Like most health care workers nationwide, Dr. Jennifer DiNubila is no stranger to burnout.
The gastroenterologist at Cheshire Medical Center is dealing with a constant inflow of tasks, from procedures to paperwork, in addition to working rotating on-call shifts.
This makes it difficult, she said, to stop thinking about work off-the-clock.
“Even if you aren’t . . . overwhelmed with things to do, there’s always a level of underlying anxiety, because something could happen,” said DiNubila, 47, of Keene. “You could have to get up in the middle of the night and go to the hospital.”
DiNubila, who’s worked at the Keene hospital for 15 years, has tried a few different ways to manage the pressure — stress-reduction courses, mindfulness podcasts, exercise — but none of it made “everything 100 percent better.”
DiNubila is not alone in these feelings. Health care workers across the country are leaving the field at unprecedented rates due to burnout and increased stress levels, with limited resources available to help.
“You’re taught to stuff it down — whatever feeling you have, whatever a patient is going through, you just gotta stuff it down,” DiNubila said. “You’re taught to ignore your own feeling and needs.”
To address burnout head on, the New Hampshire Medical Society launched a new initiative this fall that coaches physicians on how to cope with their stress and, ultimately, not burn out.
DiNibula was one of the Break Through Your Burnout program‘s first participants. The six-week course taught health care workers how to prevent and heal from burnout alongside coaching to help them integrate those tools into their daily lives.
“It was a safe space . . . and you could walk away with a little nugget of information, something to help you,” DiNubila said.
The consequences of burnout
Burnout is a type of work-related stress in which a person experiences a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity, according to health experts.
This can occur in any profession, but is particularly prevalent in jobs focused on helping others, such as health care workers. Research shows burnout rates among that population have been climbing for years, but the stress and uncertainty of the COVID-19 pandemic pushed the crisis to an all-time high.
Nearly 63 percent of physicians said they experienced at least one instance of burnout during the pandemic’s height in the winter of 2021, compared to the 38 percent reported the prior year, according to a 2022 study of 2,500 physicians through the American Medical Association.
People of color, women and people who identify as LGBTQ+ who work in health care are even more likely to report symptoms of burnout, as they are less likely to receive support, several national studies show.
This high rate of burnout has proven to have consequences, with the nation undergoing a severe workforce shortage across most health care sectors, including physicians.
One in five physicians said they would likely leave their current practice within two years due to burnout, according to a 2020 study of nearly 3,000 respondents nationwide published by the Mayo Clinic.
And the demand for physicians will continue to grow faster than the supply, leading to a predicted nationwide shortage of between 54,100 to 139,000 physicians by 2033, according to the Association of American Medical Colleges.
NH program gives tools, guidance to physicians
The pilot for the Break Through Your Burnout program — launched by the New Hampshire Medical Society’s physician health committee — included eight physicians from across the state. A few of the participants are members of the committee, including DiNubila, while others joined through word of mouth, according to Penelope Perri, a Concord-based certified life and leadership coach who created the program.
“Burnout is something that tends to sneak up on us . . . ,” she said, “so I wanted to help people that were recognizing the symptoms of burnout and wanting to unwind that.”
Perri taught participants 12 modules — ranging from the root causes of burnout to connecting to their strengths at work — over the course of seven sessions. The first session was an all-day affair in Concord, where physicians learned the foundational concepts of the program.
Perri said the course is rooted in cognitive behavioral theory, which focuses on how people’s emotions, thoughts and behaviors are linked to and affect one another.
Following the first session, Perri said participants attended six meetings to learn new modules and discuss the concepts. These lessons included group coaching sessions with Perri to help the physicians implement these ideas on a regular basis.
Perri said she also offered participants three individual coaching sessions with her if they weren’t comfortable sharing certain topics with the group.
“We wanted to bring a community and human connection aspect to this program because a lot of the research about physician burnout talks about the need for more . . . connection among physicians,” she said, “and that is something that has been lost certainly due to the pandemic.”
For DiNubila, the group coaching gave her a sense of community with other health care workers, and showed her she wasn’t the only one facing feelings of burnout.
“We were from all over . . . different hospital systems, different specialties, and we all had some common stressors,” she said. “It just lifts some weight off your shoulders.”
Dr. Angela Yerdon McLeod, a family medicine doctor at Concord Hospital and chair of the physician health committee, also participated in the program. She added that coaching helped her change her mindset when dealing with work-related stress.
“I think that everybody who went through the program started looking at things and thinking about them a little differently,” she said.
Moving forward
Beyond the local burnout effort, data show similar programs have been successful in addressing the issue head-on.
A four-month online group coaching program for female medical residents — which followed a similar coaching model as Perri’s — resulted in a “reduction in all scales of burnout,” according to a 2022 clinical trial published in the Journal of the American Medical Association.
A study on managing physician burnout, published in the National Library of Medicine in 2019, found implementing mindfulness practices, stress management techniques and cognitive behavioral tools enhanced job competence and improved communication skills among providers.
Overall, Perri and Yerdon McLeod said the local program has yielded positive results for participants.
Because of its success, the medical society will offer more cohorts in the New Year — online and in person — starting in January, according to Perri. Any physicians interested can contact Perri at hello@penelopeperri.com.
The New Hampshire Medical Society — a Concord-based nonprofit dedicated to supporting medical professionals statewide — covered the charge for the pilot through grant funding, Perri said.
Now that the pilot is over, participants will need to pay for the course, according to Perri. The medical society will continue to partner with Perri, she said, by funding advertising and offering conference room space for future courses.
But, she said the program’s “cost will depend on the size of the groups and the number of in-person and online participants.”
Physicians may be able to use their professional development funds through their employer to cover the cost, Perri noted, as these future courses will offer up to 16 hours of continuing medical education credits, which are required by the state to maintain an active license.
Yerdon McLeod and DiNubila encouraged other physicians to look into the program, even if they aren’t completely burned out.
“Anything that we can do to help one person be less burned out, it ultimately causes ripples, because they’re gonna show up better for their colleagues at work and the patients that they’re taking care of,” Yerdon McLeod said. “And that’s what we’re all here for: to take care of others.”
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