Section 12: Wellbeing and Burnout Prevention

Introduction

As pulmonary and critical care fellows, you face unique challenges that can impact your wellbeing and potentially lead to burnout. This section aims to provide you with strategies to maintain your mental and physical health throughout your fellowship and beyond, in alignment with ACGME requirements and Naval Medical Center San Diego (NMCSD) policies, including the “NMCSD GMEC Graduate Medical Education Wellness Policy”.

Recognizing Burnout

Burnout is characterized by:

1. High Degree of Emotional Exhaustion

Manifestations include not wanting to go to work or feeling exhausted upon awakening on weekdays

2. Cynicism (Depersonalization)

Patient becomes an object; manifestations include consideration of disease instead of the patient

3. Low Sense of Personal Accomplishment

Deriving no self-worth from professional activity

Signs of burnout may include:

  • Feeling constantly tired or drained
  • Difficulty concentrating
  • Increased irritability
  • Neglecting self-care
  • Feeling detached from patients or colleagues

Risk Factors for Burnout

  • Work Hours: Increases 3% for every extra hour worked during the week, 9% for every hour on weekends or nights
  • Incentives: Private practice burnout is 20 times more likely vs. academic settings
  • Clerical Burden
  • Moral Distress
  • Gender: Females are 40–50% more likely to experience burnout
  • Having children under 21 years old

Consequences of Burnout

  • Independent risk factor for medical errors
  • Increased mortality in ICUs with higher levels of emotional exhaustion
  • Patients less likely to take advice
  • Associated with suicide, depression, and substance abuse
  • Physicians more likely to leave clinical practice

Strategies for Wellbeing

1
Self-Care
  • Prioritize sleep, nutrition, and regular exercise
  • Practice mindfulness or meditation
  • Engage in hobbies and activities outside of medicine
2
Work-Life Balance
  • Set boundaries between work and personal life
  • Use time management techniques to maximize efficiency
  • Take all allotted time off and use it for genuine rest
3
Social Support
  • Foster connections with fellow trainees
  • Maintain relationships outside of work
  • Consider joining a support group for healthcare professionals
4
Professional Development
  • Set realistic goals and celebrate achievements
  • Seek mentorship opportunities
  • Engage in continuous learning and skill development
5
Stress Management
  • Learn and practice stress reduction techniques
  • Consider counseling or therapy when needed
6
Fatigue Mitigation
  • Know your department’s fatigue mitigation process, as outlined in the “NMCSD GMEC Resident Clinical and Educational Work Hours Policy”.
  • Talk to program directors early if you’re experiencing fatigue.
  • Take care of yourself and watch out for each other.
  • Ask for help when needed.
  • Utilize your wellbeing representative.

Resources at Naval Medical Center San Diego

1. GMEC Physician Wellbeing Committee

Contact: LCDR Kimberly Spahn, M.D., Chair, GMEC Subcommittee on Physician Wellbeing
Email: [email protected]
Phone: 312-513-8212
Also includes the CLER Sub-committee well-being champion.

2. Command Suicide Prevention Program

3. Provider Wellness Committee (PWC)

Assists providers removed from care due to health issues in returning to patient care. Anonymous referrals can be made via SharePoint.

4. Military OneSource

Website: www.militaryonesource.mil
Phone: 1-800-342-9647

5. Critical Incident Stress Management (CISM) Team

Peer support for adverse events.

6. MWR (Morale, Welfare, and Recreation)

7. Command Resiliency Team

8. Psychiatry Department

9. NMCSD Pastoral Care Service

Phone: (619) 532-6573

10. Resident Wellness Providers (Psychiatrist and Psychologist)

Part of the Caregiver Wellness Program, specifically focused on residency training.

11. Defense Health Agency (DHA) Provider Resilience web application

Work Hour Policy

  • 80 hours in a work week averaged over 4 weeks
  • 8 hours off between scheduled clinical work and educational periods
  • At least 14 hours free of clinical work and education after 24 hours of in-house call
  • One day off every 7 days averaged over four weeks. Certain rotations, such as the ICU at UCSD, follow a regular schedule of 12 consecutive workdays followed by 2 days off.
  • No more than 24 hours of continuous scheduled clinical assignments in a shift (may have up to an additional 4 hours for activities related to patient safety, such as transitions of care and/or resident education).

Clinical and educational work hours do not include reading, studying, or research done from home and in preparation for future cases.

Important: Do not wait until you have a work hour violation to report it. Get input and help from your chief residents and/or program directors/site directors BEFORE you have a violation.

Conclusion

Your wellbeing is crucial not only for your personal health but also for providing the best care to your patients. Remember that seeking help is a sign of strength, not weakness. The fellowship program and Naval Medical Center San Diego are committed to supporting your wellbeing throughout your training and career.

References and Appendices

Section 12 Appendix 1: NMCSD GMEC Graduate Medical Education Wellness Policy (23 March 2025)

Section 12 Appendix A: Wellness Apps and Resources

  • Healthy Minds App – by University of Wisconsin (FREE)
  • 10% Happier App – (6 months free for healthcare workers)
  • 10% Happier (book by Dan Harris)
  • Solve for Happy (recommended book)
  • Mindfulness-Based Stress Reduction (MBSR) resources:
    • MBSR offered at NMCSD, 8 weeks, in-person (check availability)
    • https://palousemindfulness.com/ (MBSR online, 100% free)

Section 12 Appendix B: Provider Resilience Web Application

The Defense Health Agency (DHA) through the Military Health System provides a Provider Resilience web application that gives health care professionals tools to guard against burnout and compassion fatigue as they care for service members, veterans, and their families.

Section 12 Appendix C: Wellness Committee Involvement

To become involved in promoting wellness:

  • Join the GMEC Subcommittee on Physician Wellbeing
  • Become a wellness representative for your department
  • Participate in wellness initiatives and provide feedback