily storm of medical practice.

The Impact of Stress on Burnout

It’s common to think of stress as harmful and something to be avoided. But stress can affect your health positively as well as negatively.

Positive stress (or eustress) happens when you face a challenge or a deadline that you know you are capable of meeting. It might be a stretch, but you know it’s possible. And importantly, there is a reward waiting on the other side.

While positive stress can propel you towards your goals, negative stress (sometimes called distress) can lead to frustration and burnout. Negative stressors are those forms of stress over which you have no control. A boss (or spouse) who is never happy, a job for which you are never rewarded or thanked, and escalating demands at work without adequate time off to rest and reset are all forms of negative stress.

Constant and unrelenting stress can lead to burnout. The World Health Organization defines burnout as an “occupational phenomenon.” Burnout is characterized by

• Exhaustion and loss of motivation

• Cynicism and negativity

• Inefficiency

Given the current state of healthcare, it’s no surprise that nearly half of physicians reported at least one manifestation of burnout in 2024.

It’s important to remember that burnout is not your fault. By definition, it is a symptom of a dysfunctional system or workplace. Perfectionists, people-pleasers, and so-called workaholics seem to be more susceptible. Not surprisingly, these personality types are common for physicians. But developing some tools to help you get through tough times can lessen the impact and improve your overall happiness and wellbeing.

Self Care and its Benefits

Self-care is not just about pampering yourself. It's about taking care of your mental, emotional, and physical well-being.

Committing to self-care can enhance your focus, improve relationships, lower stress, and mitigate burnout. Acknowledging the mind-body connection is often the first step towards effective self- care.

Nutritional Psychiatry and Stress Management

The new field of Nutritional Psychiatry focuses on the growing body of research that strongly connects what you eat to how you feel. Without a doubt, mental health is complex and multifaceted. Diet is only one part of the big picture.

But when you’re famished and pressed for time, the quickest options can undermine you, sabotaging your best intentions and sapping your energy.

As it turns out, those ultra-processed foods that often pass for nutrition in the doctor’s lounge or office snack machine can raise your risk of anxiety, sleep disturbance, depression, food addiction, alcohol use disorder, and increased inflammation. Artificial sweeteners in particular have been linked to a greater risk for depression.

Instead, consider switching in simple elements of the Mediterranean diet like fruits, nuts, whole grains, olive oil and fish. You probably know that the Mediterranean diet supports heart health and may reduce the risk for certain cancers. But this diet is also linked to improved symptoms of depression and better mental health and well-being. There’s also emerging evidence that a Mediterranean diet can improve perceptual performance.

It might take a little planning, but going Mediterranean doesn’t have to be complicated. Simply packing a nourishing lunch or advocating for healthier options at work can make a difference.

Exercise and Health

You already know that regular exercise will lower your risk for heart disease, cancer, bone disease, and dementia, among other dreaded conditions.

But research has also shown that exercise can reduce anxiety, improve sleep, and improve immune function. It doesn’t take a lot of exercise to reap the benefits. A brisk 15 minute walk a few days a week is a great way to get started.

Mindfulness and Self-Care

"Mindfulness is the awareness that arises when we nonjudgmentally pay attention in the present moment.” These are the words of Jon Kabat-Zinn, PhD., Professor of Medicine Emeritus at the University of Massachusetts Medical School, and the godfather of mindfulness in healthcare.

Put even more simply, mindfulness is undistracted attention.

Practicing mindfulness has a wealth of benefits, some of which you might not anticipate, including

• Healthier lifestyle choices

• Less stress and anxiety

• Greater parasympathetic tone

• Better cardiovascular health

• Improved immunity.

If it all sounds a little woo, know that mindfulness doesn’t have to be about practicing yoga or meditating. You don’t need a special cushion or a meditation app, although those can be nice. Instead, it’s about being undistracted, nonreactive, and fully present in the moment.

Getting started with mindfulness isn’t complicated. Simply set aside 3-10 minutes of quiet time each day to observe the present moment. Notice your thoughts and let them go, returning to the present when your mind wanders.

It is this practice of continually returning to the present moment that develops the “mindfulness muscle.”

When you practice mindfulness, you may find that your presence, and hence communication, with patients and colleagues becomes easier and more engaged.

Create an Action Plan

Creating an action plan will help you to set realistic goals and track your progress. Write out the steps that you need to take to commit to your self-care. And develop a plan that is realistic and actionable.

Consider enlisting a partner or friend with whom you can share accountability to help you to stay committed. Something as simple as a daily reminder on your phone may also keep you on track.

The ripple effect of taking your own self-care to heart will show up in your energy level, creativity, and relationships. You may notice a greater sense of self-compassion and equanimity. And in time, your path forward toward the goals that matter will become more clear.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Adan, R. A. H. et al. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 29(12), 1321–1332.

American Medical Association & American Medical Association. (2024, July 2). Physician burnout rate drops below 50% for first time in 4 years. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-rate-drops-below-50-first-time-4-years

APA Dictionary of Psychology. (n.d.). https://dictionary.apa.org/eustress

Brulé, G., & Morgan, R. (2018). Editorial Working with stress: can we turn distress into eustress? ResearchGate. https://www.researchgate.net/publication/324531212_Editorial_Working_with_stress_can_we_turn_distress_into_eustress

Davidson, R. J. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine, 65(4), 564–570.

Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, et al. (2022). Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults. British Journal of Sports Medicine 56:1188-1193.

Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4), 227–234

Lane, M. M. et al. (2022). Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 14(13), 2568.

Loucks, E. B.et al. (2015). Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Current cardiology reports, 17(12), 112.

Martinez-Gonzalez, M. et al. (2019). The Mediterranean Diet and Cardiovascular Health: A Critical Review. Circulation Research 124:779-787

Munoz, M.A. et al. (2009). Adherence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition. 101 (1821-1827),

Samuthpongtorn C et al. (2023). Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023;6(9):e2334770. doi:10.1001/jamanetworkopen.2023.34770

Shanafelt, Tait D. et al. (2022). Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clinic Proceedings, Volume 97, Issue 12, 2248 - 2258

Stubbs, B. et al. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry research, 249, 102–108.

World Health Organization: WHO. “Burn-out an ‘Occupational Phenomenon’: International Classification of Diseases.” World Health Organization, 28 May 2019, www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases.

Yin, W. et al. (2021). Mediterranean Diet and Depression: A Population-based Cohort Study. International Journal of Behavioral Nutrition and Physical Activity, 18(1). https://doi.org/10.1186/s12966-021-01227-3

Young, H. A. et al. (2022). Mediterranean diet, interoception and mental health: Is it time to look beyond the ‘Gut-brain axis’? Physiology & Behavior, Volume 257.

My Podcast Appearance on Sustainable Clinical Medicine

I'm excited to share my recent podcast appearance on Sustainable Clinical Medicine with The Charting Coach, a podcast for physicians and others in healthcare hosted by Dr. Sarah Smith. Dr. Smith not only helps physicians who are struggling to keep up with charting, but she also hosts a podcast focused on the ideas and challenges that matter most to physicians and others in healthcare.

Here are three key takeaways from our conversation:

🔑Values Alignment: Discover the power of aligning your career and personal life with your core values.

🔑Saying No and Carving Time: Learn how to set boundaries and prioritize what brings you joy and fulfillment.

🔑Exploring New Avenues: Possibilities open up when you allow yourself to pursue interests outside of traditional medical roles, sustaining and supporting your life in medical practice.

You can take a listen at the link below, or find the podcast on Apple or Spotify.

Why Are We Afraid to Talk About Work-Life Balance?

An earlier version of this article appeared on Doximity, where I was a 2022-2023 Op-Med Fellow.

For many physicians, work-life balance (WLB) is the elephant in the room. According to CHG Healthcare, in 2018, 63% of physicians finishing residency programs cited WLB as their number one consideration when choosing a job. In 2022, it was 85%.

Dissatisfaction with WLB is strongly correlated with burnout, and is a common reason that many physicians choose to leave their current practice.

Although women physicians tend to rate WLB as somewhat more important than men, among millennials it is a top priority for both genders.

Yet physicians often avoid raising this crucial issue with potential employers and even colleagues for fear of being judged and found lacking.

The Fear is Real

This fear of judgment is based in reality: providing the best and most timely care to patients often requires self-sacrifice. The profession is demanding and the stakes are high; it’s a given that occasionally, or maybe even often, you will have to put personal needs aside to care for patients whose needs can’t wait.

But it’s not uncommon for physicians to fall prey to the notion that consistently putting aside their own, or their family’s, well-being is necessary to answer the “calling” of medicine. Healthcare institutions sometimes perpetuate this with an “always on” culture, idealizing self-sacrifice without adequately compensating for it.

For physicians whose work requires collaboration and partnership with others in the profession, openly wanting more from life may also stir up fears of being perceived as weak, lazy, or not a team player.

These concerns are real, and the demands of the profession are heavy. But when you get past the angst of admitting that you want more out of life and make an effort to seek balance, you will find that your relationships, your sense of fulfillment, and ultimately the care you give your patients can flourish.

Tangible Benefits of Seeking Balance

Research shows that not only do people who make time for family, hobbies, and health feel a greater sense of balance, but they may also become better physicians for it.

• A British study found that employees who engaged in creative activities were more likely to discover creative solutions to problems at work.

• A study of nearly 300 ICU staff members, including physicians, found that those who engaged in hobbies experienced less post-traumatic stress.

• And a Duke study found that higher WLB measures among hospital staff, including physicians, correlated with greater patient safety and improved teamwork.

On the opposite end of the spectrum, not attending to life outside of work can have serious consequences. A study of members of the American College of Surgeons published in 2012 found that those with conflicts between work and home life were more than twice as likely to experience burnout and depression. Experiencing this conflict also meant that the surgeons surveyed were more likely to leave their current practice.

And yet, balancing your life is easier said than done.

A Personal Story

Each doctor has a different story. Here’s mine:

As a cardiologist I was able to find WLB, although it required a substantial degree of focus and dedication. While in practice, I wrote four books (admittedly health related), became a yoga teacher, and competed successfully with my horses. I also made time to travel and hike around the world.

However, these efforts were not without sacrifice: I had to give up significant income in order to take a half day off a week to train with my horses. And I usually chose to take most of my allotted (uncompensated) vacation time.

Although I was fortunate enough to have an organized system of cross-coverage with my partners, the time off nevertheless meant that I was often catching up on EHR responsibilities late into the evening, sometimes even from the other side of the world.

Still, for me the loss of income and long nights catching up on charts was worth it. Not only was my life richer, but my diverse experiences and friendships made me a more compassionate and open-minded physician. My patients were always curious about my adventures, and often felt more connected to me when they realized that I shared some of their own interests. And having the opportunity to “fill my cup” gave me more energy and enthusiasm for my work.

What Does Work-Life Balance Look Like for You?

Work-life balance is deeply personal. It shifts with life’s seasons—whether you’re a new parent, an early-career physician, or a seasoned leader.

• Parents of young children might prioritize family time and set hobbies aside for a while.

• New physicians may need to focus on building their patient base and refining their skills.

• Ambitious professionals seeking leadership roles might accept that these positions come with time demands that require trade-offs.

Whatever your circumstances, achieving balance starts with acknowledging your needs and crafting a plan to meet them.

Discovering Balance

Here are some things to consider as you embark on your new path:

• Acknowledge Your Desires: Wanting more from life doesn’t make you less dedicated. You’re allowed to be a doctor and a spouse, parent, or adventurer.

• Create a Plan: Start small. Identify what balance looks like for you right now, and map out achievable steps to get there.

• Reassess Your Practice: Are there opportunities to cut back hours or take a regular day off? Could changing roles or employers help you reclaim time?

• Delegate Wisely: Hire help where needed—whether it’s a scribe, a babysitter, or a housecleaner. Small investments in assistance can free you for the things that matter most.

• Reevaluate Your Commute: Use your travel time for audiobooks, meditation, or CME. Or consider moving closer to work to reclaim precious hours.

• Say No Strategically: Not every committee or project is worth the sacrifice. Be intentional about the responsibilities you take on.

• Embrace Imperfection: You don’t need to dive headfirst into a new hobby. Start small—10 minutes of yoga, a quick walk, or a short meditation can work wonders.

• Limit Distractions: Replace mindless scrolling with meaningful activities, whether it’s reading, journaling, spending time with loved ones, or pursuing a creative interest.

• Try Something New: Join a workshop or pick up a hobby you’ve always been curious about. The joy of learning can be invigorating.

• Book a Getaway: Set a date, buy a ticket, and commit to taking time off. The anticipation alone can be rejuvenating.

Taking the First Step

No matter what work-life balance means to you, realize that an ideal balance looks different for each person. It can change over the course of a lifetime.

The most important way to achieve the balance you’re seeking is to put your ideas into action. Your life will be so much richer if you consciously put in the effort, often in ways that you might not anticipate today. And you may find that in the process, you generate more joy, creativity, and resilience in your medical practice.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Colville, G et al. Coping with staff burnout and work-related post-traumatic stress in intensive care. Pediatric Critical Care Medicine. July 2017.

Dyrbye LN et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Arch Surg. 2012 Oct.

Eschleman, K.J. et al. Benefiting from creative activity: The positive relationships between creative activity, recovery experiences, and performance-related outcomes. J. Occup. Organ. Psychol. April 2014.

Saley, C. Survey Report: Millennial doctors still finding jobs the old-fashioned way. CompHealth Blog. April 2018.

Saley, C. Survey: Work/life balance is #1 priority in physicians’ job search. CHG Healthcare. March 2022.

Sexton JB et al. The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions. BMJ Qual Saf. 2017 Aug.

Shanafelt TD et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. October 2012.

Overcoming Disrespect in Medicine: Protecting Physician Dignity

An earlier version of this article appeared on the KevinMD website in August, 2023.

Treating patients with dignity is one of the cornerstones of our profession. While we’ve all had moments when we—or our colleagues—didn’t quite measure up, most of us genuinely aim to make our patients feel safe and respected. But what about the flip side of this dynamic? It’s not talked about nearly enough: physicians are often not treated with the same dignity by their systems or even their patients.

In this article, I’ll dive into the major shifts that have led to this reality and share five practical strategies to help you push back against the disrespect and reclaim your sense of dignity.

The Roots of the Problem: Disrespect and Breakdown in Advocacy

We’ve been conditioned to expect, and even accept, that patients in distress might lash out, but the toll this has taken on physicians in recent years has been enormous. As recently as five years ago there was still a general expectation of respect for the expertise and sacrifices that a physician’s work entails.

But disrespect from patients is currently at an all-time high, sometimes even escalating to physical violence from patients. A recent study found that more than one third of public health workers in the US experience some form of workplace violence. Examples included stigma or discrimination, job-related threats, and bullying or harassment.

Adding fuel to the fire is the rise of administrative oversight of physicians and their practices by people who may have little experience in direct patient care. Their reach extends not only to metrics and billing, but into personal and professional decisions that once would have been completely off limits.

What’s more, employed physicians may have little say into whether threatening patients can be dismissed from their practices. 

And at the intersection of patient and administrative stress are the widely published patient satisfaction scores. While these scores often have no relevance to patient outcomes, they’ve become yet another pressure point, pushing physicians to prioritize arbitrary expectations over doing their best work.

 Although physicians are tasked with regular training in sensitivity and respect for patients and employees, they get little instruction in how to protect their own dignity. Often physicians are advised to just let it go.

It’s not unusual for doctors, especially women, to attempt to deal with these situations with passivity and even self-deprecation, in a misguided attempt to get along. Younger physicians who lack strong mentorship may be especially vulnerable to these situations.

Unfortunately, these well-meaning attempts to smooth things over often have the opposite effect. They can actually embolden the bully and do nothing to improve the situation.

The status quo is not sustainable, and it is incumbent on healthcare systems to work to create safe and respectful environments. As a physician, you have more power than you may realize. Here are five ideas that you can implement right now:

How to Reclaim Your Dignity

 1. Establish Boundaries

Boundaries are essential for maintaining professional relationships and protecting your sense of self. Being a compassionate and caring physician doesn’t mean being a friend to your patients or colleagues.

Keep a clear line between work and personal life—avoid interacting with patients or administrators on social media, and be intentional about separating the two spheres. Setting clear expectations for respectful behavior can help prevent issues before they arise.

2. Advocate for a Respectful Work Environment

If you don’t stand up for yourself, who will? Open discussions about mutual respect—at meetings or through anonymous feedback systems—can pave the way for change.

Remember, you’re not asking for anything unreasonable. Advocating for policies that address disrespect and burnout can help create a healthier, more supportive workplace for everyone.

3. Strengthen Doctor-Patient Communication

Good communication is at the heart of the physician-patient relationship. By being empathetic and respectful in your interactions, you can set the tone for civility with both patients and staff.

Stay calm during difficult conversations—pause, take a deep breath, and step away if needed. Active listening, showing genuine interest in patients' concerns, and involving them in decision-making can help build trust and respect.

And although the EHR is great tool for communication, keeping EHR messages brief and focused can help to maintain your professional boundaries while addressing patient concerns.

4. Don’t Accept Disrespect

Firmly but politely calling out an incident of disrespect can be a first step towards creating a solution. When an issue persists or escalates, document what’s happening—it’s often more effective than just voicing complaints.

But if you feel that your safety or that of your staff is at risk, don’t allow yourself to be talked into accepting a dangerous situation. If you’re employed, your healthcare system bears responsibility. If your concerns are not addressed, sometimes engaging with and reporting to security or even law enforcement personnel is the best course of action to protect everyone.

5. Take Care of Yourself

Prioritize your own well-being. Make time for self-care, whether it’s through exercise, meditation, or hobbies to help you recharge emotionally and mentally. Mindfulness practices can give you tools that help you to stay present, focused, and composed during difficult encounters, preventing potential escalation.

Don’t overlook the importance of making time for your family, friends and loved ones. By nurturing these ties, you will stay connected to the world outside of your practice.

Reclaiming your dignity as a physician will require commitment and fortitude. While it’s crucial to acknowledge the culpability of our healthcare systems, real change will depend on strong advocacy from physicians like you. By starting with the steps above, you can begin to build a workplace that’s not only more respectful but also more sustainable. And ultimately everyone, including the patients you care for, will benefit.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Fenton JJ et al. The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Archives of Internal Medicine. 2012

Ofri, D. The Business of Health Care Depends on Exploiting Doctors and Nurses . The New York Times. June 8, 2019

Schneider, B.J. et al. The Effect of Patient Satisfaction Scores on Physician Job Satisfaction and Burnout. Future Science. November 12, 2020.

Tiesman, H. M. et al. Workplace Violence and the Mental Health of Public Health Workers During COVID-19. American Journal of Preventive Medicine. March 2023

Yeluru H et al. Physician Burnout Through the Female Lens: A Silent Crisis. Frontiers in Public Health. May 2022

Burnout is an Expression of Grief, Not a Lack of Compassion

An earlier version of this article appeared on the KevinMD website in June, 2023

Over the last 5 years, the word “burnout” has become nearly synonymous with the state of healthcare. With nearly 50 percent of physicians surveyed reporting burnout in 2023, it’s an epidemic in our profession.

Physicians are often made to feel responsible for their symptoms of burnout, but by definition, burnout is not a personal failing or a psychological illness. Rather, burnout is defined as an occupational phenomenon that happens in response to chronic workplace-related stress.

Symptoms of burnout include:

• Exhaustion

• Cynicism

• Inefficiency

Burnout is not a failure of compassion.

If you’re feeling burned out, it doesn’t mean that you don’t care. In fact, burnout may be a natural reaction to the recognition that you are unable to provide the compassionate care that your patients need.

The experience of burnout may mirror in some ways the experience of grief. Both are a response to loss. And like burnout, grief is often experienced as exhaustion and difficulty thinking clearly.

Compassion fatigue on the other hand is defined as a sense of indifference to the suffering of others. It’s an emotional withdrawal often caused by exposure to traumatic events. For physicians, it may be a response to relentless illness and death.  The COVID-19 pandemic is a classic example of a driver of compassion fatigue, especially for those who worked in the ER and ICU in the early days of this disaster.

It’s not uncommon for physicians to experience compassion fatigue from time to time. It doesn’t mean that they are not compassionate people, but rather that they are suffering and in need of relief.  

We might consider burnout as a type of disenfranchised grief. But it is not compassion fatigue. In fact, equating burnout with a lack of compassion may be a heavy-handed way of placing the blame on physicians while deflecting it from the systems that created the problem.

As a coach, I have found that many physicians with burnout are in fact grieving the lack of connection to their patients. Often this is due to system-wide emphasis on RVUs combined with excessive clerical work that undermines their ability to spend meaningful time with patients.

National organizations and many health care systems are beginning to take note, and as supportive processes are put in place, rates of burnout do seem to be slowly improving. But there is much work to be done.

If you’re experiencing burnout, it’s important to recognize it for the wound that it is, have compassion for yourself, and create a plan to move forward.

In the words of the poet Rumi, “the wound is the place where the light enters you.” What does this light illuminate for you?

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As a physician coach, I will work with you to explore what’s possible and create a plan that aligns with your personal values and aspirations. Schedule your exploratory conversation with me by clicking the button below.

Dealing with Regret: Discovering Growth and Self Compassion

High-stakes decisions with no easy solution, challenging interactions with patients and family, and outcomes that don’t always go as planned: these are unavoidable facts of life for most physicians.  

The lost opportunities or unanticipated consequences may lead to feelings of regret that can haunt you when you least expect it. Although this is completely normal, coming to terms with regret can be difficult. This aspect of professional life is rarely discussed out in the open, making the journey forward all the more arduous.

In this article, we’ll talk about regret, what it can teach you, and how it might help you to become an even more effective physician.

Regret Is Normal, and It’s a Sign of Compassion

Although it can feel crushing in the moment, regret is not a weakness or a marker of failure. Instead, it can help to reframe regret as evidence that you are compassionate and invested in the outcome of your decisions. Whether that’s the well-being of your patients, the strength of your relationships, or the integrity of your work, you wouldn't feel regret if you didn’t care deeply.

Learning from Regret

When you recognize regret in this way, you can break the cycle of rumination and open yourself up to the multitude of lessons it holds, including opportunities for reflection and growth.

Perhaps the lesson is learning to slow down, to listen more closely to your patient, to take an extra breath before responding to a difficult conversation. Maybe it’s committing to take a more active role, advocating more effectively when faced with challenging situations. Or it could be a recommitment to ongoing learning and professional growth.

It’s important to acknowledge that although the past cannot be changed, it can inform the future.

Here are some questions to ask yourself that might help to create mental space for new ideas:

• Are there ways that you can mitigate the consequences, even now?

• What would have needed to happen for things to have turned out differently?

• What actions are within your control?

• What resources might you need that were not available to you then?

• How might you respond next time you’re faced with this situation?

The Importance of Self-Compassion

As a physician, perfectionism is probably one of your driving forces. But at the same time, you may hold yourself to impossibly high standards.  

Although you may never have been taught this in training, at some point in your career, you will very likely make a decision that, in hindsight, turns out to be wrong. Other times, some outcomes will simply be beyond your control.

Self-compassion means treating yourself with the same kindness and understanding that you would offer a colleague or friend. And at the same time, caring for yourself helps you to stay present and capable of providing the best care for your patients.

Sometimes regret can feel overwhelming, despite your best efforts to overcome it. When needed, professional help in the form of a counselor or a coach can be sustaining.

Turning Regret into Action

It’s important to not only acknowledge regret, but to turn your reflections into action. Use this hard-earned awareness to make adjustments, both big and small, that will help you navigate future challenges with more confidence and clarity. Depending on the source of your regret, it might mean

• Taking a course

• Learning or perfecting a skill

• Seeking feedback or support from a trusted colleague, coach, or mentor

• Implementing measurable changes in a process or procedure

• Practicing mindful communication

• Setting clearer boundaries

• Reaching out to a mental health professional

Moving forward from regret is about progress, not perfection. It's about using each experience to inform your next steps without getting stuck in the past.

Discovering Resilience and Growth

Learning from regret will strengthen your resilience and shape your compassion for others who may find themselves mired in similar situations. Through this process, you will build a toolbox of strategies that will support you through the inevitable challenges in the future.

Regret may never completely disappear, but with time and practice, it can become a guide, pointing you towards opportunities for personal growth and a deeper connection with the values that first led you to find your place in the medical profession.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Coaching for Healthcare Leaders

As a member of the American College of Cardiology’s Physician Well-Being Working Group, I am fortunate to be part of the change that’s happening within cardiology and healthcare in general.

Coaching is increasingly recognized as a way to support and retain physicians, an aid for reducing burnout, and a tool that can improve the healthcare environment for physicians, staff, and the patients that we serve.

The first in a series of webinars put on through the ACC was presented in early 2024. You can watch it here, or maybe take it along with you and listen during your commute to work.

How Do You Know if You’re Burned Out?

Burnout is not going away.

It’s no surprise that nationwide, levels of burnout reached record highs during the pandemic, impacting over 60 percent of physicians. But now that we are back to a semblance of normal, the percentage of physicians experiencing burnout symptoms hovers a little under 50 percent. That’s still far above the “baseline” of 38 percent in 2020.

Topping the list of burnout-inducing specialties are

💉Emergency Medicine,

💉Internal Medicine,

💉OB-GYN

💉Family Medicine

Although burnout has decreased in all of these groups, more than 50 percent of doctors surveyed in these specialties described classic symptoms of burnout.

While any improvement is good news, the fact that nearly one in two physicians across the board are suffering from burnout is nothing to celebrate.

Not only is burnout demoralizing, but it also contributes to job turnover and increased healthcare costs. Not surprisingly, a Mayo Clinic study found that burnout can raise the likelihood of medical errors. And a 2019 study reported a conservative yearly cost to the US healthcare system of $4.6 billion dollars.

So how do you know if you're burned out?

❓ A. Is it just a feeling?
❓ B. Is it something we can measure?

If you answered B, you're right. Burnout isn’t just a trending term. There are standardized tools to measure burnout. The Maslach Burnout Inventory is the granddaddy of burnout tools, and has been in use since 1981.

Burnout affects doctors of all ages and across all spectrums. It is not a personal failing, and it’s not a mental illness.

If you’re experiencing burnout, it’s important to understand that burnout is not your fault, and you’re not alone. Here’s what you need to know:

✴ According to the World Health Organization and the ICD-11, burnout results "from chronic workplace stress that has not been successfully managed."

✴ Symptoms of burnout include:

🚫 feelings of low energy or exhaustion
🚫 negative feelings or cynicism about your job
🚫 loss of motivation and a sense of detachment from work

✴ Burnout is not a mental health condition.

So how do you know if you’re burned out? If you're wondering if you've just hit a rough spot or if you're truly burned out, you could invest in the Maslach Inventory. Or you could save yourself a little time and money and take a simple Two-Minute Burnout Inventory created by Chris Bailey for Harvard Business Review.

If you're a physician living with burnout, you don't need to suffer in silence. There are ways to get through it, but you can't always get there on your own.

Systemic changes to our profession are critical, and there are signs that change is coming. But while we wait for the slow gears of progress, it's important that you take care of yourself now.

Your health, your loved ones, and your patients are counting on you. If you’re feeling burned out, consider coaching, either through your institution, or through a certified Physician Coach. Studies, including a randomized controlled trial published in 2024, have found coaching to be an effective strategy for reducing physician burnout.

There are no easy answers to the complex issues facing healthcare today, but getting clarity on your own needs and values will empower you to chart your own course.

An earlier version of this article was published in April 2023.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

Perfectionism, Procrastination, and Fear of Failure

An earlier version of this article originally appeared on Doximity.com in December 2022, where I served as an Op-Med Fellow from 2022-2023.

You probably didn’t become a physician without a healthy dose of perfectionism. From preschool through residency and beyond, many of us have survived, thrived, and been rewarded for our perfectionist tendencies. And when you didn’t hit the mark? You may have felt the sting of your parents’ and teachers’ disappointment. Eventually, you may have learned to define yourself by your perfectionism.

Perfectionism seems to be on the rise, especially among people born in the 1980s and later. Those on the outside may mean well when they assure us that perfectionism is an impossible goal, but the truth is that perfectionism is a prized attribute in our profession. Our patients appreciate it as well. After all, who wants a doctor who is willing to just scrape by?

Paradoxically, perfectionism can keep you from doing your best work. It can also hold you back from living your best life. In this article, I’ll talk about how perfectionism and self criticism often go hand in hand with procrastination. And I’ll give you a few actionable steps that can help you to overcome the self-imposed inertia that perfectionism often creates.

Perfectionism, Procrastination, and Imposter Syndrome

It’s not surprising that perfectionists often suffer from impostor syndrome. If you’re a perfectionist, you may fear that you are simply not good enough and that you will eventually be exposed for all to see. And in fearing that you are not going to meet the high standards you set for yourself, you may subconsciously find ways to procrastinate as a means of avoiding that discomfort.

When you fall prey to imposter syndrome, you may overlook or give up opportunities for growth that could lead you to a more rewarding and exciting professional path. Learning new skills, taking on a leadership role, and discovering a position that is more aligned with your values may all fall by the wayside.

And when you’re uncomfortable with embracing a beginner’s mindset, you may find yourself reluctant to take up hobbies or endeavors that might enrich your life and create new connections.

Perfectionism, Procrastination, and Fear of Success

Another factor holding perfectionist physicians back is, perhaps counter-intuitively, a fear of success. This often arises from fear of change and the unknown. The end result may be the same: procrastination and a failure to act in your own best interests.

Fear of failing to meet your highest standards often manifests in such mundane activities as uncompleted charts, unanswered messages, and unopened emails. This compounds the problem, and can create enormous stress, not to mention nasty messages from administration.

Breaking the Cycle of Procrastination

If you’re having a hard time getting started on a task, big or small, don’t beat yourself up. Chastising yourself for feeling overwhelmed and disorganized may only make the procrastination problem worse by confirming your fear of inadequacy and filling you with anxiety. And thus, the problem comes full circle.

To break the cycle of fear, frustration, and despair, it’s important to recognize that procrastination does not mean that you are incapable or irresponsible. And let’s establish right now that as a busy and caring physician, you are certainly not lazy.

So how can you harness your perfectionism? The key is to focus that superpower on providing excellent patient care. Sometimes that also means treatment plans, operative notes and imaging reports. These are things that truly make a difference, and that people are depending on you to complete. They don’t have to be works of art, but they need to be complete and correct.

Often it’s the non-clinical commitments, stacks of insurance paperwork, and lingering home projects that drain your mental energy. If no one’s life or livelihood depends on it being perfect, allow yourself a little grace. Realize that for many of your routine tasks, perfection is not worth the effort and may not even be possible. For many of these, good and done is good enough. Other times, it might be most efficient to simply delegate. And sometimes, when it’s appropriate, you just have to say no.

Below, I share some practical tips for tackling a handful of competing priorities and getting stuff done.

1. Medical documentation

We’ll address the elephant in the room first: your medical charts. As charts start to pile up and paperwork is left unfinished, your anxiety levels may rise, and you may find yourself in a spiral of regret and self-flagellation. If you have a system that works for you, kudos and keep it up.

But for the many physicians for whom the EHR and report generation are a major source of stress and procrastination anxiety, it’s important to get a handle on this beast as early as possible in your medical career. Just get the charts and notes done, either immediately during or after the visit (my preference) or at the end of the session.

The fewer times you have to return to a document, the more focused and efficient you will be.

Yes, the notes need to be succinct, truthful, and useful. And personally, I always found that including a brief personal observation reminded me of the issues that were meaningful to my patients when we met the next time. But your notes do not have to be perfectly crafted works of literature. Punctuation, spelling, even virtual voice transcription errors that don’t change the meaning of the sentence can often be safely overlooked.

Consider using “smart phrases” — text blocks that you use frequently that can be automated through your EHR system — as much as possible when appropriate. Look into using an AI assistant for history taking, if you can assure accuracy. The point is not to be sloppy or incomplete, but to include the pertinent details that assure great patient care and communication as efficiently as possible.

To avoid a horrendous backlog, create a block of time once or twice each day to get patient communication, testing review, insurance, and other paperwork done. This is known as task batching. Do it consistently every day (perhaps using the Pomodoro method), and even though you may not finish everything all at once, you’ll have a process for getting it done. Once you start seeing the results of your efforts, your feeling of self-efficacy will increase.

Let your staff know that you will be working on these tasks within these blocks of time. That way you can set expectations and encourage them to direct pertinent issues to you at a time that works best for you. Ultimately, this may create a clearer sense of work flow within the practice and enhance your teamwork.

2. Professional Commitments

When it comes to committees, research, and other professional commitments, take a good long look at what you’ve signed up for. Be sure that the work is meaningful and actionable for you.

Sometimes taking on more responsibilities is the right thing for your professional growth or your career trajectory. If so, it’s important to stay committed. Procrastinating on these commitments can have a seriously negative impact on your future opportunities.

Consider working with an accountability partner who is on the same committee or working on the same project. You can keep each other on task with quick check-ins by text. Simply committing to a plan can often get you halfway there.

But if you find that you just have a hard time saying no, then it’s time to reassess. As writer and time management guru Oliver Burkeman so aptly puts it, if we’re lucky, we only have Four Thousand Weeks. That means that time is a fixed resource. When you say yes to something, you are saying no to something else.

If your commitments exceed your capacity, you will never get everything done. Choose wisely. And remember that saying no doesn’t mean never or not at all. Is there a way to stay involved with something meaningful without diving all the way in?

3. Your Personal Life

Having a life outside of the clinic or hospital helps you to decompress, stretches your brain, and keeps you connected to the outside world. When it comes to family and close friends, your time and attention matter. And of course regular exercise is critical for just about every aspect of your health.

Unlike taking care of patients, the bar is fairly low. Usually no one is depending on you to be the best. Just being present and engaged is often enough. For your home projects, exercise, and other extracurriculars, consider using a Bullet Journal or other daily log.

Experiment with using a real notebook rather than an app. Not only does writing something down tend to create more solid memory retention, it’s easy for virtual to-do lists to disappear into the ether of the internet, never to be seen again. Most importantly, choose what works best for you, and be consistent.

To get started with something new, commit to just five to 10 minutes a few times a week, or set up an introductory lesson for something that interests you. You’ll be surprised how much you can do, and it may motivate you to keep going. If you’re not perfect, all the better. You’ll learn and grow and maybe even find new life passions.

Procrastination and Self Compassion

If you’re a chronic procrastinator, developing self-compassion is important. But being kind to yourself doesn’t mean you can ignore the pressing problems that procrastination has created. That will only add to your stress, and create more trouble in the long run.

When you put off completing charts or making calls, procrastinating can also hurt your patients and your practice. In the worst cases, medical care may be delayed and important notifications missed, with possibly serious ramifications for the people who depend on you.

If the load feels overwhelming, realize that procrastination-born perfectionism can lead to important mental health conditions including depression, anxiety, and eating disorders. Get help from a mental health professional if you need it. And if you are questioning your efforts, your direction, or experiencing burnout, consider meeting with a physician coach.

Remember: your perfectionism is one of your superpowers as a physician. You have high standards, you solve tough problems, and you keep people safe. Leverage this, cherish it, but don’t let it take you down the road of procrastination.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Navigating Burnout: My Podcast Appearance on KevinMD

If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.

Kevin posts interviews and articles daily, and I was thrilled to be a recent guest. In the episode, we discussed the burnout epidemic, and why it’s not the same as compassion fatigue.

Burnout is a symptom of a system that is not working for you. In many ways, it’s a form of grief. It’s not your fault. But that doesn’t mean there’s no way out. In the interview, I went over actionable steps you can take to improve your life as a physician and to combat the effects of today’s stressful environment.

My August interview with Dr. Kevin Pho on the KevinMD podcast.

What the Failure of the ER Match Says About the State of Health Care

And How Physician Coaches Can Change The Story

When I was in medical school, the cool, smart kids went into ER medicine. It was a hotly competitive residency, and there was no guarantee that you would match. Now things are entirely different. Over 550 residency spots went unfilled by US med school grads in the residency match this month. Some centers had zero applicants match to their programs. Compare this to 2021, when only 14 ER residency spots were not filled.

The reasons? Just about any physician in the US can tell you:

• Disrespect fueled by social media personalities and irresponsible "news" outlets

• Dangerous working conditions

• Overloaded ERs being used as a source of primary care, often because people lack insurance or access

• Corporatization of medicine with a focus on numbers of patients seen and metrics that often don't relate to patient care

• Management of physicians by business people and those with less responsibility and training

• Intrusive, redundant, and burdensome EHR requirements

• Lack of adequate support staff

Some of my best friends are ER physicians. They are some of the hardest working people I know. These are the doctors who will save your life at 2 am, no matter who you are or whether or not you have insurance. And they are also the doctors that are tasked with waking up their colleagues at all hours of the night to request a consult or hospital admission. Most manage their work with grace, strength, and courage.

The steep decline in the desirability of ER residencies is a really scary trend. It’s easy to say that doctors can be replaced with mid-level care providers, but the truth is that the expertise, skill, responsibility and knowledge that an ER physician provides requires years of education, training, and commitment. Mid-levels can reduce some of the burden of less complex patients, but they are no substitute for a physician.

This sudden and shocking shift should be a call to action for hospital directors, ER directors, and the corporations and private equity firms who own and manage many of these practices.

As we wait to see how this recent revelation will impact the decisions and practices that affect ER physicians, it’s important that physicians take steps to stand up for ourselves and our profession. This is a new way of thinking about medical practice, but times have changed irrevocably. By learning how to work within the systems we now have, we can start to make important changes from the inside out. Ultimately, such changes will benefit not only physicians, but also their patients and indeed the very institutions and corporations that currently control our healthcare systems.

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 How can coaching help? Well clearly, coaching will not fix the problem. Coaching means working with one physician at a time, very much like patient care. But coaching will help you clarify your goals, identify your frustrations and obstacles, and give you the tools to create your way forward. Will that be

• Negotiation, understanding your own value?

• Creating a streamlined workflow that will allow you greater efficiency?

• Acquiring new skills to make your time more effective?

• Courage to make a lateral move to a new facility?

• A switch to a different type of practice altogether?

• A change in working hours?

• Reframing conflicts so that you are able to create a more positive working environment?

• Honing interpersonal skills?

• Advocating for change in EHR management?

Regardless of your specialty, the healthcare world is shifting. The work you do matters. By recognizing your own worth and power, and by taking action that is beneficial to both you and your patients, you will be able to create a happier and more sustainable life.

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