Uncovering the personality traits that drive physician burnout [PODCAST]

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Join Susan Biali Haas, a physician and author of The Resilient Life: Manage Stress, Prevent Burnout, & Strengthen Your Mental and Physical Health. In this episode, we delve into the personality traits that contribute to physician burnout and vulnerability, based on Susan’s expertise and experience working with physicians in her coaching practice. We explore the impact of high neuroticism, introversion, extreme conscientiousness, and agreeableness on physician well-being. Susan shares practical strategies for shifting negative thinking patterns, setting boundaries, and finding balance in a demanding work environment.

Susan Biali Haas is a physician.

She discusses her book, The Resilient Life: Manage Stress, Prevent Burnout, & Strengthen Your Mental and Physical Health.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Susan Biali Haas. She’s a physician and author of the book The Resilient Life: Manage Stress, Prevent Burnout, & Strengthen Your Mental and Physical Health. Susan, welcome to the show.

Susan Biali Haas: Thank you so much, Kevin. I’m so excited to be here.

Kevin Pho: So we’ll talk about your book in a little bit. First off, briefly share your story and journey to where you are.

Susan Biali Haas: Well, it’s been quite surprising, certainly not what I anticipated when I enrolled in medical school. I started out in an ER residency, and while I was in that, I experienced severe depression and what I know now to be severe burnout symptoms, and also what I discovered years later were trauma-related symptoms from things that I had experienced. So, unfortunately, because of my mental health situation, I did end up resigning from that residency, and I got my license to practice medicine in the community in primary care.

But from that really awful experience, it was like a fire was lit within me. I wanted to learn everything that I could about whole human mental health and resilience, and I have been passionate now, for over 20 years, about educating people, everybody I could, about mental health and well-being.

Kevin Pho: So tell us about some of the cases and stories that you hear physicians are going through today.

Susan Biali Haas: Well, I work as an executive coach. I’ve done that on the side for 15 years, and I have worked with physician clients. I have a physician leader that I’m working with right now. And what I work with the most. Obviously, the systems that we work in as physicians are really, really challenging and are the primary driver of burnout and stress in physicians. The bureaucracy, in particular, was even harder on physicians than COVID itself, apparently, according to data.

But what I work with physicians on, because this is where I can have an impact, is the beliefs that they have and the pressure that they put on themselves. And I have seen that increase with the stresses of the pandemic. So really, that’s where I try to help physicians, because everybody wins when a physician keeps working. And as I see it, the only way that a physician is going to have a long-term, sustainable career is if they learn how to really take care of themselves and have boundaries within that context.

Kevin Pho: All right. We’ll talk more about some of the things that you do to help physicians. And you wrote a book about the issue called The Resilient Life: Manage Stress, Prevent Burnout, & Strengthen Your Mental and Physical Health. Now tell us, how did your book come together?

Susan Biali Haas: Oh, it’s really reflective of my entire life’s work in this space. It wasn’t actually specifically written for physicians, because in my mental health education work, I work with all different kinds of sectors. It began as a personal mission for myself to understand everything that I could do to prevent myself from getting into a severe mental health situation like the one I ended up in in residency. And I haven’t been on medication since.

I wanted to take everything that I had learned and condense it down into one handbook. Really, the book comes with a workbook as well that people get for free. I just wanted to give all the simplest, most powerful tools and insights that I had gained over the last 20 years so that people would be able to really help themselves in this very difficult world that we’re living in.

Kevin Pho: All right. As it relates to health care professionals in particular, tell us some of the key messages and techniques that you would offer.

Susan Biali Haas: Oh, well, where do I even start? I would say with health care professionals, what I do see the most is personality factors, and learning how to undo some of what we’ve received in our training. And that’s not to say that we’re not going to be responsible and hardworking and ethical and care for our patients, because basically every physician does that by default. That’s just who we are to begin with.

But what I’m really getting people to look at, and I wrote about this in the article, so I’m getting into that territory a bit already, is that physicians tend to score very, very high in conscientiousness. Conscientiousness is a great trait to have in general. It means that you’re hardworking, you’re reliable, you’re diligent, you do great work. And at a moderate level, that’s actually preventative against burnout. But what we tend to see in physicians is that we are harder on ourselves than anyone would ever be. We have standards, and we have probably been putting those standards on ourselves for so long that we don’t even realize where they came from.

So a lot of the work that I do with physicians, and actually my practice is closed, so I’m not saying this to try to get new clients. Rather, I want to really help physicians understand that it’s so important to look at the reasons why you make certain choices. When I work with a physician, I’ll ask them, “How did your day go?” And they’ll tell me, “Well, I had this one really difficult situation with the patient. I didn’t get my charting done again. This was really stressful. This interrupted me.”

We look at the entire day and all the things that happened and start asking questions, like, “Did you have to go over time with the patient? How could you have managed that visit better? How could you have found time in your day to get your charting done? What did you get distracted by, and why did you let yourself be distracted by that certain thing that you’re not even responsible for?” And we start picking apart those things.

So I really recommend that any physician, if you’re struggling, if you’re feeling burned out, get support. Work with a coach, work with a counselor, have a peer support person that you’re connected to. Don’t just continue to go through life and work on autopilot.

Kevin Pho: You mentioned some other personality traits that may make physicians more vulnerable to burnout. What are some other ones?

Susan Biali Haas: Agreeableness is one of them. Again, in moderate levels, agreeableness is being other-oriented and connected to other people, and it’s so important to have strong networks around us for our resilience. So agreeableness in moderate amounts, again, is a protective thing. But physicians have usually been indoctrinated into being, and probably already were by nature, yes people. And so it’s like a default: If anybody needs us, if they need our help, the answer is yes.

That’s something that we really, really need to watch. In fact, we are going to be our most effective as practitioners, be the most productive, and have the most sustainable long-term careers if we learn to really manage that tendency to just reflexively agree all the time or say yes, and develop skills in terms of how we communicate our nos, and how we even change expectations within the workplace and the whole culture.

Kevin Pho: So let’s delve deeper into that one, because I completely agree. I think by definition, those who go through medical school and residency sometimes have that degree of agreeableness. They want to be people pleasers and get that work done and do what they’re told. And sometimes I think that works against them going forward. So what are some ways to, like you say, manage that and perhaps set boundaries? And what are some techniques that physicians can use?

Susan Biali Haas: Well, one technique, which I already referred to, is to make it a habit, especially if you’ve had a particularly exhausting or difficult day, or a particularly challenging patient encounter that left you with a really bad feeling, like you gave much too much of yourself and maybe even feel taken advantage of, to do a post-game kind of analysis. You can do that through journaling. Again, you can work that through with a coach or a counselor or a friend or colleague and try to look at your behaviors.

Try to identify: Where do you abandon yourself regularly? Where do you routinely say yes to things that you know you have no time for? Do you routinely think magically about time? I know that happens to me all the time. I don’t have a sense of how much time I actually have for a patient encounter, for example. So really work at developing an awareness of how you’re acting and how that’s impacting you and also your practice of medicine.

And then in terms of tools, one thing that can be really helpful, actually, and is a real anchor of the way that I live today and the things that I teach people about, is mindfulness practice. That may sound like a cliche, but there is just unbelievable evidence about the incredible cognitive impacts and even brain structural changes when you practice this regularly. The more that you do that, the more you empower the executive function of your mind to be strengthened, and to not just be acting reflexively or out of fear or out of stress, but to be able to step back and think more in the moment: What is happening here? What are the choices that I have? What is the best way that I can manage this? It really gets your brain online in a much higher-functioning way. That can be really, really helpful in changing habitual responses and choices.

Kevin Pho: Tell us one of your success stories. Give us maybe a before and after of a hypothetical or previous client, a physician who comes to you burned out and perhaps not managing some of these personality traits that made them more vulnerable to burnout. Tell us what you did, and give us an after picture.

Susan Biali Haas: Yes, I can think of one example. A really, really wonderful physician. They’re all wonderful; physicians are just an amazing, amazing group of human beings. But this one, oh my goodness, the level of care and passion for preventive medicine and education. So not just problems in the moment, but such a passion for educating patients on how to really create health for themselves. But this physician had worked themselves into such a level of burnout and exhaustion that they were ready to quit medicine entirely, to just get rid of their practice and do something else.

My job at the time was actually to help that individual figure out how to transition out of their practice, how to get over the guilt of it, etc. But whenever people come to me for help quitting, which they often do, I have an opportunity to work with them in their current context. And so we worked on all kinds of things: for example, how to better manage the patient encounters, how to stick to the appointment times, and how to make time for billing in the day to stop having it take over all their evenings and weekends.

And also, and this was probably the biggest shift, I got that physician to really, down to their cells, understand that prioritizing their well-being in the context of their practice was not selfish. It wasn’t going to be harmful to the patients. Actually, by being able to perform and exist at their best, in the highest state of their own well-being, and honoring their own boundaries and desires, it would be a gift to their patients, because it would mean that they wouldn’t quit.

And that physician, I’m still in touch with them. They have not quit, and they have recovered in their practice of medicine. They found a way to run their practice in a way that feels much more manageable, and they are actually now even taking on some more patients and opening their practice again. So it’s really phenomenal when we look at changing things on multiple different levels, and how things flow in the workplace as well is really important. I don’t want to put this all on the individual, but the change is really remarkable.

Kevin Pho: We’re talking to Susan Biali Haas. She’s a physician and author of the book The Resilient Life: Manage Stress, Prevent Burnout, & Strengthen Your Mental and Physical Health. Susan, tell us, what other key messages do you have to share with the physician audience regarding your book?

Susan Biali Haas: Regarding my book, I would say that when we look at the data on resilience and what makes us as human beings the most resilient, when you look at the people over history worldwide who come through the biggest disasters the most intact, it is not those tough individuals. It’s more the people who are surrounded by resources, so much of which is community and relationships and support, and they’re the people who maintain those connections and who are willing to receive help and make use of the resources around them.

So as physicians, we’re so used to white-knuckling it on our own. And so get that coaching, get that counseling, reach out to that peer support line. Don’t try to do this on your own, and you will be so much stronger and healthier and happier.

Kevin Pho: And my final question, Susan: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Susan Biali Haas: Put yourself first. As physicians, we’re never going to be excessively selfish. It’s just not in our DNA. So don’t be afraid of that. Don’t be afraid to ask yourself, “What do I need the most in my life and my work right now?” and figure out ways to get that, because a healthy, happy physician is the best thing that we can bring into the world and for our patients.

Kevin Pho: The book is The Resilient Life: Manage Stress, Prevent Burnout, & Strengthen Your Mental and Physical Health. Susan, thank you so much for sharing your time and insight. Thanks again for being on the show.

Susan Biali Haas: Thank you, Kevin.

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