Reprinted from the August 2023 Infectious Disease Advisor
Burnout a term physicians are all too familiar with. Grueling hours, demanding work, administrative burdens, and inefficient medical systems all contribute to the physical, mental, and emotional exhaustion experienced by clinicians. Recent reports of physician burnout are so alarming that the American Medical Association (AMA) now refers to it as a unique health crisis.
The American Psychological Association (APA) defines burnout as “physical, emotional or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others.”
Although physician burnout has been an ever-present issue looming in the background, recent data show that its prevalence has nearly doubled over the past few years. It seems to be a ticking time bomb, with many providers threatening to cut back hours or leave their practice entirely! A physician shortage in an already short-staffed country could turn disastrous if changes are not made soon.
In a report from the 2012 JAMA Internal Medicine, 45.8% of physicians reported experiencing at least one symptom of burnout. Now, a 2022 study published in the Mayo Clinic Proceedings reported that overall, 62.8% of responding physicians reported experiencing at least one symptom of burnout a stark increase from recent years.
While the prevalence of depression is approximately 8% in the general population, 29% of medical residents report experiencing depression. And according to the Association of American Medical Colleges, the rate of suicide among physicians is nearly double that of the general population.
Understanding the driving forces behind burnout and knowing the signs can help physicians before the situation becomes critical. But this may be easier said than done.
Physicians have a physically, mentally, and emotionally taxing job. They have to treat sick, frightened, or dying patients on a daily basis, including meeting with their families and/or caregivers and completely seemingly endless bureaucratic tasks all on a schedule that is out of their control. As time goes on, the relentless nature of this occupation takes its toll on many caring and compassionate physicians.
Physician burnout does not appear to be caused by any single factor; instead, it occurs as the result of an accumulation of stresses associated with the work environment, increased pressure to perform, extensive work hours, and countless other demands. The following are some of the factors driving this phenomenon.
The AMA recognizes that administrative burdens and bureaucratic tasks like documentation, ordering laboratory studies and medication, and speaking with insurance companies largely drive physician burnout. Christine Sinsky, MD, the AMA Vice President of Professional Satisfaction, states, “While burnout manifests in individuals, it originates in systems. Burnout is not the result of a deficiency in resilience among physicians; rather, it is due to the systems in which physicians work.”
While the Office of the National Coordinator for Health Information Technology states that EHRs can help improve productivity and work-life balance for physicians, this dream has yet to be realized. Many physicians report that EHRs actually contribute to their burnout symptoms. Authors of a study published in the New England Journal of Medicine found that for every one hour that physicians spend with patients, they spend an additional 1-2 hours documenting their visits, prescribing (see page 4)
Led by Leonard Perlmutter, Conference Director & Curriculum Developer
medications, and ordering additional tests. Authors of another survey of 585 primary care physicians found that 37% of them experienced burnout; of those physicians, three-quarters of them attributed their symptoms to EHR work.
From the very beginning, physicians are held to extremely high standards throughout their schooling and training. Dike Drummond, MD, penned an article in Family Practice Management focusing on the five main causes of physician burnout, with one of them being the influence of medical education.
Physicians often push themselves to overperform and be “workaholics” and perfectionists while in school and residency. “The same traits responsible for our success as physicians simultaneously set us up for burnout down the road,” writes Dr. Drummond. There is also a cultural stigma in the medical field surrounding mental health. Physicians are less likely to reach out for mental health services and help out of fear of jeopardizing their medical license. They also struggle to find accessible services that offer care during their overloaded workday.
The term “work-life balance” is often thrown around these days as a goal to strive for. In an ideal world, everyone would be able to strike the perfect balance between work, family, friends, and hobbies; however, this is rarely the case for physicians.
In fact, Dr. Drummond notes that medical residents are often taught the exact opposite during their training. Generations of residents have passed down the practice of ignoring emotional and spiritual needs out of fear of weakness. Although the average U.S. work week is 40 hours, most physicians find themselves working 40 to 60 hours each week. Even more startling is that nearly 25% of physicians report working between 61 and 80 hours each week.
Tait D. Shanafelt and colleagues found in their recent survey that satisfaction with worklife integration (as it is termed in the study) decreased by 15.8% from 2020 to 2021. Long hours leave physicians’ schedules too packed to enjoy time with their families, pursue hobbies, and simply take time for themselves. Some physicians may also face challenges in their
home life that leave little room for relaxation.
Depending on the specialty, physicians can see up to dozens of patients every day. The pressure to examine and treat as many patients as possible is a looming presence. Outcomes from the Minimizing Error, Maximizing Outcome (MEMO) study conducted by the Agency for Healthcare Research and Quality revealed that more than 50% of physicians reported experiencing stress from time pressure.
Specifically, the study revealed that more than one-half of physicians feel pressure to conduct physical examinations quickly. Many also state that they need more time than their appointments allow to provide necessary patient care. Constantly working against the clock contributes to physician burnout, especially if they are trying to reach an unattainable goal of seeing so many patients every day.
Physicians in any specialty can experience burnout, but it is more common in some than others. Medscape surveyed more than 9100 physicians across dozens of specialties to learn more about their experiences with burnout and depression. Approximately 65% of emergency medicine physicians reported burnout, and similar rates were reported by physicians in other specialties: Internal Medicine: 60%; Pediatrics: 59%; Obstetrics/Gynecology: 58%; Infectious Diseases: 58%; Family Medicine: 57% Reports and surveys also show that female physicians are more likely to report experiencing burnout compared with their male counterparts. The Medscape physician survey found that 63% of female physicians experienced burnout compared with 46% of male physicians.
According to Dr. Drummond, physicians who are burning out often enter “survival mode,” during which they simply try to push through their day so they can make it home. Over time, physicians become less motivated, less interested in their work, and less invested in their patients. In the 1970s, Christina Malasch, PhD, and colleagues determined that the main burnout signs were exhaustion, depersonalization and
decreased personal achievement. Other generalized signs of burnout include: Feeling anxious, angry, frustrated, or frightened; having the inability to feel contentment, happiness, or pleasure, especially surrounding their career; and physical symptoms: including muscle tension, headaches, lack of sleep and gastrointestinal issues.
Exhaustion means more than simply feeling tired. Physicians can experience physical, mental, and emotional exhaustion. During burnout, energy levels, mental health, and critical thinking skills all head toward a downward spiral. Common signs of exhaustion in physicians include: Constantly feeling tired or rundown; Struggling to get out of bed in the morning or for their shift; Coming home feeling exhausted and drained leaving little energy for cooking, cleaning, and spending time with family; Thinking, “I’m not sure how much longer I can keep doing this.”
Another sign of physician burnout is feeling decreased personal achievement or having negative views on one’s work and worth. For example, a physician may feel that they cannot do anything right at their job, or as if they are not making a difference. Physicians may: View themselves in a negative light; Have low morale or self-esteem; Feel like their job does not serve a purpose, or they are not helping anyone; They may also constantly doubt the quality of their work waiting to make mistakes that will result in disciplinary action or termination.
Many physicians spend hours each day connecting with patients to build trust and meet their needs. Burnout often puts patient interactions in a newer, darker light, and many physicians find themselves feeling emotionally detached from their jobs. This attitude and outlook is known as depersonalization.
Instead of viewing their patients with kindness and compassion, depersonalization causes physicians to act negatively or indifferently toward them. These attitudes can also extend to colleagues and the medical profession in general.
Physician burnout affects not only physicians but also the scope and quality of care that patients receive. Exhausted and burned-out providers are more likely to make medical errors and struggle to connect with patients. A 2014 survey found that 10.5% of physicians had made at least one major medical error in recent months. Of them, 77% had experienced symptoms of burnout. Burnout is also associated with more malpractice claims, and generally erodes the trust and relationship between physicians and patients.
The combination of patient dissatisfaction, pressure to perform, and a broken support system has the potential to push physicians out of their chosen field. With fewer physicians in practice, patients will have reduced access to care. Even when burned-out physicians stay in their position, they are more likely to cut back their efforts, consistently perform suboptimal work, and take more sick days.
“My appeal to every caregiver would be to love yourself. Express the same compassion to yourself as you would to those you care for. And look in the mirror and ask yourself: ‘Are you happy?’ ‘Are you thriving?’ And if not, why is that? This CME Conference curriculum definitely meets the needs of a tremendous number of caregivers who are doing amazing work, but who are struggling to maintain a sharp, creative edge. From beginning to end, this conference contains news to use! It’s the antidote to so many of those day-to-day challenges we all face.” –Mark Pettus, MD and Conference Presenter
“This CME Conference has been the most influential factor in transforming my life and medical practice.” –Janine Pardo, MD and Conference Presenter
You’ve changed and grown since you last attended AMI’s annual CME Conference. And I’m certain that in your many rich experiments in Yoga Science you’ve found greater insights, compassion and a clear sense of purpose that continue to benefit your family, patients and yourself.
As you may know, this year’s Alumni Dinner will provide you 2 additional CME credits. But even more importantly, following our meal together you’ll be asked to share ways you’ve integrated your knowledge of Yoga Science into your medical practice and home life. By participating in this discussion, each of you will help co-create with me and our faculty, a new educational webinar syllabus that in 2024 will begin to educate, inspire and support many other dedicated physicians as they too address the challenges and opportunities of serving their patients well while enhancing their own health, sanity and love of medicine and life.
I urge you to join me this coming October 17-21 at the Equinox Resort and Spa in Manchester, Vermont to deepen your understanding of Yoga Science, and to empower other physicians and health care providers to flourish.
• Demonstrate knowledge of how using the tools of Yoga Science as mind/body medicine can help heal disease, manage addictive habits, alleviate stress, and reduce and prevent burnout
• Develop equanimity, discrimination, will power, creativity and energy with a daily practice of AMI MEDITATION & diaphragmatic breathing
• Incorporate long-term strategies for healthy lifestyle choices using Yoga Psychology
• Demonstrate knowledge of the principles of both Ayurveda and Epigenetics
• Utilize Yoga Science practices to transform trauma and increase resilience
• Utilize Food as Medicine to maximize personal wellbeing
• Demonstrate knowledge of the research and therapeutic modalities of yoga and meditation as mind/body medicine
• Reimagine a medical practice that incorporates Yoga Science tools
• Recognize the physiological benefits of Easy Gentle Yoga, and identify and disable chronic pain mechanisms for improved exercise, health and pain relief
• Help themselves and their patients reduce conditioned habits of negative thinking and other symptoms of burnout through the healing powers of AMI MEDITATION and mantra science
• Use Chakra Psychology (subtle emotional/mental causes of stress) to assist in diagnosing and treating dis-ease
• Recognize how AMI MEDITATION and meditation-in-action change neural pathways in the brain to help manage pain and increase creativity
• Identify altered pathways in the brain due to stress or burnout, and recognize the capacity of Yoga Science and AMI MEDITATION to assist brain chemistry and circuitry to heal and rebuild itself
• Use the holistic practices of Yoga Science to create a personal and medical culture of health and wellbeing for themselves and greater compassion for their patients
AMI Classes for September-November 2023
Proven Effective in a Peer-Reviewed Clinical Study
Developed and Taught by Leonard
PerlmutterAMI MEDITATION® provides a practical, proprietary curriculum that will bring joy and fulfillment back into your life! You’ll learn how to easily transform burnout, stress, worry, anger, and sadness into energy, creativity and will power – by employing the Super Conscious Wisdom of Your Conscience. And as you practice what you learn, you’ll successfully balance all your personal and professional responsibilities.
AMI MEDITATION®
PROPRIETARY CURRICULUM
is derived from the award-winning book, The Heart and Science of Yoga and the new book, YOUR CONSCIENCE
by Leonard Perlmutter (Ram Lev)
Yoga Science & Philosophy–WEEK 1
How to use the mind for the best choices
How to create new, healthier habits
Understanding pain as an agent for healing
Increasing energy, will power & creativity
Antidotes for worry, stress and depression
AMI Meditation®–W EEK 2
Systematic procedure for AMI Meditation®
Diminishing distractions with your Mantra
Learning the one-minute meditation
Building focus and fearlessness
Breathing Techniques–WEEK 3
Breath as Medicine
How breathing irregularities foster dis-ease
Three-part diaphragmatic breath
Yoga Psychology & Ayurveda–WEEK 4
Coordinate the Four Functions of the Mind to access the power and Inner Wisdom of Your Conscience
Use the power of NOW to build and heal relationships
Ayurvedic Medicine & Nutrition for your health
Easy-Gentle Yoga Exercises–WEEK 5
Yoga stretches to detox the lymph system and benefit your muscles, nerves, joints, glands & internal organs
Physiological benefits of yoga postures
Mind / Body Self-Care Plan–WEEK 6
The healing power of prayer
The practical benefits of contemplation
Creating a therapeutic self-care plan for yourself
Learning to budget your time
Integrating spirituality into daily life
(Ram Lev) Endorsed by Dean Ornish MD, Bernie Siegel MD, Larry Dossey MD
AMI’s Foundation Course was developed and is taught live on Zoom by Leonard Perlmutter (Ram Lev). Leonard is a noted educator, philosopher, Yoga scientist and founder of The American Meditation Institute. He is the author of The Heart and Science of Yoga,® YOUR CONSCIENCE, and the mind/body medicine journal, Transformation. He is a direct disciple of Swami Rama of the Himalayas. Leonard’s lectures are enlivened by his inspiring enthusiasm, vast experience, humor and clear teaching style. He has taught at M.D. Anderson Cancer Center, The New York Times Yoga Forum, Kaiser-Permanente, numerous medical schools and the U. S. Military Academy at West Point.
PHYSICIANS • PAs • NPs (18 CMEs)
americanmeditation.org/physician-cme
Registration Includes: Lifelong support, a 20-minute Guided Meditation, a copy of The Physiology of Easy-Gentle Yoga, and a FREE subscription to AMI’s Transformation journal.
Check with your health insurance plan provider.
AMI Founder
Oct 3 - Nov 14 Tuesdays excl. Oct 17
Nov 21 - Dec 26 Tuesdays
Jan 9 - Feb 13 Tuesdays
6:30
“Mastery
MAKING THE BEST CHOICES 10 Indispensable Keys for Inspired Decision-Making
FREE:
September 2023
SEP 11 - OCT 23: GITA/YOGA PSYCHOLOGY see p.10
Mon. Nights, 6:30 - 8:30 PM ET (6 wks) Live on ZOOM
October 2023
OCT 3 - NOV 14: AMI MEDITATION® Excl. Oct 17 see p. 8-9
Tues. Nights, 6:30 -8:30 PM ET (6 wks) Live on ZOOM
OCT 17 - 21: CME PHYSICIANS CONFERENCE see p. 3
OCT 30 - DEC 4: GITA/YOGA PSYCHOLOGY see p. 10
Mon. Nights, 6:30 - 8:30 PM ET (6 wks) Live on ZOOM
November 2023
NOV 2 - NOV 16: MAKING THE BEST CHOICES see p.10
Thurs. Nights, 6:30 - 8:30 PM ET (3 wks) Live on ZOOM
NOV 21 - DEC 26: AMI MEDITATION see p. 8-9
Tues. Nights, 6:30 - 8:30 PM ET (6 wks) Live on ZOOM
American Meditation Institute
Education
September-November, 2023 • Vol. XXVII No. 1 ©2023 PO Box 430, Averill Park, NY 12018
americanmeditation.org \ Tel. (518) 674-8714
ami@americanmeditation.org
AMI is a tax exempt, non-profit 501(c) 3 educational organization. Donations are fully tax deductible.
DONATE TODAY! To
AMI’s Annual
THURSDAYS, 6:30 - 8:30PM ET $125
NOV 2 - NOV 16 (3 WKS) LIVE ON ZOOM
YOGA PSYCHOLOGY BHAGAVAD GITA STUDY
LEVEL II: This course presents the profound teachings of the Bhagavad Gita as a handbook on the science of life and the art of living. If you are seeking a manual or guide for the supreme task of living a fulfilling and purposeful life in the world today, this ongoing study will provide you the practical wisdom, tools, meaning, courage and confidence you need. Each week Leonard and Jenness will teach you how to reduce stress, enhance your health and creative abilities while offering you a fresh, positive perspective on all your personal and professional relationships. This course provides the practical blueprint necessary to resolve all of life’s challenges.
MONDAYS, 6:30 - 8:30 PM ET, $150. (6 WKS)
SEP 11 - OCT 23; OCT 30 - DEC 4 LIVE ON ZOOM
To Benefit Older, Retiring & Retired Healthcare Providers Addressing Unique Stresses of Life’s Physical and Emotional Challenges
In part, the 12th annual Heart & Science of Yoga® Physicians Conference was designed to benefit those providers who are in the process of making life transitions. When docs enter the “Afternoon of Life,” they all experience certain physical and life changes including retiring from a lifetime purpose of healing. These changes can cause significant stress and consternation. Society’s prescriptions for this (golf outings, vacations, or returning to work) are not adequate for some. This CME conference offers a profound alternative. If you are entering this stage of life, you can benefit now from the future of self-care and healing. Please join Leonard Perlmutter and his distinguished faculty of Yoga Scientist/ Physicians this October at the Equinox Resort and Spa in Manchester, Vermont for a week of self-discovery and enlightenment. It will be the best gift you ever give yourself !
Leonard Perlmutter (Ram Lev) –– AMI Founder
This advanced 2-week course provides important instruction on the subtle energy healing of Tantra, a system of powerfully effective tools for self-care and stress management. Each week you will be taught new skills that reduce the effects of stress, illness and physical exhaustion by purifying the mind and body. These deeply therapeutic practices minimize tension, facilitate energy flow, calm and train the mind, awaken creativity, enhance memory and retard the aging and disease processes by boosting the body’s innate healing wisdom. This course will provide complete instruction in the practices of yoga nidra, shitali karana, shavayatra, and tantric visualization.
SATURDAYS, 1:30 - 3:30PM ET $125 (2 WKS)
DEC 9 & 16 LIVE ON ZOOM
This class is open to the general public and recommended for physicians, nurses, and other healthcare professionals.
October 17-21, 2023
Equinox Resort & Spa • Manchester, Vermont
americanmeditation.org/cme
12th Annual Conference
32 CMEs
34 for Alumni
Physicians
PAs • NPs
Healthcare Executives
“This conference curriculum of Yoga Science has transformed my life, and I’ve returned annually because it’s so restorative. The discussions with peers have been exceptionally inspiring, and now as a presenter of “Food as Medicine,” I hope you’ll join me.”
Kristin KaelberMD PhD, Internal Medicine & Pediatrics, Ohio
