The Doctor is Not OK: A Conversation about Physician Burnout

Burnout has become almost expected in medicine—but that does not mean healthcare professionals should simply accept it.

In this episode of Emergency Minute, Dr. John Parente sits down with executive leadership and burnout recovery coach Elsa Arend to discuss why burnout is so common among physicians, healthcare workers, and other high-performing professionals.

Drawing from John’s more than two decades in emergency medicine and Elsa’s experience recovering from burnout during her corporate career, they explore the warning signs that are often ignored, including emotional exhaustion, detachment, cynicism, declining empathy, and the feeling that there is simply no way out.

They also discuss why burnout is not merely an individual failure. Heavy workloads, increasing patient volumes, inadequate staffing, administrative demands, and a culture that discourages physicians from asking for help all contribute to the problem.

In this episode:

• How to recognize burnout before reaching a breaking point
• Why physicians often feel trapped in their careers
• The difference between everyday stress and true burnout
• How healthcare systems contribute to emotional exhaustion
• The importance of boundaries, self-awareness, and recovery
• When coaching, therapy, or a career change may be necessary
• How to rediscover purpose without abandoning everything you have built

Elsa Arend is an ICF-credentialed executive leadership and burnout recovery coach who helps professionals move from stress and overwhelm toward greater clarity, confidence, and energy.

Burnout can feel isolating, but it is not a personal weakness—and recovery is possible.

Subscribe to Emergency Minute for honest conversations, medical insights, and stories from inside the emergency department.

Elsa's website: elsaarend.com

LinkedIn: https://www.linkedin.com/in/elsa-militello-arend-7576734/

Clarity Call Offer: https://calendly.com/elsaarend-4/coaching-consultation

• A complimentary 60-minute "Clarity Call" where you will: 1.)Gain clarity on the core challenge you're facing and uncover one key insight that helps you move forward. 2.) Identify 2–3 practical next steps that create momentum, increase confidence, and support meaningful progress.

Transcript

SPEAKER_01 0:00

Hello, and thank you for joining the podcast Emergency Minute. Your host is an emergency medicine physician who brings over 20 years of experience in healthcare. Dr. Parente will take you through some of the trending topics and challenges faced in the ER and all of healthcare. Join in the fight against misinformation. And don't forget to follow on social media at Dr. J Parente. Now, here's your host, Dr. John Parente.

SPEAKER_02 0:26

Hello, everyone. Welcome back to Emergency Minute, episode number three, where we talk about something very uncomfortable, but also very necessary. The topic of burnout, specifically amongst physicians, healthcare workers, and anyone else for that matter. But before we dive in, thank you to everyone who checked out the last two episodes. How not to get sued in the ER with Steve Crando, a legal expert who was a fantastic guest on the show, and AI in healthcare with expert Dr. Josh Russell, who also did a great job of terrifying all of us on being replaced by the robots like Terminator 3. If you haven't checked out those episodes, then shame on you. But in all seriousness, just kidding. What really helps my show grow more than anything are reviews on Apple, Spotify, YouTube, or wherever you tune in to catch emergency minute. So if you're like, you know what, this dude isn't so bad. I think I'd like to help him out. Or maybe you think this is the worst show you've ever seen, and you want to hate review it, I'd appreciate it. Either way. So let's talk about today's guest, Elsa Arend. Elsa is an experienced ICF credentialed executive leadership and burnout recovery coach. Her background spans business leadership roles across marketing, client services, operations, and talent management. Elsa is frequently called upon to speak on topics that include burnout, emotional intelligence, healthy boundary setting, confidence building, embracing imperfection, and learning how to assert and use one's voice. Drawing from her own personal experience as a former marketing executive who faced burnouts twice, Elsa deeply understands the journey from stress and overwhelm to clarity and renewed energy. Using trauma-informed coaching techniques, she empowers her clients to design lives that they are excited to wake up to each day. Elsa does hold a BA in communications and journalism from American University. She is certified through several coaching programs, including the Center for Executive Coaching and the Certified Life Coach Institute. Without further ado, welcome Elsa. Thank you for being here with us. I really appreciate your time today.

SPEAKER_00 2:27

Thank you so much for having me.

SPEAKER_02 2:29

You know, so it's an interesting story. Uh first we met actually through Patrick O'Malley, who I think is the sort of introducer of everyone on earth at this point with his Shift Change platform. Um, so it's great that he was able to put that together and we talked. Now, we were supposed to have this podcast about a week or two ago. And you were actually the one that convinced me to sort of tell this story. You know, right now, those of you that don't know, you probably do by now. But my I just lost my dad in February was very, very tragic, very sudden. And that sort of put me out of the podcast, you know, sort of world for several months as I was sort of processing that. And then just now, my mom recently was diagnosed with metastatic cancer. And so we put together this trip where we could all go uh one more time as a family and enjoy ourselves uh down in the Caribbean. And it almost didn't happen because she got sick right before the trip. And it wasn't until about 8 p.m. the night before we were all leaving, 12 of us, uh, down to Turks and Caicos that we finally kind of got the green light from from the physicians. So it's it's kind of a wild ride, kind of a wild story. And then it was you that actually kind of convinced me to you know sort of tell that story on on social media, which which um was a lot of fun actually, uh, for her and and for the whole the whole family. So thank you for that. I'm so glad.

SPEAKER_00 3:44

Yeah, I'm so glad. And it's no big deal. We got to reschedule and you got to support your mom, and it's all good.

SPEAKER_02 3:50

Yeah, and the fun part was is so we had something planned for her every day, and so I'm really glad we were able to go. We were able to, we had like tattoos one day that we had like tattoos on our body, and like even like the like the the waiters and the bartenders and stuff wanted a tattoo of her. So they got these like fake tattoos all over the resort of my mom's face, which was pretty hilarious. Um, and then my my wife does like t-shirts and and hats, and she does all this custom stuff, and so she made these these hats that we all had. So we had 12 hats, hers said queen, and then everybody else had all these other like hilarious sayings that sort of were applicable to you know their relationship with my mom. So it was it was actually it was really funny.

SPEAKER_00 4:26

So I actually got to see some of those. I think your daughter was wearing one of the hats and in one of your social posts. I was like, that's cool.

SPEAKER_02 4:34

Yeah, yeah, we got to do that. So so it was good. So so today obviously is uh is an uncomfortable topic that I think a lot of us, especially in healthcare, we just sort of power through, you know. We we have to be tough, you know. Residency trains us to be tough. Emergency medicine tells us we have to be tough. We don't get breaks, we don't get lunch, we don't, and we just we we just have to sort of power through. And I think something that's becoming sort of more, I guess we're becoming more self-aware as a as a specialty, especially in emergency medicine, of you know, of the the reality of burnout. Um and that's that's kind of your field. So, you know, in contrast, now you spent 23 years as a marketing executive, senior vice president, executive vice president, and in most people's eyes would be a wildly successful career. Um what did what did burnout look like for you and and and when did you first realize that like this was this was a thing and this was happening?

SPEAKER_00 5:34

Yeah, that's a really good question. And I think for a lot of us, we don't understand what's happening to us. We just feel like we're losing our mind or something is quote unquote wrong. Um, yeah, so I worked uh in marketing for 23 years and it was a wonderful career. And it's one of those kinds of environments, probably similar to medicine, that the harder I worked and the more results I produced, and the more money I made, and the more titles I got. And I started to notice this pattern where my body was giving out on me. My hair started falling out right here, which as a woman, like, you know, all of us tend to have a degree of vanity, but when your like hair is missing, it's it's it's very difficult. And so that was one of the kind of cues to me that something was deeply wrong. I was experiencing insomnia, and then all of a sudden I started to lose my ability to speak, and I remember distinctly I was in a large conference room. I had people in the room that I was leading the meeting, and then this was back before Zoom and all of this. So there was like a speaker phone in the center of the conference room table, and I was trying to project so the people outside of the room could hear me. And as I was doing that, my voice just started to break almost like a record that's skipping. And I remember standing up there thinking, what just happened? This is very weird. Um, and that was kind of the beginning that the all of these symptoms kind of all accumulating had me pause and say, Okay, I don't think I'm just tired or I'm working too hard. There's actually something possibly diagnosable that I could get some support with.

SPEAKER_02 7:14

Wow. Yeah. And and so, like, how did that journey look? Because I'm hearing your story now, and I and I feel like a lot of these types of patients probably would end up in the emergency room, you know, kind of scared. Did they have a stroke? Did is there some sort of medical emergency? And, you know, I think sometimes we're it's very difficult in the ER to sort of sort out what's what's a medical, you know, issue versus a mental health issue. And I tell my patients all the time, like both of those are equally as important. And there is that mind-body connection where if you are you know dealing with a crisis or an overload of some sort, you can have you know physical manifestations that you know produce that. So, how how did you how did you approach that?

SPEAKER_00 7:56

Well, I'll tell you, I wish I walked into your emergency room because that would have saved me a lot of time. Because the people that I went to go talk to, they were convinced it was mental health. So that was part of what was so frustrating about this, because it was kind of just pushed to the side. There's nothing physiological. This is just your stress, this is mental health, you need to take a leave of absence, and here's some Xanax. Like that's basically how that was handled. And I kind of thought, well, let me believe in the medical community. I don't mean that disrespectfully at all. I was, I was like, yeah, let me just let me just go with this. Um, and my symptoms progressed and they kept getting worse. So I was like, is this? It's it's almost like you lose, uh, I don't know, like you lose a sense of yourself, like you, you're not sure what to trust when this is happening. And finally I said, you know what? Let me go get some more opinions on this. And I went to go see an eye, ear, nose, and throat doctor. So very specialized medicine. And the first doctor that saw me, he scoped me down the nose and had me do a bunch of things. And he said, I think you're just stressed. Like I don't really see anything, or maybe you've got like some uh esophageal situation happening, or maybe there's like an acid reflux situation. So so he they were trying to diagnose it, but still my symptoms kept getting worse. And it wasn't until I went to a speech therapist who was a physician that she diagnosed me in five minutes and she said, You have a rare vocal cord disorder called spasmodic dysphonia. You have muscle tension dysphonia. That is when you have two parts of your vocal cords, they're supposed to flap. That's how you make sound. And she said, This one's getting paralyzed when you speak. And so when it's paralyzed, sound can't go through. It's like it's that's what the record, you know. I either sounded like I was about to burst into tears or like the record was skipping. And she said, This is what's happening. And oh, by the way, there's no cure, you will continue to get worse. Um, Botox is how we deal with it. So we'll inject your vocal cords. Um, that'll help with the paralysis phenomenon. And um, you know, you might want to consider going on disability. Like that was that was my exchange with the medical community.

SPEAKER_02 10:10

Wow. That's that's terrifying. Yeah. So so then what happened next? Like, where, like, how did you end up where you are now? Because that seems like a pretty big leap from where from where you were.

SPEAKER_00 10:24

Yes, a very big well, one of the things that you will come to know about me, John, is that I am very stubborn and I'm very much a believer in the body's ability to heal. Like, I've just always believed it deep in my bones. I believe there's a mixture of and an importance of Western medicine, but there's also a deep curiosity in me with the eastern, deeper ancient wisdom. Um, like, I don't know, what do you call them? Cultures, medicine philosophies. I don't know what you call the wisdom from some of these other, like like in Asia or in Ind, you know, in in India and specifically in China, um, in Bali. Like they have all these like cool and interesting things. So I just started to get curious and I said, you know what, I'm not gonna give up on my career. I'm not gonna take disability and somehow I'm going to fix this. I don't know how, but there has to be a way. So that was my stubbornness. And I did take some time. Uh at one point I did have to take a leave of absence. It was, I guess, a sabbatical. Like I wasn't working, I wasn't tenured at anything, but my company believed in me so much. They said, go take your time, do whatever you need to do. I did, I was able to work on myself, kind of work on therapy, things like that. But it wasn't until so two things happened. I hired my first coach, which that's the segue into me becoming a coach, because it was kind of like I'm willing to try anything.

SPEAKER_02 11:42

Right.

SPEAKER_00 11:43

Her name is Kate, Kate Stillman, if anyone wants to look her up. And I said, All right, well, like how can you help me? Like, I've got this issue, my hair, like what's going on? And so she helped me to deconstruct what was happening, and she helped me understand that it was a lot of my patterning, my mental patterning, how I had a um kind of a system of overriding my needs and pushing myself, which that's you know, the people that I work with, and you probably fall into this, John. Like, we're very ambitious people. And sometimes we're when we're so ambitious and our body can't keep up, it just starts to break down. It starts to literally break down. So working with her over a nine-month period of time helped me start to untangle and disrupt those patterns that had probably been with me since I was a child. I'm a child of a trauma surgeon, and he was chief of surgery, and he was one of the big administrators over a huge hospital system. So I grew up under a kind of like this patriarchal system where anything's possible. We're gonna work really hard. My my dad would brag about having 24 cups of coffee back when he was practicing trauma. There was no regulation around how much, how many hours they could be in the surgical operating scenarios. I mean, it was just crazy. So she helped me kind of deconstruct some of those patterns that I had grown up with. And then I started working with a physician in New Delhi, India. And the combination of those two things brings me to where I am today.

SPEAKER_02 13:08

Wow, that's that's fascinating. And now, you know, here you are as a coach. And I think a lot of who you coach are are physicians, correct? Is that that's a big part of your your sort of uh practice now? So what do you what do you see in in the physicians that come to you as far as like what is it that you see as one of the things that they see as a as a no turning back type of thing? And that's why they end up making the call to to sit down with you. Because I have a feeling that most of the people, by the time they get to you, I feel like the damage has probably already been done. And and maybe I'm being presumptuous, but um, I know it would take a lot for me to make to make that call. And so I I guess you know, I'd love to hear your thoughts on that.

SPEAKER_00 13:50

Yeah, yeah. So uh to answer your question, I work with trauma surgeons, I work with emergency medical physicians, PAs, urgent care. I kind of run the gamut on all so it's interesting to see the different facets of of how the medical community is dealing with burnout. I will tell you, it is very insidious. It is a big, big problem. I'm sure I don't need to tell you that or your audience, but it is something that is causing a big, big problem in our in our medical communities right now. And one of the things that I see, you're right, often people come to me when it's kind of in a very uncomfortable place. Um, and and I have kind of coined this standing on the burnout cliff. And the reason I call it the burnout cliff is because these folks are usually willing to jump off the edge of a cliff into the vast unknown because they cannot stand to operate in the pain that they are existing in day to day. And so what that looks like usually is I can't practice medicine anymore. I can't practice this um career that I've spent so much time and money, like there's no other way. Um, and and it is interesting because you know, there's the person, but there's also the environment. Because a lot of times to become a doctor or not just a doctor, like we're talking about clinicians all across the board. Typically, you all are the top of your class, you're overachievers, you're highly ambitious. John, I'm sure you can relate to this for your as you know, this is you and and your colleagues. Like, we're gonna push ourselves to these crazy places. And here's the thing the medical community environment supports it and almost demands it. And I heard a surgeon once tell me I had to hang my heart on a hook and basically reject all of my needs to be able to stay inside of this environment. And that is how I survive. I just every day get into the environment, I hang my heart on a hook, and I'm just moving. And it's a recipe for a lot of pain.

SPEAKER_02 15:51

Yeah, and I I think especially in emergency medicine, we are we have to be skilled at building up walls around us in order to maintain some level of just humanity. I mean, because there's, you know, one of the things I've talked about before on social media and other podcasts is I think the one thing that really separates emergency medicine from a lot of other, just about any other profession on earth, is that we have to be able to tell a family that their six-month-old just died, and then literally turn around and go back to the desk, and there's 25 more people waiting to be seen that are there with back pain and ankle sprains and chest pain and strokes, and like there's no there's no timeout, there's no, you know, take the rest of the day off, you've had a rough day. Um, it it's it's it's mind-boggling. Like the the system, like you said, is is almost just this cauldron of you know, um, catalysts for all of these things that we talk about. And our job is really just to put our head down and and keep going. And that's I think that's where it's tough because you try to have balance and and build these walls around you, but at the same time, in order to have growth, you can't have the walls too tight and have good, like positive interactions with other humans. You also need to have those walls to where people can get through them time to time as well. So I I think that that balance is is really hard. And I guess, you know, is that is that something that you see like in what you do?

SPEAKER_00 17:24

A hundred percent. I would say that's largely what people are struggling with, that they are in patterns in an environment and systems that want them to be the way that they are showing up, but they have come to the reality I can no longer do it like this. And so one of the things I tell them is like, okay, you're investing in a relationship with me to retain your income, retain this career that at one point you're really passionate about, and we're gonna learn some new skills. You're gonna get some support along the way, and we're gonna start to unravel some of these things. I wouldn't even call them bad habits, it's just it's a way of being, it's a way of thinking. So a lot of these patterns are just happening almost unconsciously. Um, like I was working with one emergency um physician, and one of the things that was really guiding her, and she has a family at home and a husband and all these things. She's so passionate about her patients. But what she would find is that she was giving, giving, giving. She might see there's 25 patients to be seen. So she's taking care of as many people as she can during her shift, and she's ignoring the notes that she knows she needs to do. And my understanding for my clients is that the electronic medical records is the bane of all of your existence. Maybe that's changing with artificial intelligence. But she talked about how painful that was. And her pattern was really oriented towards I gotta see as many patients, I got to help as many people, I gotta like it was her heart. But that patterning, what it left her with was writing notes late into the night, working on notes over the weekend, feeling resentful and angry that she couldn't go to her children's sporting events, feeling kind of despondent and lacking energy when there was times that she could have done that in her personal life. And so when we're able to really drill that down and show her what it would look like, and and this was hard. This was hard for her to dismantle, but she did it. And I'm very proud of her. I worked with her for a year and she was able to do this. What would it look like to take people one at a time and like have the person finish the notes and then go? And I wouldn't say she does it 100% perfectly, and we're not working towards that. But one of the things I teach my clients is if we're willing to disrupt these patterns at 1%, teeny tiny shifts every time you show up into your shift, into the emergency room. How might how might that change the quality of your life? And so she started doing it. The first day she started doing it, she called me stunned. She was like, There was people left in the emergency. I didn't get to get out to everybody once my shift or the people she deemed that she should have been handling. But she said, you know what? I have nothing to work on tonight. I can just be with my kids. And it blew her mind. So that's what I'm talking about.

SPEAKER_02 20:11

Yeah. Yeah, absolutely. And I think I like what you said about the system because I think a lot of people will think that this is an individualistic problem. Like this is this is my problem. And in some ways, it is my problem. But I think the the system sort of breeds this type of culture uh over and over again. I mean, I can tell you, you know, from an emergency medicine standpoint, you know, I have to see a massive number of patients. And by the way, the resources that I have have done nothing but decrease over my 20-year career. The the number of hours of PA coverage, the number of hours of doc coverage, the nurses, you know, they're they're getting fed up and they're leaving healthcare and they're calling in sick and they're doing things. And so then we have less nurses. And like, and but these are people's lives, and you have 20 or 30 people in the waiting room who you know could have catastrophic diagnoses, you don't even know, even if it's a minor complaint. So it's an inordinate, inordinate amount of stress on us when we're there in the hot seat, as I like to call it. And you're right, I mean, it it is a me problem, but it does seem like the system really does nothing to help us, and the only you know, choice is to work harder. I mean, it's the only, and so I think a lot of people end up feeling trapped. I think a lot of physicians that I speak with say, you know, they can't get out. Um, in fact, I would go on a limb and say, I don't know a single physician in my circle, and I'm uh it's a pretty big circle in all of like the northern part of Ohio. I don't know a single physician that wouldn't quit medicine today if he if he or she couldn't.

SPEAKER_00 21:38

Like that, and that's that's a sad state of affairs, isn't it?

SPEAKER_02 21:40

That's a horrible thing to say out loud, but like it it's the system demands so much from us. And I think that's why I wanted to have this podcast and this conversation with you, is because like, how how does someone start to recognize those signs or those symptoms of burnout and say, I can't, I can't necessarily change. The system, but how can I do things, change those 1% things that you talked about on my end in order to, you know, improve my overall well-being?

SPEAKER_00 22:10

100%. So the the way, and I wish someone had taught me this when I was going through all of this in 2011 and 2012. There wasn't as much information available, I feel, as there is now. Um, so there's three ways that you can kind of check in with yourself to know, okay, is this burnout or not? Um, burnout, I'll tell you what burnout is not. Burnout is not um poor sleep. Like we have, we can have a couple bad days of sleep or a couple weeks of bad sleep. That's not what burnout is. Burnout is a number one, a prolonged period of mental, physical, and emotional exhaustion. So prolonged could be three months, six months, nine months. It is just like you are digging yourself into a well that you never feel like you replenish. And I know there's there's people out there listening to my voice, and you know exactly what I'm talking about. It's like constantly on fumes. Maybe you need to take a vacation, leave the country completely unplugged to be able to feel that. That is number one, sign number one. And it is the sign that most high achievers don't want to look at. I know I didn't. I was just like, nope, that's my father used to say, sleep is for weenies. So that's what I used to think. Like, okay, sleep is for weenies. I'm gonna keep pushing myself. So, number one, number two, this is where the sign really starts to drive in. And it is detachment. When you start to feel detached from the things that used to make you happy, that is a big red flag. So that could be in care, patient care, or any kind of practice, a specialty that you may practice that used to really fire you up, light you up. You used to like to read the research, what's going on with this? You don't care. And this could this could cross over into your personal life. That, you know, I really used to love golfing with the guys, or I used to love to, I don't know, go for hikes with a family on the weekend. I don't want to do any of that. That's a big sign that there's a there's a bigger problem here. That's detachment. And number three is a lack of efficiency. It's almost like your your wheels are stuck in mud, you know, and they're spinning, like there's an effort, but then you're not moving anywhere. And you can start to see it. Like you, you've if you're at your desk, and I know clinically we're not at our desk that much, but maybe on your days off and you want to be productive, but then you just find yourself aimlessly scrolling. That's an example of lack of efficiency. Like you have a plan, you know what you're supposed to be doing, and I'm here mindlessly scrolling. Or if you're in a clinical setting and you know you want to see 10 patients, but you're struggling just with two, not because they're necessarily difficult cases. It's just your wheels are stuck in the mud. So those are the three big ones.

SPEAKER_02 24:43

Yeah, that's that's some scary stuff. The the detachment thing uh definitely resonates with me and hits home because you know, again, we talk about putting up these walls and and everything else. And, you know, I often wonder for my own self, like, am I just detached because of those walls and some sort of like, you know, self-protection of my soul? Uh, you know, or am I starting to experience, you know, burnout? I mean, this is my 23 year or my 23rd year of practicing medicine in the emergency room. Um, so I I guess, like, are there things that you can do if you're starting to experience these symptoms? Is there anything you can do to protect yourself from these, or or maybe just help recognize, you know, what you're going through is maybe not just a phase or not just a bad night of sleep, like you said.

SPEAKER_00 25:30

100%. And this is this is hard, what I'm about to say. This is hard. Um, the very first thing that you would need to do if what I just said kind of rang true, is you've got to create some space, a teeny amount of space. I'm not saying like wipe a whole day clean, because that's probably impossible for our overachievers. But I'm asking you to carve out maybe 15 or 20 minutes, and I'm asking you to sit with yourself. And I want you to really think about is what I'm doing and how I'm doing it sustainable? And just be in the curiosity of it. Because if we are not willing to create space, none of the stuff that we're stuffing down, mentally, emotionally, physically, there's no space for it. It's like, you know, imagine if you're like in a tight chamber and the walls are closing in and you feel your body compacted. Well, you're just going to be responding to the pain of like, oh gosh, the walls are closing in. But as soon as there's a little bit of space, there's a little bit more perspective. Like, oh, okay. That felt really painful. What is happening? And you might want to have a notebook with you. You might want to go on your back porch, you might want to go for a walk. I love to walk and think. Okay, but you can't be listening to a podcast like what we're doing right now to do it. But like, you need some space, tiny amount of space. Number two, and this is where it's hard. You have to be willing to tell the truth. And that is so hard. It's so hard to admit to yourself I don't know if I can keep holding this. The way it exists today, and I'm not telling you to burn down your career or any side hustles, or I'm just there's an acknowledgement. I can't do this anymore. And then once you're able to tell yourself the truth, you then find somebody else that you can talk to. Maybe it's your your wife or your part, you know, whoever your romantic partner is, your spouse, your your best friend, someone that you feel safe with, and say, you know, I'm I'm in the contemplation of it. And I will, I promise you, that will be one of the hardest things, hard, hardest conversations you have. But it's gotta happen. Because if we are not clear, if we don't have a level of awareness around this, we can do nothing. Nothing. And then after that, once we are willing to admit it to ourselves and somebody else, then we start to get curious. Okay, well, if I knew how to do this by myself, I would have already done it. So now I need some support. I need some new support to get some new skills. Because with these new skills, I can show up differently. And so, people like me, people in the shift change community, this is things that we're dedicated to. And I know there's I work inside of a hospital system in northern Virginia. They hire me to coach their physicians. And a lot of hospital systems have resources or you can work independently on your own, like find, okay, who's a good person? It could be a therapist, it could be a coach, it could be someone else that you trust that's going to help you with skill development. Please hear me when I say that. Skill development. We're not going to just unpack our thoughts and just like, you know, stir the soup. That's not it. I mean, if you feel like you need to do that, then hire a therapist. I'm talking about skill development. I need to learn the skill of disappointing other people. I need to learn the skill of putting my needs first. And if I don't even know how to put them first, we'll put them somewhere on the board. Um, I need to learn the skill of managing my nervous system. Most people have no idea how to do it. I had none. I knew that there was meditation and breathing. And I'm telling you all who are listening, nervous system management is one of the most important skills when you are an overachiever. If you can manage your nervous system, you can manage anything. I mean, I almost like brag about it at this point, John, that I can get off in a humongous roller coaster. And I know you have big ones in Ohio, like a huge roller coaster, and five minutes later, my nervous system is completely regulated. It is a ninja black belt skill. Because if you develop that internal resilience, it's almost like fire can come at you and you are steady and it is powerful, and a lot of people don't know how to do it.

SPEAKER_02 29:42

That's incredible. I've uh I've not, I definitely want Stephanie want to schedule a call with you now that having this conversation. Uh because that sounds like that would be useful. That would be a useful tool to have, especially in some of those uh those moments that we have in the emergency room. And um, so that that's fantastic. I've never heard of that uh that angle. Um, you you see um with healthcare professionals, you know, how how do they differ, do you think, from the people that you see and talk to in like the business world or other executives? Like, or is it just you know, sort of different uh shades of the same character? Like what what's the difference there?

SPEAKER_00 30:19

It is different. I I will say there's certainly similarities. The biggest similarity that I see is that high achievers, it there's there's like very the big similarities with high achievers. So you can find them in corporate America, you can find them clinically, you can find them running a nonprofit and not making a lot of money. It doesn't matter, it's the the person is just very ambitious. So I tend to see that as an as a very like a constant. What is distinct about clinical environments? There's a couple of things. Number one, the stakes are so high for you guys. They're so high. Um yeah, maybe it's an ankle sprain some days, or maybe it's just you know, a dog bit somebody, and you know, there's a little bit of trauma to it, but but some days it's serious. Some days someone's having a stroke, some days somebody's coding. Um, some days life, the balance of life is in your hands. So the stakes are high. They're high. And and you were talking, John, that like you've maybe maybe built up a wall, you know, to kind of help, like the barrier. I've heard Patrick O'Malley talk about it the in that terms. That is a way to protect yourself, but still seeps in. It's impossible. We are human beings, and some of the best physicians that I've ever interacted with have such a high instinct. Like they can walk into a room and they know it, they can feel it, what's going on with the patient. Do you do what I'm talking about, John?

SPEAKER_02 31:49

Yeah, yeah, for sure.

SPEAKER_00 31:51

Because we're humans, sensing other people. That stuff is it's it's it's going into you. So, so that's that's where it's different. So, number one, the stakes are way higher. And number two, the environments expect us of you. Like, if I were to, I work a lot with big Fortune 100 companies, and there's employee assistance programs, they want work-life balance. If you're working too hard, you know, we've got HR kind of looking down, breathing down our noses. Why are you worried? That doesn't happen in clinical settings, at least not that I've ever been made aware of. So it's almost expected. Those are two of the big differences.

SPEAKER_02 32:26

Yeah, and we do see that in healthcare, unfortunately. There's sort of this um message and this narrative put out by a lot of administrations uh and and you know, hospitals and companies and things like that that are, you know, we care about your well-being, you know, how can we help you? And oh, by the way, you know, make sure you show up to work. You're gonna see, you know, 30 more patients with uh half the you know volume of uh uh of help uh when it comes to hours of coverage and things like that. So it kind of is a um disingenuous attempt to care about our well-being in some levels. And unfortunately, that sort of runs rampant throughout healthcare. And I think that's why we're seeing a lot of nurses leave healthcare right now, and that's why there's a nationwide shortage because this kind of started and snowballed from COVID, and people just found different fields and things like that. But it it's really impacting emergency medicine now. And I think one of the hardest parts for us too is you know, this sort of, like you said, that expectation. And you know, there was a shift I worked a few weeks ago where I was uh me and another PA, and there were 25 patients on the on the board, all active. Um that's insane. Like that's absolutely certifiably insane. I think I had, you know, out of those 25, there were almost 10 that needed to be admitted, which means they had like really significant problems. And I think one or two went to surgery, one or two were strokes, one was uh ICU, one was, you know, just 25 patients' hands in my life right now, like in this very moment, you have to take a step back and you're like, what do I have to do right now in order to um, you know, in order to not uh lose something, uh not, you know, drop a ball that may be um uh you know, you're juggling a thousand balls. I don't want to drop one of them, you know, or at least I'm going to drop some of them, they just can't be the important ones. And and that I think that's that's where you get into, you know, how do we fix this? And and I don't know that the system can be fixed. So the only thing that you could try to fix is yourself in that in that moment, right?

SPEAKER_00 34:21

A hundred percent. And I do say you can put five people in the same exact scenario at home and at work, five drop five people into the same situation, and they're not all gonna respond to the stimulus in the same way. So that's where we go back to where is their nervous system? How boundaried are they? How willing are they to, or what's their willingness to disappoint people? Um, what patterns do they have when a clinically, when you're working clinically, you got to do the thing. Like I'm not suggesting that we're not working hard, but when you are home, if you're tied up in that same intense cranking energy on your days off, you are going to get screwed. You've got to learn to downshift. And most of my people do not know how to do this until we do work together. And I'm telling you, if you learn these skills, not only are you staying in medicine, but you're creating longevity for what you can create and the impact. This is something I'm really passionate about is keeping people in medicine, really good people. So I I I I hope that this is stirring some hearts in this moment.

SPEAKER_02 35:27

Yeah, absolutely. I'm sure you know the listeners, you're working, it would work for me, and that's that's all that matters, but I'm sure the I'm sure the listeners are too, because these are these are some tough topics. And and like you said, I think probably the hardest conversation to have is the one with yourself, which we we are terrible at doing, and then your you know, your wife or your husband, loved one, whoever, where you say, like, I this is you know, I something that you said earlier on the show was is this sustainable? And I can tell you what from my perspective, it is not what I'm doing now. Um, but I'm 47, and you know, one of the things I'm talking with Patrick next week is the the sort of the back 40, as uh you know, him and uh Lon uh had talked about as far as like a sort of a second career. Um, but I I think it is important that we we do learn to set those healthy boundaries. And and I think that's something that I struggle with, and something that I'm still learning to do. Um, but it sounds like that's kind of where getting back to like your field, like that's what you can help people do. You can help people learn what's a healthy boundary versus maybe what's not a healthy boundary. Maybe that's a wall that you need during clinical shifts, but maybe you don't bring that wall home. And and we see this, right? I mean, we see this with unfortunately, you know, suicide statistics of physicians. We see this with divorce rates. We see, you know, we see a lot of this coming out in the metrics. I just saw something recently, and I know it was a flawed study, and I every time I put it on social media, I get all kinds of hate about it. But you know, ER physicians are one of the lowest uh ages of of of mortality out there for like any profession. It's like 58 years old or something. And I know it's because we're a newer specialty and there's some flaws there, but the point is when I saw that, I was like, man, that's that's like eye-opening. And some of it's shift work and sleep deprivation and that kind of stuff, some of it's high-risk lifestyle, whether they're you know, but also some of it it's just it's just not safe sometimes to, you know, work 24 hours and then drive home in a car on a highway. God knows what could happen to you. So I so I think it's it's a good point that you talked about as far as asking and seeking help, which we're all guilty of not doing uh well, and asking people like yourself, how do we have the tools? You know, what how do we get those tools to sort of set these boundaries and deal with these things?

SPEAKER_00 37:44

And that's exactly it. It's really about skill development, it's about getting tools, it's not about digging up all these complex emotions. That's more a therapeutic realm. And if that's helpful, go and do that. But what I'm suggesting is building your internal fortitude, learning these skills so that you can hold this better. I'm not suggesting that you drop it or you let it break. You stepped into this for a reason, you're a passionate. Let's continue continue to hold it, but hold it better.

SPEAKER_02 38:13

Yeah, and that makes sense. And so I guess so, what would be the steps for someone? You know, first obviously identifying that they are either, you know, experiencing burnout or they're on that path where they don't think it's sustainable, like you talked about having that conversation with themselves and with their family or their significant others, their support system. And then what's what's that next step? Is it is it reaching out to someone like yourself and just having that phone call and that conversation on how do I, you know, sort of deal with these things? Is that is that sort of that progression?

SPEAKER_00 38:46

That yes, that's what I see. I mean, you could do it by yourself, but anytime we do something by ourselves, it takes longer. And if you're in this acute kind of, uh, I don't know if this is sustainable place, we want to disrupt that as quickly as possible. So working with a professional is is important. So you could look in your hospital system, uh, talk to your medical director, talk to human resources, see if there are any resources. Like I said, I work with the hospital system in Northern Virginia and I'm on not on staff, but like they you they utilize me to to help their physicians stay in their job. So there might be someone like me that's already there and they're gonna, they're gonna come, they're gonna pay for everything, and then that's gonna be easy. Um, in other cases, I've had people hire me or other coaches, and then they share the bill with the hospital and say, all right, well, you're gonna pay for this because this is keeping me here. And the hospital's like, great, I'm happy to pay for it. So you see things like this. And if you're not comfortable with coaching, maybe, maybe, just maybe, then you continue to do your self-exploration by listening to podcasts, being willing to just kind of question yourself, like, what's the teeniest, tiniest change I could start to make? This 1% shift, then maybe will make me feel a tiny degree better. And and maybe you're not going to do it clinically yet, but maybe when I get home, what's like a teeny tiny thing I could do differently? Like, I I coach a lot on like transitions when you're leaving the clinical setting, coming home. Like, do I do something a little different, something that feels a little like, I don't know, rejuvenating, nourishing that makes me feel like a human again. Because I promise you, if you stay in that this gear energy where you're just throttling and you don't interrupt that, you're gonna bring that into your family life. And when you bring that and you sustain it, your cortisol is just flowing through your body. And it's probably why you said 58%, or I'm sorry, 58% is is now the the mortality rate for emergency emergency medicine physicians. So stress is a killer. We know it, all of us know it.

SPEAKER_02 40:49

Yeah, no, well said. Um, you mentioned something earlier about taking a vacation. I I I have to ask this because I'll tell you that's my that's my number one coping medicine because I can't I can't have bourbon every single day. I mean, I guess you could, but they got names for that. So I I try not to. So um one of the things that I do to try to sort of escape, I don't know if escape's the right word, but um uh separate, you know, create that separation, that distance that you talk about is I travel. I like to go uh places uh down in the Caribbean, Hawaii, uh, I like to go to Italy and I experience other people's cultures and food and and just sort of get outside my comfort zone. Um, and I and I guess my question is, is that is that can that be something that builds up sort of my gas tank and that fortitude that you speak of, or am I simply just running away from the actual problem?

SPEAKER_00 41:48

Well, that's a good question. So I do believe that vacations are highly restorative because you are sorry, I have something in my eye. So vacations are highly restorative, and I think it it is a good strategy. Um, unfortunately, it's probably only a lever you can pull four or five times a year. If you're really lucky, maybe you're doing micro something once a month, but like real big getaways that feel really restorative and and uh like you know, you know what I'm talking about. Like when everything kind of just is able to melt off of you, I do think it's helpful. It is not going to keep you in your career longer, though. It's not a strategy for longevity. Um so it's really like what are you up to? Are you are you wanting to just pause the pain and kind of reset? Because it is a reset, and that's okay. Um, or are you looking to hold this a little bit differently and better and learn to effectively shift in and out of fifth gear? Um, because I I want you still in fifth gear. I want you producing, I want you to be fiery and awesome and all the things, but I want you to be able to downshift into one or zero like you feel when you're on vacation. This is what I'm talking about when I talk about having a black belt and nervous system resilience. That is exactly what I'm talking about. A vacation gives you that feeling of like my nervous system is reset. I'm I'm like calm, like a what's it called, like a pond where there's no ripples out there. It's as smooth as glass. That's what we want to be training the nervous system. And I wish more people knew this. I didn't know it until my hair was falling out of my head. So unfortunately, many of us have to go to these really nasty places to get there. And I'll tell people, if you are interested, I have um, and I know John, you're gonna walk through everybody on this. I have a burnout quiz on my website. And in that burnout quiz, you can kind of self um diagnose, if you will. Um, and I give you a green, yellow, or red. And if you're in the green, you're good. If you're yellow, it means like there's some patterns that probably need attention, but you're like not in full burnout. But if you do get a red, that's kind of like me waving the red flag at you. Like, get some help. It doesn't have to be from me. But go seek some support and get some new skills. Get those skills.

unknown 44:05

Yeah.

SPEAKER_02 44:05

Why don't you give us that website now? Cause I think that's a great tool to utilize.

SPEAKER_00 44:10

Yeah. So it's my my name, Elsaarand.com. And I think we're going to have that linked in the show notes. So you'll be able to see that. And it's, it'll take you about two minutes to do the quiz. ElsaAaron.com.

SPEAKER_02 44:22

Yeah, I'm definitely taking that for sure. Um, actually writing it down so I don't forget on my my my notes here. Um definitely doing one. I because listen, I I'll be honest, like, you know, full transparency. I I've thought about this for for years now. And you know, it's gotten to the point where you know, we talk about vacations and and I always have, you know, we joke about it, but uh, you know, a lot of jokes have some truth, right? Underlying. And it became to a point where, you know, I do get rejuvenated going on vacation, but I think the difference was I used to come back and feel rejuvenated and be like very enthusiastic about returning to work, seeing patients taking care of people. And now it's to the point where I come back and I'm like, oh, and it's like, you know, and and and that's a slippery slope there. And I obviously I still try to be extremely passionate and and but you know, it's just not what it was before. So I think that's one, you know, obviously concern I have it as far as the nervous system and the sleep that you were talking about. It's interesting. One of the things that I've noticed, my wife notices, is that when I'm here and I'm obviously, like you said, in fifth gear, um, you know, I have to actually take some these gummies that help me sleep at night. Uh a great company, by the way, uh called uh Get Soul. And I and I take them every night uh before I go to bed. And they're just little C BD gummies. Um and they they help me sleep. I've tried everything, trazodone and magnesium, some melatonin and everything else. But these for whatever reason seem to be the best things that I've ever tried to help me sleep. Um, and what's interesting is that when I go on vacation, I I don't I don't bring them. I don't, it's like I don't need them. I just sleep normally and I feel very well rested. And I it ha there has to be a connection there with like cortisol and and stress and and everything because I I sleep like a champ when I'm on vacation. So I just keep telling my wife we just got to keep going on vacation.

SPEAKER_00 46:12

There you go. I mean, there that's a really powerful insight you're having, and I think that's really good that you recognize gosh, when I'm on vacation, my nervous system is completely balanced. I don't need support. But when I am in fifth gear, I currently do not have the skill to get it down into zero without intervention, without like uh whatever you call that thing, the CBD gummy. Yeah, and that's okay. That it's working, it is a tool that's working. That's why I'm telling you, this is a black belt ninja skill to be able to do this, and it's really cool.

SPEAKER_02 46:40

Love it, ninja skills. All right, that's that's definitely what I need. Um, well, let's do let's do a little uh factor fiction. One of the uh things I do on the show just uh for fun, just kind of a rapid fire questions. Uh so if you truly love what you do, burnout won't happen to you.

SPEAKER_00 46:56

Fact or fiction, absolute fiction. All right, do you want me to share more or just answer a fact?

SPEAKER_02 47:02

Yeah, go ahead. Yeah, go ahead.

SPEAKER_00 47:04

Yeah, because um someone like you, I can tell you really love what you do. Um, and there's parts of you that are experiencing burnout. So, yes, you can absolutely and be very skilled and very talented.

SPEAKER_02 47:16

So it's fiction. All right, love it. Uh, burnout is just depression with a better PR team.

SPEAKER_00 47:23

It's definitely not depression. There could be uh aspects of it that feel like depression. That detachment, that's something like if you if anything's kind of resonated with you, I want you to, those three kind of qualifiers, like, you know, uh do I feel like there's a lack of uh efficiency? Do I feel detached? And do I have prolonged um kind of this prolonged stress thing happening? Detachment is something that usually walks around like depression, and it's probably not clinically depression. So that's another fiction.

SPEAKER_02 47:52

All right, love it. And then the last one I have is uh the best thing a burned out professional can do is leave their job. Fact or fiction.

SPEAKER_00 47:59

Definitely. I I can't even tell you the amount of people. Like I had a woman today, it's fiction. She and I worked together, I think, three years ago. She is an attorney, she's a partner in a law firm, so different than what we're talking about here clinically, but she was ready to burn it all down. She was standing on the burnout cliff. She even reached out to me because I talk about that term so much. She was like, Elsa, I'm standing on the burnout cliff. I want to burn my whole legal career down. This is a woman in her 40s, ready to burn it all down, and had no idea what she was going to do. Today is her birthday. I just sent her a little birthday. I said, I love you, I'm thinking of you. Um she said, Elsa, I would not have the life I have today if I had not worked with you. Thank you, thank you, thank you. And she's still the partner at the law firm, she's still making all the money, and she is happy as a little clam. And she was happy to tell me that she was leaving the office early to get a pedicure, and she was really excited about it. So there's my answer.

SPEAKER_02 48:54

That's fantastic. Well, well, happy birthday to her. And uh I I'm not much of a pedicure guy, but I I can definitely see the uh the mental health uh gain in in that for sure. So I I always try to sort of wrap up the show with at least something positive, uh, because a lot of the things we talk about, unfortunately, are very can be very negative, uh, depending on how the conversation goes. So, like what's the reason for hope, you know, now as we move forward? I I think one thing I've seen is that at least it seems more acceptable to have some of these conversations out loud. You know, we're seeing professional athletes coming out and talking about the importance of mental health. We're seeing, I think organizations uh are you know putting some things in play. I don't know that the hospitals are are quite there yet, but like what have you seen that is uh to give us some hope for for the future in this in this you know area?

SPEAKER_00 49:47

Yeah, I think there's a lot of reason to have hope, John. I think that the culturally we are just recognizing that I don't know what happened to all of us where we got them. Oh, and I don't know if this is distinct to the United States, if this is happening in other countries. I don't know if your listeners are in other countries, but there's something happening here in the United States where we just really equate our identity and value with our output. And you know, you can go to a lovely country like France where they're they really they they they have an ability to flow into these two states really nicely. Um, if you've ever experienced that country or culture, I used to live in Mexico and I remember I was eating really fast when I first started working for a corporation down there. And my boss, he was the president of the company, he looked at me and said, Why are you eating so fast? And I said, I don't know. And he said, You know, we're off for two hours here. Because we in Mexico, it's cultural that we take the siesta. You know, you eat and then you go back to wherever you live and you sleep, and then you come back at three o'clock refreshed. And we work later till seven o'clock, but we're refreshed. So, in in our culture, I think we've normalized this intensity. And I think we're all starting to realize, like, ooh, I'm not sure this is working. I think for the first time, I think COVID is when the mortality rate started to go down. Um, so obviously medicine is improving, but I think the quality of our lifestyles is somehow downshifting. And I think we're all kind of getting curious about that. Um, and I will say, I have a lot of men that I work with in my practice. So that also shows me there's more openness to really gain new skills and tools. So I think there is reason to have hope. There is support out there, and people are believing in us. And I just think culturally we're ready to disrupt this.

SPEAKER_02 51:33

I love it. Yeah, that sounds great. And and I guess the question then is one of the things I see are these medical students, uh, PA students, residents that are very early on and they're already telling me that they're fearful of burnout, um, that they're tired of, you know, dealing with X, Y, or Z and healthcare. You know, what do I tell them as someone that, you know, they often look up to me as a director of the department and things like that. Like, how do I get them pointed in the right direction so that maybe they can build those habits early on in their career and not end up, you know, in a in a bad situation down the road 10, 15, 20 years later?

SPEAKER_00 52:10

100%. And I'm so thankful that you're bringing this question forward. I was actually talking to a medical intern a few weeks ago and she kind of she had similar concerns to what you're you're sharing here. It all goes back to the nervous system. I would tell them, and maybe you're gonna become a ninja in nervous system. If you can learn to regulate yourself, you can do anything. You can do anything if you're willing to disrupt the patterns that are at play here. I'm not telling you to change your clinical environment. It's going to be what it's going to be, but you yourself, you can learn to change. And I don't care if you're a resident, an intern, you're an attending, I don't care. You can learn this skill. And for some reason, in this culture, we don't have a strong handle on this yet, but there is hope. Okay.

SPEAKER_02 53:02

Well, I love it. I such a great conversation. And I certainly thank you for joining me today. I um I can't thank you enough, especially with your patience with everything going on with my mom, and and also for you know, sort of giving me the sort of the I don't know, the catalyst to saying, hey, you know, why don't we put that story out there? And it um it actually did very well. I wanted to make sure I wasn't being accused of uh using uh my mom's, you know, sort of bad situation for clicks. That's certainly not the not the case. And I'm hopeful that people that are you know following me on social media know that I'm a much more genuine person than that. Um, but uh, you know, you know, clicks for cancer, you know. So um uh nothing like that. But I I do appreciate it. Um so thank you for for joining the show today and thank you for the thoughts and prayers for for my mom and my family. It really it truly means a lot.

SPEAKER_00 53:54

Absolutely, absolutely.

SPEAKER_02 53:56

So we talked earlier about where we can find you, and I know you mentioned your website. Now, one of the things I wanted to touch base before we left the show was that guests of the show, so any of listeners for emergency minute, uh, can receive a complimentary 60-minute clarity call. And I would love to hear what is involved with that because to me that sounds very enticing.

SPEAKER_00 54:17

Absolutely. So, anybody listening, I invite you to take me up on this. And this is my way of supporting the medical community. It's something I'm so passionate about. Even in just one conversation, you can get an insight that's going to help you take new actions that might make you feel just a little bit better. So, what these clarity calls look like, it's 16 minutes, it's a virtual call. You could be anywhere in the world, it doesn't matter. Um, and you kind of bring to me whatever got stirred in you listening to this conversation. You might tell me I'm at the burnout cliff, I want to give it all up, I've been practicing medicine for three decades and I cannot stand it anymore. You know, whatever is true for you, you bring that. And we're gonna coach you on that. And through the coaching process, you're gonna get an insight that's going to give you a tool. We're gonna work on a specific tool and a specific action that you can start practicing so that when you leave the call, you feel like you have some degree of like, okay, I'm equipped. I'm not gonna be sinking into the hole this week. I might have five shifts lined up, but I've got something that I can kind of sink my teeth into. And that is my uh my give to the community. And I'm excited to talk to you.

SPEAKER_02 55:32

Well, that's a I mean, that's a fantastic gift. And so I hope everybody tries to take advantage of that. I think we're all, I think we're all guilty of like you talked about before, just sort of pedal to the metal, you know, put your head down, work harder. And we sort of just are hardwired really to put all of our other issues, ourselves included, sort of on that back burner. And I think having the tools to maybe more effectively deal with this will increase that longevity and overall our sort of well-being is, I think, kind of the goal, right? Absolutely. Well, great. Well, thank you for joining me. I I do appreciate it. Um, to everyone else out there that's listening, please check in at the end of July. The next guest will be myself and the one and the only Dr. Patrick O'Malley. I'm very excited to have him on the show. We're gonna talk about the the back 40 second careers uh shift change platform and who knows what else? Baseball. I mean, who knows with with Patrick? You never really know what you're gonna get. Uh, but he is the mayor of connecting all people who are uh driven. I feel like that's his his uh superpower. So um I appreciate you being on the show today. Thank you again. And uh as always, I wrap up every show with uh peace, love, and happiness to everybody out there. Cheers, guys.

SPEAKER_01 56:46

Thanks for joining us this week on Emergency Minute. Join us next time for more hard-hitting discussions on some of today's issues in healthcare. Don't forget to leave us a review on Spotify or follow on social media at Dr. J Parente.