Physicians Reveal the Self Care Activities That Help Them Avoid Burnout

A greater emphasis is being placed on the importance of physician engagement in self care activities as research continues to demonstrate high rates of professional burnout and associated risks within this population.

Professional burnout, which is characterized by high levels of emotional exhaustion and depersonalization, as well as a reduced sense of personal accomplishment, has been reported by at least 50% of physicians in various studies and surveys in recent years.^1-4

Higher rates of burnout among physicians have been associated with increased risks for mental health disorders, personal relationship problems, reduced patient satisfaction and quality of patient care, and a greater incidence of medical errors.^1,5 These observations underscore the ongoing need for physicians to engage in regular, restorative self care activities to reduce burnout.⁶

What Does Self Care Look Like for Physicians?

For Mental Health Awareness Month, Neurology Advisor conducted a survey involving 89 physicians from across the United States on the self care activities they partake in. The most common self care activities reported included:

• engaging in any form of exercise (79%),
• spending time with friends, family, or community (70%),
• reading (72%),
• watching a movie or show (64%),
• spending time alone (42%),
• cooking or baking (36%),
• writing in any form (18%),
• meditating (18%),
• volunteering (18%), and
• attending a class or a workshop (17%).

The survey respondents indicated that they spent an average of 57 hours working with patients and 7 hours participating in self care activities each week, potentially explaining the majority of positive responses for burnout experienced over the course of the previous 3 years (58%). Roughly one-third of respondents reported that their institution supports wellness activities/provides wellness resources and that their specialty affects the nature/extent of self care activities in which they participate in. Some physicians stated that their engagement in self care activities is limited by staffing shortages or “terrible hours,” while others reported that flexible hours and an emphasis on wellness in their specialty encouraged greater participation in self care. 

To learn more about the ways in which physicians carve out time for essential self care activities, as well as the broader support systems that are needed to foster a culture of self care in medicine, we spoke with physicians from multiple specialties.

Christa O’Hana San Luis Nobleza, MD, MSCI, medical director, neurocritical care service, Baptist Memorial Hospital and associate professor, department of neurology, University of Tennessee Health Science Center in Memphis

Which self care activities do you do on a weekly basis? How do they help you relax and reduce stress?

Dr Nobleza: I go on scheduled dates every week with my husband. I am also committed to having a weekly family night because it gets tiring for the kids to be in school 5 days a week, so they look forward to every Sunday night when we go out to eat together. I have also recently made time to go to the gym more regularly. When I have additional time, I paint. It has been a relaxing hobby. All of these things help me reduce stress. I try not to think about work or other problems while engaged in these activities. 

Why is it so important for you as a physician to prioritize self care in your weekly schedule?

Dr Nobleza: Since COVID started, I noticed that we have become predisposed to burnout if we do not invest time in self care, and we are more likely to bring negative energy home, which increases the likelihood of being less patient. Fortunately, my husband was able to give me that feedback and I acknowledged that lack of self care was driving these behaviors. It really can lead to burnout, which in turn affects interactions with patients and staff, so recognizing and acknowledging the effects of lacking self care is very important. 

How do you manage to carve out time for your self care activities? What are some personal or professional barriers that may arise in this regard, and how do you deal with these barriers?

Dr Nobleza: I work in the intensive care unit (ICU), and work can be endless — there is always something that has to be done. So, what I have done is proactively prioritize myself and my wellness, which includes my family. COVID put a lot of things in perspective, and this is one of the things that I really changed. I now prioritize myself and my family, and then during times when I am off service after I have done my wellness activities, I start looking into work-related activities. 

On an institutional or systemic level, what do you believe are some key measures that would further encourage and support regular engagement in self care activities among physicians?

Dr Nobleza: I think institutional- and system-level leaders first have to acknowledge that wellness is important to mitigate burnout, increase retention, and improve employee engagement and satisfaction. It is important that institutions and systems understand the impact of high employee turnover and employee burnout on patients and the community, and understand that a culture of authenticity and sincerity around investing in employment wellness and health is necessary for an institution to be sustainable.

Nieca Goldberg, MD, clinical associate professor, department of medicine at NYU Grossman School of Medicine in New York

Which self care activities do you do on a weekly basis? How do they help you relax and reduce stress?

Dr Goldberg: My number one self care activity is exercise. I am lucky that I get to walk to and from work daily. The walk home is especially relaxing. I also use a Peloton bicycle and do weight training and Gyrotonic exercises.

In addition to preventing cardiovascular disease, exercise improves overall mood and wellbeing. For me, walking outdoors helps me unwind, allows me to focus on the seasonal beauty of New York City, and benefits my sleep. Much of what we do in health care is fast-paced and centered on caring for others. To care for others, we must care for ourselves.

Another important activity is spending time with my friends and family. It can sometimes be helpful to talk about trending events or updates in the health care space with my loved ones. I often hear different perspectives and communicate relevant updates to my patients and colleagues.

Why is it so important for you as a physician to prioritize self care in your weekly schedule?

Dr Goldberg: If you don’t prioritize self care, it is hard to convince people to take care of themselves. You are more likely to be stressed, short-tempered, or feel generally off-centered, which can get in the way of having quality relationships with your patients and your family.

How do you manage to carve out time for your self care activities? What are some personal or professional barriers that may arise in this regard, and how do you deal with these barriers?

Dr Goldberg: As doctors, we’re often thinking about others — whether that be in the clinic seeing patients or at medical conferences to learn about the latest research in our field. While I am lucky to have a career that is personally very fulfilling, it can be difficult to carve out time for activities outside of work, including self care.

Flexibility is key. Making a schedule or planning to go to a spin class every other day is great, though understand that it isn’t always possible to follow the plan — and that’s okay! In the case of patient emergencies, I can’t always make the events or classes I had planned for, so I have found workarounds to create more flexibility in my routine — for example, getting a Peloton bike for my home.
My advice to other doctors: be realistic in what you can do. Try to prioritize self care activities 3 days per week and then increase and adjust as you have time.

On an institutional or systemic level, what do you believe are some key measures that would further encourage and support regular engagement in self care activities among physicians?

Dr Goldberg: Institutions and systems need to be aware that doctors who are living healthy lives will inspire healthier lifestyles in their patients and communities by leading through example. They will also deliver more thoughtful care when they are well-rested and supported at work.

Key measures that can be taken to support regular self care activities among physicians include:

• Using AI tools to assist in notetaking, which can help reduce the number of hours spent on administrative duties. This can also help to maximize a physician’s time with their patients.
• Having a coordinated health care team — including nurses, nurse practitioners, and advanced clinical practitioners (ACPs) to support not just the patients, but also one another, and make health care delivery more efficient.
• Giving doctors a set time to eat lunch, ideally at the same time each day if schedules allow.
• Keeping evening meetings to a minimum.

Emily Davidson, MD, MPH, assistant professor in pediatrics, Harvard Medical School and physician in pediatrics, care for children with medical complexity at Boston Children’s Hospital

Which self care activities do you do on a weekly basis? How do they help you relax and reduce stress?

Dr Davidson: I have been practicing yoga for over 20 years and teaching yoga to children at Boston Children’s Hospital for almost a decade. The combination of physical movement with breath and focus helps me stay present and grounded. I also enjoy walking outside — in good weather, I walk almost 2 miles home from the hospital once or twice per week and walk around a pond near my house on the weekend. 

I also make it a priority to meditate daily.

Spending time with family and friends, baking, and reading novels are also great stress-relievers for me. I am also a level 2 Reiki practitioner and spend an afternoon each week providing Reiki to children in the hospital. I find the calm state necessary to provide this integrative therapy, and it leaves me much more relaxed as well. 

Why is it so important for you as a physician to prioritize self care in your weekly schedule?

Dr Davidson: As physicians, we are trained to work hard to serve our patients without paying mind to our personal needs. Staying awake on call, staying up late to chart, putting off meals, or even avoiding the bathroom during a busy clinic day are all common examples of this. Yet, when our own reserves are depleted, it can lead to compassion fatigue and burnout, which can ultimately result in worse care and medical errors.^7,8

When we show compassion to ourselves and make time for the activities we need to feel well, we can approach patient encounters with greater calm and empathy. We can also be more authentic and effective when we counsel patients and families about lifestyle changes to support health if we are engaged in these practices ourselves.

How do you manage to carve out time for your self care activities? What are some personal or professional barriers that may arise in this regard, and how do you deal with these barriers?

Dr Davidson: For me, the key is consistency. I teach 2 yoga classes for kids and 2 short chair yoga and meditation classes for adults each week. On Saturdays at 7:00 AM, I take a yoga class online with one of my favorite teachers, and on Sundays I go to a local studio for a 7:30 AM class. To give me time to meditate first thing, I set my alarm for 10 minutes before I have to wake the kids up.

Time and competing priorities are barriers. By scheduling meditation and my weekend yoga classes early in the day, I can usually do them as planned. I use an app that tracks my meditation sessions and has guided meditations I can use when I need extra support to focus, but I have compassion for myself if I miss a day, and I’ll just start again the next day. 

I work in 2 clinical areas at Boston Children’s Hospital: the Down Syndrome Program and the Complex Care Service. No longer having overnights in the hospital definitely makes it easier to prioritize sleep and routines. For physicians in specialties that have shifting schedules, it could be harder to have a set routine for a specific class, but there might be other ways to establish routines. One of my friends in obstetrics takes an extralong walk with her dog on her post-call days.

On an institutional or systemic level, what do you believe are some key measures that would further encourage and support regular engagement in self care activities among physicians?

Dr Davidson: Institutions can offer the space or time for self care opportunities within the workplace. At Children’s, we are lucky to have a designated staff relaxation space called “The Secret Garden,” for reflection and rest, as well as several other outdoor gardens. We can also access staff Reiki, which provides peer support from other physicians.

Read more about the Health Benefits of Gardening: Cultivating Cardiovascular Health

Institutions can also look into ways to structurally support physicians; things such as effective electronic records, scribes, and administrative support would help cut down on the work that physicians do outside the workday. We can all work toward building a culture where we recognize and support each other’s time-off activities, as well as our academic and clinical achievements.

Editor’s Note: These interviews were edited for clarity and length.