Have you yourself experienced burnout? Have you seen burnout in a peer?

John Fezza, MD: Everybody experiences some degree of burnout at some point. This is not exclusive to medicine, but certainly can be more prevalent due to the higher stress of patient care. Fortunately, aesthetic medicine is evolving so rapidly that boredom is really not a factor. The plethora of new ideas and innovations keep our field uniquely interesting.

Burnout can come from long hours and nights, which limits personal free time. I find an occasional vacation to recalibrate helps to keep me fresh. Also exercise and good nutrition help keep me upbeat and on top of my game.

Sabrina Fabi, MD: I have moments were I may need a vacation, but I think that's true regardless of the field one is in. Although lofty, my goal is to come every day to work feeling passionate and excited, and I think it comes down to always being clear on my “why.” I would say that I am aware that physician burnout is an epidemic and so I try to stay focused on why I love what I do (which can get blurred when dealing with charts, billing, insurance companies, employees, HR issues, etc.).  

I try to make sure that most of my time is focused on doing what I love and try to delegate what takes away from that time. My passion is treating and connecting with patients and teaching and connecting with residents and colleagues, and not all the administrative tasks that sometimes take away from this. So at our practice each of us have three medical assistants so we can spend more time doing what we love, which in turn makes us happier and more efficient, and probably prevents physician burnout to a degree.

Adam Schaffner, MD: I have not personally experienced burnout or seen burnout in a peer. Many of us have seen peers whose personal and professional lives have been challenged by substance abuse, bitter conflict, and even illegal activity resulting in criminal or civil action. Burnout may, in part, be to blame for some of these downturns. I believe more than complete burnout, many of us struggle to meet all of the challenges we face on a daily basis. We have more patients we want to treat and more commitments we desire to fulfill than time permits in a given day. I believe it is critically important to learn to say “No.”  When appropriate, doing so allows one to focus  energy on those things that absolutely must get accomplished on a given day and still have quality time to spend with family.

Jason Emer, MD: My focus is strictly cosmetic and there is not a day that goes by that I do not go home and think of a treatment that I performed that day on a patient or the results from my surgeries the week before. It's constantly on my mind. The cosmetic industry is becoming more of a customer service oriented business, similar to a hotel or restaurant, and not only do you have to be top of your game with regards to innovation, technical skill, and medical knowledge but you must also provide the best service and concierge care to keep patients satisfied and keep your reputation (both locally and online) honest and representative. It's not as simple as going to work and performing your duties and ending the day anymore. You have to be always thinking ahead and outperforming your best and that is a lot of stress. There are times where I would rather be on vacation, but then I think about my hard work and dedication over the years and appreciate how lucky I am to be doing what I love everday.  

Jose Raul Montes, MD: I have not experienced burnout. I have not seen burnout in a peer either.

What is the biggest contributor to burnout in your opinion?

Dr. Schaffner: Burnout is caused by many different factors including, but not limited to, the number of hours worked per day, inadequate sleep, inadequate exercise, suboptimal diet, and inadequate time away from work to rejuvenate. During a long workday, the intensity of the work, managing employees, dealing with demanding patients and completing a myriad of administrative tasks can cause both emotional and physical exhaustion. 

Dr. Fezza: The biggest contributor to burnout is increased regulation. More stringent rules combined with decreasing reimbursements are a large factor in burnout.

Dr. Montes: I believe the biggest contributor to burnout is patient load and working at the office too many consecutive hours and days without taking any time off.

Dr. Emer: For those who do medical dermatology I think it's medical billing, insurance companies, and medical documentation. For my high-end cosmetic practice, it is completely customer service. We have to provide a very high level of concierge care and have to live up to very high levels of expectations with demanding patients…It is a significant undertaking to be successful and keep all staff (and yourself) happy. 

Dr. Fabi: I think unnecessary rules/regulations that take away from connecting and caring for patients, which is the main reason many of us went into medicine to begin with.

What do you do for yourself to help avoid burnout and maintain balance?

Dr. Fabi: I think “balance” is like a unicorn. Everyone talks about it but no one has ever seen it.  Probably because it is dynamic, different for everyone, and based on individual values/priorities and what brings people personal joy. Stressing one's self to keep “balanced” is probably as stressful and unenjoyable as feeling burned out. 

I recognize I am a better doctor and happier when I walk into work when I also engage in the other things that bring me personal joy, which are traveling, spending time with loved ones, meditating, reading, and working out. I think this is different for everyone, and probably changes with time.

Dr. Schaffner: To minimize the risk of burnout, optimize diet, exercise and sleep. Schedule days out of the office to catch up and rejuvenate.  Patients expect you to be at 100 percent each and every time you see and treat them. It is impossible to give them 100 percent if you have not given yourself 100 percent of what you need to be at your best.

Dr. Montes: As a priority, I personally work out every other day at the gym. Regular physical exercise is fundamental to keep me energetic and enthusiastic with my daily duties as a busy cosmetic practitioner. Daily meditation and silence for 5-10 minutes helps me stay focused and calm during a busy day.

Dr. Fezza: Keeping a good attitude and surrounding myself with positive like-minded staff and individuals helps avoid burnout. Also taking the time to smell fresh air and stay in shape really helps. Lastly, realizing I am part of an amazing field of medicine that is incredibly diverse and exciting keeps me interested in my work and avoids boredom and burn out. 

Compared to when you first started practice, how would you describe your outlook regarding your work: improved, same, or worse? Why?

Dr. Montes: My practice has been in a steady growth and evolution over the past 20 years. I am always studying and searching information on new products and/or procedures to meet my patients' needs. I have learned along the way what makes a practice successful. It is very simple: Put the patient first in your “mathematical” equation and be unique!

At the beginning, I thought that I needed to imitate my “successful colleagues” and compete for the new products or procedures on the market. However, experience has made me realize that I have to be loyal to myself first in order to enjoy the work on daily basis and be successful. I take advantage of my strengths and skills, using my own “style” on everything I deliver to the patients. The whole experience must be excellent in terms service and outcome. The goal is to surprise our patients in the best possible way.

Dr. Fabi: Improved, because I am more self-aware and am clearer on why I love doing what I do, and what it takes to keep focused and not let other things take away from that.

Dr. Fezza: I still love my work as much as the first day I started. In fact my excitement about aesthetic medicine and surgery never slowed. Having been a professional bond trader on Wall Street prior, I did not experience this in my other career. The combination of helping patients along with the technical and artistic components makes it a perfect fit for me.

Dr. Schaffner: I believe the best days lie ahead. I continue to learn from colleagues and through experience, which allows me to deliver better care and obtain better results each day. I believe healthcare will continue to face significant challenges which will require all of us to be as creative and efficient as possible to yield the results we desire.

Dr. Emer: I absolutely love what I do and wouldn't change a single thing. You always have to be yourself and my philosophy has (and always will be) that it's not about the device or the procedure, it's about the philosophy and the physician and the unique approach to treatment that keeps patients coming in.