By MICHAEL E. LIPKIN and RUSSELL S. TERRY, JR.

Burnout has always been a concern in medicine, and that concern has been amplified by the added stress of COVID-19. Many months into an unpredictable and distressing situation, we have both hung on to our mental health and professional passion by seeking out strategies that work for us. We offer them in two perspectives: veteran and relative newcomer.  

Dr. Lipkin: A Veteran’s Perspective

When lockdown began in March, we slowed down my practice for about 6 to 8 weeks, and then returned to full pre-COVID levels. It feels like the uncertainty has affected me most, since it has not been clear if and when things will get substantially better. Everyone is both experiencing and projecting persistent anxiety, stress and uncertainty. Isolation is a problem as well. I no longer have the time or ability to sit down with colleagues and vent over a beer, which was an outlet I counted on to mitigate burnout. At the same time, on a more concrete level, the pandemic has made everything we do incrementally more difficult, which is grindingly stressful. These tips are helping me cope and avoid burnout.

There are so many changes—just accept them. As COVID affects so many areas of practice, there’s a kind of low-grade stress that fluctuates with events. It seems like everything is a little bit harder. We have to shift some patient visits to telehealth and make sure they get COVID tests before surgery. We’re all looking over our shoulders, wondering who’s going to get us sick. There’s always the specter of more shutdowns and how they might affect our livelihoods. Budgets have been cut back, so hiring is frozen and there’s virtually no incremental spending. Everything will stay this way for now, so the best thing to do is accept that we’re going through a tough period and focus on the big picture, rather than the list of irritations.

Look forward to something. The day-to-day grind can get dreary, so plan something to look forward to professionally. You might sign up for a virtual meeting. I like to speak and teach, so I’ve done some industry webinars and an asynchronous course at the American Urological Association. New technology is something to look forward to as well. I’m looking forward to soon trialing the MOSES 2.0 holmium laser for kidney stones. Surgical technologies can make our jobs faster, easier, more enjoyable, and less stressful, so I’m excited to try this new 120Hz holmium laser, which promises to make my work more efficient. We might have a trial for single-use ureteroscopes to look forward to in the future as well.

Get moving—preferably outdoors. I started running during this crisis, and getting outside by myself to exercise has helped me clear my head. Running helps make me feel relaxed. Sometimes it’s hard to garner the motivation to actually do something different, but it pays off if you find something that works for you.

Be thankful. When you’re feeling bogged down in the midst of this crisis, it helps to be thankful for day day-to-day victories. We’re all fortunate to have the opportunity to impact people’s lives in a positive way. It can be wearying at times, but it’s worth being thankful for our work. And the appreciation patients are showing for their physicians right now frankly feels pretty good.

My son now has us do something called “roses, thorns and blooms” at dinner every night, where each of us names something positive that happened that day, something that bothered us, and something we’re looking forward to. It’s been a good reminder for me that good things happen every day, even if they’re small.

Dr. Terry: The Newcomer’s View

In March and April, when everything ground to a halt, I was a second-year fellow at Duke University working on my robotics training. They had to limit staffing to one trainee per OR, so residents covered the reduced caseload and fellows like me worked from home on research and remote tasks like reviewing patient charts. It was a very strange transition. I’d been going in early and staying late through years of college, med school, internship, residency, and fellowship, and then all of a sudden I had to figure out how to fill these quiet, no-structure, work-from-home days.  

On the positive side, I got to stay home and spend more time with my 9-month-old daughter than I ever thought would be possible. The downside was the aimlessness, which felt very stressful. I returned to Duke in May and finished my fellowship in mid-August, and then we moved to Gainesville, Florida, where I’ve been settling into new positions at University of Florida and the VA Medical Center during the pandemic. Throughout all this upheaval, a few tips have helped me stay balanced instead of burnt out.

Turn off the news—and call your family. Early in this pandemic, I had to stop watching the news because the overwhelming negativity was stressing me out. I lived and worked in a bubble, and it actually helped a lot. I replaced that focus on the outside world not only with my work and my wife and child, but also with loved ones I suddenly had time to catch up with via phone, text or FaceTime. It’s something I’ve continued because nurturing those close family relationships has been beneficial for my mental health and boosted my resilience, as well as helped my family get through the crisis.

Enjoy your coworkers. During lockdown, isolation from coworkers was tough. Whether we’re venting, telling jokes, or talking about our families, it’s energizing to be around people that are like-minded and enjoy working hard on the team that supports you. One of the most enjoyable parts of coming back to the hospital was getting into the OR with our familiar circulator nurses, scrub nurses and residents. Now I appreciate the people I work with more than ever.

Say no when you need to. One of the most consistent pieces of advice I’ve gotten from mentors is not to feel pressured to say “yes” to everything people ask of me as the new guy. That’s even more important now, when COVID makes many things take longer and require more resources. In addition to my responsibilities with patients, I’m now onboarding at two institutions and moving into a new house, so I’ve tried to restrict extra activities. I was asked to help screen residency applications this year, which is something I normally love to do, but I surprised myself by saying no. It’s the right decision because stretching myself too far could affect the quality of my work and certainly would add to my stress. This is a marathon, not a sprint, and I’m trying to treat it that way for now.

Focus on the good you’re doing. When we came out of lockdown, a triage system moved acute cases to the front. Virtually all of our first cases were high-risk cancers. As an endourologist who does a lot of stone surgery, I was also doing kidney stone procedures on patients whose severe stones had resulted in serious infections. Instead of procedures that improve quality of life, we were doing mostly life-saving surgeries. Operating on people in acute physiological distress felt very meaningful, and it helped create urgency about our work. We were eager to get there every day. The experience has also given me a greater appreciation for all the people and the actions it takes to get our patients to surgery and care for them postoperatively. I see the good we’re all doing as a team.

Michael E. Lipkin, MD, is Urology Clinic Chief and Associate Professor of Surgery at Duke University, Durham, North Carolina.

Russell S. Terry, Jr., MD, is an Assistant Professor and Director of MIS Education and New Technologies at University of Florida in Gainesville.