EP141: Thriving in Medicine: Preventing Burnout and Finding Fulfillment with Dr. Tamara Beckford

Breaking Free from Burnout: Insights with Dr. Tamara Beckford

In this episode, we host Dr. Tamara Beckford, a board-certified emergency medicine physician, burnout coach, and CEO of UR Caring Docs. Dr. Beckford shares her journey into burnout prevention, highlighting strategies for managing emotional wellbeing, work-life harmony, and creating healthier environments for healthcare providers. She discusses the three D's of burnout—depletion, depersonalization, and detachment—and emphasizes the importance of addressing burnout to prevent severe mental health issues. Dr. Beckford also explores the generational differences in medical work culture and suggests practical approaches, such as coaching and self-assessment, to foster harmony and longevity in medicine.

00:00 Introduction and Guest Welcome

01:03 Dr. Beckford's Journey to Burnout Coaching

01:43 Understanding Burnout: The Three D's

02:48 The Impact of Burnout on Mental Health

04:11 Challenges in Healthcare Training and Culture

07:12 Finding Harmony in Medicine

16:48 The Role of Coaching in Burnout Prevention

18:50 Therapy vs. Coaching vs. Friends

22:24 Overcoming Fear and Discomfort

26:27 Visualization and Journaling Techniques

28:08 Final Thoughts and Encouragement

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. I'm excited to have Dr. Tamara Beckford with us. Dr. Beckford is a board certified emergency medicine physician, burnout coach, and CEO of UR Caring Docs, where she helps high achieving women break free from burnout to live fulfilling lives. As the host of the Dr. Tamara Beckford Show, she's interviewed over 250 physicians on self care, resilience, and wellness. And she's become a leading voice in the conversation around preventing burnout. Tamara, it's an honor to have you here today. Thank you for joining us to discuss strategies for managing emotional wellbeing, work life balance, and creating healthier environments for healthcare providers. 

Tamara Beckford: Y'all, thank you so much for having me. I'm excited about this conversation. There's so much that we could talk about, but we have such limited time, but yeah, I'm really ready.

Christine Ko: Awesome. Okay. So you are well known [00:01:00] for being a leading voice in preventing burnout. Can I ask, what is your story?

Tamara Beckford: I started coaching because I started actually personal development in 2019, before the pandemic. And I recognized that in doing a lot of this personal development, by the time the pandemic came, I was thriving, and I didn't burn out during the pandemic. And I'm wondering, why am I thriving? I realized it was just some of these little tools. And I started to do workshops on self care. I started to really talk about the importance of stress management and burnout prevention. So I speak on and do workshops and then I also coach on it.

Christine Ko: That's amazing. Can you talk about burnout? 

Tamara Beckford: Absolutely. So burnout, for those who have experienced it, they're like, Oh, yes, it sounds like what I'm going through or what I went through. I usually characterize it by the three D's. The first is [00:02:00] depletion, which goes along with the emotional exhaustion of burnout. The second D is the depersonalization. That's when you start to just become cynical. You start using the phrase like, it is what it is. Anything that anyone asks you, it's what it is. And then you have this detachment. Where even though you're having a great impact, you don't feel like you are. And let's really think about all the things that we do on a regular basis when we're at work.

We're pouring our energies into work and to really get none of that emotional feedback is exhaustion, right? So once you start to have all three of that, then you start losing the meaning, and the sense, the purpose; that all wraps around into burnout. 

Now the reason why I am really concerned about burnout, although I recognize it is multifactorial and that, we can say, of course, we, the [00:03:00] institutions and the organizations that we work for, they have a role to play in it. But my concern is for the individual. When we don't address burnout, when we don't address what's going on, then we really have that bridge towards the mental health issues that can happen afterwards, right? So the anxiety, the depression, and then we know we lose a lot of our colleagues with death by suicide.

So those are some of the reasons why I am really passionate about burnout and about making sure that the story around it and the rhetoric stays in the forefront. And we don't brush it off like yesterday's news. 

Christine Ko: Yeah. It seems to me like the health care system is becoming more aware of burnout. It's being addressed a little more, but it does still seem like it is pushed aside. Like it's almost too late when someone starts thinking about it, like you said, they already have maybe a more serious mental [00:04:00] health issue and hopefully not have attempted suicide. Do you have an idea or an opinion about why we do wait so long? I 

Tamara Beckford: I think one of the reasons why we in healthcare wait so long: part of it is, although we should be able to recognize the signs, we've been trained to work through those signs. And it's part of our training of being a great doctor, being a great fill in the blank in health care. You go! And we reward these behaviors. And now we're at this juxtaposition where the behavior that we've rewarded are now causing some of the issues that we're trying to prevent. So what do we do?

When we think about, in medical school and your training, and you're moving from the didactics to the clinical years, there are so many people that have such [00:05:00] huge transitions, and they're not able to just smoothly move on, right? Because all of a sudden you've been studying, and you're studying your notes and then you can go to bed and get up and stuff, but then now you have to be up all night. And then you have to round and you have to be alert. And not only is, this is not paper anymore, this is a person. So, you start to realize, wow, this person's life is in my hands, the mistakes that are made. And then you can see how one internalizes all of this. And so when you're up, and you're able to do that great job, you're rewarded.

And so when we think about behavioral issues, right? If I'm rewarded for being up and doing such a great job, then this must be the way it needs to be. But, once we are inherently doing the same thing for years and years, it takes its toll. You always hear the rhetoric, Medicine is not the way it used to [00:06:00] be when I was a ___, and, yes, it's true. And you have the other side of the rhetoric, the newer generation, which is, they have better boundaries, and they recognize that it's not sustainable. And therefore, they're putting their foot down from early. And then you have the older docs who are saying, but who's going to do the work? So they get frustrated, and they just do it. How do we bridge that dynamic with the work ethics of the newer generation versus the work ethics of the older generation? How do we get that happy medium between the two? Where you have the working all the way throughout weekends, and no time off, and just continue going in post call, full day of clinic, working again on nights, being on call, full day of clinic again, being on call not getting that much rest, full day of clinic, you know... versus, we'll limit the amount of call [00:07:00] to this amount per month, and those who are on call and those who are in clinic will try to figure out a way that both can get a little bit of balance for time with their families. For longevity in medicine, there has to be a balance. And that balance, once we can find it, or even I think balance is now an old word, harmony is a new word. Once you get that harmony, then you'll have the longevity in medicine. Then you have those who feel like this, I can do this for a longer period of time, versus those who feel burnt out and after 10 or so years. They're like, this is not for me and I'm leaving.

Christine Ko: Yeah. So now maybe the better term is harmony. Do you mean harmony between the sort of the older generation who was used to this like, work medical culture and the younger generation that's putting their foot down and it's, that's not sustainable for us. We don't subscribe to that medical culture. Or were you [00:08:00] talking about a harmony of, for any individual, to be able to do the work and also live a life that doesn't feel frustrating? 

Tamara Beckford: Now that you've explained it that way, it actually ends up being both, in that the harmony between the two generations, because in order for both generations to coexist, they have to understand and be open to listening to each other. We are very dogmatic in our thinking, and our way is the right way. The younger generation feels their way is the right way, the older generation feels their way is the right way. However, there is a coexistence between both, and there's a balance that can occur. Now, when I mentioned the word harmony, I was saying that balance is now called the old term with work life balance. And it's more like harmony, which is the new term, which is how can we have things flowing? [00:09:00] Because there's never going to be true balance, but you can have a harmony . 

Christine Ko: Yeah. It's funny. I just had to give a talk that the title was given to me as work life balance. So I crossed it out. Cause I feel like there's just no balance. I've tried for many years. And there's no balance. I like this concept of harmony. The analogy that I decided to end with in my talk was a work life compass. To be aiming yourself toward meaning, whatever that means for yourself, but to have meaning in your life. I liked the analogy of compass because I realized that a true compass, a navigational compass: the magnetic north is actually slightly off from true north. It's 1200 miles off. And I felt like that was true for me too, that often I feel like I think I'm going in the right direction. I'm drawn to something, so that's the right thing to be pulled towards, but it might be way off or a little bit off, compared to true north, you know, where I should really [00:10:00] be going.

Tamara Beckford: I like that. You sit, and now you have to sit and decide what's the meaning to you, and what's important to you, the true north or your north.

Christine Ko: True north being whatever's true north for each individual. 

Tamara Beckford: Exactly. 

Christine Ko: No one else can decide for you. 

Tamara Beckford: Absolutely. And I love the fact that you get to decide that for yourself, that your true north is where you're working towards. And it doesn't matter where it is for someone else, because you know what it looks like for you, on your journey there. I won't say when you get there because we never truly get there, but along the journey towards that true north. Love it. 

Christine Ko: That's another thing too. Yeah, it's hard to know when you get there. I agree. It's, the destination always seem to be moving away. So when you talk about harmony or, we use an analogy of a compass, what barriers do you [00:11:00] think there are towards getting there? 

Tamara Beckford: Great question. I think one of the barriers that we have to getting to our true north is one of mindset. For example, if we have someone who's often been a type A workaholic, and then now they've recognized it's not sustainable, but those qualities got them there. And then they recognize that those qualities are no longer enough. And at the pace, they can't use those qualities to get them where they want to be, which is their true north, which is their harmony, which is them feeling fulfillment. The barrier to just making that change is so hard. Because there's a lot of fear. We start using terms like, all I know how to do is... Or, our [00:12:00] mind starts to catastrophize. Because we use the term, all I know how to do is fill in whatever the blank is.

Christine Ko: I think you're right. I think that what happens with medical training, medical school, and then the training, is you have such little time to do anything else. Increasingly, right? You become so time poor that really whatever hobbies you may have had or, outside interests outside of your job, become more and more atrophied, like not used, and you barely have time, maybe, even for the important relationships in your life. And so that kind of can atrophy as well. And so there's a high rate of, say, even like divorce, among physicians. And so it really, it sounds like you're saying that fear is really what holds us back and holds us to keeping our noses down on that grindstone. 

Tamara Beckford: Fear definitely keeps us [00:13:00] back as physicians. As you mentioned, we look at the rest of our lives, as you said, atrophied. But what we fail to do is look at all the skill set that we are developing along the way, you know. Being able to get in a room and connect with someone and to think logically about what's going on in a few seconds and to be able to make that diagnosis based on the history because 80 percent of the history you can make a lot of diagnosis that way. That's critical thinking, and those who are in other industries would marvel at someone that are able to do that. And you're able to help in other industries. But our minds are set to say, if I can't do it in medicine this way, then I'm not able to use this skill set at all. And I'm here to open people's minds to that to say, no, that's wrong. You are able [00:14:00] to use those skill sets. You can use all that you have learned, and that you have, to do other things and to be able to give your gift in other ways. So I really think we at times limit ourselves, but we have a lot more skills than we give ourselves credit for in medicine.

Christine Ko: So that's great. It sounds like you're saying that we do have skills. We're not just doctors. We really do, ultimately, we have skills in connecting with people and in critical thinking that is ingrained in what we do. And we can use those skills in other ways, if we want to, maybe, not do as much health care work. What would you say to someone, though, who really does love their job, but feels that the job is, like, overwhelming because of the way the culture of medicine still is. What advice would you give for someone like [00:15:00] that?

Tamara Beckford: That's a great question. For someone who loves their jobs, and I'll also want to preface this by saying that all the prior information that I've provided is just a scope for us to really think broadly. It's not to say that we want people to leave medicine. We want people to recognize the options that they have to contribute to using their skill set. So, if you love what you're doing, and you love your job, if you are feeling burned out, there's a great chance that there are others within the department who are feeling similarly. So what are some small changes that you guys can make in order to affect the small organization, which is your department, that you can feel and bring back that joy and peace that you had before you got to burnout, right? What are some small ways? And it doesn't have to be anything that's huge. [00:16:00] Maybe it starts with how you approach how you're feeling and then maybe you can move on to how you can start to implement changes and then move on from implementing to see if it works within your department, and then move it from your department to another, and then have the ripple effect cause the change that's needed. It's important that if you feel strongly enough and you want to be part of the solution in your institution or even in your department, that you can start that way. 

Christine Ko: Yeah. Do you have other practical tips to, if you do want to trailblaze, what are other ways to change the culture and set boundaries and prioritize self care? 

Tamara Beckford: Absolutely. For those who really want to get into effecting the change, coaching and having one to one personalized coaching of your physicians within the organization has been [00:17:00] shown to be beneficial. The JAMA article that came out in 2023 showed that for a cohort of women, it was a roughly a little over 200 women that did coaching in an eight week program, one to one coaching; and they were able to reduce their burnout by approximately 40 percent, but most importantly, able to increase their professional fulfillment by that 40 percent, and this is just within eight weeks. This is more than just executive coaching. This is really life coaching on how that they can find, like you say that harmony, and follow their North star and to be able to have, dare we say, balance. 

Additional ways, you can do an audit. How is your day? And how have you organized your day? What are you looking forward to by the end of the day? How is your energy level when you start? And how's your energy level when you end? What are the different interactions that you're having throughout the day? Are these interactions [00:18:00] infusing you with energy? Or are they pulling energy from you? Now, the ones who are pulling energy from you, are there any opportunities for you to limit those and the ones that are infusing you with energy? Are there opportunities for you to get more of those? You work on that little by little until you can bring in more things that bring you energy than you have that pulls energy from you. So the ones that pull energy from you, I call them energy vampires. So you want to limit the energy vampires.

Christine Ko: I love that. Okay. So, I have variably thought about coaching. I recently started therapy. I've asked several people what the difference is between, or not the difference, okay, I'll put it this way. I'll say, maybe if I had better friends, I wouldn't need a therapist. Can you talk about coaching versus therapy versus having awesome friends? 

Tamara Beckford: Okay. Alrighty. So we'll start with the [00:19:00] awesome friends. Shout out to all our awesome friends who've been there for us, who have seen us at our worst and has helped us to get up off the floor and put on clean clothes and get out the door. Love those people. Alrighty. So awesome friends are needed in all stages. So, irrespective of having a therapist or having a coach, having an awesome friend is still needed. So no one gets cut. Number one. Number two, having a therapist helps a lot of times dealing with, okay, issues or circumstances that got you to where you are. Unresolved issues that occurred in your past. So, the therapist will help you to break through and to give a little bit of clarity as to probably some of the behaviors and the thought patterns that you currently have based on the experiences that you've had in the past. [00:20:00] The coach helps you to break through to get to the place that you are looking for in the future. So, it's future based versus past based. So the future version of you, what does that look like? What are the goals that you're trying to accomplish? This future person, does this future person do the same thing that this current person does in order to accomplish those goals? And a lot of time the answer is no. This future version of myself is more than likely a little bit bolder. That future version of me, those goals that I accomplish, probably requires me to do some things that I'm really afraid of or requires me to really be in a state of discomfort. Can I make it through that state of discomfort on my own? Maybe I'll [00:21:00] just stay here in my comfort zone. Why? Because if we really think about it, everything's going so right here. Why would I want to go in a state of discomfort just to get there? That coach will help you through that state of discomfort to get to that version of you. And then when you get there, You realize, wow, I really did a great thing. And it wasn't as bad as I thought. So that's coaching. It's a guide to get you to that future version of you that you're looking towards, and it's really trying to help you. If we think of the life that you want to live, why not live that life now? So a guide can help you to get there, which is a coach can get you there, so that you can experience all that you really want to experience, especially when we talk about that North Star and that navigation. Instead of saying later on, especially as doctors delayed gratification Kings and Queens, I'll just delay [00:22:00] gratify. Well, why can't I do it and live that way? Now, what do I need to do to enjoy this now? That's what a coach does. 

Christine Ko: Yeah. Okay, cool. So it's almost like a coach is part of your compass, like a navigational guide, whereas the therapist sort of looks at what you were drawn to, like the ways in which your trip went off the right path and helps you through that. So it sounds like a coach can help you overcome fear, the fear and discomfort. And you said fear is a major reason why we stay and keep doing the same things we've been doing, even though we know they're harmful to us, or we just recognize that the culture isn't quite right for us, but what can we do? And plus we're used to it. And I think, I know even if I don't like things, it's still easier almost. It's. Oh I know what it's like at least, already. Yes. 

Tamara Beckford: And that's that comfort. It's a comfort in being in a setting that you're used to. Because, like, for some people, public [00:23:00] speaking is a huge discomfort, right? Getting on stage, palpitations, sweaty palms, feeling like the world is going to end. However, there are so many people who are very uncomfortable in public speaking, and they do it, they get over it, and then.... Now, they're like a master of public speaking. Like I've had some friends who were like that. They're like, I would have had to take propanolol even to do grand rounds, and then now they're on stages, and they're rocking stages. But in order to get to that phase, you have to move past the discomfort, irrespective of feeling the fear. You go on stage until it no longer is uncomfortable. 

Christine Ko: Yeah. Okay, great. So a coach can help you overcome fear and discomfort. Are [00:24:00] there other things you can do to overcome fear?

Tamara Beckford: Yes. Say you don't have a coach, visualizing yourself at the end succeeding is such a great tool. Visualization, aka our imagination, is a tool that we have really suppressed as we've gotten older. Let's think about ourselves as children, as they get older, we start killing their dreams. And we said, Oh, come on, be realistic. So the imagination starts to get suppressed. Now, when we get to this phase of where you're afraid of something, tap back into that imagination. And imagine yourself at the end of whatever it is that you're afraid of. So let's go back to the public speaking. Yeah, there's one thing about seeing everybody in underwear. I don't know, that wouldn't have worked for me. But seeing the round of [00:25:00] applause. Seeing the curiosity. What I love about public speaking is looking at the audience and then seeing when they glimmer, when everything clicks, and they light up like, Oh, now I see what you're talking about. So now imagining that is what gets me out there on the stage and not sitting and thinking, Oh, you're going to trip and knock out your two front teeth. I don't know why you went up there on the stage in the first place. It gets you beyond that. Seeing the value that you bring, being able to visualize that person who's coming up to me afterwards and saying, wow, I'm so glad that you mentioned that because I noticed that A, B, and C, and now that you've given me this tool, I'm going to use it because I saw myself doing what you mentioned. All of that supersedes me worrying about what's going on or what will happen to me. 

Christine Ko: So, you are a [00:26:00] coach. Have you seen common scenarios, or just common struggles, that you could talk about and ways around them?

Tamara Beckford: Absolutely. A common struggle is feeling that you have no control. Especially when you're really deep within burnout, everything feels insurmountable because you're just exhausted. Now, this is also a tool: visualization and journaling and writing things down. Because a lot of times we keep things in our head, and we can't really see the forest from the trees. And when you write down what's actually going on, what we feel we do not have control over, and we start to look at it. There's a great percentage of that that it's not really true. So getting to that realization of, wow, that's not true, but that's a rhetoric that I've kept in my mind [00:27:00] consistently. That's a breakthrough. So that's part one. 

Then part two is saying it out loud. When we hear ourselves saying the things that we've written down, it even breaks it down even further, and it reinforces like, Wow, this is really not true. Then we look and say, what is true and what can I do about it? And then we start to break down the barriers. Where would I like to be and where am I now? What are some steps that I can take towards getting there? We start working on those steps because once you have a step towards it, then this feeling of, I have no control. I'm just stuck where I am. It starts to fade away. Because you realize, I'm not stuck. This is just a temporary journey. This is just a page in the book of my life, right? But while you're going through it, if you have not [00:28:00] addressed it, it feels like it's 35 chapters.

Christine Ko: Endless chapter. 

Tamara Beckford: Endless chapter. 

Christine Ko: Do you have any final thoughts? 

Tamara Beckford: Yes, I do. I really want to encourage those who are feeling that they're stuck, I really would love for you, even if you just do that quick exercise that I just mentioned, just know that right where you are right now, like I said, it's just a page in this journey that you have called life. And there's, usually, 99 percent of the time, there is an opportunity for you to change the situation. Now they're external and they're internal. The externals are a little bit easier. The internal requires work, and when you're ready to do the work, the other side, it's so pleasant. So I encourage you to [00:29:00] not give up, to seek the help. If it is a coach, if it is a mentor, if it is best friends, to just seek the help and to start on this journey to the life that you truly want to live and really soak it up when you get there.

Christine Ko: That's awesome. Thank you so much. 

Tamara Beckford: My pleasure.