Have you been feeling frustrated, angry and irritable as a result of interaction with your patients and staff? Have you been experiencing physical symptoms, such as digestive problems, headaches and backaches, while at your practice or when thinking about it? Have you been crawling deeper and deeper inside a liquor bottle or cocktail to escape the stressors inflicted on you by work? Have you taken solace from work by using narcotics?

If you answered yes to any of these questions, you may be experiencing private-practice burnoutemotional exhaustion due to mental stress inflicted by the day-to-day goings-on in your private practice. (See Other Symptoms of Burnout).

Other Symptoms of Burnout
The following are other symptoms of burnout, according to those interviewed:
1.   Loss of focus.
2.   Loss of enthusiasm for optometry.
3.   Boredom.
4.   Forgetfulness.
5.   Difficulty concentrating.
6.   Insomnia.
7.   Withdrawal from career and family.
8.   Procrastination.
9.   Loss of sexual desire.
10. Cynicism.
11. Clinical depression.
12. Mental and physical lethargy.
13. Inability to replenish after vacations or time off.

Burnout can affect as many as 40% of U.S. physicians, according to an American Medical Association article.1 Also, one in five physicians report significant career dissatisfaction.2 

A live poll posted on Review of Optometry online (www.revoptom.com) revealed that only 11% of re-spondents do not experience any stress from their private optometric practice. Meanwhile, 33% of re-spondents said they were very burned out due to private-practice stress, and 12% of respondents acknowledged being on the verge of a nervous breakdown as a result of stress inflicted on them by their private-practice.

Burnout is like a leech. Instead of sucking your blood, however, it slowly sucks your soul, leaving you feeling physically and emotionally depleted. But, you can detach this situational-induced parasite by following these four steps.

Admit Youre Burned Out
The first step in conquering burnout is to acknowledge its occurringsomething many health-care professionals deny until theyve hit rock bottom, says Peter S. Moskowitz, M.D., founder and executive director of the Center for Professional and Personal Renewal (CPPR), a Palo Alto, California-based organization that provides career and life coaching to health-care professionals.

Burnout can affect as many as 40% of U.S. physicians, according to an American Medical Association article.

Most healthcare professionals have been trained with a work ethic that expects them to be married to their discipline; to just accept whatever time, if any, is leftover for family and themselves, he says. Older health-care professionals tell me that their instructors never discussed stress management or the importance of selfcare.

As a result, these people have poor stress management skills and view symptoms of burnout as a weakness, he says. They shut themselves down emotionally, denying that theyre unhappy and exhausted and that things are not going welluntil they inevitably spiral out of control.

Sound familiar?

Dr. Moskowitz experienced burnout first-hand as a private- practice pediatric radiologist. There was just this point when I came to realize that, although I was very successful professionally and had what appeared to be an ideal life on the outside, on the inside I was dying, he says. I was killing myself with work, and it took almost losing my wife and kids to make me realize I was in real trouble. I never should have let it get that far.

While this scenario is not strictly reserved for the baby boomer health-care professional, Dr. Moskowitz, a baby boomer himself, says that most of his clients are mid-career professionals who have let stress get too far. This indicates that burnout is more prevalent among older heath-care professionals. One reason younger health-care professionals may be better off than their predecessors: acknowledgement by academia that stress is a viable problem.

I spend half of my time teaching pediatric radiology at Stanford Medical School now, and for reasons I am not entirely clear about, my students, residents and fellows know all about what life-balance means, he says. As a result, they have well-developed stress management skills upon graduation.

Many health-care professionals deny they"re experiencing burnout until they"ve hit rock bottom.

Currently, several U.S. schools and colleges of optometry, such as the State University Of New York (SUNY) College of Optometry, offer on-campus counselors to their aspiring O.D.s. The counselors are available to help students cope with their personal lives and workloadeducation that inevitably prepares them for the working world. Also, Nova Southeastern University College of Optometry, in Fort Lauderdale, Fla., offers a course for its first-year students called Strategies for Success, which delves into time and stress management.

The bottom line: Stop pretending that what youve been experiencing at your private practice is not wreaking havoc on your emotional health, and take comfort in the fact that, despite what you may or may not have been taught, stress is now acknowledged as a surmountable part of the practice of optometry.

Identify the Cause
If youve accepted that youre burned out, identify the specific causes of your burnout, says John A. Fromson, M.D., assistant clinical professor of psychiatry at Harvard Medical School and chair of the American Psychiatric Associations Physician Health Committee.

While no single specific cause of burnout has been identified, seven factors have been found to contribute to the occurrence of burnout in individuals working in the field of helping, according to Fundamentals of the Helping Process (Waveland Press, 2004), a book penned by psychologist Richard D. Parsons about the training and skill development needs of these individuals. The seven factors are:3

1. Unrealistic expectations. You have unrealistic expectations about what you can do to help a patient and the speed at which you can do it.

2. Overpersonalization. You take too much personal responsibility for the actions or experiences of your patients, and you shoulder the blame for the lack of progress or the limited success youve had with a patient.

3. Loss of objectivity. You identify too closely with your patients and their problems, thus losing the ability to view the situation and process objectively. As a helper you should care, but care professionally.

4. Task overload. You feel that you have too much to do and not enough time or energy to complete daily tasks.

5. Poor organizational skills. It is not the amount of work you have, but how you go about accomplishing it, and you know it. You just cant seem to achieve efficiency.

6. Failure to care for self. You are unable to say yes to yourself. You do not take a lunch break, you take work home, you dont remember the last time you took a vacation, let alone a day off, and youve sacrificed hobbies, your health, etc. 

7. Lack of support. You feel as though you must handle your own problems and the problems of your patients alone.

So, how can you overcome these seven factors? By doing something else many of you resist: seeking help.

Seek Help
Most health-care professionals are trained to be independent and tough; theyre taught that theyre not supposed to have any emotional problems, and if they do, they should handle them alone, says Dr. Moskowitz. Break free of this isolation by finding a person or organization you feel comfortable enough with to discuss your feelings, says Dr. Fromson. There are three sources you can turn to:

A colleague. Talking to an-other private-practice optometrist about a belligerent patient, difficult case, managed care, problems with your staff and other issues inherent to private-practice optometry is not only freeing emotionally, but enables you to get a different perspective on the problem and feedback on how that colleague would handle the situation, Dr. Fromson says.

Optometrist Ernie Bowling, of Summerville, Ga., agrees. I dont think I could make it [in private-practice] if I didnt have my buddies from optometry school to call on from time to time, he says. Misery loves company, and I guarantee you that somewhere along the line, somebody else is going through the same exact thing you are, and that person can tell you what hes done to make it better.

Anyone involved in intensive health-care must have four characters in his or her friendship circle whom he or she can rely on, says psychologist Robert J. Wicks, a professor at Loyola College in Maryland and author of Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to Pro-fessional Resilience and Personal Well-Being (Oxford University Press, 2006) and Riding the Drag-on: 10 Lessons for Inner Strength in Challenging Times (Sorin Books, 2003)

These characters are the prophet, the cheerleader, the teaser and the soul friend. The prophet asks you: Who is pulling your strings? This person, though not well-liked, is important because he gets you to begin to realize that youve relinquished a lot of your power to patients, supervisors, family and friends.

The cheerleader is also needed because a prophet alone in your life will burn you out, Dr. Wicks says. The cheerleader encourages you and is very sympathetic to your situation.

The teaser does not allow you to take yourself too seriously, which is is important because on the way to taking your health-care profession very seriously, you often wind up taking yourself too seriously, and thats a great danger, he says.

Finally, the soul friend is one who champions you to be all you can without embarrassing you that you are the way you are, Dr. Wicks says. Once you talk to these four friends, you feel more integrated emotionally and that your perspective has come back.

A psychiatrist, psychologist and/or career counselor. Dr. Moskowitz was able to emerge from the depths of burnout with the help of a psychiatrist who a friend referred him to and a career counselor. I went to a local career center and took some tests that helped me to reassess what my career values weremeaning my attitudes about the basic aspects of work, such as: Do I like working alone or in groups? he says. The career counselors also helped me to determine what specifically needed to change to make me happy in my work environment. The reassessment, however, revealed that my career values had changed. How? Dr. Moskowitz discovered that he wanted to go back to teaching pediatric radiology part-time and that he wanted to help improve the lives and careers of health-care professionals like himself by going back to school to become certified as a career/life coach and open his own career counseling center, he says. He works there part-time, too.

Stress management support. Search on the Internet for stress management support groups and associations, and ask both your colleagues and state optometric association if they can recommend a person or support group you can confide in, says Dr. Fromson. Examples of stress management associations: the Center for Professional & Personal Renewal (www.cppr.com), the Center for Professional Well-Being (www.cpwg.org) and the Renewal Group (www.renewalgroup.com).

Asking for help does not mean that you have a weak character or that youre in the wrong field, says Dr. Moskowitz. It shows initiative because these resources can help you develop a visionno pun in-tendedto improve your mental health and hold you accountable for making that vision a reality, he adds.

Make Changes
After talking to colleagues, a psychiatrist, a psychologist, a stress management group and/or a career counselor, you will come to one of three conclusions:

I want to stick with private-practice optometry and make the necessary changes to restore my happiness and enthusiasm for it.

I want to look into another specialty within the field of optometry, such as teaching.

My career values have changed, and I want to try a career that jibes with these new values.

Most of you will probably come to the first conclusion. After all, youve invested an enormous amount of time and money in your private practice. If this is you, be vigilant in using the tools youve been taught by the folks youve sought help from, says Dr. Fromson. (See Techniques for Overcoming Private-Practice Burnout.)

Techniques to Overcome Private-Practice Burnout
By Robert J. Wicks

1. Vary your schedule during the week. That way, a routine such as 10:00a.m. to 6:00p.m., every day doesnt lead to monotony.

2. Take part of your lunchtime for a short walk. If your practice is located in a mall or medical building, go outside to increase your oxygen exchange.

3. Break up the day with telephone calls to friends and family.

4. Keep your enthusiasm for the profession alive. Do this by reading articles and books that are in line with a particular diagnosis or disease youve encountered during your daily practice. Also, seek to share the knowledge you have by preparing handouts for your patients. Arrange opportunities to lecture at the local community college or senior center about vision care and common dangers to watch for at different stages of ocular disease. Finally, seek out stimulating continuing education opportunities.

5. Develop a self-care protocol. This should include an annual health exam and participating in leisure activities, such as visiting a museum, going out to eat, reading, watching a movie or visiting an historical site. This protocol should also include physical activities, such as walking and swimming.

6. Schedule time for personal debriefings, meditation, reflection or quiet time. This should include psychological, spiritual, philosophical or motivational reading as a way to strengthen your inner life.

7. Schedule enough time with family and friends so that life isnt totally work-centered.

All the above suggestions are tied to two basic questions: Am I finding meaning and enjoyment in my work and life? If not, how do I address this problem? If so, how do I ensure, given that life changes constantly, that I can monitor my life and move with it so the meaning and joy continue, albeit possibly in a different way?

To be resilient, you have to take decisive action. So tell yourself, for instance, Im going to start to say no when I feel too many patients are being scheduled be-cause Ive learned that diligence and industriousness do not go hand in hand with overload, Dr. Fromsom says.

Many people are able to restructure their jobs so that theyre happier, but some also come to realize that, due to circumstances beyond their control, theres no way to modify that job to the extent they need to in order to be happy, says Dr. Moskowitz. If this is you, look into a different facet of optometry, or find a new practice with values and a work style that are in better alignment with your own.

Just because one facet of optometry does not meet your needs, that doesnt mean that all facets of the field wont, says Dr. Fromson. Try practicing in a group setting, teach, become a military O.D., work for an eye-care company. There are just so many different venues.

You are different from many of your friends and neighbors in that you are your own boss. This means that you have the power to implement the changes you feel will make you happy again. So, make these changes, assess how they are working, and free your soul from the parasitic depletion of burnout.

1. Brody DS, Brody P. Clinical Case 3: Managed Care and Physician Burnout. September 2003, Volume 5, Number 9. AMA: Helping Doctors Help Patients. URL: www.ama-assn.org/ama/pub/category/10965.html. (Accessed 10, January 2006)
2. Linzer M, Visser MR, Oort FJ, et al. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001 Aug;111(2):170-5.
3. Parsons RD. Fundamentals of the Helping Process by Richard D. Parsons, M.D. (2004) Long Grove, Il: Waveland Press. p. 149-150.

Vol. No: 143:02Issue: 2/15/2006