EP156: Defeating Burnout: Dr. Kathy Stepien's Empowering Insights

Overcoming Burnout: Insights from Dr. Kathy Stepien

In this episode of The Girl Doc Survival Guide, Dr. Kathy Stepien, founder of the Institute for Physician Wellness, shares her journey from experiencing burnout as a physical therapist to thriving as a pediatrician and coach. She discusses the importance of self-compassion, setting boundaries, and recognizing one's own capacity in order to prevent burnout. Dr. Stepien offers practical advice, such as pausing before making commitments, being mindful of emotional exhaustion, and monitoring irritability. The conversation highlights the significance of human connection and reaching out for support in overcoming feelings of being stuck.

00:00 Introduction to Dr. Kathy Stepien

00:36 Breaking Free from Self-Sacrifice

01:49 The Silver Lining of Burnout

02:44 Skills to Prevent Burnout

04:41 Setting Boundaries and Saying No

12:17 Recognizing and Addressing Survival Mode

14:37 Message to Those Feeling Stuck

16:27 Conclusion and Final Thoughts

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. I'm pleased to be here with Dr. Kathy Stepien. Dr. Kathy Stepien is a pediatrician who knows firsthand the cost of putting everyone else first. After experiencing burnout in her first healthcare career as a physical therapist, she transformed her approach to medicine and founded the Institute for Physician Wellness where she's helped thousands of physicians move from surviving to thriving. Today, she'll share practical insights on breaking free from survival mode through self compassion and community. Welcome to Kathy.

Kathy Stepien: Thank you. It's great to be here.

Christine Ko: You've made a comment that you come from a long line of women who never stop. How did you break free from that pattern of self sacrifice?

Kathy Stepien: To be honest, that perhaps was one of the gifts of burnout. Recognizing that it's just hardwired in me to go and take care of everyone and always be [00:01:00] doing and helping and contributing and actually finding meaning and joy in a life committed to service of others. But at the same time, really not having the skills or insights about, wait a minute, where do I fit into that? And, the old adage about, you can't give from an empty cup. Sooner or later that cup does get empty and then what? And so recognizing then that caring for myself is an essential piece of allowing me to be an excellent physician, to help other physicians, to be the mom I want to be, the partner and community member and all the other roles that I have. Through my experience of burning out that I realized, oh, wait a minute. Although it's hardwired, something's got to change if I'm going to be in health care. 

Christine Ko: The silver lining of burnout is maybe that you realize to have more self compassion. When you experienced this burnout, I believe you were actually in your first career as a physical [00:02:00] therapist?

Kathy Stepien: I was, and I really loved physical therapy, so many things about it, but I don't think I had the skills to be able to navigate a career in a helping profession without over giving. And at some point, I didn't have anything left to give. It's interesting, and I think this is a common story with many of the women physicians that I work with where I rollercoastered in burnout for a while as well. I would do things and I'd feel a little bit better and then I'd just feel burned out again and then rollercoaster feel better and up and down up and up for years actually. When I was changing careers and decided to go into medicine, I knew I needed to do things differently, or I would burn out in medicine as well. 

Christine Ko: I like how you put that you didn't have the skills to not get burned out in a helping profession. What skills do you think you learned that have prevented you from becoming burned out again in this second career as a pediatrician or even third career also as a coach? 

Kathy Stepien: Actually, there's so many. It's hard to narrow it down to just [00:03:00] maybe the few, but a big one is recognizing what is mine to carry and what is not mine. For those of us who are socialized to be helpers and go into medicine, it's so easy for us to take on the responsibility of others. We care about our patients, and so we carry that emotional piece of it as well. We want to be part of a team, and so we offer to help and overextend ourselves. We get appointed to certain committees and boards, and much of it is super fun, and we want to be doing it, and so it's hard to limit that. But to recognize, oh, wait a minute. This is mine. This is my responsibility. And that is not my responsibility, and letting go, and even being okay with what's not mine to carry, even if it disappoints others. So we carry stuff often for many reasons, but one of them is because other people will be disappointed. Letting go of people pleasing, letting other [00:04:00] people own what they are feeling, and not carrying that for them has been a big piece for me as well.

Christine Ko: Yes. I was talking to Jessie Mahoney and she called this over responsibility where we're taking responsibility for things that we don't necessarily have to. And then, I think the second piece of it, or part of it is, as you said, we tend to be people pleasers in medicine. So we don't want to say no to things. Once you have said yes to something, it is your responsibility. It's not over responsibility to take responsibility for something you've said yes to. But I think a lot of us say yes, even when we already know that we're past capacity. As you said, we don't want to disappoint someone else. When I'm at capacity, I have to say no and be able to hold that boundary. And it's hard. I find it hard. Do you have tips on how to overcome the tendency to not want to disappoint others? 

Kathy Stepien: I'm so glad you brought up boundaries because I think that walks [00:05:00] really closely with the recognition of what's mine and what's not mine. And I think you're really onto something so important here. Boundaries can be very difficult for a lot of reasons, and it might be different reasons in different situations. Sometimes we overextend ourselves because it truly is fun, or it's part of a career step, and we love it. Yes, I can do that and thank you for the invitation. And, in that way, it's almost like we're not having a boundary with ourselves with recognition of we do that. We say yes without perhaps fully recognizing if we say yes to that, what we are saying no to. Recognizing that it's a compassionate move for ourselves to recognize what is reasonable, what am I setting myself up for? What am I committing? And often it's really fun stuff. And so we want to do it, but also recognizing that maybe it would be more kind and less exhausting to not do it all at the same time, right? We can not try to do it all at the same time or all at [00:06:00] once, that there's room for joy in what we are choosing to pour our energy and time into. Another piece of this: it can be hard to set and manage those boundaries, for many reasons, but one of the reasons is because we're so worried about what other people will think or say or do. We'd like to think we're not in middle school anymore. The chit chat at the nurse's station or the comment about, she doesn't really care about her patients, or whatever we're thinking people might be saying when we set a boundary. That actually impacts us more than we might realize: they're going to think I'm not a good doctor. They're going to think I don't care. Whoever they is and whatever they are thinking really is none of our business. Because we know we're a good doctor. We know why we say yes to some things and no to other things.

So letting people be disappointed, letting people own whatever they're going to think and recognizing that when we set a boundary, it's a reason that is in alignment with who we are [00:07:00] with our core values, with how we want to show up in the world. And it makes sense to us, and it's okay if it doesn't make sense to them. 

Christine Ko: I was talking to a friend and colleague, Markus Boos, and he said it's hard. It is hard for us to stop thinking about what other people think because in medicine during training, our success is dependent actually on how other people are evaluating us, what they're thinking of us. There are just so many years of medical training where, I do think, to be a good doctor, you do have to be aware of what other people are thinking of how you're doing and where you're measuring up on whatever scale or whatever task it is. When he said that, I felt oh, that makes sense that then we, in medicine, we're trained to be aware of what others are thinking about us and saying about us. And, so it becomes even more difficult.

Kathy Stepien: It certainly can be the [00:08:00] water in which we swim. We're in this culture where through our training or through socialization, we feel like, a threat to our safety if we're not aware of what other people are thinking. It can feel, especially during training because of the power differential and the kind of the vulnerability of the situation, it can feel quite threatening. Even if it's not consciously, we feel it in our bones, right? We feel it where it's, oh, this matters, and that can really shape our behavior. We might show up in a different way. And two things. One, I would say, is that really true? Like, we should be showing up authentically and our best self, no matter what, however we're being evaluated. So part of it is, yes, we're in a vulnerable position by nature of the training itself. But also recognizing that regardless of what they think, we're still there to learn and develop our skills and be our best self as a physician. The second thing is, at some point, we are not in [00:09:00] such a tenuous training situation, and we become attendings and move forward in our careers. One could argue that, especially if you're an academic medicine, one could argue there's always going to be a piece of that. But coming back to that sense of safety, we can trust ourselves to set healthy boundaries, to be really clear with expectations and manage them, because we know that we are safe, that it is safe to do that, and we can trust ourselves to make those decisions and that distinction in a whole variety of situations.

Christine Ko: Yeah. I want to just go back to something you said a little earlier that sometimes it's not even disappointing others, but we don't want to disappoint ourselves. And that's why it's hard to say no. It resonated what you said that sometimes I'm saying yes because I want to do something. I enjoy my job quite a bit. I love my job. So, I want to say yes to giving a talk in Germany. I want to go to Germany, and I want to give the talk. Do [00:10:00] you have tips or tools to help prevent me from doing that?

Kathy Stepien: Oh, I can completely relate. I love to just throw myself into things wholeheartedly, and it's almost, oh look, you know, another squirrel! Or, I'm in a candy shop, it's, oh, I like that too! Right? Especially when we really enjoy it, it's so easy to overestimate what we can do. I have found for myself one thing that can be helpful when I get requests is to give myself a pause. Rather than answering immediately or when I first learn about an opportunity or someone's reaching out to me, I try to give myself a little space to decide. I don't make the decision right away. I don't reply to the email right away. And if it's an in person request, I'll say, Thank you for asking me, and, How about if I get back to you at the end of the week? or, Let me check my schedule and I'll get back to you, depending upon the situation. And so, by buying myself a little bit of time, I can let it sit and [00:11:00] digest a little bit. I can look at my calendar, the practical piece of it. But I can also just touch base with, where am I at? What's my bandwidth at any given moment? Or, what do I expect it to be in 6 months when I say yes to a commitment? Taking that extra pause has been super helpful tool for me.

Christine Ko: I like it. You said pause, space, wait.

Kathy Stepien: One of the things that goes along with that , by giving a little bit of time to wait and then decide, it allows us to continue to love what we're doing. It allows us to say yes to the things we most want to say yes to. We can set down that scarcity mindset that we need to be doing it all, all the time, everything all the time. And, it creates the opportunity or the situation for us to continue to love medicine and continue to contribute in a way that really lights us up and makes a difference. We get to share our time and our talents without feeling depleted. Although it may feel [00:12:00] adulting to pause, reflect, give ourselves a little time to decide, it's in virtue of our best self. In doing so, we get to keep enjoying, and don't overextend and then get resentful that we're taking a red eye flight to Germany or whatever it might be.

Christine Ko: Exactly. Do you have any tips on how you might recognize that you're in survival mode before you hit burnout?

Kathy Stepien: I wish we had a green, yellow, red. Boy, so often we're in green or we're in red, and we miss that yellow light. What are some of the indicators before we hit full on burnout? I think looking at how it is that we're interacting with others. I find that when I'm feeling a bit depleted, I'm not as patient with my family. I might not be as patient with my staff or with patients themselves. And it feels just terrible. And if I ever find myself just answering a little more shortly, or not listening; not treating other people like how I would want to be treated, [00:13:00] then I'm like, okay, that for me is an indicator like, Oh, yellow light. So that's a big one for me. I think also for many physicians, that feeling of emotional exhaustion, if you are leaving the clinic or the hospital at the end of the day, and there's just a feeling of spent, not tired in a good way and feeling good about the contribution you made in that day, but just going home and feeling like exhausted in a different way, exhausted in a way that feels very hollow. If that's there, that's another yellow light.

Christine Ko: Other people have said that on this podcast as well, that being irritable is a sign that maybe there's impending burnout or you already are in burnout. If you're feeling irritable, you shouldn't be saying yes, even to super fun things. Hopefully it's just a yellow light and you're not quite there yet. So what do you recommend when you see those yellow lights going off? What would I do? 

Kathy Stepien: A big piece of it is giving ourselves permission to be human, to [00:14:00] even have a yellow light, right? So often we have expectation of perfection, and we just push s so hard, and we can be so harsh for ourselves. You know, if we're feeling a yellow light or we see the red light coming, we're just feeling spent. A bit crispy is how I think of it. Giving yourself permission to be human. Permission to feel tired, permission to take some time to recharge in a deep way, really honoring what we need to be well. It's stepping back and just allowing ourselves to be human and have human needs and developing skills to make sure that those needs are met.

Christine Ko: I like it. Do you have a message to anyone listening in right now who feels stuck?

Kathy Stepien: Oh, my heart goes out to people. I know what that can feel like. And I've had so many p hysicians share that with me that they're just in this rut and don't know how to get out. And they just feel so stuck. One of the things I hope everyone understands, and certainly as a physician, the neuroscience is [00:15:00] really clear: when we are feeling that way, the brain function changes. We just are not able to have a more expansive view. We're not able to see the path out. We want to know what it is. We're going to keep searching, and try solving for X. We try to keep solving it. But actually, when we're in that kind of depleted state, our brain function changes, and we just don't have the same capacity to get unstuck. Be gentle with ourselves when we are feeling stuck, recognizing that it's not a sign of weakness, that it, too, is part of the experience of being a physician. For the majority of physicians in our country, at some point, we may have symptoms of burnout. Recognize that although our brain is telling us, and our body might be telling us, we're really stuck, that it's not true, that we're really never as stuck as we might like to think that we are. We have so much to give that there's so many more [00:16:00] options that we might not be able to see at the time. Reach out and connect. That human connection. None of us have to practice medicine alone, and none of us have to feel stuck alone, and connecting with others and recognizing that you're not alone. There's a path out of it.

Christine Ko: Yeah. When we feel stuck, we're not going to be able to find that path out ourselves. But hopefully if we are able to ask for help, individuals around us can help us get unstuck. That's a good way to end. Thank you so much for your time, Kathy. I really appreciate your insights. 

Kathy Stepien: Thank you for having me. It's great to visit with you.