Burnout seems ubiquitous in our culture. So many people across all sectors are experiencing this. It is truly a pandemic on its own. However, before you can grasp its significance and impact, you must realize what it is, how it occurs, and how you can get out of it.

Burnout is defined by the WHO as a syndrome resulting from “chronic workplace stress that has not been successfully managed” and resulting in “feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism and reduced professional efficacy.”

However, researchers such as Dr. Maslach, who created the Maslach Burnout Inventory, believe that burnout is a “mismatch between workers and workplaces” encompassing different areas of work mismatch such as amount of work, control, rewards, community, lack of fairness, and value conflicts.

I found an illuminating description of burnout by Dr. Brittany Busse to be “physical and mental exhaustion due to prolonged unabated stress, a type of severe exhaustion that can lead to death if left untreated.”

At the core of these definitions is that you will activate your stress response when you perceive circumstances as stressful (unfair, overworked, lacking community or control, for example). In short, once you perceive a situation that makes you angry, fearful, or stressed, your nervous system activates and floods your system with the sympathetic overdrive of stress hormones. The amygdala signals “danger,” and cortisol begins to permeate every cell of your body, leading to physical, emotional, psychological, and spiritual consequences.

Chronic stress has true implications in the interplay of psychoneuroimmunology. It is associated with headaches, hair loss, insomnia, bruxism, hormonal imbalances, elevated blood sugar, hypertension, heart disease, GERD, indigestion and malabsorption, pelvic pain, autoimmune diseases, and cancer. More tragically, chronic stress and burnout have high incidences of depression, anxiety, and suicide.

In the US, the levels of physician burnout affect up to 65% of frontline physicians like emergency specialists and 56% of all others.  Additionally, 25 % of physicians are depressed, 13% have suicidal ideations, and each year, more than 400 physicians die by suicide (Medscape 2023 Burnout Report and Death by 1000 cuts). These numbers have dire consequences personally for the physician, their family, and the communities they treat.

It is essential to understand that experiencing burnout is not an inherent fault, weakness, or problem of the person living through it.  Instead, this is a normal neurophysiological response to an abnormal situation. It is also imperative that the workplace take steps to create an environment where genuine caring, support, and healing for the healthcare team are at the core of its workplace values.

Whether the focus is on the physician or the workplace, returning to the basics to ensure your core needs are taken care of is essential. It is imperative first to safeguard basic needs such as sleeping at least 7 hours each night, eating healthy nutrition (and avoiding sugars, alcohol, and drugs), drinking adequate water intake, exercising, and connecting with others are priorities that are encouraged, respected, and followed.

When the basic needs are not prioritized, it is easy to feel, look terrible, and begin the path of illness, burnout, and mental health challenges. As Dr. Maslow has described in his Hierarchy of Needs, your core physiological needs must be met to thrive and achieve self-actualization. Only after these basic needs are met can you move to safety, belonging, accomplishment, and self-realization. You can only rise in the hierarchy of needs Dr. Maslow described with a solid foundation of our basic needs. These are critical and often overlooked as essential building blocks to wellness.

Once basic needs have been met, it is then time to find ways to stop the cascade of stress hormones being secreted. You must prioritize a daily routine to stop the stress response and instead activate the parasympathetic nervous system to reset our nervous system to achieve balance and homeostasis.

How can you go about this? I will share ten ways to help reset your nervous system and start a path to wellness.

You need to realize your worth and that you matter. Your health and wellness must be a priority, not a nice afterthought after completing the daily to-do list. Once you start with a strong premise and “why,” the rest can follow. Your beliefs create your feelings, and it is feelings that lead to your actions and, ultimately, your results. If your beliefs are not rooted in the importance of self-love and self-care, you won’t be able to move forward to a better place.

You must establish boundaries. Once you have examined and shifted your mindset and beliefs, it is imperative to learn to say “no” as this usually means saying yes to something else. It is time to sit down, identify your priorities, and align your values with your actions. If something does not align with your beliefs, goals, or priorities, it is time to say NO (or no thank you). You don’t have to say yes to everything. Doing so will leave you depleted, frustrated, and overwhelmed. It will also cut into your time to take care of yourself. Saying no is an essential skill.

Pay attention to your surroundings and what you are focusing on. What are you consuming? What are you listening to, reading, and who are you hanging out with? As Tony Robbins says, “Proximity is Power,” yet proximity to people or things that are not uplifting or positive is a sure way to stay or get dragged down in negativity and cynicism. Changing what you read, listen to, habits or people in your life may feel painful, but why are you still doing it if they are not supporting, uplifting or encouraging you? If in doubt, refer to #1.

Schedule a time EVERY day to activate the parasympathetic nervous system. This is done by consciously breathing, movement, prayer, or meditation. When you slow down and actively get into a state of stillness, your body shifts to a place of heart and brain coherence and will start shifting into a state of health. These activities, even when performed at least 12 minutes daily, can positively change your physiology.

Start and end your day with gratitude. Gratitude, as Cicero said, “Is not only the greatest of virtues but the parent of all others.” Gratitude and stress cannot co-exist. When you sit down and focus on what you are grateful for, you begin to see that all is well. No matter the challenges you may face, there is so much you can appreciate in the moment. What you put your attention to is where your energy follows. The more you are grateful, the more you will see the good things in life throughout the day. Gratitude also begins the secretion of serotonin and dopamine, your happy hormones. There are actual physiological changes that occur that affect our neuroendocrinology when you are in a state of gratitude versus one of stress.

Practice self-compassion. Self-compassion encompasses the premise that you are human, not perfect, and you are trying your best with the tools that you have. You must eliminate self-judgment and catch yourself when you use the words “I should”. The “I should” is filled with judgment and quickly leads to stress, anxiety, and depression. When you start using “I should,” think about how you would speak to a friend if they were experiencing that situation and use that language for yourself instead. It is also important to ask yourself, “What do I need right now?” Approaching your self-talk this way is a better way to avoid the stress response.

If you feel fear (losing your job, finances, relationship problems, or medical diagnosis), realize all you have is NOW. When you start thinking about the past or future, you begin catastrophizing. Worrying is praying for what you don’t want because you will continue to pay more attention and energy to whatever you are worrying about, and thus, you will not arrive at a solution. Consequently, worrying will activate your stress response. By being present and mindful in the moment or practicing gratitude is an excellent way to stop the stress cycle. When you are in a state of stress, your cortex (the processing, calculating part of the brain) is turned off, and thus, you cannot literally “think clearly.” Shifting your mindset to the present moment and practicing gratitude, movement, breathing, prayer, or meditation will get you out of the hamster wheel of worry.

Reach out for connection with others. You are not an island, and we, indeed, are all interconnected. Whether you see or believe it from a Spiritual or quantum physics perspective, you need to realize it. Reaching out to others is a crucial way to get rid of apathy, feelings of depression, or overwhelm. When you can talk to others about things you are dealing with, you will immediately feel better as you will not only realize you are not alone, but you can be an observer of your thoughts and emotions, which decreases their emotional weight. Connection is essential.

Laughter is great medicine; it lets you realize that not everything is terrible. All things have a silver lining if you are willing to see it. So many times, you may believe things are happening TO you, yet they are happening FOR you if you allow the lesson to be learned and grow from the discomfort. This is a massive shift in perspective, but getting out of a victim mindset and realizing you are co-creator of your reality is imperative. Sometimes, even in the best or worst times, you may need laughter whether you learned the lesson the first time or not. At least it may make a funny story, which may be the point of it all.

Think about your purpose. Why are you here? What are your strengths, and how can you serve others? Purpose and service are Spiritual ideas, and many times, burnout can occur because you have silenced your gifts and purpose, and you are not serving others in greater ways. This may be daily in your medical practice, but this can be outside of medicine as well. It is when you give to others that you always receive so much more. A great way to get out of and stay out of burnout is to find ways to serve and give your time, energy, money, or expertise to causes that bring you joy and aligns with your purpose. It can be done by reminding yourself why you are a physician but also thinking about ways you can find purpose and serve outside of medicine. This may be an excellent time to think about writing that book you always wanted, becoming a speaker, or launching a business if this is something that you have dreamed about.

When you have reviewed and incorporated these steps, you will begin to see a shift, and you will feel more balanced in your physical, emotional, and spiritual states.

Once you have worked on prioritizing and taking care of your basic needs, changing your mindset, and resetting your nervous system, it is time to take continued action to care for yourself. Self-care is not optional. It is essential.

You must realize you can’t change others, and many things are beyond our control. The only thing you can change and take control over is yourself and how you react to situations. For one person, a roller coaster is terrifying and stress invoking and for another it is the best day ever! Learn to look at situations as the best day because the reality is that every day is a miracle, and tomorrow is never promised. Live your life with purpose, service, and gratitude, knowing that if you had one month to live, you lived your life to the fullest without regrets.