Information on this page & website is not medical advice and is intended for a Canadian audience. For medical advice speak to your physician.
YOU CAN OVERCOME BURNOUT
HELP IS AVAILABLE
Hear what a recent graduate from the "Recharge to Prevent or Overcome Burnout" course has to say:
"I just finished this course and can highly recommend it!!! The multiple sessions really helped me with personal accountability, versus a session here and there. Each week was a very different topic and they gave me the words, tools, insight and power to make the big and small changes in my life that really needed to be made. I was burned out, like so many, and finally feel like I can breathe again. Still a ways to go, but at least I feel I am on the path now."
-testimonial posted by a Canadian physician
GET HELP NOW...
AVAILABLE ON THIS PAGE:
Order the RECHARGE Course
Take the Burnout self-test
Get 10 Tips to Overcome Burnout
Read about system issues
Listen & Relax with 7-min guided Arrival Practice (free recording)
Learn how to set limits & say 'no' (free video)
Hear Dr. Kostenuik speak candidly about burnout (video from OCFP)
Get the Psychological First Aid Tools (click here)
Join the monthly live series Finding Stillness through Mindfulness, Meditation, & Yoga Nidra ("yogic sleep") (details here)
"RECHARGE To Prevent or Overcome Burnout"
8-Session Online Course
Now Available On-Demand!
8+ Videos, Workbook, & Action Plan
This 8-session online interactive series includes a practical action plan to help get you off the path to burnout and into healthy sustainable habits for a more enjoyable and fulfilling life.
Dr. Marcia Kostenuik is a physician, medical psychotherapist, teacher, speaker, and coach who treats physicians suffering from burnout and stress. Individual coaching is also available, email email@example.com for details.
The positive feedback from participants who have completed the Recharge program has exceeded initial expectations. If you are not satisfied with the program, email firstname.lastname@example.org for a refund.
EARLIER DETECTION CAN HELP
You can immediately begin to address both system-level and personal issues that contribute to burnout. Learn more about the interplay between your personality, nervous system, relationships, and system issues so that you can take immediate action to prevent or overcome burnout.
Burnout doesn't happen overnight. Read below to learn how to recognize early stages along what I like to call "The Path To Burnout". Learn more about individual and system-level variables that can be addressed to reduce your risk.
Resource links are listed below.
TECHNOLOGY CAN HELP DETECT WHAT YOU MIGHT BE IGNORING...THE PHYSIOLOGICAL EFFECTS OF STRESS & BURNOUT
Many busy "successful" people push themselves past their limits without ever noticing the effects stress is having on their body, mind, relationships, and function. Part of my approach to overcoming burnout is to help individuals become aware of the unrecognized early and late physiological effects of burnout. Monitoring and responding to physiological parameters can empower individuals to make life-saving changes before it's too late. Incredibly, individuals will push past every limit until the point of complete collapse. Monitoring the early physiological effects of stress can put a stop to this risk. As soon as I see my sleep data and heart rate variability data heading in an unhealthy direction - I can make immediate lifestyle and work changes - and dig deep to ensure my priorities are in keeping with my health and my values.
HOW CAN YOU TUNE IN TO YOUR BODY?
Daily mindfulness, meditation, and mindbody practices can help you tune inwards and listen to your body and mind. You may then be more able to recognize early signs of fatigue, exhaustion, mood changes, poor concentration as well as physical signs along the path to burnout including elevated heart rate, changes in respiration (e.g. shallow/rapid breathing), muscular tension, headaches, and gastrointestinal issues.
Apps such as Headspace, Calm, and Insight timer can help you get started. The Muse biofeedback headband is another tool to help you learn how to be mindful every day. As you become more aware of your body's response to stress you will be able to make informed choices about how to respond effectively. The Recharge to Prevent or Overcome Burnout course helps individuals every step of the way, as it can take a lot of retraining to learn to respect your body's limits and take back control over your life.
HOW CAN YOU MONITOR THE PHYSIOLOGICAL EFFECTS?
Monitoring the effects of stress on your body can help you make wiser decisions about when it's time to "go for it", take on challenges, get in a good workout, and when it's time to take it easy, recharge, recover, and relax. Technology can help you immediately become more aware of changes that you may not be noticing in your heart rate, heart rate variability (HRV), and sleep patterns. Stress and burnout can have profound effects on your cardiovascular health. Burnout has a strong reciprocal correlation with sleep disturbances and severe insomnia.
A wearable device like a smartwatch along with smartphone apps can help you detect what you might otherwise ignore. Heart Rate Variability (HRV) is a marker of stress that can be readily monitored. I adjust my workload and life choices when I see my HRV starting to decline. Low HRV can reflect too much stress and adrenaline. Use apps like Apple Health to keep an eye on your resting heart rate and HRV. Heartwatch app monitors your sleeping heart rate, HRV, and much more. The Welltory app tracks HRV and will give you messages to take a break, get some rest, go to bed early etc.
The AutoSleep app will help you learn your sleep habits and create better routines. Headspace and Muse Headband also have great resources to help you sleep better. I teach Yoga Nidra ("yogic sleep") in my Finding Stillness series and this can also help resolve sleep difficulties and lead to profound relaxation.
You can also track daily activity (e.g. steps) and VO2 max to gain a greater understanding of your general fitness and to motivate yourself to get moving. Exercise such as walking outdoors in nature can have amazing cumulative benefits.
Whether you use mindfulness, biofeedback, or other technologies to become more aware of the impacts of stress and burnout on your body, it will have the same beneficial effect of empowering you with information you can use to motivate needed change in your life. The body doesn't lie.
See more on these resources below.
Take a moment to check in with yourself!
Recognizing, Avoiding, & Treating Burnout
THE 12 STAGES OF BURNOUT
Read about the 12 stages of burnout that you may not have known about. Early recognition can make all the difference.
MBI BURNOUT INVENTORY TEST & SCORE
MASLACH BURNOUT INVENTORY ARTICLE
"The Maslach Burnout Inventory (MBI) is the most commonly used tool to self-assess whether you might be at risk of burnout. To determine the risk of burnout, the MBI explores three components: exhaustion, depersonalization, and personal achievement. While this tool may be useful, it must not be used as a scientific diagnostic technique, regardless of the results. The objective is simply to make you aware that anyone may be at risk of burnout." Get MBI Questions and article by Christina Maslach & Susan E. Johnson here
BURNOUT PERSONALITY & TREATMENT
Learn about physician burnout and how to treat system issues related to medical culture. Read about the four personality traits that predispose physicians to burnout: Perfectionism, Workaholic, Superhero, Lone Ranger; and learn more about what you can do to reduce your risk or recover.
Monitor Heart Rate Variability (HRV) using Welltory. HRV is a marker of stress, and Welltory's cool interface and "liquid" display as well as tips and articles can help you make healthier choices to allow your body and mind to recover from stress.
Use AutoSleep to track your deep sleep, quality sleep, and sleep habits to start making better choices and to learn what works for you.
Get moment-to-moment feedback as you practice calming breathing exercises. The handheld device can be used on its own or with your computer. Within moments watch your cardiac coherence improve and notice feelings of wellbeing and relaxation. Read more: EMWave (HeartMath)
WORLD HEALTH ORGANIZATION ICD CLASSIFICATION OF BURNOUT
Read the International Classification of Diseases (ICD-11) description of Burn-out syndrome.
OMA WHITE PAPER - BURNOUT TASKFORCE
PHYSICIAN WELL-BEING 2.0 BY DR. SHANAFELT MAYO CLINIC
Knowing more about yourself and your personality can help you gain self-awareness and allow you to make healthier choices. Here is just one example of a personality test - see if it is useful for you (and consider having your partner/friend/adult child try it too!). Remember, this is just one lens you can use to look at your personality. If you are having severe difficulties, contact your physician or a mental health professional.
DYSFUNCTIONAL FAMILY ROLES
If you grew up with a parent, caregiver, or family member who suffered from a personality disorder, addiction, or other mental illness there may have been a tendency for children to play particular roles that can last into adulthood and lead to difficulties that contribute to burnout. Search "dysfunctional family roles" or read a brief article here.
FUNCTIONAL VS. DYSFUNCTIONAL FAMILIES - HEALTHY BOUNDARIES
Learn more about what makes a family functional, including establishing healthy boundaries. This article can start you on your journey of discovering more about how healthy attachment and boundaries can support wellbeing and reduce the risk of burnout.
Guided awareness mindfulness practice, approx 7 min, by Dr. Marcia Kostenuik. Use this practice at the start of your day or any time you need to come back to your body and the present moment. Think of it as a reset and a check-in with yourself.
To Prevent or Overcome Burnout
Now Available On-Demand!
Due to the increased demand for help with burnout I have decided to make my 8-week online series available in an on-demand version. The complete series of Video Recordings, Session Notes, and Action Plans, can be accessed on your own time. I'm so happy to be able to offer this to those of you who wished to take the live series but couldn't fit it into your schedule. I hope you will go through the material thoughtfully and allow time for personal reflection and growth.
The Recharge on-demand series allows you to:
Follow a step-by-step plan to overcome & prevent burnout
Watch video recordings & slideshows by Dr. Marcia Kostenuik
Read workbook including full session notes
Reflect & make changes as you complete the written action plan
Emerge from the Recharge program with a fresh perspective
If you would like additional private coaching this can be arranged (additional fee)
The positive feedback from participants who have completed the Recharge program has exceeded my expectations. If you are not satisfied with the program, email me and I will refund you the full fee.
WHY ADDRESS BURNOUT NOW?
I have seen too many physicians and patients injured by the effects of burnout. In the past 21 years, as an emergency room physician, family physician, and medical psychotherapist, I have lost close friends on both sides of this equation. Cynicism, detachment, and exhaustion lead to errors. Sadly, burnout and errors can push physicians to the brink. Most physicians with burnout deny even serious symptoms due to their strong sense of duty and obligation. Guilt and moral distress lead some doctors to push past safe limits until it's too late. Getting through the denial of even severe symptoms of burnout can be difficult. Do a self-test here.
My goal is to help those suffering from burnout before serious adverse events occur. Too many doctors wait until their health has suffered severely. In some cases, they reach out to me only after a cardiac event or other stress-related illness finally hits. In other cases, their relationships have been injured, or a medical error or complaint has caused them intense stress or forced them to leave their job permanently. I don't want another doctor to suffer unnecessarily from the personal fallout that accompanies burnout. Help is available.
This series is suitable for physicians, nurses, health care professionals, psychotherapists, executives, managers, workers, caregivers, parents, and anyone concerned about burnout.
Benefits of the RECHARGE Program
Participants report experiencing benefits in their professional lives and personal relationships
Learn how to recognize the signs of burnout earlier and how to make meaningful and lasting changes
Learn how to set healthier limits, make room for a life outside of work and caregiving, and explore what deeply matters to you
Assess how well you are matched to your work role and how to leverage your strengths while addressing challenge areas
Improve your quality of life and relationships by learning a new approach to priorities and habits
RECHARGE to Prevent or Overcome Burnout
On-Demand Version Includes:
8 Video Recordings
8 Session Notes & Action Plans
More than 8 hours of recordings with Dr. Marcia Kostenuik
Bonus Video: How to Say 'No' Kindly (and without the guilt!)
Holiday Special Rate:
RECHARGE On-Demand Program Fee: $400 CAD
(Regular Fee: $800)
Holiday rate avail. Dec 18, 2021 - Jan 3, 2022
1. Send an email titled: "Order Recharge Program" to email@example.com
2. Send e-transfer payment to firstname.lastname@example.org
Once your email & payment are processed:
-You will receive a confirmation email & receipt
-You will receive an email with access to the program content
See below for details about the live Recharge series. The on-demand course has all the same content with 8+1 videos and PDFs of the workbook chapters including session content and action plans.
If you are not satisfied with the program email email@example.com to obtain a refund.
This course is not medical advice or psychotherapy. For medical advice or inquiries about therapy speak to your physician. Any decisions you make about your work or personal life are your own choices. This course is not private coaching. If you require private coaching you may contact firstname.lastname@example.org to enquire.
“Out of your vulnerabilities will come your strength”
GETTING OFF THE PATH TO BURNOUT
Dr. Kostenuik speaks about one of her talks called "Getting Off the Path to Burnout" and how she teaches physicians the importance of recognizing early signs, monitoring physiological stress responses, and setting healthier limits. Marcia shares some of her personal experiences and answers audience questions. This talk is from the Ontario College of Family Physician's Practising Well Series.
LEARN HOW TO SET LIMITS
Saying 'No' Kindly (and without the guilt!)
Learn how to recognize & understand the cost of not setting healthy limits & boundaries. Dr. Kostenuik shares ethical principles & effective communication skills that can help you say "No"- without the guilt!
More About Setting Limits and Saying 'No'
Including answers to FAQs
The Reality of Having Limits
Many physicians struggle with the reality of having limits. It runs counter to conditioning experienced in medical school and residency training. Medical culture and physicians themselves create pressure that pushes them to behave in seemingly super-human ways that ignore limits. This pattern has been reinforced in our society and has guided patient expectations.
Not only do physicians have limits, but so does the health care system. This is a tough reality and is leading many to feel guilty once they finally do learn to say 'no'. Who will pick up the slack?
Initially, many of us thought we could work around the clock to help the pandemic effort and "flatten the curve". We anticipated a relatively quick recovery. Saying 'yes' to overtime and increased workloads made sense and matched our values. Taking on new roles or expanded job descriptions also had a clear purpose. The changes we made were expected to be brief and temporary. Our efforts indeed helped many patients, although it still never seemed to be enough.
As physicians and caregivers, some of us are used to giving, helping, sacrificing, and supporting whenever we sense a need. The constant giving might persist despite exhaustion and physical symptoms. Many doctors ignore their bodies' needs for food, water, and sleep. In a short-term crisis, this sacrifice and effort can be highly valuable for society. Now, almost two years later, we recognize that the increased needs and backlog created by the pandemic are ongoing. Statistics confirm that most physicians are experiencing burnout. If doctors don't learn to respect their limits, this situation will only worsen.
As a society, we can work together and respond effectively and caringly to the global issues Covid-19 has created. This doesn't mean it will be easy, or that our response efforts will be perfect.
We will all need to collaborate respectfully in order to create sustainable plans that address needs and respect limits. Health care administrators and doctors can work together to find approaches that are sensitive to the pain and suffering of workers, patients, and society. If we can reduce rates of burnout in health care workers, we can return to the ideal of providing compassionate care, even when we can't cure or solve everything.
What To Do About Guilt
When it comes to communicating limits, guilt is often the stopper. Guilt may block you from saying 'no', or may linger after communicating your boundaries. This can occur even if your words were respectful and effective.
In the video, I explain that guilt is not all bad. You can learn to understand and have compassion for your own experience of guilt, "dial it down" a little and then use your awareness of guilt as helpful information to guide wise decisions.
Old conditioning can be very powerful and can lead to intense feelings of guilt. If you have been conditioned to feel deeply guilty for saying 'no' you might experience overwhelming challenges with setting healthy boundaries. Some individuals may start to notice that their very identity has become tied to being the one who always says 'yes'. If deeper issues are getting in the way of communicating your limits, you might benefit from personalized coaching or therapy.
The good news is that when you use mutually respectful communication and effective negotiation skills it will become much easier to communicate your limits. With some practice, you will learn to anticipate common pitfalls and reduce the likelihood of negative responses from others. As your skill improves, you may notice that while others don't love to hear your limits, they will respect them. If you learn to offer alternatives and help find meaningful solutions, you will gain even more respect.
Once you learn to work with both healthy and maladaptive guilt (see video) it will no longer prevent you from expressing your truthful limits.
But What About The Demands?
No matter how much work demands increase, this does not change your capacity and limits. This message may be difficult to hear for physicians who feel pressured to meet the never-ending and escalating demands related to the pandemic.
You may be able to work harder, longer, or faster for a short time, but this is not sustainable and can lead to serious adverse outcomes. More health care workers than ever are experiencing symptoms of burnout and this is further decreasing their capacity to work and cope. To keep our health care system afloat and to adapt to changing needs, we are going to need creative solutions. It will help if we come to accept certain limitations and manage human resources realistically. Successful strategies will require sustainable solutions that match healthy human work capacity. As far as we have come, this pandemic is not over.
System-Level Issues Related to Burnout
Fortunately, there are many evidence-informed strategies to help address system-level issues contributing to burnout. The fact that most physicians are experiencing burnout indicates that system-level responses are needed. I will share more about these strategies next month.
For now, as an individual, you can learn to work smarter rather than harder. When possible streamline processes, adjust expectations to be more realistic, reduce repetitive or unnecessary steps, and change what you do to be more efficient or impactful. Since the pandemic hit, I have helped more physicians than ever by introducing more group work. Solutions that have added capacity and impact include providing peer support, teaching, engaging in public speaking, developing courses, and producing videos. However, even as I have been creative in finding ways to meet increased demands, I have also had to say 'no' to many things. I also need to be ever cautious about respecting my own healthy limits. If we each use our strengths to do what we can to help, it will go a long way. We just can't do everything all the time.