Title: Joe Sherman, MD – Helping Healthcare Providers With Burnout & Rediscovering Joy In Their Career
Guest: Dr. Joe Sherman
Joe: There is a range, depending on the specialty, between somewhere around forty to forty five percent of all physicians claim to be burned out presently, and that are practicing presently. Physicians get to the point where they’re emotionally exhausted from the work that they’ve done and the systems that they work under. So then as almost a defense mechanism, they become depersonalized and detached from patients and who they’re caring for.
Peter: Welcome to Biz and Life Done Well podcast, where we explore what it means and what it takes to do business and life well. I’m your host, Peter Wilson. If you’re like me, you’re intrigued by stories of common people who have achieved uncommon success in business and life. Join me as I interview fascinating people about how they got started, their successes and failures, their habits and routines, and what inspires them. Today, my guest is Doctor.
Joe Sherman. He’s a coach and consultant for physicians and healthcare organizations. And for thirty five years, he was a practicing general pediatrics doctor and he was primarily in teaching roles and working with underserved populations in Uganda, Bolivia, and then a little closer to Home DC and in the Seattle area. And when we were talking before the podcast, you mentioned one of the primary issues that you focus on in terms of coaching organizations and individuals is with burnout. Let’s talk about that.
What is burnout with physicians?
Joe: Burnout is a term that’s used in a lot of professions, but in particular amongst physicians for quite some time. And it consists of three aspects. One is a sense of emotional exhaustion and this is mostly from not so much the amount of work done and the hours of work done and caring for patients, but it does come from this sense of, don’t have very much more to offer emotionally and I’m just exhausted. The second component is a sense of detachment and cynicism. It’s physicians get to the point where they’re emotionally exhausted from the work that they’ve done and the systems that they work under.
So then as almost a defense mechanism, they become depersonalized and detached from patients and who they’re caring for. And this last aspect is a sense of under accomplishment, low accomplishment. It’s with all of these, with all of that’s happening, all the pressures and stressors occurring, we often feel as if we really aren’t that helpful. We’re not really getting much done. We’re not really helping our patients as much.
So this kind of triple threat of emotionally exhausted, removed and detached, in a sense that we’re really not making a difference, really makes a lot of physicians feel like I’m stuck. Why am I doing this? Why did I ever decide to do this to begin with?
Peter: So when we chatted briefly before we got on the call here, and you said that there is an epidemic. So what is the scale and scope of that epidemic for burnout?
Joe: There are a few instruments that are used like scales and questionnaires and surveys that have been taken by many physicians through their employers or their organizations, or even you can do it yourself online. They’re called burnout inventories or burnout questionnaires. And through these questionnaires, there is a range, depending on the specialty, between somewhere around forty to forty five percent of all physicians claim to be burned out presently and that are practicing presently.
Peter: I’m imagining that those numbers are likely to have gone up in the last year and a half, what we’ve just gone through.
Joe: The pandemic has put physicians, and every time I say physicians, I really want to include all clinicians, all primary care providers, specialty providers. It’s put different types of pressures on all medical providers. And this idea that we are all medical heroes, that we are looked up to as self sacrificing, saving others at the risk of our own lives, really puts even more pressure and more stress on medical providers. And it’s predicted that the next pandemic that will occur once COVID passes is an epidemic of mental health crises amongst healthcare providers.
Peter: That is, wow, it makes me pause as I think about my own providers that I see. As a patient, I don’t necessarily think about that. When I’m going in there, I’m always expecting answers, expecting to receive something. So you’ve got these providers that are just constantly giving. And so you mentioned that there are some contributing factors to this situation.
So I’d like to kind of cover that a little bit in terms of what is the cause, maybe the root cause of this sort of thing.
Joe: Yeah, first, just what you bring up, this idea of being the patient walking into an exam room and you have certain expectations your doctor and what you expect from her and what she’s gonna be able to do for you. And I remember my wife returning from an appointment that she had with a doctor and she came back and she was very upset and she just said, none of my questions were answered. I don’t understand. Doctor Jones usually is very pleasant and has always listened to me and I’ve always respected her. And at this time it just was I feel like she got angry at me and she was mad at me and all these different things.
So I said, The next time, can I join you? Can we go in together? And we went in for her next appointment, and Doctor. Jones walked in, said hello, and said, It’s okay for me to be here, yeah. And as before she got started, I looked at her and I said, Doctor.
Jones, I haven’t seen you in a while. How are you feeling? How are you doing? She immediately just stopped and started to talk about how difficult it was at that present time, how the department that she was working under was changing. They’re moving her clinic, they’re changing the electronic health record that she has to work with, their, her staff, support staff has changed and turned over so much, and it’s really causing a lot of stress on her, and she’s having a hard time being able to give the quality care she wants to, to her patients.
And then, after we talked a little bit back and forth, she went on with the visit, and afterwards my wife said, that’s the most attentive she’s ever been to me. She really paid attention and really it’s like, well, I hope she wasn’t intimidated by me, but I think part of it was that she felt listened to, she felt understood. There was a chance for her to actually say what was happening in the situation, and all of those external stressors that had nothing to do with her being present to her patient at all, but it had to do with all the other things happening that she was called on to do that when she first went to medical school was not on her mind as what she would end up doing once she got into practice.
Peter: We have a family friend of ours that is in Nashville that went to Vanderbilt. She’s a general practitioner. When we visit, she has an office at her home, and she spends at least two hours every evening in her office, writing notes, doing all this paperwork stuff, minimum two hours, and she’s already worked a full regular day.
Joe: It’s estimated with the electronic health record, especially if you’re in primary care and you’re seeing several patients a day, that for every hour of patient encounter, hour of face to face patient care, that there is two to three hours of administrative work that is associated with that. And that administrative work of charting, of looking up the labs, of acting on results, of doing all of these other things, is not really accounted for during the regular clinic day that you have. Most employers or organizations where doctors work don’t say, Oh, we’re gonna give you four hours of patient care today and then we’re gonna build in another four hours of administrative time for you to do all the things that go along with taking care of those patients. So people end up doing their charts and all of their work at home. There’s, when I talk to physicians about burnout or what’s causing stress in their jobs, one thing that they say to me is, Don’t just come to us telling us that we need to meditate and be mindful and still give us the same amount of work and all of the faulty structures and supports that have been there before and say it’s all our fault.
And that causes even more resentment and bitterness. So there are some organizational factors that contribute to it. The electronic health record, which is an amazing thing because it keeps all medical information in one place, it can be transferred from one provider to another, information, everything, it’s great, it’s a great invention. However, what it’s also done is that it’s taken all of those duties that were done by other people in the past before we had it and put it in the lap of the provider, the physician, him or herself. So I’ll give you an example.
When I first entered practice, after finishing pediatric residency in 1988, I worked in an office, which was a private pediatric office in Washington, DC. The charts were paper charts. And so I would walk into an exam room, there would be a piece of paper, just a chart, and I would see a young child and that child would have an ear infection. And I would write ear pain with a cold for two weeks, exam, left ear looks fine, right ear, red, bulging, whatever, ear infection, amoxicillin, and here’s your prescription, you go home. I’m finished.
I’m done with that patient. There’s no more work I have to do, anything. That patient checks out. If I had to do lab work or anything like that, those lab results would come and a nurse would look at them, would go over them, ask me questions, take care of things. Appointments were made.
Phone calls were made to a receptionist who would answer a phone call or give it to a consulting nurse who would answer those questions. So gradually, the electronic health record had everything in it where we had to check all these boxes, we had to make sure we put the right coding in for billing, we had to answer all those emails that come through on the portal that people have such great access to, we had to follow-up our own lab results, we had to do all kinds of scheduling and deal with insurance companies, all of these extra things that were added on make the day much longer and much more stressful. It also decreases the amount of time that we have to actually have a relationship with patients. And that’s why most of us went into this business to begin with, because we want that relationship. So I would say extra duties that have to do with the electronic health record, I would say the decrease in amount of support staff that’s provided for providers, the increased administrative duties that are placed on the shoulders of providers that weren’t there before, and often the increased pressure to see higher volumes of patient encounters.
All of these things contribute to physician burnout from the organizational perspective. I would say individually, even though physicians laugh and say, Don’t bring me that mindfulness stuff and all that meditation. That is something that I do bring. And the reason I say that is because there’s a culture in medicine where when we first entered medical school, it was almost like a bargain that we have with society. We will spend a lot of time studying.
We’ll pay a lot of money to go to medical school. We’ll have this huge chunk of time taken out of our lives that our peers are moving on with their lives and getting jobs and meeting people and having families and experimenting and doing all kinds of things. We’re just gonna be working that whole time. In exchange, society will actually provide a very good income for you, will put you in a position of respect, affirmation, validation, and you’ll also have a certain amount of autonomy because as a physician you’re always gonna be needed and so therefore there will always be jobs for you and you can choose the type of practice in the field that you wanna go into. And that’s kind of the way things were definitely back in the 80s when I was going to medical school.
And then now what’s happened is a lot of those things aren’t true anymore. Physicians aren’t the highest paid profession anymore that used to be. Society has changed dramatically to where people’s health insurance and healthcare providers change constantly. It’s not like you have this long standing relationship with one medical provider. So it’s much more of an industry, in a business, rather than a relationship, something that you gain a lot of professional satisfaction and fulfillment from.
It’s kind of become more of a job. And at times, doctors really bear the brunt of people’s frustrations with the larger health system that we function So I think we individually as physicians tend to be perfectionists. We tend to think that we’re never doing enough, that we have to self sacrifice, that we need to do all of these things. And then we work under a system that doesn’t really reward that as much as it used to. So now it’s kind of like, now what do we do?
And the reality is that we need to take better care of ourselves, and we need to look out for ourselves because the more we look out for ourselves, the better care that we’re able to give to other people. And so that’s really the message on the individual perspective is self sacrifice, perfectionism, and this sense of heroics is actually working to make things worse, as opposed to self compassion, setting limits, taking care of ourself, will actually make us better providers for our patients.
Peter: How do you work with individuals and organizations?
Joe: Most of this comes from my own experience, both positive and negative. Okay. Because I would say that I questioned whether or not I wanted to be a doctor all through medical school, all through residency, and really all through my career. I would say, I questioned whether or not I really wanted to be a doctor when I was pushed to do things that I really didn’t wanna be doing. Not so much I don’t wanna put in that extra work, but this is, the way that you are calling on me to be a doctor is not the way I want to be a doctor.
I would rather be in relationship with other people. I want to be able to establish that relationship, be there to listen to them, spend time with them. I’m not as interested in all of the technical and technological parts of it. Other doctors are, and that’s great. So when I found myself after living and working in Bolivia for four years and spending time always in relationship with people, as a physician, a teacher, all of these different things, And then came back and was told, You’re going to work in this clinic.
You’re going to supervise other people to work in this clinic. And we’re on a shoestring budget, so you just have to make it work. I tried to make it work, and I tried to make it work for everybody, but eventually I burned out and I couldn’t do it anymore. What I realized was that I had to stop altogether and really look and see what were the things that brought me into medicine to begin with. And that’s really what I do with clients, is when they come to me, I say, Okay, let’s look at the experiences that you had from the beginning in your life in medicine, outside of medicine, and what were those times where you just felt like, wow, I could be doing this every day, all day long for the rest of my life.
And then we look a little bit more at what were the factors and characteristics of those experiences. And by doing that, you can derive what are your core values, what it is that really motivate you to be doing anything in life. And then being able to look and see, is that present or not present in your job right now? And if it’s not, what can you do to expand the possibilities of injecting more of what you’re passionate about in your work? And if you find that you can’t do it where you are presently, maybe start exploring elsewhere.
But I would say most of the time it’s possible to find and expand what it is you really love doing in your present position.
Peter: How long have you been a coach and consultant?
Joe: I started in 2014 and in that time I was still working clinically part time.
Peter: Okay.
Joe: And facilitating retreats for physicians as well as reflection groups where certain medical teams would get together periodically and talk about their patient encounters and how they were impacted by those patients and by the encounters that they had with them. And then gradually I expanded that to include not only retreats and group work, but also individual one on one coaching with physicians. And I’ve been doing the one on one work for just about two years now, and do a combination of both one on one coaching as well as group work and facilitating retreats.
Peter: So do you remember the first time you actually witnessed a breakthrough? Yeah. What was that like?
Joe: I’ll tell you, it’s it’s a feeling like sorry to say this, but the more the more that I can get out of the way of directing a client, a physician, and allow her to come to a realization of what’s already inside of her and come to the conclusion or the discovery of a certain motivation, a certain value, a certain strength that she has that she really wants to live out. And all I do is ask questions, ask open questions, inquisitive questions. Wow, what did that feel like? Or when was another time that you had that similar feeling? What were you doing then?
How can you expand that a little bit more in your life? And just being able to witness that and to have people come up to these, with these decisions and these ideas on their own about, you know, I’m gonna ask to see if I can expand a little bit more of this activity in my job and see if I can hand this other duty off to someone else who would rather do that. And so that to see people go from feeling like they’re stuck and there’s no way out to feeling like there’s possibility and that they get excited about what medicine can be for them. That’s really the most rewarding part.
Peter: You’ve also talked about working with organizations, so that obviously that’s a different dynamic altogether, right? So what is that like?
Joe: I feel like with healthcare organizations, they’re often stuck in the same dilemma, the same issue of we’re given a system that we have to work it with and we have to try to make it work even if we don’t think it’s the best system. So what do we do? And so a lot of people who are in healthcare administration follow a business model, and medical providers follow this medical model, and they work in parallel. And it’s like they’re talking two different languages because they come from two different camps. And what I feel like my greatest contributions to healthcare organizations is, is to try to break down those communication barriers.
It’s almost like acting like I’ve lived overseas and I’ve worked in other cultures. I’ve had to learn different languages and I’ve stumbled and fallen and tripped and made mistakes and then learned from that. And I learned what it was like to be from a different culture. And after living in a certain country over a number of years, I start to see visitors from my own country come and I see things from a different perspective than when I first arrived. I go, oh wow, I see this from a Bolivian’s perspective, but I can also see it from the Americans’ perspective.
So it’s this kind of walking in each other’s shoes. And I often hear physicians say, those business people, those administrators, they just don’t know what it’s like. They don’t know what it’s like to take care of patients. They don’t know what it’s like to have people’s lives in your hands. If you talk to the administrators, you’ll often hear, I often hear, the medical providers think that the world just revolves around them, that they don’t have to deal with real money situations.
And if they didn’t pay attention to that, then they wouldn’t even have a job. And so they hear these kinds of different things. And it’s, people aren’t talking with each other. I’ll give you an example. I worked in a small clinic, it’s in South Seattle, it’s a pediatric clinic, and it’s a non profit clinic and it sees the patient population consists of about 50% insured with commercial insurance, 50% covered by Medicaid or no insurance.
And it’s a small staff and the director, the administrative director of the clinic sits down every week and we have a small staff meeting. And one day we were talking about a certain service that we offered to our patients and families. And I was hearing him say that we would offer this type of service to people who had commercial insurance and another service to people who had Medicaid coverage. And this disparity really got me because I was like, administrators, all they care about is money. So I kept arguing with them and everything and he kept trying to explain it to me.
And afterwards I was obviously frustrated. So instead of going to our neutral corners and just burning, he came up to me and he said, Joe, he said, I want to make sure that we understand each other because I want you to know that I am trying to do the same thing that you are, we’re working together. We all have a common mission and that mission is to deliver quality healthcare to the people who live in this area. And I said, Yeah, well then why are you doing this? He said, I don’t think you understood, let me explain it again.
And he explained it to me, and as he explained it to me, it turned out I really didn’t understand healthcare finance the way he did. And I was stuck on something that I obviously misinterpreted. And as it turned out, he was explaining how he was able to play with the system so that all patients get equal care and that we just didn’t get reimbursed as much from Medicaid as we did from commercial insurances. But he made it so that everyone was able to have access to the same thing. And it was this ability for him to want to sit in my shoes and listen to me and my stubbornness, getting over my stubbornness and saying, Gosh, what is it like?
What is it that we’re trying to do here to finance the clinic? And I think it’s that that I think organizations can do. Administrators can hang out with physicians, hang out with providers, sit in the office in the clinic, watch and see what it’s like, who does what work, where are things not working, listening and talking to the receptionist, the medical assistant, the person who is in environmental services, trying to understand exactly what happens during the course of the day to make things run smoothly and actually see that happen. Then all of a sudden, there’s a whole new view of how things are done. At the same time, I think it’s important for we physicians to walk in the shoes of administrators who have to answer some pretty tough questions and come up with some ways to really make a common mission work for everybody.
So I think that that’s the place to start.
Peter: So you mentioned being in other countries, but do you see the local care providers experiencing some of this, or is it just a whole different set of issues that they deal with?
Joe: Most of the countries where I have lived and worked are under resourced countries, and especially Uganda and Bolivia are two places that are the most under resourced of their areas. The healthcare system is completely different. There’s much more of a government centered healthcare system. We are so privileged to have so much technology and so much access to specialized care that people in those countries don’t come close to accessing. So it’s a whole different approach.
I think in both Uganda as well as Bolivia, there was also this sense of traditional medicine and traditional healing, along with what they call, you know, westernized medicine, allopathic westernized medicine. And people of all socioeconomic groups always practiced a little bit of both, the traditional healing as well as the western medicine healing. And there was a much higher volume of patients that were in need of care and people who were extremely appreciative to have any type of medical care
Peter: at So it sounds like you’ve had an opportunity to really fulfill your own desire by doing this. Sounds like you’ve found your why here.
Joe: Yeah, yeah, it’s interesting. I think I’ve had my ups and downs in my medical career. Always, when I have been able to live and work in under resourced countries amongst people who put the community first and relationship first. That’s where I flourish. That’s where I feel most at home.
The pace of life is slower. People expect that relationship with each other, is much more of a priority than trying to accomplish or achieve something. And that’s where I have felt like those values that I hold very high, which are connection to other people, relationship to other people, service to, to others with a common mission and a sense of solidarity, of sharing in our own humility as well as our own gifts and talents. That’s where I have found, for me, to be the most fulfilling experiences.
Peter: If somebody wants to get ahold of you, what would you recommend would be the best way?
Joe: Probably the best way is through my website, which is joeshermanmd.com. And also LinkedIn, I have a LinkedIn page that also has a lot of my, I’ve written articles and often put on workshops and retreats for healthcare providers, well as just reaching me directly through my email, joejoeshermanmd dot com. I always offer an initial free consultation to talk over what your issues are, either as an individual or a medical team or a larger organization, and then talk over what we both think together would be the next best step to take.
Peter: Well, really appreciate you joining me today. This has just been a real fascinating conversation for me. So thank you so much for being with us.
Joe: Thank you, Peter. I really appreciate the time.
Peter: Thanks for listening to this episode of Biz and Life Done Well with Peter Wilson. You can subscribe to us on iTunes, Google Podcasts, Spotify, and most of the other popular podcast platforms. Please tell your friends about us and leave us a review so even more people will find out about us. Thanks again. We’ll see you soon.
