The demands of doctors are high and the pressure to always perform at their best is ever-present. Long hours, heavy responsibility, and constant pressure to be perfect is enough alone to drive doctors to burnout. But that’s just the tip of the iceberg. Dr. Jeff Moody experienced this firsthand. After being burned out for an extended period of time, he experienced thoughts of suicide and the jolt woke him up to the knowledge that something had to change. But what, and how?
In his new book, The Doctor Is Burned Out, Dr. Moody identifies the factors that lead to burning out and then offers mental exercises, paradigm shifts, and critical habit changes that can help physicians create a new you while enjoying a more satisfying, joyful life. In today’s episode, Jeff shares with us why burnout exists, what often leads doctors to burnout, and why they often don’t have anywhere to turn when they’re ready to seek professional help. Enjoy.
Miles Rote: Hey everyone, my name is Miles Rote and I’m excited to be here today with Dr. Jeff Moody, author of The Doctor is Burned Out: A Physician’s Guide to Recovery. Jeff, I’m excited you’re here. Welcome to the Author Hour podcast.
Dr. Jeff Moody: Miles, you are a gentleman and a scholar, I’m excited to be here, this is a big deal. It’s fun to get to talk about something that you’ve been working on for a couple of years.
Miles Rote: Yeah, congrats on coming out with this book. I’m really so excited for everyone to check it out. And before we dive into what’s inside, can you tell us a little bit about you and your background?
Dr. Jeff Moody: Well, I am a full-time practicing urologist, which is a doctor who does kidney stones and prostate cancer and those types of things. I live in Colorado, I have three awesome kids and a beautiful wife. And in spite of all that great stuff, I got really-super duper burned out about five years ago to the point where, actually, I had some suicidal ideation. I thought about killing myself just for a brief instant and then as soon as that happened, an electric shock went through my body and I said, “Something has to change.”
That kind of began my journey to getting better. I learned a lot and I read a lot of books and I did a lot of work on a lot that hurts my life. When I finally felt like I was recovered or recovering from burnout because I really think of it more like, almost like an addiction versus something that you recover from, it’s not a cure per se. Because there’s always going to be things that will light you up or trigger you and get you back in a little bit of a burnout mode.
When I was finally getting to the point where I was recovering, I thought, “You know what? Somebody else may benefit from this.” Initially, what was written in the book was probably 80% therapy for me, to just get things out of my brain and on paper. Then I kept working on it. I learned about Scribe, came to Austin for a workshop, and Tucker grilled me mercilessly for two days and told me that I have maybe one of the most impactful books that he’s ever read–just because of the secondary effects, “I helped a doctor who then helps more patients,” and the ripple effect from those things. It’s been quite a journey, it’s been a lot of fun, and it’s been very transformational for me.
Miles Rote: Amazing. There’s so much I want to talk about in everything you just said. But I’m going to rewind to the beginning because I think it’s a really interesting thing that happened when you had that suicidal ideation, and you mentioned something going off in your body where you realized, “Something had to change.” Now, that doesn’t happen with a lot of people, and that’s something that people could burrow themselves deeper into. What do you think it was that initiated that sense of knowing that something had to give?
Dr. Jeff Moody: Part of it for me was when I got to that point, at that shock I think really was fear. I realized, “Oh my god, is this what this has come to?” I just thought if that’s what’s happening right here–A, that’s not a path that I want to go down, and B, there has to be a different way of doing what I do and doing what a lot of doctors do.
A Widespread Problem
Miles Rote: You mentioned that you’re a urologist. I remember seeing in your book that you have a chart of all of the different specializations of being a doctor and the rate of burnout for each one. And urology I think was at the top, if I’m not mistaken.
Dr. Jeff Moody: I hate to say it but we’re number one, we are the number one most burnout specialty–no, that tends to vary from year to year and that was 2018 data. I think last year, we were number one or number two again. I think part of the issue, just specifically for urology but clearly this is a field-wide problem for medicine but specifically, urology, the year I started my training was 1992. They had cut 25% of the training spots because there was going to be this horrible oversupply of urologists and too many urologists running around, needlessly. In the last 25 plus years, there have been about a thousand urologists who haven’t been trained that would have otherwise been trained.
I get about five job offers a day because there is, surprise, a horrible shortage of urologists across the country. I think part of it is just a numbers game that was on the wrong side of the supply standpoint for urologists. But also, what’s happened in the last 25, 30 years in the United States. Has it gotten younger and healthier? No, it’s gotten much older and much more ill.
A lot of urologic diseases, prostate cancer, bladder cancer, kidney stones, and things tend to skew more to the older population. It’s a demographic tidal wave that’s coming towards us as well from a disease standpoint.
Miles Rote: That makes sense. Let’s define burnout in general. What does it mean to be burned out?
Dr. Jeff Moody: Well, that is really the question. This is an interesting question because there’s a bit of a debate in the burnout community about burnout as a misnomer. Burnout blames the person and blames the doctor, and maybe it should be called moral injury, or maybe it should be called a human rights violation.
I think there are definitely levels of burnout that qualify from those definitions. But you know, I always say, “I don’t care what it is called, I don’t care if you call it Fred.” I think the issue is, it is a problem no matter what it is named. The classic psychiatric or psychological definition is emotional exhaustion, depersonalization, and a lack of personal accomplishments. The way I think of that is, I don’t care about you and I don’t care that I got anything done today. Your compassion bucket gets emptied almost completely is the way I think of it.
Miles Rote: Right, which is the last thing we want in our physician.
Dr. Jeff Moody: You want your doctor to actually give a hoot about you? To take care of you? I guess that is part, we’re supposed to know things and be nice to you and do the right thing and actually care about you. That is the ideal doctor.
Miles Rote: As someone that is a patient, I want my ideal doctor to feel that way, obviously, and I want them to feel good, I want them to feel compassionate. What are these burnout drivers? You mentioned three in your book. Maybe we can talk about those a little bit in detail.
Dr. Jeff Moody: I think there are a number. If you really talk about it, and I do speak on this topic. When I survey the audience members, “What are the things that drive your burnout? Is it seeing patients and doing surgery?” Virtually 0% of doctors say that doing the work of being a doctor is what burns them out.
The thing that 100% of physicians, when I survey them, say that burns them out is electronic medical records, which is this perverse data collection program of which I implore thee, designers and the software makers of these things, actually, try to use this thing and see what you think of it. Because, also, it’s been frustrating because electronic records have been out for 10 to 20 years. And there really has not been an improvement in the user-friendliness of them.
I would think at this point, if Google can tell me where the best rutabaga is, I would think that the electronic medical record–and these are not cheap programs, these are typically 10 to 20 to $50,000 per doctor to implement these– that it could actually then improve them and get to the point where, “Man, this thing almost reads my mind.” That’s what I would love to happen. But we call it a click-fest.
You do a lot of clicking and you have a lot of, I always call it menial, very low, a lot of repetition, and a lot of lack of really getting the right information in and out of the system in an efficient manner. The other issue is these electronic medical records will generate gigantic notes, like a 10 or a 12-page note. To a point where, realistically, we don’t even read the notes when we get these notes from other doctors. Because you can’t find the one or two bits of information in 12 pieces of paper in any reasonable amount of time.
So, we’re like, “Well, I’ll just talk to the patient.” You forget what the note says, we try to be very intentional with how we use our EMR and, in general, we don’t have computers in our exam rooms. Because we actually like our patients and interacting with our patients. I know a lot of patients will go see their physicians and there’s a terminal in the room. The doctor stares at the computer screen, tapping away, looks over, maybe, occasionally. But the appointment is with the computer versus with the doctor because the problem for the doctor is, if they don’t do that then, they’re adding hours to their day later trying to get that data inputted.
It’s very much a Catch-22 situation. EMR is a big driver of burnout. There are some perverse incentives in general and in any other industry in the world, if you do something better and more efficiently, you’re rewarded for that. In medicine, you’re actually typically penalized for that. An example I use in the book is kidney stones. If I have a patient with a kidney stone and I go in and I take it out in one fell swoop in just one operation, boom, they’re done, and I get paid for doing that operation.
But sometimes, say my patient has stones on both sides, you can do one side and then wake the patient up and then come back and do the other side. Then you actually get paid twice. If I go the extra mile and I do both sides at the same time, I actually get paid less. It’s kind of perverse. You ought to give me a bonus. I’m saving the hospital some money, I’m saving the patient on their anesthetic, it’s safer, you ought to be thanking me and no, you just pay me less. That part can be frustrating too for people.
I think there’s a lot of other drivers for burnout that can be specific to the situation. Maybe it’s a resource issue in a hospital system. Maybe it’s a compensation plan that hospital systems use for their doctors. Sometimes it can be expectations such as patients every day expect more and if you don’t meet their expectations, you’re going to hear about it on Google.
It could be five minutes after the appointment, “I didn’t like the carpet in their office.” Okay, I hope the care was okay. The expectations just continue to rise for patients, which I think is not unreasonable but I think also, we have to focus on what’s important.
Miles Rote: I think that’s a great point. Have you found since patients are typically walking into offices more armed with more information, not to say the information is accurate or inaccurate but more information, do you find that that contributes to this burnout with patients coming in with maybe more to offer or questionable information to offer?
Dr. Jeff Moody: In general, I am all in favor of patients being more informed and more interested in their own care. One of the things we say is, “I can’t care more about your disease than you can.” I can help you but you’re going to be the one driving this bus and getting yourself better. I always feel like, for me, I like to think of myself and the patient as a team. We’re coordinating and cooperating against the disease but as far as, patients coming in–we can always tell a particular patient is an engineer because they will come in with about 50 pages of information.
God bless the engineers, they’re very intelligent but they really like to get into the details. And studies show–I think WebMD–the studies show that more than 50% of people when they go online, they’re going online for medical information. I think that’s great and what I typically end up doing with patients is, if they come in with some data or a website that says, “Rutabagas will cure prostate cancer,” I say, “You know, I don’t have any evidence that it doesn’t work but I don’t have any evidence or a scientific paper that it does work. We’re going to stay focused on the things that we know are pretty effective and if you want to do that in addition, go for it, god bless you, I don’t think that’s harming anything.”
People start to get a little persnickety when they bring in the data, and I pull up my coffee cup that a patient actually gave to me, and it says, “Don’t confuse your Google search with my medical degree.”
Electronic Medical Records and Backwards Incentives
Miles Rote: That’s great. We have patients coming in with health problems but what about the health problems of physicians, given all of this burnout? Is this a problem, just even speaking in the United States? But maybe even worldwide where physicians are suffering from health problems?
Dr. Jeff Moody: Many multiple different factors can lead to burnout. But the stress of burnout can lead to high blood pressure and, maybe coronary disease and those types of things. It’s definitely an international problem–studies in the UK showed that they have high rates of physical and mental health issues. That’s one thing I would like to highlight for the readers as well or the listeners as well, that mental health is a giant issue. One of the reasons why I wrote the book is I want to start normalizing the conversation around burnout and stress and mental health and that it is okay for physicians to access mental health services.
There are certain mechanisms in place to help physicians who have substance abuse problems and other types of problems that are called physician health programs, which in general do a good job with those court-ordered or mandated issues but if somebody has depression or anxiety or some of those things, they are not great ways for physicians to access those services in a way that is beneficial for the physician, and then also not perceived in terms that it is harmful from a medical licensure standpoint.
Multiple times a year we have to answer these 150, 100 question long questionnaires. “Do we have any mental or physical ailments that will preclude you from practicing medicine? Are you using drugs? Do you use drugs or alcohol?” It is a very in-depth questionnaire. I think the concern for physicians is does that lead to a situation where if they answer in the affirmative to some of those things, would that affect their ability to practice medicine or their license or their livelihood? So, then you tend to close those things off.
Like you say, “Well, I’m a little depressed but I am going to ignore that, and I am not going to do anything about it.” I know multiple physicians who, when they access mental health care, they pay cash for it. They don’t run it through insurance. They don’t want anyone to know. I know people who will drive to a different city to access that care because they don’t want anyone to know.
Miles Rote: This is blowing my mind. You would think that doctors would have access to the greatest type of care in that sense.
Dr. Jeff Moody: Well, I have heard of this kind of the superman or superwoman complex, where there is that fear–there was a study that 60% of surgeons who had suicidal ideation would not and did not seek mental health care because of fears of actions against their license.
Miles Rote: Unbelievable.
Dr. Jeff Moody: So then, unfortunately, it turns into this pressure cooker. You are under all of this stress and all of these weird, horrible things are happening with your patients and you are trying to help them. And you are having stress but then you can’t do anything to help your stress or your mental health issues because it could affect your ability to practice medicine potentially.
Miles Rote: Of course, how does that affect the patients then? Because of mental exhaustion, the performance of doctors must decline significantly.
Dr. Jeff Moody: Well, I can tell you there are multiple studies that show that burned out doctors provide worse care. It is a fact. They are a higher malpractice risk. Patients who are cared for by burned out doctors in the ICU settings or intensive care unit have a higher death rate. It is a fact. It affects patient care and patient’s lives. That is the other reason why I feel so strongly about this is that it is not just a, “Buck up and get over it,” kind of a thing. This is a systemic issue that really affects quality of care.
Miles Rote: Wow, I had no idea about any of this, so this is amazing, thank you.
Dr. Jeff Moody: Hey, read my book. It’s all in there. You’ll know more than you ever wanted to know.
A Step at a Time
Miles Rote: Bringing attention to these things is so important. So, if physicians are running into all of these different problems, it sounds like everywhere they turn they hit a wall. What are some solutions? How can physicians get out of this cycle of burnout?
Dr. Jeff Moody: Well, everybody in the world, ends up in a box called their life, which is of their own creation, either by something they did or something they didn’t prevent. So, they end up in this box and as they go through the book, we talk about ways to reconstruct or build yourself a new box. Again, for me, it is a multi-factorial–where many different things cause burnout.
So, let’s attack pieces at a time. You can either go big or you can say, “What is the number one thing that is driving my burnout?” Then you think about that as you think of an action you can take, and you give yourself a deadline. Giving yourself a deadline actually triples your chances of actually achieving that goal. Then once you get that done, you take the next thing on the list, then the next thing.
The way that I went about it was, I had horrible insomnia. So, I thought, “Let’s get some better sleep.” And you actually get some better sleep then you’d probably make better decisions, feel better, feel like working out, eat better. So for me, it was more of an environmental, nutritional care, self-care kind of a package first.
Then, one thing I think that it is important, and I talk about in the book is that A, you have to give yourself permission to do those things and you have to make it a priority.
Yes, it is actually okay for you to take 30 minutes and work out every day. Make that a priority but you have to give yourself permission first to do it. Then figure out if there is an efficient way to do that for you. Then that makes you feel better, then you get better sleep, then you make better decisions, then your mental health is better. Instead of being a downward spiral, which I think most physicians get in when they really get into the depths of burnout, this becomes an upward spiral of improvement and recovery.
Miles Rote: Yeah, it has that compounding effect and as you mentioned, you can choose first to tackle the problems that will take care of the most solutions, as you mentioned, sleep. That essentially will take care of many other problems by solving that one problem.
Dr. Jeff Moody: My electronic medical record was just consuming hours of my day. And so finally I figured out, “Well, there is this one little task that I repeat 20 times a day. Can I have somebody else do that for me?” And in 15 minutes, one time, I taught somebody else how to do that. And boom, it saves me 30 minutes a day every day for the rest of my life. So those kinds of small things, they turn into big needle movers for the rest of your life and your career. Those are things that I really, really try to get our clients to focus on.
Miles Rote: Yeah and those are the things too, we don’t realize how it’s going to positively impact our lives and change our lives once they happen. Food, for example, you can eat bad food for a year. And then you are so used to that way of being that you could eat good food for a month and be feeling really good. And you really had no idea that you could feel so good because you have been feeling bad for so long.
Another thing you do talk about is agreements. Basically, just the importance of setting up agreements, whether with yourself or other people, and setting boundaries to be able to have autonomy over your life. So, what does that look like?
Dr. Jeff Moody: I love Eleanor Roosevelt. I love her, she is just a quote machine but one of my favorite quotes from her is, “No one can make you feel inferior without your own consent.” In the same way, no one can force you to do something without either your agreement or your lack of disagreement. Whatever it is. Where are you going to work, how much you’re going to work for? What are the important drivers in your life? What are the priorities in your life?
Those are things that you control and you either agree or fail to disagree. I try to make this very simple and I like for people to just list their agreements and then think, “Is this an agreement that brings me joy, or is this an agreement that brings me pain?” And you know, sometimes it’s both, like coaching a kid’s soccer team, you know it is wonderful, but it can be painful too.
Agreeing to marry your wife or your spouse, that is a great agreement. Maybe I agreed to a position where I am paid less because I am gender different from the person who does the exact same job as me. That’s an agreement that you shouldn’t agree to, but then once you do you realize that that is probably an agreement that’s affecting you negatively. So, I like to have people have a more active role in the creation of their life instead of just passively taking what comes.
In medicine, unfortunately, the training system, which is a focus of a whole other book for me–the training system really trains you to just take whatever is doled out. That’s what you get. That’s the way it is, and you can’t change it. And this is the way medical school works and this is the way residency works. You just have to take what is given. So, I think that’s unfortunately sometimes where people learn how to make these kinds of lack of positive agreements or a lack of a disagreement, and then it seeps into the rest of their life and the rest of their decision making.
Identify Your Values
Miles Rote: One thing that you talk about to help improve our agreement and ways to set up our life is really being able to identify your values, that can essentially be guardrails for our choices in life and the agreements we make.
Dr. Jeff Moody: It’s huge, it is one of the things that if you sit down and in probably five minutes on a piece of paper, you say, “What are the things that are important to me?” Number one and then, “Are your agreements lining up with those things?” You may say, “Oh, my family is a top priority.” Well, you are home one night a week for dinner? Maybe you need to change your agreements around that, maybe you need to agree to be home every night for dinner and be with your family.
Maybe that means you need to change the agreements you have at work, like, I am not going to be on call every other day. I am not going to work until 8 PM every night. You have to get your values and your agreements in alignment, absolutely.
Miles Rote: Yes, I totally agree and I must say Jeff, one of my favorite things that surprised me in this book is the idea and importance you talk about loving yourself. I think this can feel like such a scary ‘woo-woo’ thing in the physician world and talking about these things. So, tell us why it is important to love yourself, and what that means to you?
Dr. Jeff Moody: Kamal Ravikant wrote a fabulous book…
Miles Rote: Love Yourself Like Your Life Depends on It, yes. Yes, it is driving me crazy too, such a good book.
Dr. Jeff Moody: It does because your life does depend on it and the problem is, again, I am not trying to blame everything on our training program. But between medical school and residency and everything else, I do feel it is an abusive system. You are taught that you’re never enough and you’re never right enough. And what if you miss something? It is a very much a fear-based, on high-alert at all times kind of training system.
There is not a lot of positive reinforcement. There is very little positive reinforcement, at least from the training system itself. What keeps me going, a lot of times is the patient is giving me positive reinforcement. But the problem is, I feel like a lot of people get torn down to the point where maybe they’re not even at ground level. They are kind of underground.
My point is, when you are in a hole, stop digging. Stop beating yourself up and let’s turn that around and let’s talk about simply loving yourself. Then having good, positive feelings about what you do and who you help. Think about all of the positives you bring to people’s lives every day. And once you have started to rehabilitate your psyche, and you are on the upswing, then you think, “Hey, you know what? I am worth it to exercise.” I am worth it to take the time to eat well. I am worth it to spend time with my family.
Prioritize things and then act on those priorities. Because you have to start with something–the point where you are not beating yourself up. You have to turn that around, and for me the quickest way, the easiest way to do that was to just repeat, “I love myself, I love myself, I love myself.” Even if you don’t believe it, Kamal’s point in his book is it starts to give you a new groove in your brain, a better way to think, and starts to rewire your brain in a positive direction.
Miles Rote: I couldn’t agree more and speaking of having to love yourself, I think you had to do probably a lot of that writing a book, congratulations. If readers, Jeff, could take away one or two things from your book, what would it be?
Dr. Jeff Moody: Burnout is not your fault. It is a result, not something that you did or didn’t do. |t requires a plan and a concerted effort and that is why I really try to give people a lot of options for ways to get themselves better. So, it is something that you can recover from, it is definitely possible, and you just have to start.
Miles Rote: I love it. Jeff, this has been such a pleasure and I am so excited for people to check out the book. Everyone, the book is called, The Doctor Is Burned Out: A Physician’s Guide to Recovery, and you can find it on Amazon. Besides checking out the book, where can people find you?
Dr. Jeff Moody: One of the things I felt super strongly about after writing the book is I thought, “You know what? I want to let people access services in ways that are easy and meaningful for them.” So, we have an online course at jeffmoody.com. Then we have burnout breakthrough live streams on YouTube and Facebook. We are going to be doing consulting for groups and hospital systems. There are different ways that people can access that information. So, we are here to serve people who are burned out.
Miles Rote: Amazing. Jeff, thank you so much, jeffmoody.com. Jeff, thanks again, this has been so much fun.
Dr. Jeff Moody: Miles, you are a gentleman and a scholar still.