During this live webinar, the following topics will be discussed by the panel: “Burnout in Ophthalmology – Importance of Balance in our Career” by Dr. Grossniklaus, “How Do Leaders Help Themselves and Others Prevent Burnout?” by Dr. Fountain, and “My Personal Burnout and Inspiration through Orbis” by Dr. Suh. Questions received during registration and during the webinar will be discussed.
Lecturers: Dr. Hans Grossniklaus, Emory Eye Center, USA, Dr. Tamara Fountain, Rush University Medical Center, USA & Dr. Donny Suh, University of California at Irvine, USA
Dr. Suh: Good morning. Thank you for joining us this morning on this very important topic of burnout. And the importance of leadership and inspiration. Let me share my slides. Well, thank you very much, so we have a very distinguished panelist today and I’m truly excited. Our speakers do not need much introduction. First we have first speaker is Dr. Tamara Fountain. She’s a professor at Rush University Medical Center and Chair Emeritus of Plastics Surgery and Board of Directors of American Board of Ophthalmology, and she was the past President of the American Academy of Ophthalmology in 2021 and past President of the ASOPRS and served 15 years with OMIC and chair of the Board of Directors. And our second speaker is Dr. Hans Grossniklaus. Founding director of the Ocular Oncology Service. He’s a world renowned ocular oncologist and he’s the past president of American Association of Ocular Oncologists and Pathologists and Board of Director of the American Board of Ophthalmology. So I’d like to ask so I’d like to ask four quick questions before we start so we can gauge the audience level of burnout and we’re going to give you about 10 seconds and if you could answer these questions we would really appreciate. How often do you feel burnout? Never, rarely, sometimes, often, nearly all the time? OK, great, thank you. And we’re going to go to the next question. If you experience burnout, what factors contribute? First, too many bureaucratic tasks, lack of control, autonomy and lack of respect from others, emphasis of profit over patients, not enough or declining compensation, and too many hours at work. And overburdensome electronic medical records tasks. So it’s actually pretty evenly distributed. All right, next is what would help your reduce — what would help — what would help to reduce burnout? Decreased workload, fewer hours or patients or more support staff, greater respect from others? More income, paid time off. Therapy or wellness initiatives, recommitment to medicine to patients over profits. Greater control and autonomy this OK, again it’s distributed pretty evenly. Next final question … what are you doing to avoid burnout what are you doing to avoid burnout in spend time away from work, talk to friends or colleagues about problems, break up large tasks into small tasks. Meditate, or none of the above. OK, great, great, thank you. Let me stop sharing my slides so that Tamara can share her slides. So our first speaker is going to be Dr. Tamara Fountain and she’ll be talking on this very important topic. Thank you. >> Dr. Fountain: Thanks so much, Donny. What a pleasure it is for me to be onscreen with colleagues I admire. And a pleasure to be speaking with you today. I can’t wait to hear from Dr. Suh and Dr. Grossniklaus, and I want to say that all of you who are impacted from in Turkiye, our thoughts are with you. I’m going to go over the scope of this globally and the role of leaders in finding solutions. So we all know what burnout is: Essentially it is a constant or prolonged stress or frustration that is borne of exhaustion, either physical, emotional, or motivation, and it’s interesting, in 2019, the WHO added burnout, so it’s now a diagnosable condition. When you look at the scope and reach, this is a table from an article on burnout in Lebanese physicians, and in a review I did, I found papers on burnout in China, in Nigeria, in Brazil, Russia, in India. Now, this is about 20,000 physicians concentrated in the European countries. And at that time, 2019 — remember, this is before Covid, the vast majority of people reported no burnout whatsoever, and even fewer reported any depression. When you looked at what were the top burnout factors, you’ll see here very common to the things that you all said impacted you, as well: Too much paperwork. Too many hours at work, a lack of respect, feeling like a cog in a system that emphasizes profits over patients. Other factors including regulations from the government, a feeling of insufficient financial compensation, increased EHR burdens and overall, a lack of control. So they asked those physicians, well, what would help reduce the burnout, well, it shouldn’t be surprising that most of the reasons have to do with undoing some of the things that caused burnout in the first place. More support staff to help us with our tasks, more control over our schedule. Over our call hours. Greater respect. If that’s something we could wave a wand and engender. More compensation, decreased regulations, decreased patient loads. Greater flexibility. And more respect from our patients. Interestingly, from these 6 countries when asked whether the workplace had burnout programs available, most said no, or didn’t know. This is interesting, as well. How many of those physicians were seeking help for their burnout or depression? And of those who experienced it, very few said they were seeking help. And I think this is a very ominous sign. When you look post-Covid, as we might imagine, things are even worse. In a study done in 2022 across ten high-income countries, they found that most physicians reported increases in their workloads, and unfortunately our younger physicians defined in this survey — and I love this cutoff — age 55, I love to be considered young when you’re under 55, but the young physicians were more likely to experience stress and they were much — they were more likely to seek professional help than their older colleagues. And this should get everybody’s attention. When physicians are under stress, they don’t provide the quality of care that they would give otherwise. Half or more of older physicians reported that they would stop seeing patients within the next three years, and this means that we’re leaving even more of a burden to our younger physicians, who are already more burned out. The US population of physicians was surveyed very recently, and I’d like to just share a few of the outcomes of this survey: If asked if they were burned out or depressed, 53% said they were burned out and 23% said they were depressed. This is about a 25% increase in the number of people who are considered burned out. When you look at the population of physicians across the board, it’s primarily in the US, our primary care colleagues, in particular, post-Covid are bearing the brunt of burnout. Ophthalmology tends to be a little bit further down on the list in the US. There is a gender gap in burnout. Women reporting far more. In 2018, these figures were 38% of men and 48% of women. It is felt that women carry more of a burden at home, and during their time at work, feel a little bit more stress because of a greater lack of autonomy over their work setting. The take-home message from this slide is when you look at burnout by setting, the people who experience the least burnout are those who control their destinies, are in solo private practice in an office. That’s very interesting. What contributes to burnout? We should start seeing a pattern here on what the survey said, what the global survey said and here, as well, in this very most recent survey of US physicians. I found this interesting, would ophthalmologists take a salary cut to have a better work-life balance. More than half said so, but interestingly when asked what would help most with burnout, increased compensation was on the top. And there’s a thought when doctors don’t feel like they have much control over the factors that bring on burnout that at the very least they’d like to get paid more, a feeling that they’re valued more, so I think this was part of why increased compensation was higher when asked in this way. When asked if your workplace offered a program to reduce stress or burnout, most didn’t know or said no. When asked if they sought professional help, look at these statistics, only 13% said that they were reaching out for help with their burnout and I think this reflects the traditional thinking of us as physicians for ourselves that to seek help is a sign of weakness. And so the vast majority of people aren’t getting help and many of us won’t even consider getting help, even when we thought that we need it. How has burnout had a negative effect on your relationships? Now, I will remind everybody, that around the world it is Valentine’s Day. But unfortunately, burnout is impacting our family relationships, as well as our romantic relationships, and you can see here some of the quotes on how burnout has affected different people. They’re quick to anger. It’s put a strain on my marriage. No time for friends and family. My son hates me for not being around. How do physicians cope in exercise is number one, time with family friends, sleep, spending a little time alone, as well. I was interested here that nutritional eating did not make the list, but eating junk food and binge eating did. So I’m looking forward to hear perhaps from Dr. Suh and Dr. Grossniklaus This is a quote from a doctor at Northwestern University. And she said here: For me, doctoring — I simply could not sustain that belief any longer. We recognize that systems have an impact on burnout and and in the United States has described tackling burnout as one of its biggest programs for 2023. Looking at the statistics, we see the increase from 2020 to 2021 in burnout. We see the decrease in people who would recommend being a doctor to their family members or would choose medicine as a career. Look at that decrease from over 70% to just barely 50%. 20% of us are planning to leave in two years and a third of us are planning on cutting our work hours. In 2021, over 100,000 physicians left the workforce, but less than 20,000 joined. The root cause of burnout, interestingly, how much EHR, the increase in portal messages, the tasks on top of patient care that we have to take care of. And it’s found through AMA statistics that women spend almost an hour and a half or almost two hours more on EHR tasks and have more childcare duties. We’ve all heard that if we can be more resilient, but if you look at the definition of what resilience is it’s the ability to being able to bounce back from stress. But the key to being able to bounce back is that compressive stress has to end. And we’re all tolling under conditions where the continued stress doesn’t end and that’s why resilience is just not enough. This is a quote from the Vice President for Professional Satisfaction from the American Medical Association, and she says if one-third to one half of nurses and physicians cut back or leave, we simply won’t have enough health care providers to meet the needs of our patients, which is why the AMA has launched their initiative to reduce physician burnout and they’re looking at many different areas that impact us as we’ve seen in our surveys. In particular, this year they’re looking at EHR improvements to see if we can get more efficient. But there are many areas here that the AMA is looking at. The American Academy of Ophthalmology offers courses at our annual meetings. We also have website resources recognizing the role of the individual in combating burnout, the roll of our practices in combating burnout and role of Covid-19 measures in combating burnout. This is a most recent email blast that goes out to all academy members highlighting our initiative in 2023 to reduce burnout. So to wrap up, my take-home messages to us all today are: Burnout is real. It’s affecting us globally. And it’s worsening. Moral injury is what happens when we know what we need to do for the best care of our patients, but we are incentivized to do something else by a mismatch in our health care system. We know that burnout destroys lives. It impacts us physicians in the way of broken relationships, substance abuse, depression, suicide, but impacting our care on patients, it impacts our patients, as well. Decreased patient satisfaction, decreased quality of care, increase in medical errors, decreased productivity and increased physician turnover. Burnout manifests in us as physicians but it originates in the systems that we practice, and therefore, the solutions to burnout have to at least begin with our systemic roots. And let’s remind ourselves why we chose the profession of ophthalmology. Restoring sight is one of the most rewarding things that we can do, and I think it’s important for us to remember that and to grasp that as we lead ourselves on, and I think it’s also the role of organizations like Orbis and our super national societies to help our hospital systems, help our governments understand the impact of physician burnout and work together to make it better. And now I’m going to turn it over to my colleague Dr. Grossniklaus, who’s going to talk about the personal habits to overcome the impacts of burnout, because those things can make a tremendous impact. As well. >> Dr. Suh: Thank you, Dr. Fountain. That was just amazing. So our next speaker is Dr. Hans Grossniklaus. He’ll be talking about the life tree in ophthalmology. He actually has a book on this topic. I don’t know if it’s been published already, Hans, but. Dr. Grossniklaus: Thank you. I share Dr. Fountain’s message about Turkiye and Syria and our thoughts go out to you. So this isn’t a book. This is part of journaling which one might use as a mechanism to deal with stress, so I started journaling a few years ago, and one thing that Dr. Suh didn’t mention is I’ve been a volunteer for NAMI, the National Alliance for Mental Illness, and a leader of family sessions for NAMI, so a number of things I’ve learned from my volunteering for NAMI, I’ve been able to apply in my own life, regarding handling stress and dealing with burnout. A number of years ago, I was in the Philippines giving a talk, and I was invited to go to the Palawan Islands, and I was there thinking about things, thinking about my life, questions I had, maybe some of you have had is what am I doing, why am I here, where do I fit in, what’s my purpose? And I developed a framework for thinking about this which Donny has called the life tree. I think that’s a good name for it. And I came to the conclusion that there are a number of branches of the tree that can help explain to me why I am here and I am doing what I’m doing. And I or you would be the trunk of the tree, so this is a metaphor for my life, possibly your life. You’re there, I’m where I am because of my parents and background, which are the roots of the tree. There are a number of branches of the tree that lead to where I am today. One is inspiration, that’s a big part of my life. What inspires me? What makes me tick? What’s my Truth North? Why am I doing what I’m doing? This could be from patients, from colleagues, from my parents. It’s probably going to vary from individual to individual. Another branch of my life tree is balance, and Dr. Fountain alluded to this. This is work-life balance. And I know there’s a big part of my life that’s not ophthalmology and this is my friends, my family, and I also have volunteered, as I mentioned, I volunteered for NAMI, so I would suspect for all of you, you have more to your life than ophthalmology and probably some of these things are part of your life that help with the balance between your professional life and personal life. Another thing I thought about was counsel. So if I’m having a problem or a situation that I’m trying to deal with, I use others to listen to my problems. These are people that are very good friends that I trust. I’ve basically developed a network of friends that I can talk to any time — any time of day, any day of the week that will give me advice or at least listen to me, and of course my spouse is probably the most important member of this counsel. And the counsel keeps me grounded. So that’s part of my life tree, probably a part of your life tree, as well. Another part is these so-called guiding lights or parts of the tree that lead to benchmarking, and this is where I was able to decide where I was at a certain time in my life, and how it sort of compared to other people, such as my mentors, people in and organizations, etc., so it’s kind of thinking of my life in such a way that I’m not the first person to go through this. Many of the things I’ve been going through with probably other people have gone through with. And the next is my niche. Everyone on this conference has their own niche, and you will find your niche at some point. And your niche will be different from everyone’s else’s niche. You are you, no one else is you. You have your own story and it’s unique, and so I started thinking about these things and journaling about these things. And then I came to the thoughts about healthy ways to deal with stress and avoid burnout. And for me, things could be quite stressful, as I am — besides an ocular pathologist and ophthalmologist, I take care of ocular oncology patients, so there was a survey a number of years ago, a Gallup survey, asking people what are the diseases you most fear in your life and the number one disease was cancer and the number two disease was blindness. So I’m dealing of patients who have cancer of the eye which could lead that their death and they could go blind from the cancer and my treatments that I use to treat the cancer could cause blindness, as well. So these are very stressful for me, trained as an ophthalmologist, I want to save peoples’ vision, but sometimes I have to treat a cancer that will cause a person to lose vision, so it’s kind of a paradox for me which causes stress. Also I do research, I teach, I do outside things, so there are many things in my life that were stressors. Then I thought about ways to deal with these stressors and avoid burnout, and these come mainly from NAMI, from my volunteering with NAMI and learning about different ways to deal with stress and many of you have done these, I think the last question in Donny’s survey asked about these things, and many of you are doing these. probably just haven’t named them the way you do it. The first is diffusion, this has to do with talking with others, diffusing your stress with your colleagues and your spouse or significant other, so there’s only a certain amount of stress that you have, and the stress is lessened and distributed among others. I do this every day as a pathologist. A physician will send me a piece of tissue, ask what the diagnosis is, and what to do with it, so I’m dealing with that contributor stress about the pathology of the disease they’re dealing with and how to take care of it. We as physicians do it all the time with patients. Patients ask us to help them, and then we essentially take on part of their burden by essentially conveying that we will help with your disease, we will take — you don’t have the burden of worrying about treating it or getting better, we’ll take on that burden with our understanding of the disease. A second that I’ve used are baby steps. A number of years ago I was writing a huge grant, a thousand-page grant, and there were multiple parts to the grant, and looking forward to doing this, I wondered how am I ever going to do this? It’s such a huge task. Well, the way I did it was broke it down into small parts, and I thought I can’t do this big huge grant, but I could break it into parts, and I can do Part A and once I have Part A done, I can do Part B and once I get Part B done, I can do Part C and that’s a way to deal with burnout. Another is modeling successes. And I’ve questions about this: What does model success mean? Well, in part you’ve dealt with stress in the past, and many times you will be confronted with a problem, it will be a stressful problem, but if you think back, you’ve probably dealt with a similar problem, as well, and you’ve come through and you’re still standing, you’re still here, you’re still breathing, so you’ve dealt successfully with problems in the past. I’ve dealt successfully many times with problems in the past that come up again and again, especially in patients who have cancer of the eye, and I just remember how I got through it and what I did to get through that stressful situation. And the last skill is mindfulness, and this is — mindfulness is being in the present. Don’t dwell on the past or worry about the future, you can’t do anything about the past. The future is yet to come. Don’t worry about the possible outcomes. People sometimes jump to the worst possible outcome and become attached to that and start worrying about that. We don’t know what the future holds. So one metaphor I use for this, or a tool I use for this is thinking about sitting on a hill and watching a train go by, and all you know for real what is right in front of you, that’s my reality. I’m seeing the car of the train right in front of me. I don’t know anything about the engine that’s ahead — that’s pulling the train. That already happened. I have no idea what’s happening to the engine and I have no idea what’s happening with the caboose, that’s yet to come. So that’s part of mindfulness and meditation is part of it, as well, being in the present. So those are some of the things that I have journaled about and thought about, and developed a way to verbalize skills that help me and hopefully will help you deal with stress and burnout. Now, remember, you’re the trunk of the tree, I’m the trunk of my tree, and the trunk comes from your — my goals and aspirations, inspiration, and asking myself what makes me tick. And this leads to my true north. So the true north is the compass toward your life, your life tree, and your niche in the world. And there’s a book I would refer you to if you want to read more about it. Bill George’s book called Discover Your True North. So with that, I’d like to thank you very much for inviting me to participate in Cybersight, and I also want to say, it’s all about the journey, your life journey. Thank you very much. > Dr. Suh: Thank you, Hans. I’m going to share my slides. Let’s see. Are you seeing my slides? Is this OK, Hans? >> Yes, I see them. Perfect. Thank you very much, Hans, as the audience probably know, Hans is an incredible individual and he’s extremely insightful and a great person to get feedback, and he’s a — you know, I always enjoy listening to Hans, and so I would like to talk about my story of burnout and hope with everyone, and actually I actually read many great questions and we’ll address — we’re actually going to get together at the end of my talk and respond to some of the concerns and questions of the talk. And as you know, this is only a one-hour session and we can’t cover all aspects of the burnout, obviously, so we were kind of like going at a high level, and but I am planning on having more sessions in the future to address some of the specifics. First let me just say that, you know, I’m a pediatric ophthalmologist at the University of California Irvine, I’ve been doing what I’m doing now, I’ve been in practice for 22 years, it’s just been an amazing journey but when I first started as an ophthalmologist, this was something that I’ve always wanted to do, all my life. And growing up in a very humble background with a mom, and a brother, I was painfully aware of the inequality of access to health care, and this is one of the issues that I wanted to address, and so I was ready to tackle — I was ready to tackle this problem, and joined various medical organizations. One of them was Orbis, and so this was me when I first started. So this is many, many years ago, with a lot more hair. Darker hair. So I was just very excited, and one thing I liked about this particular organization, Orbis, was that it’s a both airplane- and hospital-based program. So the airplane-based program is that you work inside the airplane, this is where we train the local doctors, and we audience, you know, watching the lectures, watching the surgeries, and learning. And a lot of times that it’s a two-way street, in where we learn a lot from them, as well. And we have the simulation eye models and we take advantage of these webinars, we have augmented and virtual realities, so we train the local doctors to be the best doctors they can be. Then we also have hospital-based program where we actually go to the local hospital and use their equipment and working with the local doctors and helping them to train. So this was my dream. I was — I had this dream of just making many patients happy and help — and giving access to care to those that are in need, and flattening the inequality. But as you all know, and as many of you have served the global health, the reality can be furthest from the truth. First, I started this 22 years ago, and at that time, the — many of the local hospitals did not have internet. So first I didn’t even know how to pack and a lot of times you pack things and you pack as many things as possible, but a lot of it, as a matter of fact on my first program, about half the stuff that we packed were taken away at the customs. And then — and once you get to the final destination, once you get to the country where you’re trying to work, and with all the luggage, and you have to go to the hospital, and sometimes this in itself can be extremely dangerous and so sometimes you have to go through dangerous roads and sometimes the roads are flooded, and then once you get there, the first day of clinic is actually not very pleasant, because these patients have been waiting for a long time, and they are waiting for you to help them, and the type of patients that you see can be very challenging. here’s a patient with a brain tumor with bilateral Bell’s nerve palsy, and these are so challenging and I wasn’t able to do anything here because the muscles were stuck and here’s a patient with the chronic condition and these conditions are extremely advanced. And when we get to these hospitals, sometimes the equipment is not adequate, so we have to set up the equipment that we have brought. And sometimes we just have to tape it to the walls and so we can identify what we have brought. And when we start doing surgeries, as you can see here, it’s a very basic, and we don’t have a lot of things to really help us. What I mean by that is that, even the gloves, many of the countries don’t have different size gloves, and as all know, we have many individuals who are joining us today. You know, we here in the states and European countries, we have gloves in different sizes, but many countries, many places around the world, they just have one size. So a lot of times, I can’t even feel my finger as I’m doing surgery, and sometimes many places don’t have air conditioning and heaters. And I don’t know if you can see my hand right here, that’s all sweat. I’m just wearing simply gloves and I’m just sweating and I’m just sweating, completely soaked. And we have the fan going on while I’m in surgery, in this very delicate surgery and as you can see, if you don’t hold onto the sutures, it will be blown off. And the equipment that you’re exposed to is something that you’re not familiar with. For example if you’re looking for scalpel, this is what they have. It’s a very dull razor blade, and a lot of times it’s been used for so many years, it’s just too dull. And then chairs that we have, you know, when we do our surgeries, this is it. This is what you’re sitting on for hours. And then finally you’re completely exhausted at the end of the day and remember, you’re jetlagged because you’re in a different timezone and then you try to get sleep and then you have insects crawling on your body everywhere. It’s hard for me to really describe how uncomfortable this is. Because you can’t go to sleep and you just feel very, very uncomfortable. And inside, you just want to cry. You just, you know, you just — you know, you just don’t know — like, you don’t know where to voice your discontentment, but outside as a leader, you have to show a smile, and you have to act as if you are in control. This is actually not very different than what I do here, and so you’re working on empty fuel in a place where you don’t understand the language, and you don’t — you cannot read their names many times their first and last names, you don’t know what they are, and they, in some countries around the world, they have many duplicates or triplicates of people with the same names, and so you can see how this can be very, very confusing, and this is a setup for a wrong-site surgery. And I’m going to tell you, this is, you know, when I went through this early on, and in a — when I went on a medical mission programs, I realized that this is actually not very different than what I go through here in the states in my own practice. I used to think that gosh, you know, it’s going to be so much better here, you know, we have more control, we’re — you know, we have — we’re going to have, you know, everything’s going to be so much more pleasant, but I realized that when I go on a — these global health programs, my stressors are just condensed down, and that’s the only difference. So here in the states, I have the similar type of stressors such as increase in demand, limited resources of time, and lack of control, and we actually, based on survey, that’s very important for us. And many of the external forces that you have no control over: Support staff, EHR, and all these factors that you have no control over, combined, result in fear. And that can lead to lack of focus and meaning, so fortunately or unfortunately, this happened very early in my career, and I lost — I definitely lost my focus and my meaning. And I felt very inadequate and ashamed, because I felt like, you know what? I don’t see this in other people. Why am I feeling it? And I just — little I knew that the others just weren’t voicing it, because they were ashamed, themselves. it’s a sign of a weakness. And at least how I was taught. You’re tough, you’re a surgeon, you’re a physician, you can overcome this. And you hear this all the time. You’re tough. You can do this. And Hans brought up a lot of great points about the “my tree,” the tree. But the thing is that once you have these fears set in, this can impact relationships in every sense. Your families, your friends, your mentors. You start retracting and not making those connections, and then over time, you can lose confidence, and as a surgeon, we need certain level of self-esteem and so with the lack of respect coming from outside with your feeling inadequate, it’s very easy to lose this self-confidence and self-esteem. And that can precipitate into imposter syndromes, and it just — and it turns into a vicious cycle. And then when you combine this with the — in certain situations with the medical-legal issues, we talked about the wrong-site surgery, and these are, remember, to err is human, and when we make a mistake, and when our partners and our friends and our patients are focusing just on the mistakes, that can really devastate anyone, anyone. And that’s what I was feeling. Early — during early career of my life. And I was seriously thinking about changing my field, because I was the first physician in my family in history. And I was thinking maybe this is just not for me. You know, I just went into the wrong field. So I was contemplating about changing my profession. You know, I’m not good at this. There are many other professions out there. That’s when I received a letter from someone. It was a letter, and it was a something that I think about a lot. And it came from a patient that I took care of years ago during one of the medical mission programs, and she was — this letter says: Doc, are you doing OK? We are praying for you. The thing is that this is a beautiful young lady from an orphanage. I don’t know if many of you have been to orphanages, I grew up right next to an orphanage as a child, so this is a place that I fear. I have a fear of orphanages, and I have visited many, and for many different reasons, which I don’t want to get into. And this is a child who was from an orphanage that — who sent me a letter saying: I am praying for you, and I want to go into a medical field to help people like you. This was a — I lost words. I lost words at that time, and many of my friends know that I don’t — you know, I rarely am speechless, and this was a time that I was completely speechless. I just didn’t know what to say. So, and many of you know this quote: “Sometimes our light goes out and for some it’s often, but it’s blown into flame by another human being.” And she was that other human being. She was my true north. She was my inspiration. And so I’m going to just tell you that, you know, all of us will experience storm, and even here in Southern California, the weather is not perfect all the time, I guarantee you. And we will all experience various types of storms and challenges, and in situations like that, having a lighthouse, a true north, is extremely critical. And the studies have shown, from many sources, and Tamara talked about this earlier, inspired, you know, for those who are inspired, they experience more purpose in life and more gratitude, and I think this is the key. This is a key. It was, you know, being a physician is not an easy task for anyone, and I’m going to tell you — and for those who are in practice right now, I’m going to tell you — is not easy for anyone. Anyone. And I have talked to many, many, many physicians around the world, and they all are looking for places where they can be inspired, they’re looking for the lighthouse, and of course this child is my lighthouse, but I find lighthouse on a daily basis, they are they’re not that far away. You just have to open your heart. With that, I would like to thank you and being an ophthalmologist to me is a true blessing and because you can help people to see, and I just hope that you can find your true north, or the lighthouse, and enjoy your career. Thank you. So having said that, we’ve got about ten minutes to address some of the questions and I know Tamara was — >> Dr. Fountain: I’m here. >> Dr. Suh: Oh, you’re here. Great, great. So let me go through some of the questions and I don’t think we’re going to have time to go through all of them. We’ve only got about ten minutes and let’s just kind of go through. So number one: OK, great. The — I think Cullen made a good comment: Health and wellbeing of all members of the team, even support personnel is of vital importance and smarter ways of working may help and make use of triage in order to manage huge workloads. >> Yes, the only comment that I would like to make with that is that the team, the group of team, they make it or break it. For Orbis, the — we ophthalmologists truly, I believe, play a very, very small role, so we have the nurses, technicians, pilots, engineers, biotechs, and we have the, you know, various people, like the group of people that are working together to make one program successful. It’s tremendous, and we ophthalmologists play a small role, and we have to think that we don’t — we’re not in complete charge. We have to ask for help with the people that are around us, and I agree with that completely. Dr. Tamara mentioned that burnout has roots on the system. What can we do in our institutions to reduce burnout? Great question. Tamara? >> Dr. Fountain: Well, I think if we recognize that we all have a common goal of trying to treat the patient, I think if we can start where we can agree on, I think for many institutions, including my own, the friction always lies in the money, and how you prioritize patient care. During Covid, it was interesting to look around and see how, not just in health care, but see how many people decided that the value and the joy that they got in their job simply was too little to justify the working conditions. And so I think that we as a society — I’m talking about a global society — are starting to recognize how important it is to have happy, well adjusted workers, whether that’s in hospitality, whether that’s in education, whether that’s in medicine. So hopefully with the recognition — and certainly in the United States and with my reading, I know it’s not just here, but it’s getting increasingly difficult to access health care. There are fewer physicians, you saw my statistics, we have a net negative for physicians at a time when we need them even more. So I think it’s going to start getting everybody’s attention when you can’t, you know, go out to eat because your local restaurant closed because people don’t want to work in restaurants anymore, and I think that’s going to get people’s attention when they can’t get good care or can’t get an appointment. So I think our interests should all be aligned in how can we provide patient care and to work together with the stakeholders, the providers, as well as the administrators, on a common goal and recognizing at least in America, how critical and central EHR is to our misery. But I think it’s something we can definitely tackle, it’s just that our incentives have to be aligned to do so. >> Dr. Suh: Thank you. Great, great, the next question, I think Hans would like to address, is that isn’t it — you know, this is an excellent question: Isn’t it awkward to talk to a psychiatrist about burnout, being a doctor yourself? So how do you find a therapist for a doctor? So and the next question, actually it’s — it’s related. Thank you for the important topic, which forces us to face our demons. How can we improve support staff and therefore morale and wellbeing? We don’t seek help or refuse to agree to some suggestions made by management, lest we are classed as weak or not a team player. So seeking for help, Hans, I think this is kind of like the theme. What are your thoughts, please? >> Dr. Grossniklaus: Yeah, these are great questions. My first thought is we are all people before we’re doctors. We’re all humans. And being a physician is part of us, part of me, but it’s not all of many, so there are many parts to myself that are not anchored on me being an ophthalmologist and none of us are, you know, — are just ophthalmologists. That’s not our entire identity. So if I go there and just think about my life and other parts of my life, such as work-life balance, it’s easier for me to talk to another physician about stress and burnout than if I’m — if I put on my doctor hat. So it’s basically take off your doctor hat, you’re not a doctor when you’re talking to a health care — a mental health care professional, and it doesn’t have to be a psychiatrist. There are lots of counselors and therapists available that are trained in helping people deal with stress, deal with stressful situations at work, how do you find them? Well, in the US, you can — there are resources such as the National Alliance for Mental Illness, NAMI, it’s got a website, you can contact NAMI, find therapists in your area. There’s a worldwide one, it looks like it’s called United for Global Mental Health. You might find these mental health support organizations in other countries, as well. But there’s a whole world out there outside of ophthalmology and it may be difficult to admit that I have a problem or a person has a problem, and one might feel ashamed, but there’s no reason to feel ashamed, that’s the stigma of mental illness. We need to look at mental illness and depression is part of a mental illness and burnout is probably associated with depression, so it’s a condition, just like anything else, like, a, you know, like an eye disease or any other condition, so one thing is dropping the stigma of having to ask for help, and just sort of letting go of things and realizing there are resources that are readily available. > Dr. Fountain: I think our younger generation is a lot more — they’re a lot more accustomed and comfortable with seeking mental health therapy; that’s just been my observation with residents and my own adult children. So there’s a room for optimism here, I think. >> Dr. Grossniklaus: I completely agree. My daughter is a physician, as well, and I think she would support that, as well, yes, so there are things, if you need help, admitting one needs help is not a weakness. It might actually be with a strength. >> Dr. Suh: Yes, yes, Hans, that’s a great point. Being vulnerable is actually a sign of strength. And just like Tamara reported. More than 50% of the physicians are actually burned out, so this is a major — this is a significant problem that we are ignoring. And I think just like anything, we need to face it head on and I think we’re going to go for two more questions and then end it. This one is a question for Tamara. This theme would come up quite a bit. Our world nowadays is full with ungrateful people, no matter how much effort we put into treat our patients, these ungrateful people will always try to find tiny mistakes we did, and then there was another question that was very important: We do not mention the medical-legal stress that we doctors go through. You being the very heavily involved with OMIC, this is a very significant area that you’re familiar with. So these are significant stressors that come from the legal world, the medical-legal world, the ungrateful patients. what are some tips you can share with us, Tamara? >> Dr. Fountain: Yeah, that’s a whole half-hour lecture, seriously, dealing with the ungrateful patient. I think it’s human nature, I think it has something to do with us really not wanting to get eaten by mastodons, that we amplify the negative. Mostly I have grateful patients, people have given why me flowers and written me cards, but I can tell you the names of five people who have been really unhappy with my care, and I think that’s just human nature. When I give talks on medical-legal risk and dealing with a lawsuit — which I personally have, as well, you know, you — as much as possible, we have to try to compartmentalize when negative things happen to us, and I think one great quote someone said to me once is: You know what, in life the really, really good things, they don’t last, but also the really, really bad things, they don’t last, either. So we just all have to kind of hang in there, push forward, recognize that we aren’t the only ones, think again about the teachers, the school administrators in our children’s’ districts and the heat and the vitriol that they are taking right now. So it’s — it’s, I think, a reflection of the coarsening of society and we are just part of the population that is on the receiving end of that. But I think one redeeming feature, when I think about it, is just to maintain perspective and at the end of the day, we are all physicians taking care of patients, we chose this field for a reason, and we still have the reward and the privilege, the true privilege, of laying on of hands and making people better, so on my down days, I like to recapture those moments, and like everything else, the bad stuff, that will go away as well as the good stuff, so I just try to keep one foot in front of the other and one day at a time and that’s my advice for us all. >> Dr. Grossniklaus: I would say you are remembering the happy successes and the privileges in taking care of those patients and we all have successes. >> Dr. Suh: Thank you, Hans. One last comment I’m going to address. So here, it was a nice comment from a physician from Botswana: Hello from Botswana, burnout is a major concern in my country and this lecture is quite insightful to me. So I’m going to share this with you: There are many countries around the world where there’s one ophthalmologist per one million population. And I actually have been to these places, where I go to their clinic and these patients have been waiting since 3:00 in the morning outside in rain, waiting to see you. And of course, they have certain expectations when they see you, when they see the doctors, but if their expectation does not match what they expect, then there’s a huge disappointment, from both sides. From both the patients’ and the doctor’s perspective, but you know, that’s why it’s very, very important for us to focus on training young doctors, new doctors and new generations, and that is something that we really need to focus on, and Tamara talked about how we have more people retiring than the people coming in, and this is a — this is one of the things that I think we do need to focus on, but I do want to thank those individuals around the world who are serving those people in need, you know, with the — so very little resources, and Orbis, our organization, truly appreciate that and that’s something that I have witnessed myself. And from, you know, from the bottom of my heart, I thank you for what you do. And I think this is such an important topic that I think we’ll have another webinar in the future focusing on some of the areas that we did not touch on. What are some of the concrete things that you can do to your practice, you know, what are some of the things — we talked about the medical-legal aspect and how do you deal with the ungrateful or the unhappy patients? And I think these are very important topics that I think we should probably — we could probably have a time to address some of the things — and share and talk to us about how they address it. Because I could guarantee you, they all, every ophthalmologist that I know, go through these type of stressors, there’s no exception. So having said that, Tamara, I know you have a very busy schedule. Some places around the world, I know this is 1:00 in the morning for some. It’s early in the morning and we have to go to work. Thank you very much and this is going to be recorded — this is recorded and it’s going to be shared with everyone out there around the world for people to watch and please share this video with everyone, all your colleagues, all your friends, and thank you for what you do, to help our patients with their vision and sight. Thank you. Bye everybody!