Preventing Burnout in Health Care

0:00:13 William Moyers
Hello! And welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues that matter to us and the issues that we know matter to you as well. Substance use disorders, prevention, research, treatment and recovery support. I'm your host, William Moyers, and today we're coming to you from on the road at the campus of the Betty Ford Center in Rancho Mirage, California. Joined by my friend and colleague Joseph Skrajewski. Welcome, Joseph.

0:00:42 Joseph Skrajewski
Thank you, William. Pleasure to be here.

0:00:43 William Moyers
You're the Executive Director of Medical and Professional Education. And our topic for today is preventing burnout in health care professionals. You mean to tell me that health care professionals can burn out?

0:00:56 Joseph Skrajewski
It's hard to believe, William, but health care professionals can in fact burn out. Over the course of my career, and I'm sure over the course of your career and others, one thing I've seen more than ever is how hard health care professionals work. Day in and day out, we put in long hours, we're essentially surrounded by individuals who are suffering. Who are living with challenges and we're trying to help them see the light at the end of the tunnel. We're trying to help them find that resilience, find that happiness, find some balance in their lives.

0:01:25  William Moyers
Mmm-hmm.

0:01:26 Joseph Skrajewski
So that they can be as productive as possible. And so, one thing that I've really found important over the course of my career is working with health care providers that are stressed out, that are burned out, because I quite frankly don't wanna see them resort to unhealthy habits. I don't wanna see them have to end up in treatment if possible. I really want them to find some active balance in their lives based off of what they're doing in the work force, and then what they're doing with their families. And what I've noticed is you—you probably see this in a lot of our settings, you see a lot of health care providers in treatment. I see lots of physicians, I see lots of nurses, I see lots of pharmacists, I see lots of physician assistants, I see lots of social workers, I see lots of addiction counselors.

0:02:08 William Moyers
Hmm.

0:02:09 Joseph Skrajewski
People that love helping others out of neglect to themself. And so they're coming into the office early every day, they're on their computers charting outside of their small group of one-on-one individual session times, they're working late hours into the evening, they're going home taking care of their significant others, their children, and they're doing that over and over and over again. And why I found this so important is I work a lot of the time with family law lawyers and with judges.

0:02:39 William Moyers
Mmm-hmm.

0:02:39 Joseph Skrajewski
And working with judges I would watch them day in and day out in the courtroom, and what they would see in front of them were people that were living with addiction. It's like 80, 90 percent of the cases presented in the courtrooms involved alcohol or drugs of some sort. And so here they were, they would hear these stories, and what would they do? They would go home at the end of the day and they would stuff the emotions and stuff the feelings. And come back the next day and do it all over again. And they would live with things like vicarious trauma, they would live with things like—like sadness and remorse. They wouldn't get to see a lot of light at the end of the tunnel. It's not like individuals were coming back to the judge and saying 'Thank you so much, judge, you really helped influence and impact me!' They're usually not seeing individuals at the best of times. And so we started providing educational experiences for judges first and foremost to help them with sentencing people to treatment. As opposed to sentencing them to prison or jail. As you know, drug courts have been incredibly successful over the years in helping not just reform people but helping them get clean and sober and stay clean and sober.

0:03:39 William Moyers
Right. Right.

0:03:41 Joseph Skrajewski
Then you would at different professionals like clergy, right? People would go to their churches or their synagogues and they would share with individuals about their drinking and about their using. People that would run these churches or synagogues or other religious experiences would then stuff those emotions and listen to all these horrible things all day. And sometimes they would drink at the end of the day. And like if you're a judge or lawyer or a clergy person, and you're hearing this stuff day in and day out—

0:04:10 William Moyers
Mmm. Mmm-hmm. [nodding]

0:04:11 Joseph Skrajewski
—And you start drinking, what are you living with? You're living with shame. You're living with guilt. You're living with remorse. You're living with secrets. And so we started seeing all this stress and some burnout in clergy and in judges and lawyers, and then you'd see your—your peers, your health care providers, working these long hours all day too. And I would see it in medical settings all the time too. And it would always start in the home.

0:04:39 William Moyers
Mmm.

0:04:39 Joseph Skrajewski
And they would try to keep it quiet, right? Significant others would try to cover up the addiction or cover up the mental health and illness. And then it would progress to the point where it would make its way to the office. And in the office you're surrounded by support staff, you're surrounded by assistants, you're surrounded by others. 'Oh, Doc didn't have any alcohol on his breath, that was from the night before.' Or, 'Oh, you know, he's got black circles under his eyes, Doctor just works so hard here,' so we had this—this underlying alcoholism and drug addiction that was taking place.

0:05:09 William Moyers
Mmm. Hmm.

0:05:11 Joseph Skrajewski
And people were trying to cover it up over and over again. And the sad reality is that people would—would only seek help when they were caught. When they would actually have Board action against them—

0:05:22 William Moyers
Consequences.

0:05:22 Joseph Skrajewski
When they would have consequences. And so we started doing things like clinical diagnostic evaluations to help people get medical write-ups and psychiatric write-ups and clinical write-ups. We started talking to them about setting healthy boundaries and about taking care of themselves. We started sharing with them the consequences as to what could in fact happen if they don't stop drinking, they don't stop using. We started showing them other individuals—

0:05:47 William Moyers
Yes. Mmm-hmm.

0:05:47 Joseph Skrajewski
—That were going through the same struggles. I mean, if you work with health care providers, and you put them in a group together, they tend to call each other out on their BS, they tend to hold each other accountable—

0:05:57 William Moyers
[chuckles] Mmm-hmm.

0:05:58 Joseph Skrajewski
They tend to be able to relate better. You have specialty groups nowadays like Birds of a Feather for pilots.

0:06:04 William Moyers
Yes.

0:06:05 Joseph Skrajewski
Lots of pilots in treatment. You've got specialty groups nowadays called the Other Bar. Lots of lawyers in treatment. You've got specialty groups called Caduceus meetings for medical professionals. And then you've got professionals groups for other individuals like police officers, like firefighters. I go to a lot of Twelve Step meetings, let's say I have a loved one that's going into surgery tomorrow. If I'm sitting next to a surgeon that's practiced while under the influence and they're sharing about that in my Twelve Step meeting, I might be having second thoughts about my loved one going into surgery tomorrow—

0:06:34 William Moyers
Sure. Right.

0:06:37 Joseph Skrajewski
So we have these safe environments, these specialty meetings, that are all over the world, for people to share their stories as well. So in—in looking at our peer groups, in looking at burnout, in looking at stress, in looking at addiction, which again is so prominent in our field and in health care as a whole, we simply wanna make sure that they realize there are resources available and that we're there for them.

0:06:58 William Moyers
And that it's okay to ask for help, right?

0:07:01 Joseph Skrajewski
And that it's okay to ask for help! Because here we are, we think we know everything, right? We think we have all the answers and all this training and all this schooling, and I'm supposed to be the subject matter expert—how do I reach out for help? Right? How do I go to somebody and allow myself to be vulnerable and allow myself to say hey, you know what, I'm hurting right now.

0:07:22 William Moyers
And—and the fact of the matter is that it's okay to ask for help! I mean, often times no matter what it is, but particularly health care professionals or those who are successful in business or successful in law, they feel vulnerable in asking for help, right?

0:07:36 Joseph Skrajewski
They do! And I—I think that they're afraid to ask for help and they don't realize that there are services available to them and it's not the end of the world. It's not the end of the world that they need to seek help for addiction. I've had medical students go through our programs, our Summer Institute for Medical Students—

0:07:51 William Moyers
Yes!

0:07:52 Joseph Skrajewski
Whereby they're actually in treatment at our facilities learning about addiction through the individuals living with it, who then go on to residency and end up back in our facilities as patients two, three years later.

0:08:04 William Moyers
Interesting. Interesting.

0:08:05 Joseph Skrajewski
And they look at me in the eye and they say 'Joseph, thank goodness I had that experience—

0:08:08 William Moyers
Yeah. Yeah.

0:08:09 Joseph Skrajewski
—At your SIMS program, because I wouldn't have gotten here this soon. I might have never thought I had a problem. I wouldn't have introspectively looked inward and asked myself some questions. I might not have sought help. I might not have realized that I wasn't so alone.

0:08:24 William Moyers
Mmm-hmm.

0:08:25 Joseph Skrajewski
And so we see that nowadays. We see a lot—I mean I don't know fifteen, twenty percent of our patient population could be licensed health care professionals—

0:08:31 William Moyers
Wow.

0:08:31 Joseph Skrajewski
And I'm proud of that! [hits hands to chest]

0:08:32 William Moyers
Yes! Yes.

0:08:33 Joseph Skrajewski
I'm really proud of that. Because I know that those individuals are gonna have a profound impact on health care and on the world as a whole through getting help sooner than later.

0:08:43 William Moyers
Joseph, we only have a couple of minutes but talk to me a little bit about the impact that the opioid epidemic has had on health care professionals. And I think specifically about those who are working in the emergency rooms or first responders who are out reviving people who are overdosing in the streets and so on. What has been the impact of the opioid epidemic?

0:09:00 Joseph Skrajewski
So if—if you look at Hazelden Betty Ford as a whole, right, 17 sites in 9 states right now. 24,000 patients we're gonna serve this year. If you go and look at what they're diagnosed with nowadays, as far as substance use disorder goes, you're seeing opiates in like 30 plus percent of our cases. That's a huge number. If you turn back the clock ten, fifteen, twenty years ago—

0:09:20 William Moyers
Mmm-hmm.

0:09:20 Joseph Skrajewski
—It's two, three, four times what it used to be. You're seeing the same thing with regards to our health care professionals. When I see health care providers come on in, and their primary diagnosis is an opiate use disorder, I'm not surprised anymore.

0:09:34 William Moyers
Mmm-hmm.

0:09:34 Joseph Skrajewski
I almost expect them to say alcohol use disorder or opiate use disorder because there's such ease of access to getting those opiates. A lot of times opiates are being overprescribed so they're more readily available than ever. For a lot of our individuals that are health care providers they have the financial means to continue to support their habits or their usage. So that happens as well. I mean we go to George Washington University or to Washington DC area all the time and everybody's talking about opiates because they're killing people.

0:10:04 William Moyers
Mmm-hmm.

0:10:04 Joseph Skrajewski
You know, I always viewed alcohol as the slow killer and opiates as the fast killer and that's just so sad that we've classified them in a certain way. Because at the end of the day if people don't get help for these use disorders, they're gonna die.

0:10:16 William Moyers
Yes.

0:10:17 Joseph Skrajewski
You've got this progressive disease right now and I think for health care providers, a lot of times we think we're invincible. We think we know better. We think we know how to prescribe these medications or how much we can use—

0:10:27 William Moyers
Aha. Aha.

0:10:28 Joseph Skrajewski
We like to treat ourselves a lot of the time. I mean here you've got an addicted professional who's treating others who thinks they can treat themselves at the same time. [Moyers chuckles, grins] It's like the biggest oxymoron in the world.

0:10:38 William Moyers
Yeah.

0:10:39 Joseph Skrajewski
So I think our advocacy efforts are huge so that we can help other public health officials, President, National Institute of Drug abuse, National Institute of Drug Abuse and Alcoholism, SAMSA, AMERSA, all the other large public organizations. I mean their eyes have been opened but more people continue to die than ever, and we need to do better, and we need to do more and we need to do it now.

0:10:58 William Moyers
I know they're gonna be people who are watching or—or—or listening to this podcast specifically because they know they have an issue or they have a family member who's a health care professional who has an issue. We've got two minutes. Give us two, or three, or four action steps that health care professionals can take to get help for themselves. Or for somebody who works in their office or their health care profession.

0:11:21 Joseph Skrajewski
My number one recommendation is it's never too late to get help. And you don't have to have this myriad of consequences. You don't have to get a DUI.

0:11:29 William Moyers
Mmm-hmm.

0:11:30 Joseph Skrajewski
You don't have to get reported to the Board. You don't have to get caught. You can seek out help yourself, it's not the end of the world. Address the issue now, sooner rather than later. And move forward with your life, helping more individuals than you ever could have. So, I really want people to realize that stigma is still alive and well—

0:11:48 William Moyers
Yes.

0:11:49 Joseph Skrajewski
We look at people with substance use disorders at times negatively.

0:11:52 William Moyers
Yeah.

0:11:52 Joseph Skrajewski
Like they're a hindrance on the world and that's just not true.

0:11:55 William Moyers
Mmm-hmm.

0:11:56 Joseph Skrajewski
Individuals with substance use disorders are resilient people that want a better life for themselves and their families.

0:12:01 William Moyers
Mmm-hmm.

0:12:02 Joseph Skrajewski
So whether health care providers—I hope they see that. I hope they see and realize that if they get help sooner than later, they can help profoundly impact and influence thousands of individuals more so than they could if they continue to drink and to continue to use.

0:12:14 William Moyers
And the fact of the matter is is that often times you know this, you've told me about this before and we see it on the units—health care professionals are among the group that has a very high success rate, right? Once they get into treatment, they have a—their rates of recovery are—are high, correct?

0:12:29 Joseph Skrajewski
Health care professionals in particular is one area that we've actually done a really good job studying with respect to substance use disorders. A lot of other areas are lacking, but when it comes to individuals, primarily physicians and pilots—

0:12:41 William Moyers
Mmm.

0:12:42 Joseph Skrajewski
—And we monitor them for five years for abstinence, you'll see 78 to 92 percent abstinence rates after five years.

0:12:49 William Moyers
Remarkable.

0:12:50 Joseph Skrajewski
Which is remarkable!

0:12:51 William Moyers
Because why, though?! [gestures with arm out]

0:12:52 Joseph Skrajewski
Well I—I think they have the licenses at risk—

0:12:53 William Moyers
Ah, yes.

0:12:54 Joseph Skrajewski
So a lot of times it's—it's the job. But at the end of the day, my belief is that everyone's life is at risk. So people say to me all the time well of course the—the abstinence rate is gonna be higher for people with licenses. It's their livelihood. Well, isn't it everyone's livelihood when it comes to substance use disorder. One drink, one drug, one event, could in fact lead someone to their death. We need to treat this thing seriously and realize that these are our brothers and sisters out there and if we don't take action and we don't take it now, we could in fact lose them. And that's a big deal. It's a very big deal.

0:13:31 William Moyers
Joseph Skrajewski thank you very much for taking the time to share your incredible professional expertise and that remarkable articulate passion you have for these subjects. The Executive Director of Medical and Professional Education for the Hazelden Betty Ford Foundation. On behalf of everyone here at Let's Talk, I'm your host William Moyers, thanks for joining us again and we'll see you soon.