Mental Health Blog

Burnout, Mental Health, and Practical Tools for Pediatric Providers

• May 22, 2024
• The REACH Institute

“As clinicians, our training has not encouraged us to look inward and care for ourselves,” explains Rachel Petersen-Nguyen, MD, a primary care pediatrician and Medical Director at Children’s Minnesota in St. Paul. “But we are humans who have real human needs – to rest and rejuvenate and care for ourselves. You can’t just keep pushing yourself indefinitely.” 

A recent American Medical Association (AMA) survey found that 55% of pediatricians report experiencing burnout. Rampant health worker burnout has even grabbed the attention of the U.S. Surgeon General.

In her role as medical director, Dr. Petersen-Nguyen is acutely aware of the many ways clinicians struggle with mental health and the wide range of contributing factors. Here, she shares how clinicians can prioritize their mental wellness. 

Understanding What Clinicians Can and Cannot Change

It’s critical to distinguish between what clinicians can change to improve their own wellness and mental health, and what they cannot. Clinicians operate within complex systems that can be exhausting in even the best of times – and over which they have little control. 

For example, in the U.S., the majority of clinicians must meet the demands of insurance, including documentation and billing, in addition to treating patients. Even for clinicians in leadership roles, many aspects of decision-making and scheduling may be out of their control, such as requirements to see a certain number of patients per day or take breaks only at pre-specified times. 

Fortunately, there are things clinicians can control. 

Choosing to Care for Your Own Needs

Medical training and institutions often emphasize that the needs of the patient always come first. But Dr. Petersen-Nguyen explains that “As clinicians, we need to learn to be aware enough of ourselves and our own internal needs to be able to say, ‘I’m at my limit and I need to meet some of my own needs before I can meet my patients’ needs.’”

When you do recognize that moment, there are several actions you can take: 

• Address basic needs: Take a step back and ask yourself, “How can I function in a way that is good for the patient and sustainable for me?” Start by identifying and addressing your basic needs, like eating and using the bathroom. 
• Allow feelings: While a good attitude can make the difference between an adventure and an ordeal, it’s not realistic to be positive all of the time. On really tough days, Dr. Petersen-Nguyen recommends allowing yourself moments to acknowledge just how hard things are. This can then help set the stage for the moments when you’re ready to keep going. 
• Use breaks intentionally: Even if you cannot choose when to take a break, you can still choose how to use that break. Instead of letting breaks just happen, take the time for self-reflection in advance and identify what helps you recharge. For Dr. Petersen-Nguyen, going outside for 10 minutes at lunch helps her reset for the rest of the day. 
• Get help debriefing difficult moments: In her recent roles, Dr. Petersen-Nguyen has received peer support training on psychological first aid for people doing clinical care. Such training often focuses on how to respond and debrief in high-stakes situations, such as when an error has been made or there has been a challenging incident with a patient or family. It’s important to process moments when your work with patients deeply affects you. For example, something as ordinary as treating a child who struggles with the same condition you did at that age may trigger difficult emotions (and that’s completely understandable).
• Plan ahead: Notice if certain activities or situations tend to drain you and make a plan for how you will support yourself. For example, at times, Dr. Petersen-Nguyen has intentionally reduced her FTE hours so she could schedule a day or half-day off after what were inevitably tough clinic days. While this did mean reduced income, it was a tradeoff worth making to prioritize her mental health.
• Look outside of work: Dr. Petersen-Nguyen recommends clinicians follow the same advice they give patients by assessing their behaviors outside of the workplace. Are you getting enough sleep and nourishment? Do you have supportive and meaningful connections with other people? How do you rejuvenate outside of work? 
• Seek out resources and support: Just like patients, clinicians sometimes need additional support. Many workplaces now offer peer support programs or employee assistance programs, such as access to counseling services. 

Taking Action as a Manager

Clinicians in a managerial role, like Dr. Petersen-Nguyen, have a unique opportunity to drive workplace culture and expectations. For example, you can model and normalize self-care behaviors, including debriefing and processing difficult moments. You can also set standards for taking time away from work, such as establishing clear protocols for coverage and communications so that you and your employees can unplug and recharge. 

RESOURCES

• Health policy researchers are investigating the rise in clinician burnout, especially among primary care providers. Papers such as Patterns in Physician Burnout provide insights into causes that echo Dr. Petersen-Nguyen’s experiences, including the effects of administrative burdens, loss of autonomy, and high workloads.
• Looking to solutions, recent research explores the positive impact of psychological first aid for healthcare workers, including potential mitigating effects on burnout. 
• The Office of the U.S. Surgeon General also provides extensive resources about health worker burnout, including consequences and potential solutions.
• If your workplace does not yet have support tools in place for staff mental wellness, Dr. Petersen-Nguyen has reported good experiences with programs that offer easy-to-access mental healthcare services to employees (one example is Lyra Health).