Coming back from the brink of burnout [PODCAST]

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“I understand what it feels like to be in the depths of depression and hopelessness. I have had a lifelong battle with stuttering, obsessive-compulsive tendencies, depression, and suicide.

I continually fight these battles and have learned to heal and recover through family, friends, and ultra-running. Since attempting to take my life on September 12, 2009, I have developed wellness tactics to help me journey through life to achieve optimum performance and to have a better work-life balance to lead a more healthy, peaceful, and purposeful life.”

Anthony Avellino is a pediatric neurosurgeon.

He shares his story and discusses his KevinMD article, “Coming back from the brink of burnout.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Tony Avellino. He is a pediatric neurosurgeon, and he wrote the KevinMD article “Coming back from the brink of burnout.” Tony, welcome to the show.

Anthony Avellino: Thank you. I must say that it’s a great opportunity to actually be here, because your KevinMD platform has really allowed many of us to share our insight. So I’m very, very grateful.

Kevin Pho: Well, thank you so much for writing and sharing your story and coming on the show. Now, we’ll get into that article a little bit, but first off, can you just share your story and journey to where you are today?

Anthony Avellino: Sure. I’m a pediatric neurosurgeon, I’m an experienced health care administrator, and I’m an endurance ultrarunner who has battled with depression, obsessive-compulsive tendencies, suicide, and stuttering for as long as I can remember.

I started my medical journey. I graduated from Columbia University. I then trained in neurosurgery at the University of Washington. I then was at Johns Hopkins for a while, and then I returned to the University of Washington, where I had progressive leadership opportunities, from chief of pediatric neurosurgery to residency program director to the founding director of UW Medicine Neurosciences. I did that for a while, and then I was recruited to OSF HealthCare, which is a fairly large Catholic health care system in Illinois. It’s a 15-hospital health care system, where I was the chief executive officer of the neurosciences.

Then I transitioned to Michigan State University as the assistant vice president for health sciences. I came in to Michigan State at a very public and tragic time, and my responsibilities there were to create a learning and healthy quality structure. But really, I had some experiences of crab fishing over the last few years, and being in Alaska and the COVID-19 pandemic has really given a lot of us pause. I realized that I’m happiest and most engaged being a pediatric neurosurgeon.

Kevin Pho: So you mentioned you’ve had extensive leadership opportunities in the past, along with your pediatric neurosurgery experiences. I’m always interested in how physicians climb up to these leadership positions. Were these positions something that you sought out, or did they present themselves to you?

Anthony Avellino: I would say that I always had an interest in the business side of things, and I’m a true believer that physicians and health care providers should be providing leadership. At the University of Washington, the chief health system officer at that time really gave me some unbelievable opportunities. Then I transitioned to OSF HealthCare, and that was a leadership position where they sought me out. It was truly a wonderful position, because being the chief executive officer there, I went through the Ministry Leadership Formation Program. I must say that my book probably would not have been written if I didn’t go through that, because the ministry leadership program was sort of a two-year journey learning about yourself, and that really gave me some insight.

Kevin Pho: So when you straddle that line between clinical medicine and administration, tell me what the single biggest challenge is in straddling that line, and how you overcame that challenge.

Anthony Avellino: Yeah. I think the challenge for me, being a pediatric neurosurgeon, is that you have to keep your skills up. I’m a firm believer that to be a good physician executive, you have to be in the trenches. So even though I had lots of administration and leadership positions, I always did pediatric neurosurgery, and that was really important to me, because taking call and being in the hospital late at night gave me the opportunity to see where the pain points were along the OR scheduling or the EMR record. For me, being on the shop floor is a very important thing.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “Coming back from the brink of burnout.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Anthony Avellino: Yeah. For me, I never told anyone about my suicide. I often say that in becoming a neurosurgeon, I saw my life bringing healing to those with neurological disease. On completing my training, I felt a tremendous sense of pride knowing that I was prepared to have a great impact on our patients and families in their time of greatest need and hopelessness. I entered and ended each day with the knowledge that I had given my all. I, like many of my colleagues, ignored the fatigue and underestimated the accumulated trauma and stress, until suddenly I was one of those stats: burned out, depressed. The administrative, clinical, and personal stressors really struck down my physical and mental health.

So on September 12, 2009, I attempted to actually take my life, something that I’m not proud of, something that no one knew. I didn’t come public with it until after I was with the ministry formation program. I decided to speak up because physician wellness, nursing wellness, and provider wellness are really important. I wrote the article because I want to give people a plan, because oftentimes, as you go through the journey of life, you’re always climbing the ladder, and you actually don’t take a pause. I often say life is like a journey. You have to stay in the present, but you have to let the journey of life unfold.

It was interesting that the first question you asked me was, “Well, were these progressive leadership positions for you, or what happened?” I must say that the one thing I learned over the last five years is that pushing is probably not the best. You have to let the journey of life unfold. So what I hope my article does is give people an opportunity to pause, to think about where they are in the present, what’s important to them, and what brings them joy. I often say we have close to 400 physicians every year who take their life, and for me, no one should ever be at the brink that I was.

I think it’s learning about the signs and symptoms of burnout, and then really doing some introspective thinking about yourself. What are some self-coping skills? For me, ultrarunning is one of my things. Ultrarunning races are 50-mile races, 100-mile races, but I’m at total peace in the mountains, and I often find hope, healing, and purpose on the trails. But really, what does someone do to bring them joy? Because being a physician is really tough work. You actually see incredible triumphs, but you see some awful things too.

I know that as a pediatric neurosurgeon, the things that keep me up at night are not the hundreds of kids that you treat who have a great outcome. It’s the one or two kids every year where you make an honest mistake, or the disease is so devastating that you cannot help them. I’ve been in practice over 20 years. The first year, I had two or three. I have over 40 kids out there that I could not help.

My story is not unique, and I often say you have to listen, you have to learn, you have to heal. What I mean by that is you have to listen to discover your life journey, because everyone has their story. What is your purpose? But then you have to learn from them. I know it’s cliche, but people always say, “Well, you learn the most from failing.” For me, it’s how one deals with and overcomes personal struggles, but also how you heal, because I think you have to have a healthier and purposeful life.

I often say I have this formula: Performance equals skill minus interference. What I mean by that is, if you’re a lead scholar, lead physician, lead athlete, you can have all the skill in the world, but if you can’t block out that interference, whatever it is, if you’re not mentally prepared, if you’re not mentally well, if you’re not happy and satisfied, if you’re not doing purposeful work, if you’re not in healthy relationships, if you’re not showing compassion toward yourself, it’s very difficult to perform at your highest level. And also, if you can’t take care of yourself, then it’s important to take care of yourself, because to take care of your patients is really important.

Kevin Pho: So you mentioned it was about a seven-year period between that suicide attempt and deciding to share your story. Tell me how sharing your story publicly has moved the needle. Can you share a success story that came about from sharing your story publicly?

Anthony Avellino: Yeah. I must say, Kevin, when I came out publicly on June 10, 2016, no one knew my story except my friend that I crab fish with in Alaska and my wife. I must say that I was afraid to let anyone know, because there’s this fear of stigma, of what other people would think, because I was programmed from my football days to never show a sign of weakness. I was fearful of losing my job. I was fearful of losing everything I worked hard for. What would my friends and family think? I felt ashamed and embarrassed, and I’ve been through the employee assistance program twice.

But I think it’s how someone learns from it. Like I said, the reason why I have told my story and I’ve been very public about it is because no one should ever hit rock bottom as I was. But the other thing is, I have countless stories. I’ve lectured at many places around the U.S., and I’ve gotten lots of emails saying, “Well, thank you for telling me your story. It gave me the opportunity to pause and really figure out what is important for me.”

Kevin Pho: And when you first shared your story in general, what were some of the reactions that you received?

Anthony Avellino: It was interesting. When I first came out, people were very concerned. They said, “Well, have you disclosed this? What does it mean for your license?” For me, I found some overwhelming support, because my story is not unique. We have over a million physicians in the United States. People think that over 40 percent are burned out. We have 400,000 physicians there. So if my story can touch someone to seek help, that’s really important to me.

Kevin Pho: We’re talking to Tony Avellino. He’s a pediatric neurosurgeon, and he wrote the KevinMD article “Coming back from the brink of burnout.” Tony, as you know, during the pandemic I’ve talked to so many physicians on this podcast, and so many clinicians have written on my blog about how burned out they are. That’s only been exacerbated by the pandemic. So what are some of the lessons that you’ve learned through your own experience that you could share with these clinicians who unfortunately may be at that brink?

Anthony Avellino: I must say that the COVID pandemic, I think, has really helped health care systems bring wellness to the forefront. My tactics are not just for people who are going through some tough times, but also for people who aren’t, because I think a lot of the tactics that I use are helpful. I think there are some things. One, I think a lot of health care systems have put more emphasis on wellness, stuff regarding education about the signs and symptoms. Two is developing surveys along the way so they can track progress. And then three is giving people some information on some self-coping skills, regardless if it’s exercise, meditation, nutrition, or sleep. And I would argue that sleep is one of the most important things that we can do.

Kevin Pho: And as you reflect on your journey after writing the article, and just thinking back, is there anything that you would have done differently?

Anthony Avellino: To be honest, Kevin, what I would say is let the journey of life unfold. For me, if someone would have said, “Well, these are some of the symptoms that you should look out for,” I would have probably taken a pause.

My take-home message is really that my wife and I developed an algorithm, and what we say is you have to practice your TACTICS. What I mean by TACTICS, and I go through that in my article, is that T stands for take time for yourself to lead a peaceful life. A, always eat healthy, exercise, and sleep. C, continually self-improve. T, treasure family and friends. I: I choose the day I have. I think this is a really powerful thing, because I often tell people, when you wake up in the morning, please promise me that you’re going to wake up and you’re going to say, “Today is going to be a great day.” Some days are better than others, but I think having that mindset is really important. C is control disappointments and respond. And then S is you have to smile and laugh. You have to smile and laugh along the way. But I really hope my article gives people a pause to develop a plan to improve their efficiency and really develop some self-coping skills.

Kevin Pho: Wonderful. My last question is always the take-home message. You kind of already gave your take-home message, but I want to give you the last word. Anything that you want to leave my clinician audience with?

Anthony Avellino: I often say life is like an ultramarathon. You must stay in the present, and you let the journey of life. But really, it’s important to celebrate the successes along the journey. But remember that your TACTICS are really important. But really, it’s developing a plan, taking time, showing compassion for yourself, and showing gratitude to others. But last, what I would really end with is listening, because I often say that if you see a colleague in need, please take off your physician hat or your nursing hat and just listen, because you can truly save a life.

Kevin Pho: Tony, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Anthony Avellino: Sure, Kevin. I truly appreciate the opportunity, and like I said, you’re doing remarkable work. Sharing stories gives people insight and hope.

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