Physician and non-physician burnout is a tremendous problem in medicine and a reason why so many great doctors and health care workers end up leaving the field.
Physician burnout is described as a state of emotional, physical, and mental exhaustion caused by prolonged stress in the workplace (JAMA Network Open, 2023). According to a national burnout survey co-authored by the American Medical Association, physician burnout spiked to 63% in 2021 post-Covid. That number has decreased to about half of practicing physicians in 2023, but the problem persists and female physicians have higher rates of burnout than their male counterparts (Becker’s ACS Review, December 2023).
Burnout has many causes including high workload, loss of autonomy, and poor work-life balance.
Creating clear boundaries around these issues at work may help decrease the risk and rate of burnout, particularly among those who are the most impacted.
What is a boundary?
Very simply, a boundary is a clear line or fence. It marks the limit of an area and defines where one thing ends and another begins.
Why are boundaries important?
Boundaries are a way to take care of yourself. They help protect you and keep you safe. Think of a house, for instance. The boundary may be your property line, your yard, or your front door. If someone enters your home uninvited, they have crossed a boundary and you may be in trouble and at risk of danger. That’s the reason for the boundary in the first place – to let others know where your space begins and ends and where they can and cannot enter without permission.
Boundaries are not only important for physical safety, but for emotional safety as well. We often think about creating boundaries around our physical space, but it’s just as important, if not more so, to create ones around our mental space. Our mental well-being is at least as important as our physical well-being and similarly at risk of injury. Both need protection and therefore both need boundaries. This is true in our personal and professional lives.
What happens when boundaries are crossed?
You can’t control other people; you can only control yourself. If someone crosses your boundary, you can decide what YOU will do, not what they will do. Boundaries are not meant to control other people. They are meant to protect you. That means you have to decide what the consequence is of a boundary violation in terms of YOUR behavior.
For instance, if someone enters your home uninvited, the consequence may be that you ask them to leave or if they don’t leave after being asked or you feel threatened, then you may choose to call the police.
Notice … THEY crossed the boundary, but YOU implemented the consequence by taking an action.
Creating boundaries In medicine
What areas can you create boundaries around at work?
Here are just some of the areas to explore where boundaries can protect your emotional well-being and help prevent burnout. I have provided some questions for each area to help you explore your own boundaries and then an example of a boundary someone might create in each area.
Charting:
Where and when will you do your charting?
Will you only chart at work or both at work and at home?
Will you chart during weekdays only or on weeknights and/or weekends as well?
How long will you spend on charting each day/week/month?
Example of a boundary: I chart after each patient and do not go home with open charts. If I have open charts, I stay at work until they are complete (except for extenuating circumstances or true emergencies).
Email:
Will you check and respond to work email only at work or also at home? What about weekends and days off?
Will you have access to work email outside of work and are there any times that are “off-limits” to check messages and respond?
Who has access to your work email? To your personal email?
Example of a boundary: I only check and respond to work email during the weekdays. If someone sends me a work email on the weekend, I don’t respond.
Electronic Medical Record (EMR):
What type of messages will I respond to and when?
Who will fill out forms and write letters and contact insurance companies and do peer-to-peer calls?
Will I respond to medical questions by email or phone call or will they need to come in for a visit? What criteria do I have for each?
Example of a boundary: If a patient asks me a question outside the visit that I can answer in five minutes or less, I will respond. If it takes longer than that, is a more complex issue, or requires a physical examination, they need to schedule an appointment to see me.
Patient Visits/Clinic:
How much time am I willing to run late on a regular basis?
How late can a patient arrive and still be seen?
Who will do tasks that don’t need to be done by me such as special vitals like orthostatic blood pressure readings, repeat blood pressures, etc.?
Will I only do in-person visits or will I also do telehealth visits? For what issue/problem?
Example of a boundary: If my patient arrives more than ten minutes late for a follow up visit or fifteen minutes late for a new visit, I will ask them to reschedule.
Patient behavior:
Are there behaviors that I will not tolerate such as being yelled at, threatened or real violence to myself of my staff? What will I do?
What will cause me to prematurely end the visit or end the patient relationship?
Am I willing to have patients call me by my first name?
Will I answer personal questions that are not relevant to the patient’s issue?
Example of a boundary: If a patient calls me by my first name, I will tell them I prefer to be called Dr. so and so while they are in my office.
Personal time:
What clinical and non-clinical tasks are you willing to do on your days off, particularly if you work part-time or a reduced schedule?
Will you attend meetings or other conferences?
Will you join committees that meet during your personal time?
Will you take on a leadership role that requires work during personal time?
Will you cover yourself on days off or vacations or arrange coverage?
Will you check patient messages and answer patient calls when you are away from the office?
Will you check and respond to emails when away?
Example of a boundary: I only attend meetings on days off that involve multiple team members and are critical to my position/role. If I am asked to attend a one-to-one meeting during a day off, I say no and ask that it be rescheduled to a different day/time.
As you can see from some of these examples, creating boundaries can help reduce the drama and emotions that often arise in already high stress healthcare environments. When an issue comes up with a patient, a colleague, or administrative staff, for example, you have already decided in advance what actions you are going to take if one of your boundaries is crossed. This not only makes for a more pleasant work environment, but helps create efficiency by making decisions in advance, saving precious time and energy. It also creates a greater sense of autonomy, reduces workload, and improves work-life balance, all key features to decrease the risk of burnout.
If you want to learn more about working with me one-on-one for life coaching where you will learn to make decisions that best serve your life, create and implement boundaries, and prevent burnout, sign up for a free call with me today by clicking the link below.
https://calendly.com/mindfuldocmom/free-45-minute-mini-session
