In the second installment of this two-part episode, Dr. Mary de Groot shares practical strategies for recognizing and preventing burnout among diabetes care professionals. Learn how to identify early warning signs, practice regular self-assessment, and foster open workplace conversations. The episode also explores how healthcare organizations can support healthier environments and promote long-term professional fulfillment while maintaining high-quality diabetes care.
Dr. Paola Acevedo
Welcome back to Diabetes Care Conversations. I'm Dr. Paola Acevedo, a primary care clinical pharmacist and certified diabetes care and education specialist. And we're here with Dr. Mary de Groot. Thank you for being back with us.
Dr. Mary de Groot
Pleasure to join you.
Dr. Acevedo
Burnout often develops gradually rather than overnight. What are the early warning signs that providers may be experiencing burnout and when should they seek additional support or intervention?
Dr. de Groot
So one of the things we know is because burnout is multifactorial and well-being is multifactorial, burnout and even feeling kind of what I call crispy, that is kind of on those the leading edge of burnout, will look differently for different people. Right. So the first step is to look internally, right? So how am I feeling and how am I feeling now compared to how I was feeling five years ago, right? Ten years ago at the start of my career.
How has that changed, right? So taking those moments of reflection can be very helpful to tune into ourselves. Sometimes we are so busy with the demands outside of ourselves that we don't really even have time to have those moments of check-in. So doing a self-assessment can be very helpful. If we're feeling some of the signs and symptoms can be internal feelings of dread when we start the day or getting up in the morning, am I looking forward to work? Am I looking forward to that first patient of the day? Am I trudging to work? Am I struggling to find my parking spot? Or do I come with energy and excitement or even just kind of positive feelings about the day? Those are very different kinds of experiences. And are those a trend over time? Am I feeling struggle throughout the day? Is it a struggle just to get lunch? Or maybe I don't get lunch, right? Or maybe there's a struggle to just make it through to be on time for each of my appointments. How much is that kind of taking energy from us? Or are we resisting? Are we sending a lot of energy to try to resist negative feeling? One of the key hallmarks that many folks in my environment have used is delays in documentation. If we're putting off documenting our patient appointments, which of course we know that we need to do, that has a very important set of functions to it, not only to meet regulatory expectations between guidelines and standards, but also to help us formulate our care plan as we move forward with the patient. But when we put distance between ourselves and the memories of that last patient encounter, the emotional impact of that last patient encounter, that probably tells us that we're struggling in some way. Right. So if we're putting off our documentation or we're not meeting our standards, that's a pretty important marker. If we're feeling isolated, right? Patient care can be beautiful and wonderful. But it can also be fairly isolating if we're not able to connect with each other, other healthcare professionals, even if those are not profound conversations, just having those touchstones can be very important. If we have a tendency to have empathy gaps, right? If we're getting compassion fatigue, that's an important marker that we're probably beyond our bandwidth and that we need to really be thinking about how to regenerate ourselves. And I would add feelings of guilt, feelings of shame, feelings of helplessness, or if we're devaluing ourselves in some way, those tend to be markers to really pay attention to as we're moving forward because those can really take energy away from what we need to have for ourselves and also what we then have available to give to patients.
Dr. Acevedo
Thank you for that. I think our listeners will really appreciate knowing how to identify this in themselves. I think we're great at identifying kind of issues and warning signs in our patients, maybe even in our colleagues. But I think it's often a bit of a a struggle to identify it in ourselves. So those moments of self-reflection and assessment, as you said, are so important.
So recognizing burnout is one thing, but the next question is what can we actually do about it? Many of our listeners are diabetes care and education specialists who are looking for practical ways to protect their own well-being while continuing to care for others. What protective measures can they take against burnout and depression?
Dr. de Groot
So first step, self-assessment, right? Okay, we need to know where we're at. And we also need to be tuned into where are we at in our professional life course? What do we need now at this stage in our professional development that we may not have needed before? Right. When we're newly minted as healthcare professionals, right, we have a lot of learning curve that can be very growthful. But as we get into mid-career or even late career,
Sometimes those opportunities we may not seek out. We may get very busy just with patient care, patient after patient appointment. And so we need to as part of that self-assessment, not only how are we feeling internally, where are we at in terms of our growth trajectory, our professional development? So being tuned into what our needs are. Second piece is talking with others. We start with the internal dialogue, but then we need to have conversations with other people, right? We need to bring our needs and any concerns with us to our supervisors. That may be through an annual review process, that might be a sidebar conversation, right? So kind of just pulling someone aside and sharing an idea or sharing a need. Checking in, does my supervisor see me the same way I see myself? My supervisor may think that I'm a star, but I may not be feeling that same way about myself, right? So having our supervisors create psychological safety for these conversations, right? So we all need to feel safe in those conversations. So for the supervisor, we need to generate those cues of safety, but also then being a mirror of a reflection. We also need to advocate. So again, thinking about these system level pieces, advocating for realistic quality metrics, advocating for flexibility in scheduling templates when those are needed.
Mid-level managers play a key role here in creating environments that allow people to be flexible, to shine, or when they need breaks, controlled breaks, right? Allowing for that as well. One of the catchphrases that we've used in our system is that 20 minutes will get you 20 years. And what that means is that if you can give someone some flexibility in their scheduling template, you can keep them in your health system for 20 years because people will feel understood, they will feel responded to in a way that's productive and efficient and gives them the flexibility that they need to manage multiple demands, whether that's professional demands, life demands, kind of all of the above. I think it's also really important, and this is a trend that we have seen in the last 10 years or so, that there is a tendency for many of us to disengage from regional and national conversations and volunteer roles.
A lot of that has to do with kind of the existential bargain of healthcare providers these days. It's much more transactional. There's RVUs, relative value units for productivity or other kinds of metrics that systems may use to assess productivity. And so there's a tendency to say, well, if I'm not paid for it, I'm not going to do it. There's a lot of rationality in that statement. And that can feel like a protective statement.
I would also say though, there are some cons. We miss out on professional growth opportunities when we are connected to regional or national organizations. There's different ways, different skills that we can flex beyond our clinical skills that we can grow into these roles. It's also really important as a guild for diabetes care and education specialists to be at the tables where conversations about compensation, about representation, about policy, about patient care are happening. And if we are not present at those tables, our voices don't get represented. And so when we build a career where we have just a little bit of volunteer work in the mix, that can be very professionally stimulating and gives us a way to grow, even if our patient care tends to stay the same over the course of our careers, our professional careers. And then I would also say taking responsibility for our own self-care, right? We are very good at telling our patients about diabetes self-management and all of the things they need to do to care for themselves. And we would be right. We have evidence-based recommendations that we give to our patients. We also need to take care of ourselves. So seeking options for additional training or professional development, engaging in wellness programs. Many wellness programs live in many different places within a healthcare system.
Seeking out employee assistance programs where those are available or health promotion programs. All of those we can benefit from as well. And then we're living our mission and there's a good fit between what we're saying to our patients and what we're doing for ourselves. And that helps us to feel like we're living our values because we are.
Dr. Acevedo
I appreciate you highlighting the importance of having those conversations after we've done that self-assessment and also how you tied it into the importance of advocacy and how that can help individual providers, just as we advocate for our patients. Can we advocate for ourselves, right? For those better circumstances, you know, in our systems, for better pay, for what policy should look like. I think that's such a beautiful thread you've woven there.
Dr. de Groot
The other thing that I wanted to mention that I think is useful is thinking about how we work with people with diabetes. So thinking about that patient care level component of what inspires us or where we struggle. One of my favorite talks of all time, and this may resonate with the listeners of this podcast, was a talk that was given by Dr. Bill Polonsky when he won the Outstanding Diabetes Educator Award in 2020 from the American Diabetes Association. I had the pleasure of giving the talks as president of healthcare and education that year. And then Bill followed me as the outstanding diabetes educator award winner. And one of the things that he mentioned in that talk that really made an impact for me was issuing a challenge to all of us who are engaged in diabetes care in any way, which was to really tailor the materials that we have to offer to the needs of the specific patient that's sitting in front of us when we have a clinical encounter.
Sometimes we need to refresh our scripts. We need to not only update our teaching materials to the latest evidence, which of course we're probably already doing, but really kind of re-energize our spiels, so to speak, the things that we say over and over and over again, and really work on making what we have to offer as relevant to a patient as possible. Embedded in that is what we know about good patient-centered care. Which is that really evaluating where diabetes is on the map for any given patient at any given time. For some of our patients, diabetes self-management struggles and successes are foremost in their minds, right? Those are great experiences because we can be right there with our patient and offer the tools that they need. For other patients, however, diabetes may be pretty far down on the priority list of life experiences, right? There may be many other things that are kind of foundational in Maslow's hierarchy of needs that patients are dealing with before they can even get to diabetes self-care. So really checking in with patients, what is it they want from this appointment, right? Where is diabetes on their life map right now? Is it even on the radar? And listening carefully and then tailoring what we have to offer to meet the patient's needs. When we make that kind of connection, that gives more to our patient because we're providing what they can take in at that moment and can also be more fulfilling for us. So we're not feeling like we're pushing a heavy stone, right? But we're really working with the patient at whatever stage of readiness they're in for any given behavior. It can really reduce some of our fatigue.
Dr. Acevedo
Such an important reminder, Dr. de Groot. I feel that we get into our routines and we get into our, like you said, those spiels. And oftentimes we don't kind of circle back to say, is this something that's going to relate to the patient that's in front of me? So it goes back to that individualized care. And I'm even thinking about in parallel, checking in on myself, maybe changing that question that I asked myself to ensure that I'm doing that self-reflection that you mentioned. So I feel like all of this is so connected is the word that I would use.
Of course, while individual strategies are important, we also know that resilience alone can't solve burnout. Organizations have a very essential role to play. How can healthcare organizations better support diabetes professionals, including diabetes care and education specialists, in maintaining resilience, boundaries, and professional fulfillment?
Dr. de Groot
So the good news about our understanding of burnout and wellness is that there have been a lot of evidence that is accumulated about strategies that work. So the good news is that there are strategies that work, but just as with anything else, they only work if we use them. And it is a process of conversation, right? Sometimes when we're feeling the most frustrated with the system, right, there can be a little bit of othering going on, right? They don't get me, right? They don't understand what we do.
And in fact, it's really a two-way conversation, right, that we need to engage in. So a number of strategies that we know work. So staffing and coverage improvements. We certainly know whether it's nursing, dietetics, pharmacist psychology, mental health care providers of all stripes, that when we don't have enough of us, that we are stretched thin. In endocrinology, we know that that's very true of that medical subspecialty.
So we need to be creative in our solutions and we need to be consistent advocates for our headcounts. There is a business case to be made, right? We know that it's literally anywhere from three to six billion dollars annually when there is staff turnover. So small investments on the part of a health system to increase staff can have tremendous savings for a healthcare system in the short and long term. So really advocating whenever we can for the staffing needs that we realistically need, right? Very important. Flexible work models. So I mentioned this earlier. How we work with staff templates, how we work with schedules, how we fleck when there are needs. Very important. Even when total volume remains constant. And this is where mid-level managers can make a huge difference. If an employee feels understood, feels needed. They will pitch in kind of when they can give 150%, they will. But when they can only give 75% for a short or discrete period of time, we need to be appreciative of that and responsive to that within the confines of our larger organizations.
Recognition. We know that recognition is huge, right? That clinical work, because it can be a little isolating, people may not see the great work that we're doing. In our system, we created the Health Juice Box Awards. And this was created by Brittany Merchant, who leads our diabetes care and education specialist team. And there's a group of faculty that will gather every two months will gather referrals for nominations for the Juice Box Awards. We vote on those and then that gets awarded during large team meetings. It's a token. It's just a way to recognize excellent work when that's happening. And of course it's happening. There's a lot of nominations because it's happening a lot. But any form of recognition can be really helpful.
Small group task forces is another strategy, right? Bringing key people together. That's leadership, people who are involved in the nature of the pebbles in our shoes, as Shanafelt would quote Muhammad Ali in saying. And these task forces can identify and prioritize operational problems.
And then iterate and evaluate solutions. So little pilot programs, right? What can we do to change this workflow or to change that problem or to enhance documentation or administrative bird inbox problems, for example? So all of these are multiple different kinds of strategies that we can leverage to make change. Most important thing is that we empower ourselves, right? When we pull back, when we disengage from the conversations, that's when we're at the greatest risk because we're not able to share our highly relevant experiences with others. Then we won't be able to make change until we do.
Dr. Acevedo
I appreciate that response. I think what I got out of it is that it's so important for the diabetes care professional to collaborate with the healthcare organization to come up with those solutions that are that are gonna help solve the burnout or even prevent it before it happens.
Dr. de Groot
Yes. Absolutely.
Dr. Acevedo
Dr. de Groot, thank you so much for sharing your insights and expertise with us today. We delved into the complex issues of burnout amongst healthcare providers and the individual and systemic factors that contribute to experiencing it.
For diabetes care and education specialists, recognizing the early signs of burnout, setting realistic expectations, practicing self-reflection, and advocating for supportive workplace environments are all important steps towards sustaining professional well-being. A special thank you again to Dr. de Groot for sharing her expertise and insights with us today. For additional resources on diabetes care and education and professional practice, visit ADCES.org. Thank you all for joining us for this episode of Diabetes Care Conversations.
Until next time, take care of yourselves and each other.