The August issue of AAOS Now included a report on the results of the Physician Stress and Burnout Survey conducted by Physician Wellness Services/Cejka Search. The findings are a wake-up call for both organizations and physicians on the importance of seriously addressing stress and burnout.

Although respondents noted many ways that could help them better deal with stress and burnout, most fell into the following three areas:

1. Greater flexibility and control over their working hours
2. More opportunities to understand and practice better self-care and assistance with taking better care of themselves
3. Support on multiple levels in dealing with stress and burnout

This article focuses on steps AAOS members can take to reduce stress and avoid burnout.

Where to start
How much control you have over your time and how you spend it may depend on your practice setting and other work-related circumstances. The goal of achieving greater flexibility and control over working hours may need to be approached incrementally. The first step is to better understand what you actually want and need before you start to change things in your professional life.

The following tactics can help alleviate some of the stress and burnout associated with work:

• Accept that time and age change a person, as well as his or her personal goals, priorities, and bedside manner. Take time to examine what is important to you now—and how that differs from earlier in your career. Use this knowledge to frame what is important to you, as a physician and an individual, so you can incorporate it in your daily work.
• Perfectionism is a well-known trait among surgeons. Striving for perfection is admirable, but can cause a great deal of stress. Is perfection necessary in everything you do? In what areas can you afford to be more flexible?
• Related to this, how much of your stress is self-imposed rather than related to external factors? Understand whether you need to ask yourself or your organization for permission to change.
• Once you better understand your needs and the environmental factors that cause the most stress, start to look at specific tactics that can free up or rearrange time for other priorities and needs.
• Scheduling and time management—Are there ways to utilize your time more efficiently? Consider setting aside specific blocks of time for specific responsibilities such as surgeries, paperwork, and charting, following up with patients, or other duties. If you travel between locations, can you optimize that time or minimize travel time?
• Delegation—Are there noncritical or lower priority tasks that can be done by or shared with others? Can ancillary staff do some paperwork or charting, or take care of patient-related appointments or communications? Focus on identifying how you and your administrators can best use the time available and where you can provide the most value.
• Protected time—How can you carve out time that is respected and protected for breaks? Everyone needs time to refresh and reflect, but struggling to find and maintain that time can create more stress.
• Resolving issues—If issues with staff or colleagues are resulting in conflict or other work issues (operational or process issues, policies, or resource allocation) and contributing to a stressful environment, how can they be resolved? Who in your organization is responsible for facilitating discussions and implementing solutions? Is there a way to provide input in a manner that is professional and receive feedback on results?

These same principles apply even in smaller practices; you may be able to address on your own. If collegial communications or cooperation are problems, bringing in an outside facilitator or coach may help identify issues and solutions.

Taking better care of yourself
No mysteries surround self-care, which encompasses the following:

• Adequate, good-quality sleep
• Good, nutritious food
• Exercise and physical fitness
• Physical and mental relaxation
• Mental and emotional health
• Intellectual stimulation and engagement

For physicians, one of the biggest barriers to practicing self-care is time. Carving out time in the work day is a good first step. Some elements of self-care can be synergistic, such as the way exercise helps “clear the cobwebs” and provides a mental break. Intellectual stimulation that promotes mental stimulation, such as reading an interesting professional paper, can also be relaxing.

Similarly, consider the time you spend outside of work. Can you be more efficient with your time? Are there tasks or responsibilities that you can delegate or share? What do you do that doesn’t provide value or enjoyment? You might be surprised at how you can reallocate your time.

But don’t make this about creating another thing on your to-do list that leads to more stress. Remember that you might have to start small and approach self-care incrementally and that it’s okay at times if you do things that appear to have no redeeming value. Reading a novel or surfing the web may provide a needed mental break. Setting limits and boundaries on your professional time should be considered a survival skill with long-term benefits.

Specific things to consider that promote good self-care include the following:

• Enroll in a yoga, Pilates, or meditation class, or become involved in other activities that distract from or alleviate stress.
• Take time to reflect on the positive parts of your life. Doing this prior to bedtime will help you get a good night’s sleep.
• Read fiction, keep a journal, or meditate. Engaging in these activities before bedtime will also help you sleep.
• Exercise is the cheapest antidepressant available—identify more ways to integrate it into your daily life.
• Go for a 10-minute walk outside the office—it can reenergize you and clear your mind.
• Purchase exercise equipment for your home so it’s easier to use and access.
• Get a workout, running, or activity partner.
• Improve your nutrition practices by actually sitting down to breakfast, taking a lunch break, bringing healthy snacks to work, and having family dinners whenever possible.

Getting the support you need
Nobody can do it all, and nobody has complete control over his or her life. You need support to address the stress in your life. Avenues to obtaining that support include the following:

• Get tips, support, and suggestions from others in similar situations. By speaking openly with those in similar situations, you can gain insight and perspective, as well as suggestions for coping.
• Sit down with your spouse or partner and have a frank discussion about the division of labor in your household. Negotiate household roles and responsibilities, and don’t forget to talk about parenting, childcare, and eldercare issues if they apply.
• Where there is conflict, or potential for conflict at home and at work, thinking through the issues and, engage in crucial conversations with those involved.

Physicians might also consider using resources such as an Employee Assistance Program, a physician coach, family and marital counseling, or individual counseling to promote mental and emotional health, particularly in the following areas:

• Priorities and values at home and work
• Self acceptance, trust, and tolerance of others; trying to be selective with controlling or perfectionist thinking
• Giving people the benefit of the doubt, avoiding jumping to conclusions, and identifying issues that are obstacles to trust
• Being more open to reasonable feedback and seeing when you may be the problem
• Acknowledging losses and giving yourself permission to grieve
• Acknowledging and dealing with guilt feelings related to patient and care issues, relationships at work or home, or other parts of your life where you feel you have been deficient in some way

Make a commitment to yourself to take time and develop an action plan for making your work and life more manageable, using some of these suggestions. You will have to make time for this activity; waiting until you have a free moment means never getting it done. You might want to start small and review and build on your plan as time goes by. You may be surprised at how much control you really have to make important, meaningful changes to your stress level and overall satisfaction in life.

Alan H. Rosenstein, MD, is medical director for Physician Wellness Services, Minneapolis.