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Physician burnout—a topic that is top of mind for many medical professionals. Fatigue and loss of interest at work can lead to "depersonalization" with patients and a dramatic decrease in productivity overall.

In this episode, Dr. Steve Vargo discusses some of the causes of burnout and takes a broader view on how to resolve the issue. While activities such as exercise, yoga, and meditation do help, Dr. Vargo believes the longer-lasting resolution comes from HOW we provide patient care.

Connect with Dr. Steve Vargo:

Website - https://drstevevargo.com/

Instagram - https://www.instagram.com/dr.stevevargo/?hl=en

LinkedIn - https://www.linkedin.com/in/stevevargo

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Causes And Impact Of Burnout: Dr. Steve Vargo

This conversation is going to be a very important one. It's an important topic that's been front of mind for so many clinicians these days and that is about physician burnout. There's no better person to speak to about that than my friend Dr. Steve Vargo. Steve, if you don't know him already, is a Practice Management Consultant with IDOC. He is a multiple-time published author and a sought-after speaker and the host of his own podcast called the Eye Own a Business podcast. Thanks again, Steve, for joining me here on the show. I appreciate it.

Thanks for having me back and congratulations to you. As we were talking before, we got logged on here, almost 100 episodes. We are almost there. At Vision Expo, you are going to record the big 100.

Thank you very much. I was going to drop that little nugget here. This will be episode 99 that we are in here. If anything, 99 might be better than 100 because of Wayne Gretzky is the great one. Ninety-nine makes you the great one here, Steve. We will have a special little celebratory episode coming up next for the big 100. Thank you very much. Steve, why don't you give us a quick little intro if you wouldn't mind? Tell us a little bit about yourself for those who haven't met you or know too much about you.

I practiced for years in the Chicago area and I took a bit of an unusual but interesting path where I stopped practicing about a few years ago and I transitioned into the practice management side and joined a group at the time called Prima Eye Group. About a year into that, we were bought by a group called IDOC which I work with now. It's very rewarding in a different way. I'm not seeing patients anymore, but I get to work with a lot of different practice owners to guide and give them some of the support they need to operate a successful practice.

Your books have been very helpful to me. They are great. I got one of them right here. This one I love, Prescribing Change was a great book. I know you released it as an audiobook. Tell me a little bit about that so people know where we could find that.

I did go back at the request or I had the question come through enough times, “Do you have an audiobook?” I got tired of saying no. Even though I don't like the sound of my own voice, people always tell me I have got that FM radio voice. I put that together and thought, “Maybe I can record it myself because I auditioned a few people to do it.” When I heard it back, I just thought, “That is not the way I want it to sound.” It wasn't the way in my head that it sounds.

I recorded it. I haven't done that one yet. That's a project ahead, but I did one in a couple of my earlier books, Eye on Leadership, and the other one But I Don't Sell. How to sell without being salesy? How to have those conversations with patients? I did make audio versions of those. That one's still yet to come, but you can certainly get the Kindle or the paperback version.

It's cool to see that you are expanding into those different areas because audiobooks are huge. I don't listen to audiobooks as much as I used to, but for a couple of years that's all I did was audiobooks. Your books are great. I don't want to get too off track here because we got an important off-topic to talk about but the conversation about selling without selling is an uncomfortable place for optometrists especially.

For those who don't know, Steve was on the show last time, and the first conversation you and I had was about that stuff. It was talking about prescribing change and talking about how to sell and things. Please go back and read that. That was one of the top episodes. People liked it. There's a lot of value in that. Please go back and check that one out. Burnout, I'm hearing this term a lot these days and is it just me? Is it just now, all of a sudden, there's a lot of it or is it been around for a long time and we hadn't known what to call it? Why is it so prominent right now?

It has been around for a long time, but it's become something that's grown that's become more problematic, especially with healthcare professionals. I wish I could remember her name, but there's a doctor that does a lot of speaking on the issue. Listening to hear her speak was the first time that I heard the extent of it and I started doing my own research on it.

What I found is the impact it has, not just on the physician, and our mental well-being, our physical, and our emotional states, but also how it translates into the outcomes we get with patients. Even if we want to go down the road of practice management, ultimately, it can affect the financial health of the practice. Some quick stats, over 50% of US-based physicians claim to be experiencing burnout. Forty percent claim to have varying levels of depression and the suicide rate of physicians is twice that of the general population. That's staggering. We have to look at that and say something's not working here with the way the healthcare model is set up right now.

I didn't realize that the suicide rate is double that of the average person so the non-physician population. Over 50% say that they are suffering some burnout.

The highest suicide rate of any profession is among physicians.

I’d be interested to see because the term physician is broad and there are different forms of physicians within that. I wonder if there are some in there that are dramatically higher than others and what those might be. How about optometry? Do you feel like it's a common condition or common issue that we are dealing with?

Burnout, that's a great question. I apologize for not having it in front of me, but you can look that up. There is a breakdown of the different professions. Off the top of my head, I just can't remember what those are.

Is burnout an issue in optometry? Not suicide. That's a heavy topic that maybe is for another time.

I hear it a lot in my consultations with other doctors as well. I will give you a quick background on me. I did practice for years and we can go as the discussion moves on into what some of the hallmark signs of burnout, but I was experiencing some of that. I'm a sample size of one. I don't know when I was practicing what other people are experiencing until I started doing more consulting and working with other doctors.

It's always interesting because nobody ever reaches out to consulting, which is the full reason. It's always typically something that has to do with the business side or practice management. I need to lower my cost of goods. Can you help me hire an office manager or train somebody? It's those sorts of things. The more the conversation would develop and the more you get to know somebody, perhaps trust starts to develop a little bit more and people would start to open up about a lot of the more emotional problems that they are having. That burnout, that stress that they are experiencing started to come out and I thought, “This is much more prevalent than I ever thought it was.”

That was something else I was going to mention right off the top. One, it's spoken about a lot more now, but there are likely still so many more people who are maybe embarrassed to talk about it or for whatever reason don't want to talk about it, but they are experiencing it. Even those who are experiencing it and don't even realize that's what it is. You said over 50%. I bet you it's like quite a bit higher than that even.

For the person who perhaps is not sure, “Am I experiencing burnout or what I might be dealing with?” from your conversations, what have you learned? What were you able to tease out from those people who initially were like, “I need an office manager,” but then you realize that they were dealing with burnout or they came to that conclusion themselves? What are some of the signs of that?

If we look at the hallmark signs that research has found, and this is specific to physicians, this is one of the initial things we will typically experience when we are burned out. Let me also mention, to some degree, we are always going to feel some amount of stress and burnout. Everybody gets depressed once in a while. Everybody has days where they don't feel like going to work, but we need to decipher what is normal and where have we hit a point where we need to change something.

One of the initial hallmark signs of burnout is what they call depersonalization, which is probably the opposite of the reason that we got into healthcare. If you were in optometry school, if we could bring ourselves back to that time when we were maybe in optometry school and say, “Why are you here? What do you want to get out of this profession?”

You'd probably mentioned something about wanting to make a difference and make an impact in other people's lives, wanting to help people, not just their vision, but their quality of life. Depersonalization is when we lose that. When we stop seeing patients as human beings and start seeing them as appointment slots or transactions and then healthcare starts to become much more transactional as opposed to relational, we lose those connections.

Imagine going to work every day, and a lot of people feel this way. I started to feel this way. At some point, you look at your appointment sheet and you see a bunch of names on there. You start to lose that ability to make that connection with people, and we can dig more into this. Once you do that, it affects not only you but also affects the patient as well because I don't think you can be there. Be present, be reading, caring, empathetic, compassionate, and all those things that require that connection and the high quality of care and also the perception that the patient's going to have of you so it snowballs.

We want to get into that because there's a lot more. As you said, it snowballs from there. There's a lot more that will result from that lack of connection, that depersonalization. Before we get into that, maybe you could share some more of the signs, those hallmark signs of burnout. First, you mentioned this absence of human connection or this depersonalization. What would be another one?

One is the absence of a sense of accomplishment. We put ourselves in a position and again, these build on each other. If you are going to work every day and you are unable to connect, there's a ton of research showing that when we are able to connect with patients that the adherence to treatment goes up significantly, and they have done that by surveying patients.

Patients who rate their doctors as great readers. People who are very caring, empathetic, and listen to the patient that their adherence to treatment is upwards of 60% better than when there's not that connection with the physician. When there's that depersonalization, we are not building that connection. We are bouncing from room to room. Again, it's very transactional. If you look at it through the numbers I gave you, there's a greater chance that we are not getting the results and outcomes we want with patients.

It's frustrating when you are just talking to patients all day and they are nodding their heads but they are not going along with your treatment guidance. If a patient walks in your door with their glasses broken in half, there's a pretty good chance they are going to buy a pair of glasses, and that's something we are used to.

A lot of doctors now are trying to implement more advanced services and products into the patient experience. A lot of them at the same time spend a lot of time talking to patients, sometimes talking at patients and the patient doesn't go along with what they'd like the doctor to do. There's that lack of a sense of accomplishment where you are going to work. Now there's a personalization combined with this feeling that I'm not making a difference because my patients aren't agreeing to the dry eye therapy, myopia management. They are not buying into these products or services that could help them.

The last one would be emotional or physical exhaustion when you hit a point where you feel exhausted. What should be meaningful encounters with patients starts to become exhausting, then that would be another hallmark sign of burnout as well. To some degree, we are always going to have a bad day. If you are going to work every day and if that describes normal for you, then you have probably hit a point where you want to sit back and take stock of, “Am I experiencing a high level of consistent burnout? What do I need to change at this point?”

A hallmark sign of burnout is when what should be meaningful encounters with patients start to become exhausting.

I feel like that third one is probably the one that if you said, “What does burnout sound like?” it'd probably be something like what you mentioned there, that emotional or physical exhaustion where you are burnt out physically. There are other signs of that, even if you are not necessarily feeling that exhaustion, that depersonalization.

The absence of sense of accomplishment would be hard to deal with. It seems like it would become this negative cycle at that point and then you would start to feel more exhausted because you are not getting the results you'd like to get. If we could go back to that first one, how does that then affect other aspects of your work, your business, and things like that?

Maybe we flip this around to give the opposite scenario. Imagine a scenario where you were able to make that connection with patients and patients felt heard and understood. We have all been there. We have all had that experience with a patient. We can all think of at least one and hopefully more where we felt like we did understand the patient. We listened to the patient and felt understood.

There was that connection and the patient let you know that you made a difference in my life. I want you to imagine for a minute how you felt at that moment. You probably didn't feel exhausted. You probably didn't feel stressed or burned out. You had a tremendous sense of connection and accomplishment with that patient.

A lot of this is built around how we change the way we practice. I might be getting a little off-topic here, but a lot of times when we think of how we handle burnout or stress, we think of it in terms of what they call escapism. “I need to get away. I need to go on. I need to take more vacation days. Get away from patient care, exercise, or more meditation. I need to get away from it all.” Practice fewer days and see fewer patients.

Those things can't help. Especially the exercise, meditation, and all those things certainly can help, but what they found is the effects are typically moderate at best because it doesn't get into these other areas. You still have to come back from a vacation. This is what you are experiencing at work. It all filters into how the practice works.

It's a bit of a transition here, but again, if you are not able to make those connections with patients, you are not able to get the outcomes you want. What does that typically mean for the success of your practice? You are selling more glasses or you are selling fewer glasses. More people agreeing to advanced dry eye therapy or fewer. More parents signing up for myopia management or less. More referrals or fewer. If you are not getting that, you'd like to translate into negative outcomes for the financial health of the practice as well.

When you put it that way, it does help frame that whole mental state that you are in. In my mind, as you were talking, I was starting to think about all these different things about neurotransmitters. You talk about dopamine when you are feeling good and all these kinds of things. You are probably getting a hit of all of that good stuff when those good things are happening. On the flip side, you are not getting those good interactions and you are not making that connection.

Adrenaline and bad things kick in.

All the bad chemicals that we don't want are likely floating around. I never thought to put that together. It's cool to look at it that way. I'm a nerd about that type of thing, but the other thing, if you don't mind me going a little bit off track here. They reminded me of something that I heard a while back about, somebody said to me like, “What makes you happy right now? Is it thinking about your past? Is it thinking about where you are right now or is it thinking about where you are going to be?”

My thought was, “What determines my happiness in the moment is likely where I am right now. I love having the show. I'm pretty happy right now. If I knew the next thing I was going to do after this was to go do something that I hate doing, it would affect my mood right now and affect my ability to connect with you, Steve.

If I'm sitting in this room with a patient and I hate this job and then I know the next thing I got to do is go see another patient, I'm likely going to be unhappy now. In fact, going on that vacation's not going to help because as the vacation comes to an end, I'm going to go back to that same job that I was trying to escape from. It all leads to that and it becomes a negative cycle.

You talked about escapism and perhaps meditation, we know that helps a lot. It's not the way to treat the root cause of this issue. How would we get to that root? I feel like a hard thing to answer, but ultimately, we want to help define the problem. We want to help people understand whether they are dealing with this or not, but then also how they can remedy this or potentially start to make it better.

I don't think there's one right path. I do think for a lot of physicians, it's time to rethink how they are practicing, and how they are providing patient care. We got into this through a lot of the changes in healthcare. I don't want to blame EHRs. The way we have to practice now is different and we don't have that time to sit down and interact with patients as much.

It's a balancing act for me too because one of the things that I consult with a lot of practices on is how we operate efficiently in a way. A lot of practices in this era that we are in especially with vision care plans will want advice on how I see more patients. A lot of discussions I have are around how we operate patient care in a way that's perhaps faster where you could see more patients but at the same time without compromising clinical care or the patient experience. It brings us back to sitting down and, maybe I will ask you this. If you had to pick a certain, how long do you think that on average a doctor spends with each patient in the exam room? I know that it varies.

Fifteen minutes.

That's exactly what I would say. Let's say fifteen minutes, and I know there are some that are quicker and some are longer. How do you spend that fifteen minutes? If you are walking in the exam room and you are taking it as a very transactional experience and doing a bunch of tests on people, it becomes very mundane and routine. You are bouncing from room to room, but you are not taking that time to understand. Have a conversation with the patient. Make eye contact.

Could we change how we practice? That could be through more delegation, it could be through more automation, or it could be through having a scribe. Getting to that point because I don't want the conversation to go, “We have to see more patients.” “Are you telling me I need to spend longer?” “No, not necessarily.” What I'd like to look at is if we take that fifteen minutes, how can we better use it? Do get that feeling back that we are making a difference. If you are my patient, I get to sit down and we can have a conversation here. At the end of that fifteen minutes when you are walking out of the room, you feel good about the experience and I feel good about the experience that I provided.

You used the word delegate in there a couple of times. That word's come up a lot over the last years or so with different guests that I have spoken to in the series of conversations about where's the future of our profession going and so on. When I would ask the heads of these organizations and people who have hundreds of clinics under their banners what they are doing, they tend to be at the forefront of the technology and stuff because they want to implement and make their business more efficient.

The term delegation came up a lot. They are saying, “The doctor's going to be doing less of these tasks. There's going to be technology taking care of these things.” Perhaps in a few cases, doctors may have a scribe. I feel like that's a lot of where our headaches or stress levels come from. I got to run these individual tests by myself. I don't have the time to sit and connect with the patient. If that's taken care of, that does open up a lot of time for the connection piece.

That's what you have to do. Open up time. Create time. I did a podcast with Dr. Selina McGee and we were talking about dry eye and in particular nutritional supplements. One of the questions I asked her was, “How do you find the time?” A lot of times, I will hear from a doctor, especially if they are trying to introduce maybe some specialty care specialty products, but it's not working.

A lot of times what they will say is, “I wish I had more time. It's a very busy practice and I'm spending a lot of time trying to keep up with the routine care with the testing and the things I need to do. With routine care, I don't have time to talk about dry eye therapy, nutritional supplements, myopia management, or whatever else it is.” I pose that question to her and her answer got me thinking again about that efficiency issue. How do we change the way that we structure that exam slot that we have or our individual time with the patient?

She mentioned a few things. She goes, “I have had to learn how to be succinct in communication and focus on what are the most important things that I need to talk about.” Deciding early, what direction do I want this exam to go? If it is a direction, I think this person would benefit from IPL, myopia management, or whatever it is that we start working in that direction, but also being succinct with communication.

She goes, “Very rarely am I communicating with the patient but not doing something else.” We were taught in school to sit down and do a long case history. It's me and you talking, and then we do a bunch of tests. In the end, we come up with our diagnosis and then we educate the patient, but could we do that while we are doing other things?

She points out that there's an art to it because you still want to make that eye contact. She says it's something she's worked on but she feels like she's moving, talking, and educating at the same time but also with a lot of delegation. She goes, “I know what I need to discuss in the exam room and where my value is at. There are other things that I might give them handouts or a video to watch. I put a lot of effort into training the staff so they can pick up the conversation when I'm done.”

Let's call it that fifteen minutes. She feels pretty good at the end of that fifteen minutes that she made a difference in the lives of her patients. That's a doctor who enjoys going to work. Now does she enjoy every day? Probably not. Does she have her days? Probably like everybody else. She's human. We are all human. However, when I listen to doctors who say, “I love my job,” almost always, 100 times out of 100, they have figured out a way to construct an exam where they have that time to have that connection with the patient.

By the way, I'd listened to some of that and there was something about her getting rid of the patient history or something like that. Right at the beginning of the like not spending so much time on taking a big history.

That's the efficiency conversation. There's not one right way for every practice to do it, but it's good for the owners and for the managers to sit down and say, “What do we want this to look like for the patient?” They walk in the door to the minute they walk out and some of that discussion should involve, “What do we need to stop doing?”

That leads me to another question that I want to ask you, which is so important and personally feel from my experience that is very relevant to the feeling of burnout or unhappiness perhaps in the workplace. That is the culture that offices and the different staff have, whether it's your office manager, your optical staff, or the team that you have. You are going to see all these different practices and work with different doctors. How often do you see that work culture affecting the physician’s feelings and then the risk of burnout at the end of the day?

It's huge. I'm glad you brought that up because it's related. Even if you enjoy patient care but you don't enjoy the people you work with, it's going to be difficult to be happy at work. It is hard. It's one of the hardest things for a business owner or a manager to create a positive culture anyway. It's always worth fighting for. If we dig into the research, what the research has shown is that if you don't have good relationships with the people you work with, the risk of burnout skyrockets.

Even if you enjoy patient care, but you don't enjoy the people you work with, it's going to be difficult to be happy at work.

Another thing that you should probably look at is how much of this is on me and building the culture I want. I need to find the core values here and what we are all about. Do I need to rethink how I'm hiring? I know it's difficult to hire these days, but maybe it's not just about experience, but what kind of people, attitudes, attributes, and qualities we want to bring in here. Once we have defined what culture we have and does it require to do sometimes the hard decisions of letting somebody go who are not a good fit?

I don't know how many times I have heard this fear of letting somebody go because maybe it was a key position, but then saying afterward how happy everyone is that person isn't there anymore because they were not a good fit for the practices. Something else you want to look at as well is the culture and the people. Who are there every day that's going to play a major role in your own happiness with your job?

I know this from my personal experience as a business owner and as we have grown. When you have 1 or 2 staffing and are small, it's easy to manage and oversee that. When you get to 5 or 6, one bad apple can start to affect the overall feeling. When you start to get to 10 or 12, then it's hard because you may have a couple of bad apples and it's hard to know because some people are good at hiding it. It's weird people personalities.

Having a good structure and having people who have good responsibilities or understand their responsibilities of taking care of certain things will help you uncover when there are bad apples. It's important as I have learned to try to pick those out quickly. Nip things in the bud as early as you can even if it seems hard.

I have been through the process where I haven't done that early enough and I have seen the outcomes. We have done it quickly. In my opinion, multiple fold benefit. One is that you have gotten rid of the negativity that cores from the epicenter, and now that's gone. Staff will see that you are taking the initiative or doing the thing that needs no they know needs to be done and you care about how the other staffs feel at the office and it breeds a better culture overall.

As the business owner, if you are even the doctor working in that culture, it's going to help you feel better because everybody else is looking at you as somebody who's looking out for them. It's extremely valuable and very important. In fact, I was speaking with Dr. Carly Rose on the show. She was talking about that and how the hardest thing is letting people go.

She's like, “You'd love to be the leader who helps somebody flourish. You'd love to be the person that someone says, ‘He's the one who helped me take it to the next level as a leader. He was amazing.’” Sometimes you have to be the leader who's at the person's rock bottom and you have to be the rock bottom for that person. That is going to be valuable for their life as well. I never thought about how that is important as well. Taking totally off on a different tangent, but talking about staffing and HR and stuff has been a big topic these days. Give any thoughts you have on that little spiel that I gave there.

As a leader, it's your responsibility as well to look out for the potential for burnout among the people on your team. If you are not creating the right environment, if you are not intentional with that, this doesn't work. The focus of this talk has mostly been on the burnout of the physician, but from the patient's perspective, the only touchpoint, it's not that the doctor's the only touchpoint. There are a lot of touchpoints. If you are delivering that high-quality care, you are a good listener, the empathy and everything that goes into that, delivering that great patient experience, but your staff is burned out, what experience is that going to be for the patient?

As a leader, it's your responsibility as well to look out for the potential for burnout among the people on your team.

I will share a quick story with you about a chiropractor I used to go to. I have some lower back issues. I liked the chiropractor. I thought he was a nice guy. He was very thorough. I thought it was odd because every time I was in there, I didn't get that same experience from the staff. The staff could be very short, sometimes rude and they didn't deliver that same experience.

I knew one of the people who worked there as a girl I'd gone to high school with. We ran into each other one time it was the grocery store and we were making small talk. I said I like the doctor. When I mentioned that to her, she looked at me for a second and she indicated something to say, “What a jerk he was.” I said, “That's odd. I never got that when I went in there.” She goes, “No. He's not like that with the patients. He's like that with the staff.”

That explained to me the experience that I got from the staff. The staff seemed burned out and stressed out. He wasn't putting in the effort to create the culture that was going to lead to the staff feeling like they needed to feel. It's something that we have to do as leaders and as people who are building the culture in our office.

Make sure that we are intentional with building the culture that the staff is going to feel the same things that the doctor needs to feel. Once the staff starts to feel that sense of depersonalization or that sense that we are not making a difference, that sense of emotional exhaustion, then it's downhill. That's not going to play well with the patient's experience. At the end of this is the financial health of the practice.

That's obvious. When we are talking business-wise, that's always going to be the bottom line. That's an insightful story. I have worked in a clinic like that as an associate. As a young associate, the staff was going to talk to me more openly than they were going to talk to the business owner. When I was working, they would often be telling me, “He doesn't even say hi when he walks in the door. He goes straight to the back and does his thing. He doesn't even say bye when he leaves. He barely even talks to us.”

As a young associate, you get a little bit of free time. You go up to the front and you chit-chat. That’s the way I was. As great of a doctor as that person was, I still am friends with him and he's great, but at that time anyways, he hadn't made that connection with the staff. It has been a while since I graduated. I feel like back then, maybe you could get away with that, but right now post-COVID, that's going to be a lot harder for business owners to get away with not having a good culture and not giving their staff that attention that they deserve as you explained. That’s an insightful point there.

For those who are reading, if you are want to learn a little more about how to develop a cool culture, go back a couple episodes to the episode I did with Kevin Wilhelm from Marketing4ECPs because they are award-winning company in that regard, and he had some cool things to share. Shameless self-promoting on my own platform here. This is terrible. To get back to the actual conversation here about burnout, you have talked about it a couple times already in this conversation. Doctors say, “I don't have enough time.” There was an interesting thing that you shared with me. How much more time do we need to take to build that connection with our patients?

It turns out it's not much, and that's one of the biggest drawbacks. I do a presentation on this topic and I save this part for the end. I will point out that I bet a lot of you are feeling as we have been talking about this. You agree with what I'm saying that we should work toward developing that connection with patients. Do a better job of listening, being empathetic, and working harder to understand what's going on with the patient. The pushback on that will often be, “I don't have time. We are a very busy practice.”

I agree. That's why I'm stressed out and burned out, bouncing from one room to the next. That's my life at work. Here's the thing. When they went and surveyed patients who rated their doctors, they rated their doctors high on these different scales of being a good listener, being empathetic, some who they felt took the time to understand them. On average that doctor spent an additional 56 seconds with the patients a minute.

You could get that minute back somewhere else. We could do a little bit quicker refraction. Maybe there's maybe one less test we can do. We can learn to be more synced with our explanations of things. You could get that minute back, but is it possible that spending an additional minute with a patient could not only significantly impacts our own health in terms of less burnout and stress but also impact the outcomes that we are getting?

Remember when the patient feels heard and understood, their likelihood of adhering to treatment recommendations goes up significantly and all that is going to translate into higher revenues for the practice as well. It doesn't take much longer. If we could carve out that time. This is what I'm saying. If you want to go on more vacations, go on more vacations.

When the patient feels heard and understood, their likelihood of adhering to treatment recommendations goes up significantly.

If you are working 5 days a week and you want to cut down patient care to 3 days a week, put that on your list of goals and we will work toward that, but don't discount the process of how you spend your time with the patients. I have talked to doctors who have done that. There's a book out there. I have used a lot of research in my presentations. It's called Compassionomics.

That was a doctor. It was an MD that was by all definitions burned out. He turned things around by spending 1 minute or 2 at the beginning. He says, “I'm going to give them my full attention and we are going to have a conversation. I'm going to take that time to be more present.” To your point before, we are not worried about the last patient or what's in the next room. I'm going to be present with the patient, and that translated into enhanced relationships, deeper relationships with the patients he has. He says over the course of the next days to weeks, he started to feel his sense of burnout dropped significantly.

It's remarkable how much that could help that human connection. Obviously, with COVID, we have started to lose it quite a bit and that's part of the deal here. Taking the time to have that connection is important. It reminded me of two different things here. One is Darryl Glover. What does he say? Everyone's favorite optometrist. DG says that he does his two-minute drill in the beginning.

He told me that before too and that's great. I know exactly what you are talking about.

That's cool and he's good at what he does. There's another doctor who I look up to and that's Dr. Kiran Ramesh in Toronto. She now does consulting on this. She like talks to people like me. She's in a position like yourself where she's going around talking to ODs. She's got her connect and direct. She's got this idea of like when you walk into the room, clear everything away, and you walk in with an open heart and compassion. Your number one job is to connect with that patient before you do anything else.

She sounds lovey-dovey or whatever, but she's like, “Once you have love for this patient in front of you, then everything else is easy.” I have been working on that. As silly as it might sound, as hokey as it might sound, sometimes you almost get goosebumps when you talk to a patient like, “I'm so happy to help you.” It's pretty cool. It's pretty special.

There's so much negativity in the profession. We had our national convention and we have these calm round table sessions where we get in a room with 10 to 15 doctors and we talk about a lot of different topics and issues. There was a handful of doctors in the room who were telling their own individual stories.

“I have done it for 20 or 30 years. I absolutely love it. I absolutely love going to work.” It's always 100 times out of 100 when I hear that, that is going to be built around the quality of the relationships they have with their patients. It has almost no factor on money because as I got to better understand their practice, some of these practices were very low revenue practices. Some were very high revenue practices.

I have heard this from doctors on both ends and in between that absolutely love going to work, but always built on the quality of the relationships that they have with their patients. That is where I would put the focus of my attention. The staffing thing is right up there. I have never met a doctor who said, “I'm having all kinds of problems with my staff,” and wasn't stressed out.

Putting some thought into how we are providing patient care, not necessarily getting away from it. I'm all 100% supportive. If you are working five days a week and you feel like, “I need to work three in my life,” that's fine. Let's work toward that goal, but putting an emphasis on how we are providing patient care in a way that makes you happy. Especially if you are a leader in the practice, the people that I surround myself with at work every day, are they adding to my happiness or are they subtracting from my happiness and making some changes, whether it's culture or personnel changes there?

All of that going back to something else you were saying earlier is being very intentional about all of it. Sometimes we fall into this. The routine of it all and you just keep going. The next thing you know, you are burnt out and you have poor staff relations or whatever it might be. Being very intentional about it, building that culture, and taking the time to have that connection with a patient. If you plan to stay in this profession, you are going to be doing this every day for the foreseeable future. You may as well enjoy it and then you go home. If you have a family, you go home to your family feeling good and bring that good energy back to them as well.

The way things are aligned right now in the healthcare profession, it's not set up for you to be happy. Does that sound bad? The way managed care is set up administratively and regulatory, all the things that we have to do now, if you are not intentional with it, there's a good chance that you are going to fall into that 50% plus that feels burned out.

You made a great point. We do have control. Some things we don't have control over, but we have a lot more control than we think we do. How do we take control of our experience that we have when we go to work both with our patients with our staff? That's going to play into the experience that they have as well. Being intentional with it is something we have to do. The way things are set up right now if you weren't intentional, there's a good chance you are going to sooner or later fall into a place where you probably feel that sense of burnout starting to kick in.

It's unfortunate that the system is set up for not necessarily failure, but it's not set up for us to flourish and be happy. The way it's set up for whatever reason, for whoever has the impact on the system, eventually, it's evolved into what it is now. We have to take the control of it and do things to make it so that we can be happy in our own environment. Steve, to bring it all together, is there anything that we missed, any important things about burnout that you have learned, that you speak about that we should be sharing with the audience?

Experiment. Maybe set a goal over the next several months or maybe a year of what needs to look like for me to be happier going to work and experiment with that. Pull your staff together. A lot of times stress and burnout, we tend to fall into a sense of feeling like, “I need to do all this on my own.” Acknowledge it and maybe make it clear to your staff as well. I think they will appreciate that, “I want this to be a more rewarding and happier place for everybody.”

Let me hear your ideas. What are the things that we could change? What's stressing you out because there's a good chance maybe it's stressing all of us out. What are the things that we could start to change? We may not be able to impact everything, but again that is something that could help you, but it could also build the culture that you want as well and then keep tweaking it until you get to a point where you know you worked too hard and spent too much money. You took out too many loans to be unhappy.

Don't settle for that. I know that feeling. I enjoyed aspects of practicing, but there was a point where I had done it for a period of time. My path was odd because I did consulting. I'm not suggesting other people need to do something completely different, but I had to find my path. That took me into the business side of things which I had a greater passion for that, but that's not for everybody. What does that path look like for you even within clinical care? What are the things that you could change that start to restore some of that joy that you have for the profession? It's there. You have to find it.

The key thing is, in practice, changing the way eventually evolving and tweaking. Having the conversation, changing the way that we practice, and creating the environment that we want to have and the connections that we want to have at work will make us happy and then reduce the level of burnout.

The other thing if I could add is the profession of optometry, but so many other professions in this day and age allow us to do lots of different things that are related to our job like this. For example, a show, conference, teaching a class, or other stuff, or it could be totally different. I think of Dr. Danielle Richardson who's this yoga master and has her own clothing line, all this stuff that makes her super happy.

It's implementing those and making sure you have those types of creative outlets or any outlet that can help you stay passionate and keep the juices flowing. Personally, that's been super helpful for me. I love social media. I love this stuff. It's still relevant to work, but it allows me to like change my mindset a little bit. The clinical doesn't get super boring because I have switch gears to this and then I can go back to clinical and everything is still fun. That's my two cents on that as well.

It doesn't have to be work-related. I will say this too. There are so many opportunities out there that didn't exist when I graduated even within the industry to both balance the clinical aspect and the clinical care. There are a lot of opportunities now with consulting within the industry speaking. I found that I had a passion for speaking, consulting, working with other doctors, and writing. That's where the books came from. I love that.

There was a creative side of me that didn't get a chance to come out in the exam room. I found a lot of that, but are there things within the industry that you would like to do whether it's some consulting or some speaking? Do you have a unique talent or something unique area of expertise that you could build a brand around that? We both are doing a show. It’s things like that.

You made a good point. Outside of the profession, are there things that you could be doing that would bring more joy and reduce some of the burnout? Do you want to play in a rock band? Go dust off the guitar, and do what you want to do, but in my mind, I keep going back to the profession. The definition of insanity is doing the same thing over and expecting a different outcome.

Try something different and see if you feel better. The results will probably come pretty quickly like the doctor I mentioned before, he said, “Within weeks, I started to feel that sense of nice burnout starts to dissipate by changing a few things. Making a few simple adjustments to how I showed up for my patients.”

It can be that quick. It can. That's awesome. Thanks, Steve. I know you shared a few last thoughts there. Any final words you want to share related, whether it's to burnout or anything else? Maybe perhaps where can people find you and find your podcasts?

If you go to IDOC website, that's IDOC.net. You can find out more on the podcast there along with other things. The podcast is available on most podcast platforms. If it's audio, people probably couldn't see what you were doing before. You pointed to your eye. Eye Own a Business. See what we did there and then my own website. Do you want to know more about me? You can typically find me on social media or DrSteveVargo.com.

Thank you, Steve, for coming on to share your thoughts and your knowledge on this very important topic. Like I said earlier, it’s on the forefront of so many people's minds. Thank you to everybody who's tuned in to read this. As I mentioned before, if you found any value, please do share it. Take a screenshot, put up a link on LinkedIn, wherever it is, and let people know that we are having this conversation.

There's going to be a lot of information in here that's going to help the many of our colleagues who are suffering from burnout and help them get out of that rut so please do share it with them. Thanks again for tuning in to the show, Canada's number one optometry show. I will see you guys in the next 100th episode. Take care.