Join me this episode of A Beautiful PA Life Podcast for an interview with Dr. Allison Smith, PT, DPT, PhD, as she discusses the critical issue of burnout among healthcare providers, exploring its origins, symptoms, and the profound impact it has on individuals and the healthcare system. The conversation delves into the concept of mismatches in the workplace, from Maslach and Leiter’s The Burnout Challenge, identifying burnout profiles, and offering strategies for both individuals and healthcare systems to address burnout effectively. Rachel gets some individualized coaching on her burnout, including the importance of setting boundaries and prioritizing self-care, alongside the need for systemic changes to support healthcare workers. Ultimately, the discussion highlights the pursuit of a balanced and fulfilling life in the demanding field of healthcare.
Get the Burnout Deep Dive pdf here!
Join me this episode of A Beautiful PA Life Podcast for an interview with Dr. Allison Smith, PT, DPT, PhD, as she discusses the critical issue of burnout among healthcare providers, exploring its origins, symptoms, and the profound impact it has on individuals and the healthcare system. The conversation delves into the concept of mismatches in the workplace, from Maslach and Leiter’s The Burnout Challenge, identifying burnout profiles, and offering strategies for both individuals and healthcare systems to address burnout effectively. Rachel gets some individualized coaching on her burnout, including the importance of setting boundaries and prioritizing self-care, alongside the need for systemic changes to support healthcare workers. Ultimately, the discussion highlights the pursuit of a balanced and fulfilling life in the demanding field of healthcare.
Today’s Podcast Guest
Dr. Allison Smith, PT, DPT, PhD, is a Board-Certified Orthopedic Specialist in physical therapy and a Fellow in the American Academy of Orthopedic Manual Physical Therapists. In 2021, she completed her PhD at TWU in Houston after finishing her dissertation on burnout in DPT students. Dr. Smith has spent the last 10 years serving an uninsured/under-insured patient population while working for the safety net hospital system for Harris County. Her research interests include improving the work life of health care providers, addressing disparities in access to health care, and the impact of social determinants of health.
Referenced in Today’s Episode
Hello and happy Sunday. Thank you for joining me today for this episode of a beautiful PA life podcast. I am so glad that you are here to learn and to grow and to take control of your beautiful PA life. And I have such an incredibly impactful episode for you today. I have Dr. Allison Smith, who is a burnout researcher.
who gives us a straight up master class in burnout. She covers everything burnout. She talks about the history of burnout, why it developed, why PAs are particularly susceptible to burnout. She talks about the symptoms, the way that burnout shows up. She talks about why burnout develops and current research in burnout.
that looks at mismatches between the employee and their job. She goes through profiles of burnout that demonstrate when you have these mismatches, how that shows up in an individual. And finally, she talks about what can we do about it? How can we address this burnout that we're feeling and make changes in order to grow, in order to get
control of our lives and to not feel this constant feeling of exhaustion, this distancing from the patient and this feeling of futility when we constantly feel like a cog in the wheel because that is not a beautiful PA life. She recommends, she does a little coaching for me personally. So there's a little peek behind the curtain.
into what I'm struggling with right now. And you'll learn why surfing is perhaps one of the ideal things that I am going to incorporate into my life in order to try to overcome this burnout that I've been experiencing. I wrote down three things that Dr. Smith recommended recovery balance boundaries. This episode is so packed with information that
I had to create a tool for you to accompany this episode. So I put together a PDF that is a summary of all the things talked about in this episode. It's called the Burnout Deep Dive. It is chock full of all the juicy details that Dr. Smith shares in this episode. So make sure you grab this PDF to accompany this episode. After you listen to this episode,
Take a look at the PDF and go through the mismatches. Look at what in this is applicable to me. How can I overcome my burnout? And you can get this PDF at my Instagram. It's @ rachel.la.costa. Go to the link in bio and you'll find the link to get the burnout deep dive PDF. It's so juicy, so helpful. You're gonna get so much out of it. Here's the episode. I hope you enjoy it.
The issue of burnout is an issue between the person and the relationship with their job. So the context that they're in, right? Because you could take the exact same job and somebody might be thriving and like totally engaged and love working there. And you might take that same context, that same location, same building, same place, and somebody could be really, really struggling there, right? So it's that relationship between the person and their job that needs to be addressed.
Hello and welcome to A Beautiful PA Life Podcast. I love being a PA, but my career as a PA has also been filled with exhaustion and burnout and heartache and so much anxiety. And I believe that you deserve better. I'm Rachel La Costa and I'm a PA with expertise in pediatric oncology and prioritizing self care as a PA.
I'm sharing evidence -based tools and strategies to help you from feeling the pain of burnout that I know all too well. And I'm here to be your mentor, your guide. Let's change the culture of medicine together. I invite you to envision what would a beautiful PA life look like for you. Welcome. I'm so grateful you're here.
Rachel La Costa (she/her) (00:01)
Welcome to this week's episode of a beautiful PA life podcast. I have a very special guest with me. I always say it's a special guest, but you are a special guest here with me today. her name is Allison Smith. Allison, is a doctor, doctor. She is board certified orthopedic specialist in physical therapy and a fellow in the American Academy of orthopedic manual physical therapists.
In 2021, she completed her PhD at Texas Women's University in Houston after finishing her dissertation on burnout in DPT students. Dr. Smith has spent the last 10 years serving an uninsured, underinsured patient population while working for the safety net health system for Harris County. Her research interests include improving the work life of healthcare providers, addressing disparities in access to healthcare and the impact on social determinants of health.
I'm so delighted to invite you on the podcast today, Allison. I'm going to call you Allison, by the way, but you are officially Dr. Dr. Smith.
Allison Smith (01:03)
Allison is fine. Thank you for having me.
Rachel La Costa (she/her) (01:06)
Absolutely. Well, I invited Allison on the podcast today because she is well versed expert on the topic of burnout, both personally professionally. She is so knowledgeable and I am so excited to learn from her expertise today to learn more about the history of burnout, why burnout happens in healthcare providers and what we can do about it. Most importantly,
Allison Smith (01:33)
Yep.
Rachel La Costa (she/her) (01:34)
So, all right, so Allison, tell me a little bit about burnout. What is burnout? When did we first discover burnout? Hit me with some burnout facts.
Allison Smith (01:46)
Sure. So most of the research that's been done in the burnout world started in the 70s, kind of at the same time, but on opposite coasts. So in the East coast, we had Herbert Freudenberger who helped develop free clinics in New York City. And he noticed, you know, the workers would initially be really passionate about working with that group of people. But after about a year, they
kind of lost that passion, that motivation, they were exhausted. And he started to write about that and coin the term burnout. At about the same time on the West Coast, Christina Maslach was doing work with human service workers. So she was a social psychology researcher and she kind of noticed the same thing. People who worked with people or did people work tend to
fall into this pattern of exhaustion and maybe some distancing from their job. And she's well known in the burnout world because she created the Maslach Burnout Inventory, which is the most widely used burnout outcome measure that's out there. So there are some others, but that's by far, think more than 90 % of research projects use that outcome measure.
Rachel La Costa (she/her) (03:13)
Wow. So that's fascinating. So this was in the seventies that there started to be research on burnout. And I think you bring up a really good point of people who are in caretaking type of roles are so susceptible to developing burnout. And I think it's interesting what you mentioned about Freudenberger's research, that it was people who had a passion.
Allison Smith (03:15)
Mm
Rachel La Costa (she/her) (03:39)
for what they're doing. And that absolutely represents myself, represents healthcare providers who go into this field because we're so passionate about making a difference for our patients.
Allison Smith (03:51)
Yeah, for sure. I think that's why they studied people who did people work first, because we've probably all have seen this pattern, even if we're not researchers. You have this group of people, they obviously really care about what they are doing, but they're also people facing, right? They face patients or they face clients. And as we know, as healthcare workers, that can be very rewarding, but it's also
could potentially be very draining. So at what cost do you provide this care?
Rachel La Costa (she/her) (04:29)
At what cost? I think we're gonna put a pin in that. So, okay, burnout. So how does someone recognize that they're experiencing burnout? What are the classic features or symptoms of, or even definition of burnout?
Allison Smith (04:31)
Yeah.
Sure. So the definition of burnout is actually recognized by the World Health Organization now. There's also an ICD -11 code for it now, but they define burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. So some key pieces there are chronic because obviously sometimes work or life is going to be stressful.
is totally normal part of life, but is it every single day? Is it wearing on you? Do you not have time to recharge from that? And then it's work related. So that's what, that's the definition of burnout. And then there's three main dimensions when we think of burnout and they are exhaustion.
which is the stress response, right? Typically it's maybe the first sign that pops up and that could be emotional exhaustion, it could be physical exhaustion. The second dimension is cynicism. So initially it might be protective, right? Because it's like a separation between you and the job. And if you're working with people,
Rachel La Costa (she/her) (06:05)
Yes.
Allison Smith (06:08)
Sometimes you need a little bit of distance between you and them so you're not taking these problems home with you. But also we know how cynicism can be toxic. I think you had a previous guest that they mentioned they weren't using patient centered language anymore. They're like, yeah, I gotta right knee in room three and I have a stroke in room four. And it's just a really terrible way to.
Rachel La Costa (she/her) (06:21)
Mm -hmm.
Allison Smith (06:35)
to speak about your patients, right? So if you're noticing, detachment, that cynicism, that's a sign. And then the third dimension is ineffectiveness. So are you working, working, working with nothing to show for it? Or do you feel that, you know, maybe you're not productive like you feel like you should be, or you're feeling like...
Rachel La Costa (she/her) (06:36)
right? The
Allison Smith (06:59)
Maybe you made a mistake in the career that you chose. So those are some signs. And typically we think of burnout as having three dimensions because that's how the Maslach Burnout Inventory is set up. And again, like 90 % of researchers use that tool, which might also be why we have those three.
Rachel La Costa (she/her) (07:14)
I see.
Sure, sure. I mean, I think that really cuts into the heart of the issue. It really defines the issue where the emotional exhaustion, which is certainly something that I've felt in my career, it just depletes you. It depletes you so you don't have the energy to not only do the job that you're doing, but then to enjoy the rest of your life, right?
Allison Smith (07:48)
Yeah, well, I'm sure it's not news to you or anybody else listening to this, but obviously burnout has pretty terrible effects, not only on the individual. So you can have individual issues like, you know, trouble sleeping, maybe trouble with relationships. Maybe you're starting to make poor decisions on the job. It can also affect your patients. It can affect the, the
business or the hospital that you're working for. mean, the dominoes cascade to like society level. So it's not just a you problem. It's something that we really need to tackle.
Rachel La Costa (she/her) (08:30)
This is such a good point and it's bringing up for me and I know we'll talk more about this in the what can we do about this? But it is the responsibility of both the individual and the healthcare system to correct these issues because the effects, as you said, are both on the individual and on the patient and on the system as a whole. So it's like we need like a
a joint approach that both empowers the individual to manage their own burnout and also create a system that supports the healthcare providers that are giving so much of themselves to provide care to these patients.
Allison Smith (09:15)
Right. Yeah, the issue of burnout is an issue between the person and the relationship with their job. So the context that they're in, right? Because you could take the exact same job and somebody might be thriving and like totally engaged and love working there. And you might take that same context, that same location, same building, same place.
and somebody could be really, really struggling there, right? So it's that relationship between the person and their job that needs to be addressed. So sometimes it is on the individual. Unfortunately, I think a lot of systems maybe try to punt it all to the individual, right? Like you need to be more resilient. You need to have better coping mechanisms.
Rachel La Costa (she/her) (10:06)
Sure.
Allison Smith (10:11)
I am not going to change anything about me, but you need to take care of this basically. Sometimes there's a grain of truth there, but it's also about where they work in the context. So I'm really glad you mentioned that because there's actually some new ideas in the burnout research world that I think would be really cool to talk about because it's kind of new stuff.
Rachel La Costa (she/her) (10:14)
Right.
huh.
huh.
Absolutely. I love new stuff from cutting edge research.
Allison Smith (10:41)
Okay, awesome. Great. So there, if, you or your listeners want to read more about this topic, a lot of the ideas that I'm going to mention come from the book, The Burnout Challenge. It's by Christina Maslach and then her colleague, Michael Leiter. So yeah, if, if any of this rings true or you want to learn more about it, this would be a fantastic resource.
Rachel La Costa (she/her) (11:01)
I will definitely link that in the show notes so that the listener can very easily find it.
Allison Smith (11:12)
So their idea is really about that relationship like we talked about, right? So some new ideas that they wrote about in this book are related to mismatches. So mismatches between the person and their job. And it really helps to, if you can identify the mismatch, well then you can address it appropriately. And then they also discuss some different burnout
profiles. So if you don't mind, I'd love to tell you more about the mismatches.
Rachel La Costa (she/her) (11:48)
Please, look here about the mismatches, yes.
Allison Smith (11:50)
Right, so according to Maslack and Leiter, there are six main mismatches that could potentially be an issue at work. The first one is work overload. So you have high job demands. Maybe you don't have the resources that you need. Work overload could also include the emotional part, right? It doesn't have to just be tasks. It could be that emotional labor of
working with a patient that might be in a difficult situation.
Rachel La Costa (she/her) (12:23)
Sure, and then different environments might have more emotional overload. Like I work in pediatric oncology. It's a very high emotional environment.
Allison Smith (12:28)
Right.
Right, yep. The other part of work overload is not having time to recover from that, right? Because I'm sure you obviously love your job, you went into that field for a reason. However, it is very stressful. Do you have time to recover from that? Do you have the resources you need to address some of these really difficult?
Rachel La Costa (she/her) (12:54)
huh.
Allison Smith (13:00)
conversation. Do you have the time? Do you have the support people? You know, that's all really important to have.
Rachel La Costa (she/her) (13:07)
Yes, to process everything that's happening because otherwise we just become robots.
Allison Smith (13:12)
Right. Which leads me to the second mismatch, which is lack of control. So if lack of control is a mismatch, some things that you might be dealing with would be like micromanagement. So like somebody down your neck all the time, doing things a certain way, maybe incompetent leadership would be difficult or ineffective teams might be part of it.
Rachel La Costa (she/her) (13:30)
huh. huh.
huh. huh.
Allison Smith (13:42)
you know, feeling like a cog in the machine. Okay, I'm only here to crank out units and write notes. I don't have any control or flexibility or autonomy to do what I went to school to do.
Rachel La Costa (she/her) (13:56)
Yes. all being forced upon me without any asking of my role or my desires or wants and how I want to treat these patients.
Allison Smith (14:05)
Yeah, you don't have a say basically. The third one is insufficient rewards. So the first thing that comes to mind for a lot of people is salary, which is part of that, right? You wanna be paid appropriately for the services you're providing. That's not the only rewards. There's also social and emotional rewards as well. Like, do you get any recognition for
Rachel La Costa (she/her) (14:08)
Mm -hmm.
Allison Smith (14:34)
the hard work that you put in? Did you go above and beyond? Did anybody notice that? You know, like that also counts as rewards. The fourth one is a breakdown of community. So do you live or work in a culture where it's every man for themself? Is there a culture of fear? Like you must always be on, you must answer your email immediately.
Rachel La Costa (she/her) (14:44)
huh.
Allison Smith (15:01)
If you're not at work, still expect to hear back from you. Or yeah, is it supportive? Do you trust your colleagues to have your back?
Rachel La Costa (she/her) (15:06)
Lack of boundaries.
huh.
Allison Smith (15:15)
There's two more. The next one is an absence of fairness. So are decisions being made that you feel are just or are you dealing with issues of like bias, discrimination, favoritism? Some of that is, you know, at the systems level, right? And then the final one, which I think may be the biggest red flag is a values conflict.
Rachel La Costa (she/her) (15:37)
Sure.
Allison Smith (15:44)
So do your values and beliefs line up with where you're working? Another way to think about that would be does your workplace preach that they have this mission and this vision, but then in practice, they're not upholding that or even worse, doing the complete opposite of that. That's a real, that's a big, big mismatch.
Rachel La Costa (she/her) (16:05)
Great.
I can see how any one of these mismatches could cause all of those feelings of burnout, of the emotional exhaustion, of the sort of depersonalization of you're no longer feeling that connection to the patient, that loss of empathy, and that sense of futility that I'm just here as a cog in the wheel. I'm just here to meet my quota to
see these 35 patients in a day that are on my schedule. Any one of those things could cause that. And I would imagine that for the PA who's listening, they have probably experienced more than one of those mismatches in their career.
Allison Smith (16:44)
Mm
Yeah, it's likely. And that is kind of a good segue into the burnout profiles. So there's five different burnout profiles and each profile lines up with some of these mismatches. So one way you can look at this if you're trying to maybe diagnose, do I have maybe a little issue with burnout is you could listen to those mismatches and see which ones of those kind of
Rachel La Costa (she/her) (17:10)
Great.
Allison Smith (17:30)
stand out to you. And then you can do the same with these profiles. So does one of these five profiles sound like you? The first profile is full -blown burnout, right? So you have exhaustion, you have that cynical distancing, you have low efficacy. A person who has full -blown burnout has serious mismatches in all six areas. So
really, really poor person -job fit. The second profile is the complete opposite. This is where we want people to be, and that's engagement, right? So maybe they have a lot of energy, they're feeling really connected to their work, they're feeling like they are making a positive difference. They have good matches.
Rachel La Costa (she/her) (18:12)
I see.
Allison Smith (18:25)
in all of those six areas of job person fit. So you have kind of the extremes. The next three is kind of a mix in there, right? So the third one is overextended. So this person, their main dimension that they're struggling with is exhaustion, but their other dimensions, they're not as negative. And when you look at the mismatch that they're dealing with, the major mismatch is heavy workload.
Rachel La Costa (she/her) (18:29)
Nice. -huh.
Mm
Mm
Allison Smith (18:54)
Usually high demands, long hours, not enough time to recharge. The next profile is disengaged. this person, maybe they have the energy to do the work that they want to do and maybe they feel like they're kind of good at it, but they have checked out. They've lost their motivation. They've lost their passion. They're very cynical. They're very much distanced from the work that they do.
Rachel La Costa (she/her) (18:55)
Mm
huh.
-huh.
Allison Smith (19:24)
And like I said before, cynicism can be pretty toxic in a workplace. know, it almost seems like it can spread from person to person. And
Rachel La Costa (she/her) (19:25)
Would you maybe?
Right.
Absolutely. I wonder if that almost would be in current lingo be defined as quiet quitting where you're just checked out and showing up, checking the boxes, like disconnected.
Allison Smith (19:45)
Totally checked out, yeah.
Yeah. And then when you look at where their mismatches are, it's five of the six. So they're fine with their workload, right? Like I can do this. I'm not exhausted, but every other one they have an issue with. kind of just a really small step down from full blown burnout, right? The last profile is ineffective.
Rachel La Costa (she/her) (20:00)
Mmm.
Mm -hmm.
huh, huh.
Allison Smith (20:22)
So with these folks, they have a negative sense of their own professional accomplishments on the job. Maybe it's not as rewarding as it once was, or they feel like they put in a lot of effort, but they're not getting to where they want to be. Maybe they're feeling like, doesn't matter what I do, I'm just not seeming to make a difference. And when you look at the job person fit here, they
don't have any serious mismatches, but they also don't have any strong positive matches. So they're kind of in the so -so middle ground of those six matches that we talked about earlier.
Rachel La Costa (she/her) (21:00)
Mmm.
Mm -hmm, mm -hmm, mm -hmm, Fascinating. So this kind of portrays a spectrum of depending on what the mismatch is between you and your job, you're going to show up and demonstrate, kind of have a particular archetype almost of how your burnout presents.
Allison Smith (21:25)
Right. And how you would then help that person would look totally different, right? If your person is mostly overextended and their main mismatch is workload, then probably you should address their workload. For someone who's disengaged, they don't have a problem with workload. They have problems elsewhere. So,
Rachel La Costa (she/her) (21:30)
huh.
Yes, yes.
Yes.
Allison Smith (21:53)
you'd probably be best to address some of those areas instead.
Rachel La Costa (she/her) (21:59)
The thing that I really like about this breakdown and particularly each of the six mismatches is that it makes approaching the problem seem so much more feasible.
There are some individual factors at play. And by breaking it down into each of those domains, it helps to identify where is it that I'm actually having a problem that's creating this excess stress that I'm having trouble managing.
Allison Smith (22:30)
Right. And it's gonna be different for everybody, which is the hard part, right? It's the individual in the job. So if your hospital system decides to, okay, we're gonna have a mandatory resilience class, you know, some people might really like that. They might hear something new that applies to them.
Rachel La Costa (she/her) (22:37)
Great.
Right, right.
Allison Smith (22:56)
and wow, I didn't think of it like that. And it makes a difference. But for a big chunk of other people, they're gonna be like, are you kidding me? Where in my work day, where you already have me seeing 20 people, you want me to like shove in a course somewhere? Like just totally not matching their needs at all.
Rachel La Costa (she/her) (23:01)
rate.
Yeah.
Right.
Right. So a sort of a generic approach is not going to be effective for every individual. So how can you tailor the approach to the individual? How can the individual work on assessing, analyzing what is causing their burnout and what they can do about it to start feeling better?
Allison Smith (23:42)
Sure. Well, there are some things that the individual can do on their own, regardless of what's going on, that can just help with their stress management. And for anybody listening to this, I doubt this is brand new information. In fact, it's usually the thing that hospital systems kind of slap on first, right? Like one of them is,
Rachel La Costa (she/her) (24:10)
you
Allison Smith (24:11)
resilience, like how do you bounce back from stress? Yeah, if you improve that it can help you with stress management. However, you should probably address the stressor if you want to make a long -term difference.
Rachel La Costa (she/her) (24:20)
Well, in part of -
Right. Well, and part of the problem is that the culture of healthcare has been perpetuated that suffering is normal. Now, PAs were a little bit more protected perhaps than our resident physician colleagues who now have restrictions on their work week to 80 hours of work per week. But even that,
culture of healthcare is that this is going to suck. You're going to suffer. And I think sometimes then that just becomes so normalized that it's almost like our barometer or our thermometer for sensing what is abnormal becomes so skewed, particularly with the pandemic, particularly with how sick the patients were and are.
Allison Smith (25:14)
Mm -hmm.
Rachel La Costa (she/her) (25:21)
this escalating expectation of what normal is, think even for myself has completely skewed what is not being burned out even feel like what does a reasonable level of stress at work feel like because a hospital environment or a healthcare environment is innately going to be stressful and chaotic. Even if you work in the outpatient setting,
We're talking about people's lives. We're literally caring for human beings and that is innately going to be stressful.
Allison Smith (25:57)
Yeah. It's funny you say that because there were some studies done with physicians and they're actually really bad at being able to tell if they're burnt out. Yeah. Unfortunately, one of the first signs that things are bad is when things are so, so, so bad, right? And it's only when you are doing better and maybe past that point or have sought help
Rachel La Costa (she/her) (26:09)
That doesn't surprise me.
Yes, yes.
Allison Smith (26:25)
and you look back and you're like, wow, things were worse than I thought, or this started way earlier than I thought.
Rachel La Costa (she/her) (26:31)
I can.
I can definitely say that that has been my personal experience.
Allison Smith (26:38)
well, there are some things that the individual can do. So I'm just gonna mention a few of those and then maybe we can talk about some of the more systems level things that could be done as well. So from an individual level, as healthcare providers, we all know this, staying healthy, right? A healthy, strong person is gonna be able to weather
Rachel La Costa (she/her) (26:51)
Great.
Allison Smith (27:06)
stressful situations better. So that could be, you know, your diet. What are you fueling your body with? You know, drinking more water, exercising, getting enough sleep, maybe cutting out some of the behaviors that we know are not helpful, like smoking, drinking, you know, some of those negative coping mechanisms that are not serving us long term.
Rachel La Costa (she/her) (27:31)
rate.
I mean, it sounds so basic, but when you're in the depths of burnout, it for myself has been surprising to me how many of those basic elements of caring for myself, I let go. When I have so many things to do, the first thing that I kind of neglect are my own needs.
Allison Smith (27:58)
Yeah, I mean, you're not alone. It's really common, right? I'm a physical therapist. So I'm often dealing with patients who have maybe sustained an injury or have pain for whatever reason. And kind of the most common excuse that I hear for exercise is I don't have time. It's like the first thing people cut out and...
Rachel La Costa (she/her) (28:03)
Thank you.
Mm -hmm.
Allison Smith (28:26)
There's a great quote that I like to tell them. And if you don't make time for your wellness, you will be forced to make time for your illness, which I have on a sticky note so I can see regularly because it's true, right? You think you don't have time to exercise 30 minutes a day. That is 2 % of your day. You have 98 % of the rest of the time to do the other stuff.
Rachel La Costa (she/her) (28:37)
Oof.
How much time are you spending on Instagram?
Allison Smith (28:56)
please take the 2 % for you.
Rachel La Costa (she/her) (29:00)
because you deserve it, because you're worth it, because you deserve to take care of your body and have the, and the irony of us as healthcare providers, we know how much water we need to drink in a day. We know what foods are good for us and what foods are causing us harm. We know that moving our bodies is important.
But the irony of the healthcare provider who does not use their own knowledge and expertise for the care of themselves just drives me mad.
Allison Smith (29:34)
I mean, that's the tricky part with like behavior change stuff, right? A lot of the times it's not a knowledge problem. It's an action problem.
Rachel La Costa (she/her) (29:47)
That's right. That's right. The application of the knowledge. Yes.
Allison Smith (29:48)
Yep.
So we have stay healthy, we have get enough sleep. A big part of addressing stress is giving yourself time to recharge or relax. Take that PTO, right? That's why it's there. Recharging and relaxing is gonna look different for different people, right? So kind of knowing yourself, like self -awareness, what do you need? Like I'm a huge introvert.
I do not need to unwind on Friday with gigantic party of 50 people. That sounds terrible. I would rather go home and read a book or have dinner with like two or three really, really good friends and like go deep. That recharges me. But I know who I am and I know that's what I need. And that's gonna be different for different people. Somebody else might say like, my God, such a long day. Let's get out there.
Rachel La Costa (she/her) (30:28)
-huh. -huh.
huh.
Mm
Allison Smith (30:50)
Like I need to be with the people to recharge. So knowing what your needs are. And then a final one would be developing new skills. And that could maybe be work related. I know in my case, as a physical therapist, my area of expertise is orthopedics. So I did a residency program and I did a fellowship program. And I cannot tell you how much, you know,
Rachel La Costa (she/her) (30:51)
huh. Yes.
Allison Smith (31:20)
competence improved my stress level. Because I knew what I was talking about. I was much better at pattern recognition. I was better at patient education, which really helped address some of the workplace stress that I had.
Rachel La Costa (she/her) (31:24)
Yes.
that competence leads to confidence. And when you're confident in your job, you have less stress and anxiety about performing your job well or correctly, or not harming someone. And you only can gain that competence by doing, by practicing, by learning, and then putting those skills into practice and building that
Allison Smith (31:52)
Mm
Rachel La Costa (she/her) (32:08)
habit building that skill. And that just makes you feel better about yourself in general, that confidence of, yeah, I know when I do that lumbar puncture and exactly how it feels when I go through the dural sac and that drip of CSF starts. that feeling of, I'm so good at this thing that I do. As you said, whether that's in the workplace or whether that's learning a new skill. I'm...
Allison Smith (32:09)
Mm
Rachel La Costa (she/her) (32:37)
trying to learn to surf, you know? Do I do it well every time? Absolutely not, but I'm learning.
Allison Smith (32:42)
Well, and then you just pick something that like embraces multiple things, right? Surfing, you're outside. It's not easy. You got to be on that board. You got to swim out there. So you're doing a form of exercise. You're moving your body. You're taking time for yourself. You're learning new skills. You're taking time away from work. mean, picking activity like that's a great idea. Right?
Rachel La Costa (she/her) (33:08)
Check, check, check.
Allison Smith (33:12)
So those were some ideas for what an individual could do.
Rachel La Costa (she/her) (33:17)
fantastic.
Okay, what about systems -wide? What can the healthcare system do to support us? We are the frontline workers that are providing the direct patient care.
Allison Smith (33:28)
Right. So an ideal job person match would have basically instead of a mismatch, you would turn it into a match, right? So you would have a sustainable workload. You would have ample choice and control. You would have gratifying recognition and rewards. You'd have a supportive work community. You would have norms of fairness, respect, and social justice, and you'd have well -aligned values and meaningful work.
So basically, instead of having those mismatches, you would have positive strong matches in those areas as well. That would be like the engagement profile, right?
Rachel La Costa (she/her) (34:00)
beautiful.
Yes, right, right. Everything is kind of at a healthy balanced level and is well matched. And so this might require, if you recognize a mismatch in one of these arenas, this might require going to your manager and talking about the workload. This might involve asking for different ways to recognize members of the team.
This might involve more social activities or ways to build camaraderie and support between the members of the team. And I think, again, I really like these six mismatches because it's a very actionable place to aspire to, to try to move towards.
Allison Smith (35:01)
Well, and you really need management on board with this if you're going to truly make a difference. It just can't all be on one person, right? So if you're having maybe some issues in your department or in your hospital system, it kind of needs to come from higher up.
Rachel La Costa (she/her) (35:17)
Definitely not.
Allison Smith (35:29)
and then looping people in who are maybe a little bit lower in the hierarchy, right? Like getting their perspective. And that Burnout Challenge book has tons of just great ideas. They pretty much lay out a blueprint for if you really are truly serious about this and maybe you are a manager, it gives you some really good steps and things that you can do.
Rachel La Costa (she/her) (35:30)
Right.
rate.
Allison Smith (35:56)
kind of a brief summary of what that is would be like you have to talk to your people, right? Like if you're serious about making your change, what do your people say? And like not get defensive about it. We're just gathering information. If you're noticing in your group that there are maybe several mismatches, you cannot put out every single fire and solve every single problem.
Rachel La Costa (she/her) (36:03)
Mm -hmm. Mm -hmm.
Mm hmm. Listen.
Mm -hmm.
Allison Smith (36:25)
at once. So Maslach and Leiter recommend, you can you prune it down to one mismatch? Can you prune it down to something that is actually meaningful for the group that you're talking to? So an area that people really care about. They recommend setting attainable goals, right? Start with something small and doable. Pick that low -hanging fruit. Do you have
Rachel La Costa (she/her) (36:27)
Great.
Mm -hmm.
Mm -hmm. Right. Right.
Allison Smith (36:55)
27 clicks to get to this page. Can we rework that and now it's two clicks? I know it sounds dumb, but you know how much less time that's gonna take me now? Yeah, do something easy first if you can.
Rachel La Costa (she/her) (37:02)
Right.
Yeah, an energy.
Yeah, yeah, So Allison, I'm wondering if someone recognizes that they have multiple mismatches with their job, at what point would someone recognize that perhaps they've spoken with their manager, perhaps they've tried to do all the things on an individual level that they can, they don't feel like the system is going to change to support them. At what point would someone
have to make the difficult decision that maybe I need to leave this job because it's just not serving me.
Allison Smith (37:42)
Yeah, for sure. For sure. I mean, if you're trying to mold yourself into a puzzle piece to fit into the job and it is just not working out and, you know, your place of employment just does not seem to be a good fit despite all these efforts. I mean, no one's making you stay there. I know it's probably a point of privilege to say that because there's a lot of factors involved and
Rachel La Costa (she/her) (38:04)
Rate, rate.
Sure.
Allison Smith (38:12)
To make that decision is gonna be up to the individual. So maybe you make a pros and cons list because if you stay in environment like that, there's gonna be a cost, right? So there's gonna be short term and long term costs of staying and there's gonna be short term and long term costs of leaving. So if you do, if maybe you take 15 minutes,
Rachel La Costa (she/her) (38:16)
Mm -hmm.
Oof.
Allison Smith (38:40)
one day and maybe write that out, maybe the visual will help you see like, my gosh, the costs are so far outweighing the benefits of staying. Or maybe you see, yep, I'm kind of struggling in my environment right now, but if I were to leave, the costs would be greater because how am I gonna afford my rent? Or I need to take care of my children or...
Rachel La Costa (she/her) (38:51)
Right.
huh.
Allison Smith (39:10)
it's a really difficult job market right now. Well, then maybe that shifts your perspective a little bit. Maybe you stay where you're at for now. Maybe you do those individual level things to help manage the stress and just know like right now, this is where you need to be. And you can always be open to, you maybe you start looking elsewhere before you.
Rachel La Costa (she/her) (39:30)
Mm -hmm.
Mm -hmm.
Allison Smith (39:36)
jump ship, but yet at some point if the balance tips and you have the means, you could always leave.
Rachel La Costa (she/her) (39:46)
Right, right. Well, and Tracy Bingaman, who I interviewed about burnout as well, talked about how huge the financial piece is in that decision and how if you have financial stability and financial security, that gives you the freedom to be able to say to a toxic job environment, I cannot exist in this environment anymore. so, bye.
Allison Smith (40:11)
Mm -hmm. Yeah.
Rachel La Costa (she/her) (40:13)
But you're exactly right, that does come from a place of privilege depending on what your social situation looks like, that might not be an option for everyone.
Allison Smith (40:19)
Mm
Rachel La Costa (she/her) (40:21)
All right. So, Allison, you mentioned some mismatches that we experience when we're feeling burnout. Well, the one that definitely I identified the most with was the high burden of tasks, the over...
Allison Smith (40:36)
workload.
Rachel La Costa (she/her) (40:37)
What was the term for that? The workload. Now, recently for me, this is not so much in my clinical job as a PA, but more so in developing my podcast and my business where my whole, literally my whole second job. Thank you for the validation. My second job, the boss is a terrible workhorse who just
Allison Smith (40:49)
You mean your whole second job?
Okay.
Rachel La Costa (she/her) (41:05)
so much of me and does not allow me any time to rest. By the way, the boss is me. And I found myself in this situation where I put so much on my plate and not only so much on my plate, but so much on my calendar that I have not had nearly enough time to rest and recharge.
Allison Smith (41:11)
Mm -hmm, mm -hmm.
Okay.
Rachel La Costa (she/her) (41:35)
Let me explain to you what that has looked like for me that felt particularly difficult. So back in May, I took a trip to Europe to see the Eras tour in Stockholm and it was a 10 day trip. It was not until about day five or six in the trip that I actually felt like I could
relax. I had all this accumulation of stress and of expectations I had put on myself that I couldn't even enjoy my trip to Europe to see Taylor Swift that I planned for so far in advance. I'd been looking so forward to that I couldn't even enjoy it. And that was the moment when I was like, what is the
point, what is it all for if I can't even enjoy this time that I've set aside to relax? So what would you recommend in that situation?
Allison Smith (42:40)
Yeah, that's big.
Well, it sounds like you need to build in time for recovery. You only have a finite amount of hours in the day, right? So if you add something to your plate, it's going to come at a cost. It will replace something else. And the something else might be sleep. The something else might be
your Peloton workout that day. Your something else might be time with a friend or a significant other. Like those are not small things to shove off your plate. So it sounds like maybe you need to get better at saying no.
Rachel La Costa (she/her) (43:27)
Great.
boundaries are something that I definitely struggle with as a people pleaser and has just a high achiever that I like doing a lot of things. But what has ended up happening is that when I have so many things on my plate and I'm so exhausted, not to mention I also work night shift. So that doesn't help with the sleep wake cycle and that sort of thing. I feel like I'm not doing any of those tasks.
well, that creates this overthinking, this overanalyzing, this feeling of overwhelm that I feel like I have all these things. Like you could even see my shoulders are creeping up right now, even just talking about it. That I have all these things to do and I can't perform any of them well because I'm so exhausted.
Allison Smith (44:14)
Mm -hmm, mm -hmm.
Yeah, well, it sounds like the demands are too high and the resources are too low. So we need a better balance. And obviously you're a driven, dedicated, hardworking person. So it's not like you're just going to clear your schedule and do nothing. But the number of things that you have right now sounds like is too many.
Rachel La Costa (she/her) (44:33)
Correct.
Correct.
Right.
Allison Smith (44:55)
So it might be some trial and error where you have to figure out for you what that balance is. Do you have maybe two or three things scheduled to get through the day? And then do you leave an open block of time for, wow, task one took way longer than I thought. Well, you have protected time for work. And you really need to...
Rachel La Costa (she/her) (45:22)
Yes.
Allison Smith (45:24)
respect your own boundary so it doesn't bleed into your personal life. And that can be really hard, especially in your case, because you're the boss. You know, no one's going to tell you to go home or take your PTO. You know, you, you kind of are the leader there. So right now it just seems like if we're looking at a seesaw, it's just way tipped in the too many tasks direction. So.
Rachel La Costa (she/her) (45:45)
Right.
Yes. Yes. And the interesting thing is that I realized I have absolutely experienced burnout in the clinical setting many times. I've realized that I've developed really good skills and habits surrounding setting good boundaries with my job as a PA where I work in the inpatient setting. So
Basically, when I'm at work, I'm at work. When I'm not at work, I'm not at work. I set a personal rule for myself that I never log into Epic when I'm outside of the hospital. I used to have this habit, especially when I was coming in for night shift, that I would like pull into the parking garage and then open up Epic on my phone and see what the patient census was, start going through. And I realized, number one, I'm not getting paid for that time.
Allison Smith (46:25)
Yeah.
Rachel La Costa (she/her) (46:50)
literally giving away my free time. Number two, that was causing me to have, as I described to my father recently, pre -stress about the situation. My dad was like, pre -stress, what the heck is pre -stress? I was like, you have no idea. was like pre -stressing before the stressor actually even happened that I'm catastrophizing that this worst case scenario of this busy night shift, I'm going to have to take all these admissions and
Allison Smith (47:00)
Hahaha
Rachel La Costa (she/her) (47:20)
creating all of this drama in my head that was completely unnecessary. So I've created really good boundaries around my clinical job, but I had not created any boundaries around my business. Where subconsciously, I was expecting myself to work in every free moment, which is so unrealistic and frankly,
Allison Smith (47:35)
Mm
Rachel La Costa (she/her) (47:49)
frankly quite self -sabotaging.
Allison Smith (47:51)
Can I tell you some things that I've found to be not helpful? So like continuing to like add stuff to your plate when you know you're overwhelmed already is not helpful. The head in the sand, like I can do it or like I just have to get through this part, not helpful. Avoiding it, you know.
Rachel La Costa (she/her) (47:55)
Please, please.
Mm -hmm. Mm -hmm.
Right.
No.
Allison Smith (48:19)
a miracle will happen and future Rachel won't mind doing these things. No. Rumination. So you know the Buddhist second dart? Have you heard that? So there's a Buddhist proverb that you've definitely heard is pain is inevitable, suffering is optional. So they have the idea of the darts, right? So that we're going to have darts in life. Stuff is gonna happen.
Rachel La Costa (she/her) (48:24)
Right. Not true.
No, tell me.
Mm -hmm.
Allison Smith (48:48)
you know, we'll experience loss, suffering as part of life, right? That's the first dart. It's inevitable. And then for some reason, we really enjoy throwing darts at ourself, right? The pre -stress. So you're already gonna probably have some darts at work. You're gonna have a tough patient or maybe you experience loss and it's, yeah, that's suffering, but then dart yourself, right?
I didn't do enough. Why didn't I do this? I should have done that. This feels bad. Let me think about it again. You are just throwing darts at yourself. They are unnecessary. They do not help the situation. So that rumination, second dart idea, getting stuck in that is not serving you at all.
Rachel La Costa (she/her) (49:27)
Yes.
Well, that Enneagram one inner critic is just so loud, so loud for me. I know she's the worst.
Allison Smith (49:46)
I know.
We need to shut her up.
But, then part of that is just like self -awareness, right? So we know that you're a one, I too am a one. I am familiar with this voice, but like I recognize her voice now, right? I know when I have that critic who's speaking to me and I just recognize that she's speaking. It's like, thank you. I know you're trying to help. You have served your purpose. No, thank you. And just.
Rachel La Costa (she/her) (50:05)
You
-huh.
Yes, yes.
Allison Smith (50:26)
quiet it down a little bit.
Rachel La Costa (she/her) (50:29)
It kind of goes into like the parts psychology as well, right? Of this is a part of me that is trying to protect me, that is trying to help me in some way, but it is not helping me right now. It is only hurting me. is throwing darts at myself.
Allison Smith (50:36)
Mm -hmm.
Yep, at yourself, yep.
So that would be my recommendation. If you want, I think you should write this down. Recovery, balance, and boundaries. If you have a workload problem, that's where I would shift your focus.
Rachel La Costa (she/her) (50:50)
Hmm.
That is so helpful. Yes, great. Recovery, balance, boundaries.
I love it. This whole time management piece has just become so apparent to me where it's like I need to set extremely strong boundaries around my recovery time. I'm actually in this perfectionist group for entrepreneurs and Sam Laura Brown, the coach is fantastic.
but she has this concept of clean rest. When you're making your calendar that you put your clean rest on your calendar,
first as a non -negotiable, that this is the amount of time that I need for myself just to recover and to enjoy my life from all of the stresses and expectations that I'm doing. And during this clean rest, you do not open your laptop. You do not listen to a podcast about business. You do not work on your business.
That is your time for rest and it is a non -negotiable and it is the first thing that you block out of your calendar. And that is something that I'm trying to put into practice more and more.
Allison Smith (52:23)
I love that idea.
I support this.
Rachel La Costa (she/her) (52:31)
Thank you. Thank you. my goodness. Allison, this has been such a fabulous conversation. I've learned so much about burnout. I've learned so much about myself and what I can do for myself to treat my own burnout. I wrote down recovery, balance, and boundaries. And so that is going to be my focus going forward. So thank you for that insight and for sharing your knowledge and
Allison Smith (52:51)
Good.
Rachel La Costa (she/her) (52:59)
I end every podcast episode by asking my guests this question. The podcast is called A Beautiful PA Life. And so I'm wondering, what does a beautiful life mean to you? And do you have a beautiful life?
Allison Smith (53:14)
To me, I think a beautiful life is doing something that you care about. For me, it's really important that I feel like I'm making a difference in the lives of others, but also having the flexibility and time to do the things that I love outside of work. And I'm working on that. I think I've worked really hard to cultivate that. And I don't know if I've achieved it yet, but...
I'm much closer now than I was in the past few months, I would say.
Rachel La Costa (she/her) (53:50)
Well, Allison, just to applaud you and to recognize all that you've been doing on your own self work. I also want you to know that that has absolutely been modeled. Like you have been modeling that for me and I want you to know that I see that and I also aspire to that same goal of finding this beautiful balance that we can between our lives and our careers that feels good, feels right, feels fulfilling.
Allison Smith (54:18)
Yeah, I think perspective is a big part of that, right? Because we're all kind of barely here. Time is really precious and finite. So you should spend your time doing stuff that, like I said, you make a difference, but also you have time to enjoy it all as well.
Rachel La Costa (she/her) (54:26)
Oof.
It is.
Thank you, Allison. I so appreciate your insight and your time today. Hell
Allison Smith (54:43)
Thanks for having me.
Thank you so much for listening. I just got so much from Dr. Smith in this episode on burnout. I hope that you also got some gems, learned some things and have the inspiration to try to change what's going on in your career that might be contributing to burnout. I know that you're here because you want better. You want better for yourself. You want a beautiful PA life where your job is not
constantly draining you or you're excited about your job. You're that engaged profile that Dr. Smith talked about. Make sure you get my Burnout Deep Dive PDF so that you can go through all of those mismatches in this PDF and see what might be applicable to you, which of those profiles might apply to you. It's at my Instagram at rachel .la .kosta at the link in bio.
get that burnout deep dive. It's going to be a great accompaniment to this episode. It's completely free. I hope you have a beautiful Sunday. Take care, friend. Bye.
Thank you for joining me for this episode of A Beautiful PA Life Podcast. I'm here to help ease you into your PA week. So meet me at midnight every Sunday. I'm dropping a new podcast episode and also sharing a little love letter in my email newsletter. So to make sure you don't miss anything, just do two things. Number one, follow the show on your podcast app, so you automatically get those episodes every Sunday at midnight. And then number two,
Go to my Instagram page. It's @rachel.la.costa. Go to the link in bio and you can sign up for my newsletter. It's a little love letter I send every Sunday at midnight. You'll also find my Words of Wisdom Wednesdays. And, you know, if you've been feeling lately like, “it's me, hi, I'm the problem, it's me.” Check out my complete diagnostic assessment for burnout. It's a 10 question quiz. It's completely free. It's called, How Full is Your Cup?
You can find it at the link in bio. And until next time, remember, you can serve the patients you love without losing yourself. I believe in you and I'm here for you. Bye -bye.