Burnout with Dr. Lauren Bojarski

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Dr. Lauren Bojarski joins us to talk about our current understanding of burnout in the medical field as well as some of her own experiences. 

We talk about symptoms such as: 

• depersonalization
• emotional exhaustion
• the need for personal achievement and others

Check out some of the resources mentioned below:

ACGME Well-Being Tools

Top 10 physician specialties with the highest rates of depression

THRIVING IN YOUR NEUROLOGY CAREER

RESIDENCY PROGRAM WELLNESS

WELLNESS RESOURCES FOR ORGANIZATIONS

Find Dr. Lauren Bojarski on X/Twitter

Higher Listenings: Joy for Educators
A new podcast from Top Hat delivering ideas, relief, and joy to the future of teaching.

Listen on: Apple Podcasts   Spotify

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• Would you like to be a guest or suggest a topic? Email us at [e-mail]
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The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.

Episode Transcript

Michael Kentris (00:01):
All right and we're gone.
Hello, this is Dr MichaelKentris, the host of the
Neurotransmitters, and welcomeback to your source for
everything about clinicalneurology.
We are coming to you from theAmerican Academy of Neurology
annual meeting and I am veryhappy to introduce today's guest
, dr Lauren Bojarski from theUniversity of Kentucky.
Welcome.

Lauren Bojarski (00:19):
Thank you for having me, Dr Kentris.
I'm really happy to be here.

Michael Kentris (00:22):
Please call me Michael.

Lauren Bojarski (00:22):
Okay, will do so, you, you, for having me.

Michael Kentris (00:24):
Dr Kentris, I'm really happy to be here.
Please call me Michael.
Okay will do so.
You know you were so kind toagree to my request for an
interview with you.
I saw that you'd been doingsome work on burnouts in
medicine recently, so tell me alittle bit about what kind of
piqued your interest.
What drew you to that?

Lauren Bojarski (00:38):
It's a great question.
I originally started thinkingabout it in medical school.
I had been on a small committeethat was trying to make medical
students' lives just a littlebit better like maybe having
snacks after tests and they hadalready had the committee and so
I just kind of hopped onto itand heard what they had to say.

Michael Kentris (00:56):
The pizza party strategy.

Lauren Bojarski (00:57):
That was exactly right.
It was a lot of pizza, not thehighest quality either, but it
was still good it was incentive.
And we really appreciated thesentiment behind it.
And the more I thought about it, the more I thought, you know,
that just seemed like a goodthing to do.
I did go to a Christian medicalschool and it seemed like a
good thing, just in general, tobe good to other people, and so

(01:19):
it originally started there.
And then after medical school,when I went to residency, I
noticed that it just kind ofcontinued to expand in my intern
year.
So I, I started intern yearduring COVID.
Um, it was very rough, um, andit was even more difficult
because, um, I was supposed toget married a month after COVID

(01:42):
hit, so like March 20th was theday, and then I was supposed to
get married a month after COVIDhit, so like March 20th was the
day.
And then I was supposed to getmarried the 24th and we were
supposed to have a matchceremony and a graduation and
none of that happens.
So no wedding, no match, nograduation.
And I was at a very low pointin my life and when I started
intern year it became even lowerbecause with COVID, there was
no social interaction and I hadrealized that I really thrived

(02:04):
in an environment where we weretalking to each other and
supporting each other.
So a couple months after thathad happened, I realized that I
needed help and so, thankfully,our residency was really good
about providing resources.
So I reached out, I gotcounseling, I talked about how I
felt not good and after I hadfinally improved in my own

(02:26):
mental wellbeing, I realizedthat so many people had been
advocates for me, not even fromneurology.
When I was an intern, it wasmedicine who was advocating for
me and different people, youknow, would see me and they
would talk to me and I was veryopen about how I was feeling and
they would talk back and wewould have conversations that no
one was having, like someonehad mentioned to me that they

(02:46):
were on a path of severe alcoholabuse and that they had someone
who reached out to them, whoreally changed their life around
.
And you know, now he's doinggreat things and he's very
successful and he's happy.
But in that moment I realizedthat we all need an advocate and

(03:09):
then I asked the almostimpossible question how can I be
an advocate for everyone?

Michael Kentris (03:12):
Right.

Lauren Bojarski (03:13):
And that's what started it all.
I realized PGY2 year they askedus to do a research project
like a QI project, and so Istarted working on a virtual
handbook that helped theresidents on the services for
stroke and our general neurologyand patient wards.
We were able to give that tothem to help them learn the

(03:35):
paces quicker, so that theywouldn't feel useless or that
they didn't know everything.
And then so we really got thaton the ground.
We came up with a committee tokeep that sustainable and then,
past that, I found myself doinga lot of validity with ACGME.
So I've done research on thatand seeing how that correlates
to actual resident burnout intrainees.

(03:57):
And as time went on, I realized, well, trainees aren't the only
ones who have burnout.
I realized, well, traineesaren't the only ones who have
burnout.
We don't have a whole lot ofliterature for neurology faculty
and you know, attendings intheir early, mid and late career
we just we don't have that datayet and I asked myself, well,
why not?
And it's because we're nothaving the conversations, and so

(04:20):
that's why I was so happy thatyou were able to have me on
today is because we do need tohave that conversation, and I
think there's been maybe like agenerational gap where that, you
know, we're talking aboutthings that just weren't talked
about 20 years ago.

Michael Kentris (04:29):
And I'm so glad you brought up that
generational gap because it doesseem, you know, for those of us
who are perhaps quote toochronically online, we do see
this discourse every few monthscrop up where someone talks
about how, you know, workconditions are, let's just say,
less than ideal, whether that'sdue to duty hours or the amount

(04:51):
of sleep deprivation itengenders or various other
aspects of medical training.
And then you inevitably getsomeone of an older generation,
let's say who's like I didso-and-so and it made me a
better physician.
And gosh, golly, darn it.
These kids these days, which Ilove that there's this one

(05:13):
stream and it talks about kidsthese days going back to like
the 1890s, and it's just likenews clippings about how kids
these days they don't want towork hard, like nobody wants to
work right, and so this is aperennial discussion that has
been going on since likebasically the printing press in
America, at the very least, 100%yes.

(05:34):
So, that being said, we do knowwhile we don't have the perhaps
granular level of data, we doknow that job dissatisfaction
amongst practicing neurologistsis fairly high.
Do we have any inkling as to?
Does that correlate with?
Oh, I guess, before I go anyfurther as I change midstream
mid-sentence, when we sayburnout, for those who are maybe

(05:56):
more junior in their career,who have not heard burnout, to
the point that they are burnedout about hearing burnout.
What is burnout?

Lauren Bojarski (06:04):
So burnout in in my understanding.
I don't have the officialdefinition in front of me, but
my perception of burnout is theultimate end of the stress
continuum.
There's this theory called theYerkes-Dodson law.
That was theoretical in miceand the theory was that it's a
bell curve and early on in thecurve you are stress-free and

(06:29):
you don't have a lot of stress.
Uh, or your, your focus is notoptimal but you don't need it
because you're not under a lotof stress.
There is a certain point onthat curve where your focus and
or your, your stress level is atpeak, to where you're able to
function appropriately, whereyou have maximal efficiency with

(06:51):
optimal stress levels.
So my interpretation of burnoutis the end curve where you've
been stressed for so long you nolonger care, so your energy
levels have come back down andyour efficiency is very low, and
we've seen that.
The burnout rate you were askingearlier about, like you know,
we have rough estimates.

(07:12):
I think the most recentMedscape article said that it
was around 50% for neurologistsand that's across all training
you know.
So I can't imagine having thatmuch burnout and us not talk
about it.
In regards to your earlierquestion, we have three main
symptoms that we talk about inburnout.
We have depersonalization, wehave emotional exhaustion and we

(07:32):
have personal achievement.
There's some conflictingevidence on whether personal
achievement is actuallyprotective versus you know
whether it's part of the burnoutitself, whether you have
decreased.
You know personal achievement,whether that contributes to
burnout or can protect it.
But those are the three maincategories that are assessed.

Michael Kentris (07:50):
Would it be fair to link personal
achievement to personal agencyor decision-making that causes a
perceivable effect in yourenvironments?

Lauren Bojarski (08:00):
I think you could absolutely see it like
that.
They all kind of intertwine inmy opinion.
I think you could absolutelysee it like that.
They all kind of intertwine inmy opinion because they all of
them kind of focus on questionsof, for example, do you need
more time at the end of the dayto feel renewed?
Another question could be doyou feel like your job is giving
you purpose, like, do you feellike you're in control of your
job?
Do you feel cynical when you'rein the field and someone says,

(08:23):
oh, we can do X, y, z.
Are you the person who'sstepping back and be like no,
you can't.
Now, you know that's barring,you know experience and you know
exposure to the field.
However, is it something thatyou really know for sure?
Or is it just that you're socynical that you have been in
this role that you don't feelreinvigorated by what you

(08:45):
continue to do, and so that'sreally, you know, the main
components to burnout that welook into.

Michael Kentris (08:52):
And would you expand a little bit on
depersonalization?
So I feel that's one of themore insidious things.

Lauren Bojarski (08:57):
It is.
It is very insidious and Iprobably wouldn't even be the
best person to discuss itbecause I, like I said, I feel
like they all intermingle, andwith depersonalization it's like
do you feel like you're justshowing up to do a purpose?
Are you having days where youjust go to work and you feel
like you're just on autopilot?
It could be, you know, anywherefrom you going to work and you

(09:23):
feel like you don't have purposein your job, like you're just
writing notes, and who's goingto write, who's going to read
these notes?
And I'm just a pencil pusher atthis point and you know, a lot
of people get stuck in thatgrind and they don't think that
there's a way out of it.
And thankfully, here at the AANit's.
I feel like it's a burnoutpreventer or at least a burnout

(09:44):
dissuader, because you'refinding people who are
like-minded like you and thatadds to that sense of community
which we know can help withburnout, that social interaction
is really helpful and soultimately you know, being here
at the AAN, you don't have tophysically be here to have that
sense of community.
It can be in your department, itcan be with your co-residents,
it can be with your colleaguesand the people you work with.

(10:07):
It doesn't even have to be inneurology, it can be family.
It could be your dog that youlove at home, it could be your
rowing team that you reallyenjoy.
It doesn't have to be that.
You just have to find yoursense of community and culture
and that can help bring you infrom that symptom.

Michael Kentris (10:24):
I think those are great points.
The community is such aneglected aspect.
When we talk about it and Iknow you are about to start a
cognitive fellowship soon, andthat is one of the key things we
talk about with our moreelderly patients in particular
is what does their communitystructure look like?
Are they active in a faith life, a community life, activities,

(10:46):
et cetera, et cetera?
And it's something that perhapsfor us as younger people, that
we don't necessarily identifybecause, well, we're here in the
hospital or the clinic andwe're surrounded by people every
day.
Right, that's literally we'retalking to people all the time,
how could we feel lonely?

Lauren Bojarski (11:03):
and isolated right.

Michael Kentris (11:05):
And it really does speak to that, to those
conversations that you'retalking about.
So, that being said, let's say,hypothetically, we have a
colleague of ours that we'reconcerned might be showing some
signs of burnout.
What's one of the better waysto perhaps approach them?

Lauren Bojarski (11:22):
That's an excellent question ways to
perhaps approach them.
That's an excellent questionand I've had that question
before when I gave a talk aboutburnout and imposter syndrome
and the question actuallyfurther subdivided into how can
I tell if they have depressionor a mental illness?
Because we don't know thedirect correlation between
burnout and depression yet.

(11:43):
We think we know, but based offof the literature so far.
Is it on a spectrum?
Maybe Are they related?
Probably, but we don't know howthey're related yet.
And so asking someone at firstto do some introspective work is
very difficult, because maybeyou've identified those symptoms

(12:04):
in someone and they're so burntout they don't know.
So, for example, when we giveall of these surveys to evaluate
well-being, no one wants totake those and also the people
who are so burnt out they're nottaking the survey Are you
saying that paperwork is not aprotective factor for burnout?
Certainly not, but that's thepoint.
It's like how are you going toassess burnout when the people

(12:28):
who need the most help are soburnt out?
They probably don't even knowthemselves that they need help.
Not even showing up in our datanot even showing up in our data,
and our data is not great.
So how bad is it really?
And you know that's what a lotof research you know that I'm
trying to work on is figuringout.
Where are we at?
That's the number one basis ofprofessional fulfillment.

(12:50):
Is your assessment of burnout.
Where are we at?
We don't know yet.
We're still working on it.
Burnout in general is a fairlynew field, and so we need to
keep working on that and havingthe conversations you had asked.
How to identify a person withburnout.
There is something that theAmerican Medical Association
actually does.
It's called Stress First Aidand we have it at our

(13:13):
institution and we were trainedin it, you know, after I had
brought it up in a grand rounds.
It's an excellent resource andit enables someone to have the
opportunity to reach out towhoever that might be.
Um, you know it's.
It's observing the person'sbehavior.
It's identifying that theymight be in that area of burnout

(13:35):
, like in those symptoms, andidentifying in them like hey,
are you okay and not?
You know, don't do it on roundsLike don't you know?
If you think a private settingis at a bar having a drink?
At a coffee shop having a tea,what have you?
As long as it's private, thatis the most important thing that
you can do, and just having aconversation and sometimes you

(13:56):
being open about your ownfeelings can help other people
to open up for you.
Like I had mentioned earlier, Iwas very, very open about how I
was feeling, where I was atemotionally, with my friends and
my colleagues around me,because I felt like it was a
disservice to them to not knowwhere I was, if I wasn't going
to show up the next day.
They should know where I'm atand thankfully that never

(14:18):
happened.
But there's so many people who,for example, I believe up North
there was just a suicide in aresidency and it makes me wonder
like where was he atemotionally?
Was he able to have thoseresources to reach out?
You know every residency hasthose resources or some

(14:41):
variation, but do they knowabout them?
Are we doing a good enough job?
I can't tell you how manymodules I've done for everything
when I start out and I don'tremember.
I need that reminder.
And so having a colleague, aco-resident, a mentor, even to

(15:02):
help you understand where you'reat, those semi-annual
evaluations can also be reallyhelpful, especially when you
especially when you're inattending and you're in your
academic career, you have amentor and you meet with them.
It's really good to be openabout how you're feeling because
that burnout the the rate ofburnout is so bad now in
neurology that most neurologistsare leaving their career within

(15:22):
two or three years.
And the the rate of burnout oftwo to three years is increasing
the cost to the healthcaresystem.
It's two to three times thatphysician's salary to replace
that person and just inhealthcare alone it's $4.6

(15:43):
billion in healthcare costs andthat's insane to me because
we're just not having theconversation.
So, just reaching out andtalking to them and just having
a conversation, and if theydon't want to tell you, that's
okay, they are allowed to feeltheir feelings.
It's just you want them to knowthat there is someone who cares
about them.
But ultimately they have to dothe introspective work

(16:04):
themselves to identify where amI, where am I right now, in this
moment, and is it where I wantto be?

Michael Kentris (16:10):
Great points, and I do wonder, as all of us in
neurology know, there is amassive shortage of neurologists
and it is anticipated to worsenover the next 20 years or so.
I'm sure we don't have any data, but to what extent do you feel
that the worsening shortage ofneurologists and the increasing

(16:33):
patient care demands play withburnout or mental health in
large, and like this rapidturnover of neurologists?

Lauren Bojarski (16:43):
I think it's a very interesting point because
there's two sides to that coin.
There is one point where wehave the EMR.
That is a time sucker.
Between all of the view alertsthat we have to address, between
all of the patient messages,between the documentation,
between the extra time that youneed to code so that you can
fill your RVUs, it's becomingincreasingly difficult to meet

(17:05):
those targets and we're notgetting any more time to do it.
So becoming really efficienthas become essential in our
careers.
How can you be efficient if wejust said, if you have burnout,
you're not working at yourmaximum efficiency?
So really we need leadershipbuy-in to understand that this

(17:28):
is crucial, not just for ourwellness but to mitigate
turnover of physicians, toimprove patient efficiency and
seeing patients and having theability to have good Press Ganey
scores and all of thoseextraneous variables that need
to be factored in to the problemthat is the healthcare system

(17:49):
today.

Michael Kentris (17:51):
That's a lot to unpack.

Lauren Bojarski (17:52):
It is.

Michael Kentris (17:54):
So I do wonder, for instance yourself and for
many neurology subspecialties,but cognitive, I think, could be
the poster child for theopposite of quick visits.

Lauren Bojarski (18:05):
Yes, certainly the opposite.

Michael Kentris (18:08):
So when we talk about efficiency, maybe we have
a patient who maybe theirspouse also has a mild cognitive
decline.
They get lost on their way toclinic.
They show up for theirappointment 15 to 20 minutes
late.
It takes them they're notwalking so quickly.
Another 10 minutes.

(18:29):
Now we're 30 minutes into theirscheduled appointment and well,
you know, they're having some.
They've been paying their billsincorrectly and, gosh, I don't
know if they should be drivinganymore.
And you know the list goes on.
And how do we efficientlyaddress these problems in half
the time that we had slated fora patient, which I'm sure barely
ever happens?

Lauren Bojarski (18:45):
Barely happens, never happens.

Michael Kentris (18:47):
Never, ever.
You know.
I know administrators say likewell, you should double book
those patients and I'm sure thatnever causes any issues
whatsoever.
No one's ever staying late inclinic or dealing with irate
patients and their families Likewe've been sitting here for an
hour.
Our appointment was an hour ago.
I'm not expecting an answer,but I'm just curious what your
thoughts are.

Lauren Bojarski (19:08):
And you know it was.
It was funny that you say that,because the answer is I don't
know, and I think the bestanswer is that you have to work
on it with a team.
You have to have that community, you have to be open with your
leadership and say these are thebarriers that we're
encountering, barriers such asmy patients aren't showing up on

(19:29):
time.
Okay, well, can we have someonein the main office to call
patients that day, because youknow if, like you were saying,
if they have dementia, maybethey forgot, maybe you know
calling their caregiver that dayand reminding them of the
appointment or reminding them tobe, you know, an hour early,
because getting them into thecar is going to take, you know,
half an hour and sometimes, likeat our academic institution, it

(19:49):
can take up to 20 minutes towalk just at my normal speed
from one side of the campus tothe other.
So, and how is leadership goingto help if they don't know?
You know they.
You have to be on the frontlines advocating for your
patients, your colleagues andthe nurses and MAs and techs in

(20:11):
the clinic as well.
They all have insight, they allhave a part to play in the
efficiency of the clinic.
But guess what, if they're soburnt out, they're not going to
make that first step.
So maybe it's up to you.
You identify the problem andmaybe your first step in
advocacy is saying, hey, let'shave a meeting, let's have a

(20:33):
meeting with the practicemanager, let's have a meeting
with the techs, and, granted, itwill take time, but the amount
of efficiency you will gain fromthat time invested is
phenomenal.
In addition to you're boostingmorale because you are sitting
there.
Don't do it on zoom.
Don't do it on zoom.
We all have zoom fatigue.
Do it in person.

(20:54):
We have some literature thatshows that in-person
communication is so incrediblybeneficial to camaraderie, to
morale, to just enhancing yourrelationship, and so it's really
important to have that in thecommunity, like that community
sense, because a lot of peoplehave no sense of control and

(21:19):
that, in my opinion, can alsopretend burnout.

Michael Kentris (21:23):
Yeah, absolutely.
And it's funny you say thatabout all the different elements
of staff.
Right, it's not just thephysician, it's everyone
involved.
And I was talking with a friendof mine, just you know, in the
last day highly trainedneurologist, large well-known
academic institution, largewell-known academic institution.

(21:44):
They room their patientsthemselves.

Lauren Bojarski (21:47):
Oh, interesting .

Michael Kentris (21:53):
No medical assistant helping them out and
I'm like you, have a highlytrained physician, not to demean
the role, but that doesn'treally seem like a good use of
that person's time.
And to your point, right, weall, I think, when we go through
training, we all have academicstars in our eyes.

(22:14):
You know, the prestige is areal thing.
We all have our egos, are there?
Right?
We sacrifice certain things atthe altar of that ego, like
money and being more independent.
Right, there's that time, thehierarchical structure remains,
whereas I know one of my formerresidents, she's currently
practicing up in Montana as theonly neurologist in a hundred
miles and there's nobody tellingher how to conduct her practice

(22:41):
essentially.
So there certainly are thoseoptions out there for those
neurologists who are, let's say,have a more adventurous spirit.
But it's a two-way street.
Right, we go in to provide thishigher, what we perceive as
this higher level of care, thishighest level of care, and then
we run into all of thesenitty-gritty things that

(23:03):
logistically it's like well, whydon't we have a medical
assistant rooming the patients?
Why don't we have someonemaking those phone calls on the
same day?
And you wind up right in thisbureaucratic nonsense nest of
tangled hiring structures andall these things, and it is just
the hardest thing in the worldto find who is the actual person

(23:24):
with any decision-makingauthority in this structure,
which I would argue in and ofitself.

Lauren Bojarski (23:30):
Yes, can contribute to burnout.
To burnout yes, Exactly.

Michael Kentris (23:33):
And again I also do not have an answer.
But it does make us wonder,right, because I am not at an
academic institution, I'm in alarger hospital, but I still run
into some of these bureaucraticroadblocks from time to time
and I still get frustrated bythem.
And I think it's a universalthing, unless you are setting up

(23:55):
your private practice directpay, not dealing with insurance.

Lauren Bojarski (23:58):
Concierge service.
Yeah, and everyone's different.
Everyone has different ideas ofwhat they want in their life.

Michael Kentris (24:04):
Yeah.
So what are the small stepsthat we can take?
So let's say there isn't anymoney to be had, there's no
staff to be had.
What can we, as a physicianperhaps embedded in a large,
uncaring, heartless organizationI'm using some exaggeration
here do to help benefitourselves and our patients?

Lauren Bojarski (24:29):
I think that's a great question and I'd have to
think on that.
I think ultimately it ends upbeing you have to ask for what
you need and if the place thatyou're at can't provide that,
there's so many other optionsthat might fit with your needs
and your goals and your missionand your vision, because

(24:52):
everyone's going to be different.
We compare ourselves quite abit to other people, but I've
met so many people here at theAAN at this annual meeting that
they didn't do the cookie cutterversion.
And if it's getting to thepoint where you're getting burnt
out and you're feeling like Ihate my job or I don't feel

(25:12):
fulfilled in my job not sayingthat that's anyone's concept now
in this area but if you havethose concerns, then addressing
them with the people who havethe uns, say, and if you can't
get to them, then maybe if thattruly means something to you to
have meaning in your work and inyour job, and if you feel that

(25:35):
it's that strongly, you shouldconsider talking to other people
and seeing if they have otheroptions.
Like I keep harping on theAmerican Medical Association,
but they have a organizationalbiopsy, actually that you can
request their services wherethey will survey your team and I

(25:58):
don't know the specifics onlike how little or how large,
but they, I believe, will doanything from like a small
practice to a large academicmulti-system center and they
will help you understand whatthe pitfalls are within your own
organization.
And so if you can't get thatwithin your own system, like

(26:19):
within your own practice, thenmaybe asking for help from them
can be helpful.
It's just at the AMA website.
You can just searchorganizational biopsy and it'll
pop up along those same lines.
There's also articles that theygive to help with your own
efficiency.
So say you can't do, you're justat a point where you can't do

(26:40):
view alerts anymore.
Like you feel like you justit's too much.
Like you keep getting requestsfor refills and you're like I
just I can't do view alertsanymore.
Like you feel like you justit's too much.
Like you keep getting requestsfor refills and you're like I
just I can't.
Like I'm seeing 80 billionpatients a day and these
requests are too much.
You know they makerecommendations of like maybe
changing your workflow on thefront end.
So, for example, when you seesomeone, just immediately you
know the minute you see themrefill their medicines, like

(27:02):
when they check in and make surethat you have that sent as
they're leaving.
That way you know you're nothaving to deal with those refill
requests, cause you know theclinic visit can go so quickly
and it can be very easy toforget.
And so I think you know doingsmall things like that, changing
your workflow a little bit more.
You know doing simple thingslike that.

(27:24):
It really can make a difference.

Michael Kentris (27:35):
I'd like to get your thoughts on mindset, I
think more broadly, beyond justmedicine, where people talk
about a lot of change in theirmindsets in terms of, especially
, things like stoicism are verymuch having a moment in the sun
amongst certain segments of thepopulation.
What kind of data do we have oranecdotal experiences do you

(27:55):
have with respect to mindset andlet's say, these things that we
cannot change in ourenvironment?

Lauren Bojarski (28:02):
I will tell you a personal story that leads
into this topic very well.
So our, our residency washaving a lot of difficulty with
burnout several years ago, tothe point where we knew that it
was not sustainable to have thatmentality of the program.
And it was pervasive.

(28:22):
You know, it wasn't just oneresident, it was multiple people
openly saying I am burnt out, Idon't even know if I want to go
into neurology after training.
I want to take a lot of timeoff and see if this is something
that I want to do.
And that was really difficultfor me to hear because I was
coming in as an intern and Ihave not been in the field for

(28:45):
35 years like some of thesepeople have, and so I had this
mentality of well, why not dothis and why not, you know, do
that?
And I am very lucky to havebeen placed in an institution
with a wonderful programdirector who actually came in
around the same time that I dida year before, and he gave the

(29:06):
residents a sense of controlthat we had never had before.
And it wasn't huge, it didn'tneed to be.
He asked us how many didacticsdo you want to have?
Point blank, how many?
And when I talked to myco-residents in the AAN, they're
like what?
Like you were asked how manydidactics?
But that was it.
That was the perceived controlwhere we knew we need didactics

(29:30):
right, we, we need it for right,we need it for our in training
exam, we need it to be gooddoctors.
So he asked us.
He was like do you want morningdidactics and noon didactics or
do we just consolidate and doreally good quality noon
didactics, acknowledging thatyou'll have less but that
there'll be more quality forward.

(29:51):
You know, more high yield, more.
You know more of our attendingswill be able to give good
quality because they won't begiving them so quickly.
And so that sense of perceivedcontrol in my opinion, enhanced
our group resilience.
You know, resilience can bemultiple different things,
there's multiple differentfactors, but I think that was

(30:14):
one of the main things thatreally helped us.
And then that in turn gave us asense of responsibility and it
gave us a sense of passion anddrive that they had not had
before, because beforehand therewas no concept of I want to be
able to change things, becausethey couldn't, no one cared.

(30:36):
And so for us to be given thatreally changed the mentality of
the program.
And now we, you know, our, ourinterview meet and greets
weren't very well attended bythe residents because they were
so burnt out.
It took them more energy torecover when they were at home,
so they didn't have the energyto go to the meet and greets.

(30:57):
And now, within our program,our meet and greets are the
highlight of our week because wehave several of them, you know,
during interview season.
And it's again that sense ofcommunity where we get to come
together and we have controlover who we get to talk to and
hang out with.
And so even that little bit andthat extends to physicians in
practice as well Like what givesyou joy, what fills your tank,

(31:21):
is it that sense of control,perceived control, because you
know we don't have control oververy much.
You know you don't have controlover how not always of how
often you have to see patients,like, oh, it's 15 minutes for a
follow-up, that's it, that's allyou get.
Sometimes we don't have thatcontrol.
But having a sense of perceivedcontrol, what?

(31:42):
What can you identify in yourpersonal practice?
Can you get up 30 minutesearlier and meditate?
I know that's, like you know,taboo, like meditate more, and
that's not what I mean.
But I just heard someone at theAAN.
They said they get up at 4.30to row.
They're on a rowing team andthat is in their control and

(32:05):
that fills their tank.
Dr Orbe Austin is great attalking about owning your
greatness and everything, butyou should own what fills your
tank as well.
She talks about that and it'sreally important to figure that
out.
It doesn't have to benecessarily at work, but if
there's something else that willfill your tank to fulfill that,
I think that also will helpwith your mentality.

Michael Kentris (32:27):
Very true and I think that swing back around to
that generational gap.
Right, it was that expectationthat medicine is a calling and
it should be the thing thatfills your tank, that should
provide you with purpose.
And so we see this change whenwe go from the baby boomers to
Gen X, to you know, I'm amillennial myself, I think you

(32:50):
probably are.
I just hit the cutoff, you'renot quite in the Gen Z territory
I'm an elder millennial but wesee this thing where, from Gen X
onwards, we aren't seeing thatlevel of fulfillment, right.
We don't see where people go toa company and work there for
you know, 40, 50 years, get agold watch at the end of that

(33:10):
and retire, Exactly right.
We are seeing people.
There is a lack of, let's justsay, perhaps perceived loyalty
on the side of the corporateorganization to the physician,
and so you kind of get this,what I kind of refer to as like
the widgetization of physicians,where you do feel like you
don't matter, if I drop dead,they'll just replace me, and

(33:34):
it's very hard to find purposein a position where you perceive
your role as such, in aposition where you perceive your
role as such.
But we are still trained bythese older physicians, some of
whom obviously, are very goodand understand these things.
But there is this in many partsof the country, this perceived
role of like well, why are youdepressed?

(33:55):
You have a good job, You'remaking good money, You're
providing good care to yourpatients, Everything's great
right, it's all roses andsunshine, and perhaps those
stresses.
You are not getting thatfulfillment that perhaps was
there in decades past, becausethe practice of medicine is
constantly evolving, sometimesfor the better, many times not.

(34:16):
And so these kind of little youa thousand cuts, a thousand
paper cuts, if you will do buildup, and so we are dealing with
things that past generationsdidn't.
And so it's really hard to findthat fulfillment for many
people in medicine when it'slike, oh, I've got an inbox that
never goes empty, or I've gotall these patient phone calls

(34:42):
and you know I'm doing theso-called pajama paperwork at
the end of the day, when I gohome and maybe I put my kids to
sleep and all these things right.
So I think that's an excellentpoint where finding something
even if it is not work to befulfilling is so important, and
I think, also something that theyounger generation I'm

(35:03):
including myself in this, eventhough I'm pushing forward- the
younger generation.

Lauren Bojarski (35:07):
We're all young , it's fine, that's right.

Michael Kentris (35:09):
Young at heart, yes, young at heart Is that,
you know, many of us aregraduating medical school with
hundreds of thousands of dollarsin student loan debt.

Lauren Bojarski (35:16):
Don't remind me yeah.

Michael Kentris (35:22):
But so we do.
Right, we have these handcuffswhere we have to practice
clinical medicine.
Right, we can't go part-timebecause then we won't qualify
for these government forgivenessprograms.
And so we do feel there is thisfeeling of being trapped.
I have no options.
I can only do this one thing.
This is the only thing I knowhow to do.
Right, I don't have any othermarketable skills and there are
lots of podcasts and otherresources out there talking like

(35:43):
Dr Sarah Schaefer's NeurologyNuts and Bolts podcast.
I think is great, fantastic,different forms of neurology
careers and other differentresources out there talking
about how you can change yourcareer.
But I think those are allimportant things to know.
It's like you aren't trapped,right.
Even we.
We often do feel that waybecause there is this you said
earlier cookie cutter pathway.

(36:04):
Right I, I go to medical school, I get the good grades.
I go to residency, I get thegood evaluations.
Maybe I do a fellowship, I dogood there yeah, what's next?
I get the shiny academic youknow appointments as assistant
professor, associate professor,full professor.
Now I'm, you know, 60 years oldand I hate my job.

Lauren Bojarski (36:23):
Yeah, and what do I have?

Michael Kentris (36:24):
Exactly, I'm on my second marriage.
You know I'm paying alimony.
My kids hate me.
You know worst case scenario.

Lauren Bojarski (36:31):
Yeah, worst case.

Michael Kentris (36:32):
Absolutely worst.
But there, but for the grace ofGod, could go any of us right.

Lauren Bojarski (36:37):
Oh yeah.

Michael Kentris (36:42):
So I think it's great.
You know, a lot of us aren'ttrained to be self-reflective,
to apply that insight that wedirect so often in our patients
to ourselves.
Absolutely, it's become such astereotype in personal
statements, right, butself-reflective practitioner of
medicine, right, where we dowant to reflect, like I had this
experience with a patient and Ireflect on it, but not just how
it affects my patient.
But but what would thatexperience do to me if it had

(37:04):
occurred to me right To toreally like practice true
empathy and and apply that to myown future life?

Lauren Bojarski (37:13):
Absolutely yeah .

Michael Kentris (37:14):
It can be very scary to do.

Lauren Bojarski (37:16):
Yeah, going on that generational gap, dr Orbea
Austin said it best.
She said people would say like,oh, I walked uphill both ways
in the snow and back in my daywe did this and that, and I've
heard attendings say that.
But the way she says it is best, it's enforcing this mentality

(37:37):
of rugged individualism which isnot.
It's not medicine.
Medicine is a group sport.
Neurology is a group sport.
We can't do it alone.
You need if you've ever watchedScrubs I'm no Superman, I can't
do it on my own.
It's so important to keep thatunderstanding.
Where we need cohesiveness, weneed like-minded individuals to

(38:02):
be open, and I think that youknow we talk about the
generational gap again.
Back then you didn't reallytalk about that, like it just
wasn't culturally accepted.
Um, and I find that, as youknow, we get more diverse in our
careers.
We have all of these wonderfulDEI initiatives and we're

(38:26):
getting more of the populationinvolved in neurology and
multiple aspects of it In thepipeline.
We're hearing more people say Iwant this and I believe we
should do this, and those areideas we've never heard before.
And the best part about being aneurologist right now is that
there's so many good ideas.

(38:47):
We just have to be accepting ofthem and we have to hear them
and listen to them.
And sometimes we have to seekthem out because they're

(39:12):
sometimes it's the littlestvoice that has the most meaning,
because sometimes it's thelittlest voice that has the most
meaning and that is soimportant.
The best experiences of my lifebecause and it was and it was
just a one-time thing, like itwasn't even, but I had a say
among these neurologists, youknow, early, mid, late career

(39:35):
neurologists, and they wanted tohear me, they wanted to hear
what I had to say, and I thinkthat's absolutely true.
Now we have to hear whateveryone has to say.
You know, that might not havehappened years ago.

Michael Kentris (39:42):
I'm sure it wouldn't have.

Lauren Bojarski (39:43):
It probably wouldn't have.
And if we're going to combatthis burnout situation, it's not
going anywhere fast.
It's not going anywhere, youknow, anytime soon.
Maybe it's important weestablish these symptoms and
establish maybe preventativemeasures and more of that
culture as far back as medicalschool, maybe even college.

(40:03):
You know you were talkingearlier about how we're going to
have a shortage of, you know,doctors in general, but
neurologists specifically.
That pipeline subcommittee, youknow, was so great because that
can be your legacy, is helpingwith neurophobia.
You know, reinvigorating yourcareer by helping others

(40:24):
understand that.
Oh, you know what I choseneurology for a reason.
I'll ask you do you rememberwhy you got into neurology?

Michael Kentris (40:32):
So I got into neurology as an accident, so I
don't know if I've shared thison the podcast before, but I
originally applied to physicalmedicine and rehab and I did not
match into it and, as you canimagine, I was crushed.

Lauren Bojarski (40:51):
Devastating yes .

Michael Kentris (40:53):
And so the next year I applied to neurology, I
applied to actually a PMR againand I didn't match again.

Lauren Bojarski (41:00):
Oh my gosh.

Michael Kentris (41:00):
And I soaped into neurology and I was very
fortunate that there was aprogram who thought my resume
looked good enough.
I remember specifically it wasa—because I had an intern
position.
I took a phone call with theprogram director of this program
, Wright State, and I thought itwas just the worst interview of

(41:24):
my life.
Oh, no, oh no, so it's one ofthose things where I kind of
fell backwards and just got thebiggest heaping of luck, because
I do think that Itemperamentally am much more
suited to neurology as a careerthan I would have been to PM&R.

Lauren Bojarski (41:42):
We're very happy to have you in neurology.

Michael Kentris (41:44):
Thank you, yes, but it is one of those things
where it's like you don't knowwhat you do, like I was exposed
to a certain form of neurologyand actually I work with the
neurologist who I worked with asa third year medical student
and he's a little crazy.
He'll never listen to this, soI can say that I would say that
to his face.
But it was a different kind ofcareer and it wasn't one

(42:06):
necessarily.
I saw myself in right andthat's what you were saying
earlier, like seeing differenttypes of people as neurologists.
Modeling that career foryounger generations is really
important and I think you know,obviously I am I'm a white guy,
but I like to think that I canat least model the enthusiasm

(42:26):
for the specialty and forlearning and for passing on
education and I mean that'spartially why I started doing
this podcast.

Lauren Bojarski (42:36):
I was going to say you have always had that
want for teaching.

Michael Kentris (42:40):
Yes, and you know, I was at an academic
center for several years.
We moved to be closer to familyin the middle of the pandemic
the best time to move reallyRight, could you think of a
better time?
And so I didn't have neurologyresidents, I had internal
medicine residents, I hademergency medicine residents.
There was a nearby psychiatryresidence program in a local

(43:01):
medical school.
So, like, well, I have new,different kinds of learners now
and a different, less resourcerich arena, exactly.
And so what can I do?
So I thought, well, I likepodcasts.
You know a lot of our studentsbecause it's, you know, the
NeoMed where I'm affiliated with.
They have to commute a lot todifferent hospitals and

(43:22):
different practice and all that.
So, like, well, you know theycould always listen to this
while they're driving on theircommutes and we do something
with that.
And so it's and, selfishly,it's been a way for me to meet
other people in the field aswell and have good conversations
like this and maintain my ownsanity by by having maintained
this community, even if it ismostly virtual, although we are

(43:45):
very blessed today.
We for those who are hearingthe background noise we are
practicing what we preach.
We're outside, on the balcony,outside the convention center in
the sun.
It is a little shady at themoment, but 86 degrees.

Lauren Bojarski (43:58):
I don't know how what the temperature is 71.
Yeah, which is a beautiful day.

Michael Kentris (44:01):
Yes, it is a beautiful day out today.
We have some weird bird in thebackground now, but it is great,
and this is one of the fewface-to-face neurotransmitter
interviews, probably like thethird or fourth ever.
So honored I know, and it's sucha great opportunity for me as
well Because, as you said right,there are just so many nuances

(44:26):
in communication that we don'tget via a screen right.
We use telemedicine, we usetelecommunications and they are
a blessing in many ways, butit's very hard to replicate the
in-person.
You know I talk with my hands alot, as you can tell.
You know I talk with my hands alot, as you can tell, but it's
one of those things wherethere's just this ineffable
quality to in-personinteractions that really enrich

(44:50):
the experience.

Lauren Bojarski (44:51):
Yeah, and COVID kind of took that away.

Michael Kentris (44:53):
Yes, yes, it really did, and you know we're
getting pieces of it back, butin many ways it's still lacking.
You know, I know in a lot ofareas of areas, masking is still
needed in some situations andsome people have health
conditions that lend to it.
But human faces are soimportant to the way we
communicate with one another andit is something that suffers

(45:16):
for sometimes what is a medicalnecessity.

Lauren Bojarski (45:19):
Yeah, I think you're absolutely right.
It can be very difficult.
And I think with COVID, youknow, everyone learned to do
life with COVID and to do thingson telehealth and everyone
became very comfortable withdoing Zoom.
And when I say comfortable withdoing Zoom, it's comfortable
with doing Zoom, writing notes,putting in orders, doing Zoom,

(45:42):
it's comfortable with doing Zoom, writing notes, putting in
orders.
We ended up doing didactics onZoom because we couldn't have
in-person meetings and I knowpersonally I do not do well with
didactics.
Now I will say I've been veryintrigued with the AAN didactics
or the conferences that they'redoing.
I do enjoy those, but it's verydifficult for me because I want

(46:07):
to be typing my notes, I wantto get out on time, but because
I'm not getting as much of afulfillment as if I had gone in
person.
Because if at least I'm inperson, I have that cohesiveness
, I'm establishing that cultureand rapport with my comrades in
arms, as it were.
And so I personally am of theilk that we should have more not

(46:29):
all in-person communication,which is why the AAN annual
meeting is so important.
It's why Neurology on the Hillis so important.
A lot of my stuff surroundsadvocacy and like advocating for
everyone in neurology whetherit's APPs, medical students,
trainings you know facultyeveryone needs to be advocated

(46:50):
for, and with Neurology on theHill, that's your moment.
If you're feeling burnt out andyou feel like what you do
doesn't matter, go to Neurologyon the Hill and you will see
what you do does matter to a lotof patients.
Even within Kentucky, we havean epilepsy foundation and we
went to Governor Beshear'soffice and advocated, and seeing
the patients advocate forthemselves and us advocate for

(47:13):
them to the government wasfascinating, and so I encourage
anyone who is feelingparticularly burnt out, who
feels like what they're doingdoesn't matter or who feels like
they need that extra spark,like the spark you were talking
about with teaching.
If you haven't found your sparkyet, try neurology on the hill,
see what happens.
Maybe that's your next step inyour career.

(47:36):
And don't compare yourself toother people Like don't say that
you know I need to stay inacademics for the rest of my
life.
Neurology I tell my medicalstudents this all the time and I
feel it within my bones.
It is a pick-your-own-adventure.
You want to do surgery?
Go.
You want to talk to the elderlyall day?
Come with me, join me in mygeriatric fellowship If you want

(48:05):
to do some procedures, you knowyou can have an LP clinic, you
can do Botox, you know, and Ihope you know any medical
students listening to this wouldhave that sense of adventure
and just exploring all thethings that neurology has to
offer.
And maybe that's what you know,that's what we need.
Maybe we need that newnon-cynical mentality.

(48:28):
We were talking about it alittle bit before the podcast.
That cynicism runs rampant, andas well it should.
You know I, I don't.
I don't blame people.
I'm new to the field.
I have new ideas that haven'tbeen cut down yet.
I have wants for the field thatI haven't seen happen yet and I
don't know if they ever will.
But having people with thatdrive, that's reinvigorating.

(48:53):
It helps with that spark.
And along those lines too, onyour career, you can pick your
own adventure.
You do whatever you want.
You can go here, go there, dowhatever, but has anyone for you
?
Has anyone asked you, where doyou see yourself in two, five,
10 years?
Everyone always asks medstudents like where are you?

(49:15):
You know, where do you want tofellowship in?
And that's like the small talkquestion.
But you have been doing thisfor a little bit of time, a few
years, a few years, just a fewand has anyone asked you where
you want to see yourself in thatamount of time?
And maybe that's the spark.
That's what you need to trigger.
This is what I need to change.

(49:35):
This is what I don't like andthis is what I want.

Michael Kentris (49:38):
You know you are.
You're absolutely correct.
It is one of those questionsthat once you're out of training
, unless you have, like anexcellent mentor, you probably
aren't getting asked thatquestion very much anymore.
I don't think I've been askedthat question in a few years,
which is why I'm like chucklingto myself, which is why it's so
important.
Yes, and it is, but it issomething that I do reflect on,

(50:00):
like because, just as a again ananecdote, if you permit me, so
where I was down at Wright State, where I was an academic
physician, I was part of theepilepsy division there, you
know, doing subspecialtyepilepsy surgery, all that good
stuff, like you do after anepilepsy fellowship.
As one does, as one does goodstuff, like you do after an

(50:24):
epilepsy failure, as one does asone does.
So I moved back to thiscommunity teaching hospital and
here I am a neurohospitalist.

Lauren Bojarski (50:28):
Oh, I see Now.

Michael Kentris (50:29):
I went into this position knowing I did not
want to remain aneurohospitalist and so, as of
next month, which will be May asof this recording, I will be
going back to a more generalneurology type thing.
But I have the hope People talkabout.
Are you an optimist?
Are you a pessimist?

(50:49):
To your cynicism question, ofcourse and I'm going to
paraphrase someone else I heardsay this I like to think that
I'm a realist, but that Imaintain a certain degree of
hope that things will get better, maintain a certain degree of
hope that things will get better, and it is really.
You know, it's where it goes allthe way back to.
You know Greek mythology, youknow where the last thing in

(51:09):
that box is hope, which is thisfragile little creature, and we
do have to keep that alivewithin our breast or else, you
know, everything else becomesvery dark, very quickly.
Yes, and what do I hope for?
Well, I hope, you know I workwith a good friend of mine from
residency, and I'm veryfortunate for that, and I hope
you know any future neurologistswho are looking for work in
Northeast Ohio send me an email.

(51:32):
But I hope that we recruit moregood neurologists who also have
this desire to build a higherquality of neurology in an
underserved area, and I hopethat we'll build an epilepsy
monitoring unit and all thesenice things that would be nice
to have so we can provide carefor our population of over a
half million people.

(51:52):
But for the present wepersevere with what we have and
it is, I think, one of thethings we didn't really touch on
very much but is important.
We kind of skirted around theedge.
We're boundaries.

Lauren Bojarski (52:05):
Oh yes.

Michael Kentris (52:06):
And many of us again, this whole medical
training.
We are brought up, we are I'mnot going to say stop short of
saying brainwashed but I meanit's a good pun.
Yes, but we are brought up tosay yes to so many things.
Like you know, like someonehigher in the hierarchy tells
you like you need to do X, youneed to do Y.

(52:28):
The next step, if you want tomove your career ahead, is to do
this thing.
And we say yes, yes, yes.
Like how many times?
Uh, I know again right here,early in your career, but I'm
sure it's happened already.

Lauren Bojarski (52:40):
Oh yes.

Michael Kentris (52:41):
You have overcommitted and it's like now
I'm losing sleep and now I feelunwell and my mental health is
starting to suffer.
And I've said yes to all thesethings and I want to do them,
but perhaps I shouldn't be.

Lauren Bojarski (52:52):
Yes, I heard a very good quote about that exact
thing, and they said everyonehas the same 24 hours in a day,
and if you're saying yes to onething, you're saying no to
something else.
And then I heard someone elsesay if it's not a hell, yes,
should you really be doing it?

(53:12):
And I took that to heartbecause you're exactly right.
As a trainee, I was in aposition where I said yes to
everything, but I liked doingeverything.
And so I was at an impassewhere I was in a position where
I said yes to everything but Iliked doing everything, and so I
was at an impasse where I wasgetting so much anxiety because
I had so much on my plate.
And you know how it happens whenit all just happens all at the
same time, it's even worse.
And so I realized I had tocompartmentalize and decide what

(53:35):
I wanted, like what were myvalues, what did I want out of
my career and what was going toget me there?
Were my values, what did I wantout of my career and what was
going to get me there?
And, honestly, I was approachedabout a lot of different things
and you know, pending time,commitments and what have you.
I think that was the bestadvice that I received was, you
know, does it work for you Like?
Take the time, decide if it'sright for you and you know

(53:57):
you're allowed to say no.
No is a full sentence.

Michael Kentris (54:01):
I like that one .

Lauren Bojarski (54:01):
No is a full sentence.
You do not have to justify orqualify your response.
Um, if they don't like it, thenthat may not be the right
system.
That's in line with your values, and I'm not here to tell you
whether it is or isn't, but it'ssomething that you should
definitely think about andwonder, and I found that my life

(54:23):
got exponentially better once Imade that decision.
I made it about a year ago.
It was kind of like a hard stop.
I was saying yes to too muchand it was yes to too many
things that I didn't want to do,and when I started saying no to
those things, I realized I hadmore excitement to say yes to
the other things.
So, like all of this advocacystuff that I enjoy doing, I I

(54:46):
love giving these talks.
I I just gave a talk to theassociation of continuity
professionals in Dallas.
Uh, actually, last week, um,about a similar topic and we
talked about imposter syndromeand you know, doing a lot of
introspective work and they are,um, business resiliency.
They are business resiliency.
They are different focus.

(55:06):
They're not healthcare, stillhigh stress jobs, but everyone
can have hope and everyone canhave that spark that you talk
about, which gives you life,which gives your life meaning,
which fills your tank, and soit's really special to have that
.
And so I found that by sayingyes to the things that really

(55:29):
mattered to me and what I wantedout of my life and my career
and my two five, 10 year plan,it really made my life really
worth living.
I wasn't working anymore, orI'm not working as much anymore.
It's not a grind as much asit's a I get to, and that is the
mentality that you really wantto get to in your life.

Michael Kentris (55:52):
Right, I've heard that said.
Right, I don't think of it as Ihave to do it, I get to do the
thing and that does, I think,help a lot of people with
dealing with, especiallysomething that may be stressful.
Right, it's like oh, 100% Idon't have to deliver this bad
news to someone I get to deliverthis bad news and hopefully

(56:15):
change the way they perceivethat or help them through this
challenging time.
Yeah Right, Because a lot ofwhat we do is difficult,
Difficult.
You know there's a lot of hardconversations in medicine.
Now I would be a very poor hostif I did not ask you a little
bit about your research.
So tell us kind of what avenuesare going on, what kind of
projects are in the pipeline.

Lauren Bojarski (56:36):
Well, so my research right now.
I actually just presented aposter downstairs about it.
So when we talk about burnout,we need to talk first and
foremost about assessment ofyour burnout.
There's a lot of different waysto do it.
The most validated that I'veseen is the Maslach Burnout
Inventory, and it's really nicebecause then it's subdivided

(56:58):
into health services and thenfurther into medical personnel,
so it has a really nicheevaluation.
It's been very well validatedin the literature.
Unfortunately, dr Maslach soldit a couple years ago, and so,
unfortunately, it's a veryexpensive way to have validated

(57:19):
burnout information, but that'skey.
I do believe, though, that wecan't do anything about burnout
until we get a good grasp onwhat's the prevalence, what's
the incidence, where are we at?
How is our trainees differentfrom our attendings versus our
APPs, versus our nurses versusour medical students?
And so my research was lookingat the ACGME.

(57:41):
They give out a yearlywellbeing survey, and I was
wondering is it valid?
There had been.
In my literature search, Ihadn't found any validity
measures that said yes, this isa good measure of wellbeing and
burnout in the residents, andthe power of that survey is
astronomical thousands ofresidents and fellows all across

(58:02):
the country, and I'm like wekeep doing this.
You know survey fatigue.
Should we keep taking a surveyif it doesn't tell us anything?
So I was like let's validate it.
And so me and my close mentor,dr Anger, and Dr O'Connor as
well, they kind of formed thisidea of maybe we should, you
know, give our own, like the MBI.

(58:24):
We should give it to ourresidents.
And so we did.
And we took 29 adult and childneurology residents as well as
psychiatry residents and we gavethem the MBI, which was the
Maslach Burnout Validated Survey, and we also gave them the
ACGME Wellbeing Yearly Surveyand we were like they're,
they're taking the exact samesurvey at the same time.

(58:47):
We did it both in the fall andthe spring and we looked at
whether they were close innumbers and I can tell you that
they you know I don't have theconfirmed metrics at this point
with P values and everything butthey were different.
You know, emotional exhaustionwas fairly equivocal, so that

(59:13):
was so.
That was reassuring.
You know that was good.
Personal achievement was alittle.
There was a little discrepancy.
The personal achievement ofACGME was a little higher so
people thought that they hadbetter, more personal
achievement on the ACGME servingum than we thought that they
would have on the MBI.
But the one that was mostdiscordant was the, the

(59:33):
depersonalization.

Michael Kentris (59:35):
Interesting.

Lauren Bojarski (59:35):
Yeah, it was a 50% difference.

Michael Kentris (59:37):
What year did you say the students were in?

Lauren Bojarski (59:40):
All years.

Michael Kentris (59:40):
One through four.

Lauren Bojarski (59:47):
And then child neurology, um, neurology had,
you know, five as well.
They were a five-year programfor us, so that was really
interesting to us.
We were like it seems like weyou know the ACGME did a pretty,
pretty decent job.
You know, until this, this oneevaluation, and that can
completely throw off the numbers, because you're only dealing
with three symptoms and burnout,and if one of them is that
discordant and it was, andobviously the ACGME thought

(01:00:09):
there was less depersonalizationand the MBI said that there was
a lot more.
And so our wonder is why didthat happen?
You know, I I don't know forsure.
Maybe it's because the ACGME,they do it at the end of the
year and everyone's got theirgraduation goggles on of
residency fellowship.
You know, like for me, rightnow I am six months, basically

(01:00:32):
no call Cause I did all of mycall between two and three.
I'm on an elective outpatientrotation getting to learn all of
neurology.
I feel more well by a lot thanI did when I was, you know, two
years ago, and so maybe there'sa component of that.
I don't know.
So that will require moreresearch.
But what I did find interestingwas that, you know, I can't

(01:00:57):
expect the ACGME to spendmillions of dollars to give an
MBI to everyone.
That was never the idea.
Regardless, I think ultimately,you know, like I said, I'm not
going to ask them to give thevalidated Maslach burnout
inventory to every resident andand I understand, you know they

(01:01:17):
they do have money, but I alsounderstand how corporations work
and I'm not I'm not so ignorantof how life works that I would
ask that.
I think that would not be fair.
But what I would ask is that wecontinue to work towards a more
accurate and valid measure sothat we can have a better
understanding of burnout.

(01:01:39):
My project also showed thatthere was 51.6% of participants
who had signs of depression.
They had depressive symptoms.
Is that an extension of theburnout Like?
Is that the end stage?
We don't really have the datayet to say what exactly is the
interaction between the two, butsurely it's multifactorial and

(01:02:02):
could totally be related.
And I find it interesting thatit was so high, with these
perceived measures of the ACGMEsurveys being relatively OK.
So that was a very interestingcomponent too.
So I don't know, you know, Idon't know how we would fix it.
I don't claim to be part of theACGME.
You know organization committeeand leadership, gme.

(01:02:27):
You know organization,committee and leadership.
But I do offer a request.
You know that we put more stockinto validating the measures
that we're putting out, so thatwe can have a better
understanding.

Michael Kentris (01:02:33):
Yeah, it kind of goes back to that.
That old quote, uh who I forgetto attribute it to, but uh,
what gets measured, gets managed.
So we, should.

Lauren Bojarski (01:02:41):
we should like that yeah.

Michael Kentris (01:02:43):
It's from business, uh, talking about, you
know, like key performanceindicators, but it is medicine's
a business.
Yeah but we need to know, likeyou said, it, does what I
measure actually matter?
Like if I'm going to makedecisions based off that, then
we need good data.
So, yeah, very, very happy tohear that you're out there
trying to make sure that whatwe're trying to do actually

(01:03:04):
means something.

Lauren Bojarski (01:03:05):
Well, and everyone's got survey fatigue.
Don't give me a survey.
That doesn't work, or you know,and I don't know, maybe, maybe,
things will change, you know,and I look forward to that.
I hope that they would change.

Michael Kentris (01:03:18):
Yes.

Lauren Bojarski (01:03:19):
And you know I'm not going to be a trainee
for very much longer, but thatstill translates over to, you
know, in your career too Right,because we have to think right.

Michael Kentris (01:03:30):
We're relatively young at this point
in our lives, but 20, 30 yearsfrom now we will need well,
actually me, sooner probably Iwill need physicians, and I
would like for them not to bedepressed and burned out.

Lauren Bojarski (01:03:42):
Exactly.
I would like them to enjoytheir job.

Michael Kentris (01:03:44):
Yeah, the people who will care for us, who
will care for our family andother loved ones.
So I think it is definitely inall of our interest to make sure
that the people who are goingto be caring for us and those we
love are not hating their jobsand want to get out of there as
quick as possible, right, andaren't making decisions under

(01:04:05):
less than ideal mental healthsituations.
So I definitely am glad to seethat there's a lot of urgency
towards addressing some of theseissues.

Lauren Bojarski (01:04:15):
I think, yeah, it's important, and I feel like
the conversation hasn't quitepicked up enough.
You know, I hope that it willpick up and we'll see how it
goes.

Michael Kentris (01:04:26):
Absolutely Well , if you want to find out more,
where can they find you?
What kind of resources wouldyou recommend checking out?

Lauren Bojarski (01:04:34):
Oh, that's a great question.
Well, I'm on Twitter.
I'm very active on Twitter.

Michael Kentris (01:04:39):
I've forgotten my Twitter handle but I'm We'll
add it in the show notes.

Lauren Bojarski (01:04:43):
Yes, that'd be perfect.
Um and uh, I would say thebiggest resources are, you know,
checking your local institution.
If you're a trainee, um,certainly look up the ACGME.
Um, the national website.
They have some resources there.
Um, within your own departmentat your institution, um, you can
have both like department ofneurology and GME wellness

(01:05:07):
things that you probably got inyour orientation that you forgot
about so you can go back tothose websites.
Usually it's GME wellness oryou know GME resources and then
whatever your institution is For, you know, people who are
post-training, the AAN hasfantastic resources as well.
You can type in wellness and itwill come up with like a list

(01:05:30):
and there is a PowerPointpresentation actually in there
that you can give to yourconstituents and to your
colleagues and help themunderstand.
The last resource I wouldrecommend is the American
Medical Association.
I talked about them quite a bit, but they do offer fantastic
resources.
They have really good articlesas well that can help you

(01:05:52):
improve your efficiency.
If you're looking for somethinglike that, they'll tell you,
actually, even how long it takesto read the article at the top.
So if you know that you have afour-minute bus ride from here
to there, you know you're goingto the AAN party and you have
four minutes, you can just readthat article and it's very quick
, and so I would recommend that.
And yeah, those are, those areprobably the best resources for

(01:06:15):
everyone.
Perfect.

Michael Kentris (01:06:16):
And you can, of course, find me on X, formerly
known as Twitter.

Lauren Bojarski (01:06:20):
Oh yeah, Sorry.

Michael Kentris (01:06:20):
That's OK.
I feel like we always have tosay it that way, these days Back
in my day.
I'm at D-R-K-E-N-T-R-I-S, DrKentris, and you can, of course,
find the Neuro Podcast channelat neuro underscore podcasts and
check out our websitetheneurotransmitterscom.
Thank you once again for comingon and having this very

(01:06:42):
educational discussion aboutburnout with us.

Lauren Bojarski (01:06:44):
Thank you so much for having me, Michael.
I really appreciate it.
I had a great time.

Michael Kentris (01:06:47):
Awesome, me too .