RHR: How to Fight Practitioner Burnout with Dr. Akil Palanisamy

In this episode, we discuss:

• Burnout among healthcare practitioners
• How common the problem is
• The results of widespread physician burnout
• The difference between burnout and moral injury
• How technology is contributing to the problem, not alleviating it
• How to fight physician burnout

Show notes:

• The Paleovedic Diet by Dr. Akil Palanisamy
• The Sutter Health Institute for Health & Healing in San Francisco
• Unconventional Medicine by Chris Kresser
• 1440 Multiversity retreat for healthcare professionals
• Akil Palanisamy’s website, DoctorAkil.com

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Chris Kresser:  Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week we’re going to be talking to Dr. Akil Palanisamy, who is a friend and colleague in the Functional Medicine space. And I’ve known him for several years. He is the author of The Paleovedic Diet, a really interesting book combining Paleo and Ayurveda, a traditional Indian medicine which is an interest of his. And he also runs the Paleo Symposium that’s put on by the Institute for Health & Healing at UCSF every year, that I’ve been a featured speaker at since it started.

But today actually, we’re going to be talking about something different, which is burnout amongst healthcare practitioners. It’s a really important topic that has pretty significant implications not only in terms of the effect on individual clinicians, but on patients and their access to care, things like medical errors and just the healthcare system overall.

So if you’re not familiar with Akil, he’s an integrative medicine physician who blends his medical training with Functional Medicine in Ayurveda, the traditional medicine of India. He studied biochemistry at Harvard and received his medical degree from UCSF and completed his residency at Stanford. Dr. Akil also completed a fellowship in integrative medicine with Dr. Andrew Weil at the University of Arizona. He sees patients at the Sutter Health Institute for Health & Healing in San Francisco, where he also serves as physician director for community education. He’s been a consultant with the medical board of California for many years and as I mentioned, he’s the author of The Paleovedic Diet: A Complete Program to Burn Fat, Increase Energy, and Reverse Disease.

So I’m really excited to dive into this conversation with Akil. I think you’ll find it interesting, even if you’re not a healthcare practitioner that’s experiencing burnout, because we talk about a lot of issues that are relevant to anybody doing any kind of work, really. So I hope you enjoy the conversation. Let’s dive in. Akil, thank you so much for joining us. I’m so glad to have you here.

Akil Palanisamy:  Thank you, Chris. Pleasure to be here.

Burnout among healthcare practitioners

Chris Kresser:  So today we’re going to talk about a really important topic that I don't think gets enough attention, and this is physician burnout. So, and I would extend it to burnout for any healthcare practitioners. We might be focusing a little bit on physicians because this is where most of the statistics are available, but it’s certainly a problem across the entire healthcare world whether we’re talking about:

• Nurses
• Nurse practitioners
• Occupational therapists
• Chiropractors
• Acupuncturists
• Anybody working in the care profession

In my book Unconventional Medicine, I talked a lot about how this is one of the major challenges within medicine in general, not just conventional medicine, but also integrative medicine and Functional Medicine. And it's something that we need to develop a sensible approach to if we’re going to meet our goals in terms of preventing and reversing disease. So this is something that Akil has thought deeply about and has been involved in a number of different initiatives from his work at Sutter to working with medical students and other physicians to address this problem. So I'm really looking forward to having this conversation. So why don’t we start a little bit with the stats on burnout, Akil?

Ask yourself: Does medicine still feel like your calling? If daily stress and exhaustion are turning you away from the profession, you might be headed toward physician burnout. Find out what causes burnout and learn how to rediscover your sense of purpose.

How common the problem is

Akil Palanisamy:  Sure, yeah, I think it's really rampant, and most studies report around 50 percent or higher of physicians report some significant burnout. And that's up from about 40 percent just five years ago. So, I think the numbers are really scary and also this is a global problem. So this is across the board. Many countries throughout the world and also regardless of the stage of training. So medical students, residents, physicians, even the number of years of practice has no impact.

Chris Kresser:  Wow.

Akil Palanisamy:  I will check on this number, so, I mean, I know because I did my medical training 20 years ago, and it was like, I would say, a soul-crushing and exhausting process.

Chris Kresser:  Right, right.

Akil Palanisamy:  So I started early in this topic, and that’s why I’m so passionate about it.

Chris Kresser:  Yeah, yeah. That’s really revealing in some ways. If medical students are as burned out as people who've been in the profession for 10 or 20 years, that's an indication that something’s already going wrong, even at that very early stage.

Akil Palanisamy:  Right. I came across a really fascinating study. They interviewed almost 3,000 medical students about burnout and 53 percent of them reported feeling burnt out. About 15 percent were depressed, about 5 percent had seriously considered suicide. But the interesting thing was 100 percent of the students, every single one reported feeling humiliated at some point, demeaned, disrespected as part of their training. And that had huge effects on their performance and judgment, and that was my experience too. It’s part of the culture of training doctors.

Chris Kresser:  It really is, isn’t it? It’s almost like fraternity hazing or something. I've heard for residents that it's … and it seems to be perpetuated for some of the same reasons, like this, “I went through this, so you have to go through it,” type of mentality. And I've even read the studies that support that.

Akil Palanisamy:  Yeah, right. When I started my residency, I was super thrilled because they had just passed a law limiting the work hours, continuous work hours to 24 hours in a row. That was like a huge drop.

Chris Kresser:  That’s a big development.

Akil Palanisamy:  And I was like, “Wow, this is fantastic. I only have to work 24 hours in a row, like, every week.” And people thought that would solve the problem of burnout. But it hasn’t because that’s just one of many factors.

The results of widespread physician burnout

Chris Kresser:  Right, and so we know that there’s a huge problem with the shortage of primary care physicians. I don't remember the exact number from the study I shared in my book, but it's something like, predicted to be a shortage of around 50,000 primary care providers by the year 2025, which is not very far off in the future. And yet one of the costs of burnout, as you said, is that two-thirds of physicians know a doctor who is likely to stop practicing medicine or at least to reduce their access to patients, switch to concierge model, or something like that within the next five years as a result of burnout. So this is a real problem that's really kind of having an outsize effect on our healthcare system.

Akil Palanisamy:  Yeah, absolutely. I mean, I think it is genuinely a public health crisis. And I think that that word is increasingly being used in the literature because this really does impact not just individual physicians but patients, healthcare organizations, the entire healthcare system in our country and other countries around the world. So I think the scope of the effects and the impact of burnout is being recognized now and it's huge in terms of not just the individual level, but medical errors as well. So, recent studies have shown that there’s a strong relationship between physician burnout and medical errors. And already medical errors are one of the major leading causes of death in the United States. And so I think as we get more burned out physicians and higher rates of medical errors, I think that's one of the big issues in terms of the costs of this problem.

Chris Kresser:  Yeah, this is critical, and I highlighted this in my book. But if you go to a site like CDC or a general website and you search for the top 10 causes of death, let’s see what happens if we do that right now. Cardiovascular disease is still holding at number one, and then you’ve got lung cancer or you’ve got other diseases that come shortly after that. The data is often changing. Cancer continues to go up the list. But you’re not going to see medical errors on these lists, right?

Akil Palanisamy:  Right.

Chris Kresser:  There was a study published in the British Medical Journal in 2016, just a couple of years ago, and then another one by Barbara Starfield, who’s since passed away, back in 2000 in JAMA. And both of those found the same thing, that medical errors are actually the third-leading cause of death. And since only 5 to 15 percent of the atherogenic events are even reported, Dr. Starfield actually speculated that medical errors could be the number one cause of death if all of the atherogenic events were reported. So this is something you don't see on the typical list, but that doesn't mean it's not true.

Akil Palanisamy:  Right, exactly. Yeah, because when you experience burnout, the impaired judgment, lack of attention to detail, communication breakdown, all the things, the depression, that just greatly increases the risk of medical errors.

Chris Kresser:  Right. So this is a, it's a common problem, it's a problem that has not only effects on individual practitioners and their health and their lifespan, their feelings about their work, but also to patients and their safety and their ability to get the care that they need, and then to society as a whole. The healthcare crisis continues to deepen, and we need more doctors, rather than fewer. The fact that 50 … that two-thirds of physicians know a doctor who’s likely to stop practicing medicine in five years is exactly the opposite direction that we need to be going in here.

The difference between burnout and moral injury

So let's talk … so, we’ve been throwing this term “burnout” around, and I'm sure that means different things to different people. But you actually emailed me before the show with a really interesting distinction that I want to highlight—the difference between burnout and moral injury. So can you talk about that a little bit?

Akil Palanisamy:  Yeah, absolutely. So traditionally, burnout is defined as a work-related syndrome characterized by emotional exhaustion, a cynical feeling, and feeling like you're ineffective on the job. But this concept of burnout really doesn't resonate with doctors. I can tell you from talking to many of them that they really don't connect with this concept of burnout because the problem is you're pointing the finger at doctors. And you’re saying, “You’re burned out, you need to start doing yoga and eat granola, and just like change your lifestyle.” But you know, these are some of the most resilient people out there.

Chris Kresser:  Absolutely.

Akil Palanisamy:  Medicine, I mean we’ve survived decades of intense training, sleep deprivation, the training process itself is incredibly stressful, the work demands. So these are some of the most resilient and resourceful people out there. And so I think the problem is really,  a big part of it is the system. But the distinction that you mentioned between moral injury and burnout, the concept of moral injury actually was first used to describe how soldiers responded to what they did during war and when they came back, having to do things that went against their morals.

In healthcare, it refers to physicians being unable to provide the high-quality care that they would really like to, essentially, not being able to be true to themselves. So I think the problem is not that physicians are burned out and so we don't care. The problem is that we care very deeply.

Chris Kresser:  Care too much.

Akil Palanisamy:  Yeah.

Chris Kresser:  Not too much, but it’s the care that’s causing the problem, yeah.

Akil Palanisamy:  Right and then as a result, in our current healthcare system, it's so hard to consistently meet patients’ needs and provide the kind of care that we envisioned we would going into medicine. Because most doctors think of medicine as a calling, and so that failure and inability to meet needs of patients in the way that we really envision, that is hugely damaging, and I think that has a huge effect on physician well-being. And so that's the concept of moral injury. So I think that it's really much broader than just pointing the finger at doctors.

Chris Kresser:  I think that’s really, really important to understand, and I've always made it clear that when I'm criticizing conventional medicine and its shortcomings, I'm not criticizing individual doctors. Of course, I might be criticizing some individual doctors, but not as a group because the vast majority of doctors that I have met are people that genuinely want to help their patients. They went into medicine for all the right reasons and they do recognize that they're not having the impact that they would like to have, and it's painful for them. But there's, they feel like their hands are tied because of the way that the system is set up. And they’re just as much victims of the system as the average patient is.

And I think this is a good example of how that plays out where we all want to have meaningful and rewarding work. We all want to get to the end of the day and feel like we really made a difference. And doctors, I think, especially. That's the path they chose. They didn't go into private equity. They didn't choose to go into a career that was really not about helping people, but more about making money or enriching their own lives. Not that there's necessarily anything wrong with that. They willingly chose to go through a very arduous path that involves many, many years of schooling and as you said, rigorous training with residency, working 24 hours straight, often graduating with hundreds of thousands of dollars of debt. I mean, it’s an enormous risk to take, an enormous amount of investment of money and time and energy to become a physician.

So you don't make it through that generally, unless you really have a guiding moral compass that is pushing you through it. And so it's really, I think, even more important and critical that we figure out a way to, where we create a path forward for doctors and other healthcare practitioners that really do want to have that feeling at the end of the day. Because that's the antidote to burnout, where when you really do feel like you're transforming the lives of the people that you're working with, and you're having a huge impact. Because in that situation it doesn't mean you won't get tired and it doesn't mean you won't occasionally feel, “Geez, I need a vacation.” But you're not going to have that moral injury, and that’s what makes all the difference in the world.

Akil Palanisamy:  Yeah, I know, exactly. And I think that the rates of suicide among physicians is a real wake-up call because it’s twice that of I think active duty military, and then there was a report from the UK that there was a young junior doctor who, she took her own life by walking into the sea.

Chris Kresser:  Yeah, that’s not, yeah.

Akil Palanisamy:  Statistically, women physicians are a significantly higher risk of completed suicide than matched females in other professions. So it’s not uncommon, unfortunately, and I think that, yeah, exactly what you said about that moral compass that physicians have, I think being able to feel like you're true to yourself. That's a basic need that all of us have, and I think especially those who go into medicine, we feel that pretty intensely.

How technology is contributing to the problem, not alleviating it

Chris Kresser:  Right. And there may be lots of choices every day that they have to make that are, don't feel true to themselves because of the way that the system is set up. And I know from my own research and I know you and I have talked about this, one of the influences in terms of burnout has been the rise of electronic medical records or electronic health records, EMRs and EHRs. Initially these were hailed as, that this is going to dramatically reduce the amount of paperwork that doctors would have to do and they were going to be great time-saving and productivity devices, and they were going to be doctors’ best friends. But the reality has not quite lived up to that, has it?

Akil Palanisamy:  No, no. Yeah, I would, I think that studies show that about like half of the average physician’s workday is spent entering data or doing other clerical work in the EHR. So the amount of time actually spent with patients is less than a third, and for me I think it's a bit of a double-edged sword. Because it does make it easier to respond to patient messages rather than playing phone tag with patients. But on a typical day, I might get 50 to 60 electronic messages in addition to charting visit notes for each patient, and each of these questions or patient calls, etc., requires some thought.

And increasingly we’re being measured on how quickly we can respond to these messages because the priority is patient satisfaction, and that's eventually going to be tied to financial compensation and that kind of thing. So I think this EHR, it takes up so much time, and it really hasn’t translated to the reduced workload and that sort of thing. And when we deal with insurance in my practice, I think that's a huge benefit for patients because it improves access, and for Functional Medicine and integrative medicine, I think we need to move in that direction where insurance covers services. And so we offer that, but then it creates a whole universe of responsibilities in terms of the paperwork, the criteria for each progress note when we’re billing insurance, the forms, the prior authorizations, the other kind of paperwork. So it just adds another layer of paperwork to everything else that we’re dealing with in terms of the EHR every day.

Chris Kresser:  Yes. And then there’s another issue of when you're actually in the room with the patient, that connection that you're trying to make with the patient is now being mediated by a computer screen and having to type into the computer. And we’ve all seen, I've heard many stories of people going to doctors and complaining that their doctor was hardly even looking at them because they were working on the computer the entire time, and this is especially true with younger doctors from what I've heard, who never operated without an EHR.

So they never had the experience of being in a visit with the patient without the computer being part of that. And I think with all the data that we now have in terms of how important the physician-patient relationship is to the outcomes in care and the research on the placebo effect, and just the, in Carl Rogers's words, the unconditional positive regard and the type of connection that is made just is therapeutic in its own right. And I think the EHR can compromise that in some ways.

Akil Palanisamy:  Yeah, absolutely. And I'm always torn because I want to maintain good eye contact and really be present with each patient, but then if I don’t touch the EHR at all, then at the end of the day I’m like, this one’s like …

Chris Kresser:  You’ve got eight more hours of work.

Akil Palanisamy:  Exactly.

Chris Kresser:  It’s really challenging, and, I mean, my solution to that, which is not possible for everybody because of the model I work independently, so I’m able to just kind of set things up how I want. But I have a nurse practitioner that's by my side at every appointment, and she takes the notes. So I'm able to just maintain eye contact with my patient and not really look at the computer. And I recognize that's not a viable solution for most practitioners, but it's something that I felt compelled to do because I, like you, didn't want to get home and do four hours of data entry into the EHR after a full day of seeing patients. And but I didn't also want to sacrifice the connection with the patient.

So I think the other thing that's also not always in an individual physician’s control is the quality of the EHR or the EMR system. So many of them are just completely bloated and full of functions that they'll never use, and just really difficult to navigate, and they’re a nightmare in terms of software development. They’ve been just sort of cobbled together and put on top of each other, and it’s, for anyone who likes software and technology, EMR software is not going to be particularly inspiring for the most part.

Akil Palanisamy:  Yes, yeah. No, I think you’re right on that. And the point about having additional support for progress notes, I think, is a good one because studies show that having some type of help with the charting actually reduces burnout, and it's obvious, right? And I think at Sutter Health where I work, they really take burnout quite seriously. And so they’ve supported having scribes, which is the same thing. They take notes and they kind of do everything, and you just have to sign the note.

So I think it’s really, it’s a shared issue with burnout between individuals and healthcare systems and organizations. So I think it’s very important that all of these systems realize they have an important role to play, and I think Sutter Health is a really great example of that. They've supported a lot of these changes, and like this example of scribes and with our EHR, which is Epic, just helping us to use it in the most efficient way possible. So I think systemic changes are really a huge part of the solution as well.

Chris Kresser:  Absolutely, and this is a recurring theme in this conversation. It's that individual physicians can only do so much when they're employed in a larger organization, and they’re not free to just do whatever they want. And so we have to continue to work to raise awareness institutionally about these issues so that the institutions themselves can make the changes, and then individual physicians will benefit from those.

Akil Palanisamy:  Right.

How to fight physician burnout

Chris Kresser:  So let's talk a little bit about some of the work you've done in the past with medical students and other doctors at Sutter on burnout. What kind of things have you done to approach this?

Akil Palanisamy:  Yeah, I think for me during medical school, it was really a survival mechanism. Because I was pretty burned out and the training, yes, I absolutely had that being belittled and demeaned when I was on the wards in my rotations. And so I really got interested in the certain classes that were offered on finding meaning in medicine and really connecting with your purpose or actually reconnecting with why you went into medicine, and keeping that front and center. And also developing tools for maintaining well-being like mindfulness.

So mindfulness is one thing that has been studied. There’s actually been about 14 studies looking at physician burnout and mindfulness, and nine of them have shown positive outcome in terms of:

• Reducing burnout
• Improving well-being
• Improving mood
• Improving resiliency

So I think, I don't think that's the entire solution, but the more tools you have in your toolkit, the better. And we don't really get any training in general in terms of how to deal with stress and how to manage emotions during our healthcare training. And so I think I got into mindfulness very early, studied MBSR, developed a daily meditation practice, became involved in educational programs teaching people about mindfulness. And then since … then during residency and now practice, after that I've been very interested in workshops and events that kind of focus on that aspect of meaning and really reconnecting with a sense of purpose, a sense of direction. Kind of helping people be true to themselves.

And so I think small group exercises and workshops where people are getting out of their left brain and reconnecting with their right brain, using art and things like that, have been really effective. So for me, I've benefited as much as I’ve helped anybody in this work, and it's been just partly for my own gains, but I think you teach what you have to learn. And for me, being involved in burnout and teaching people about it has been a lifesaver.

Chris Kresser:  That’s so great. I think all of those are fantastic tools for kind of exploring the causes of burnout on an individual level and helping people respond in a way that will reduce the risk of moral injury, if we will. And I know for me, one of the ways that I've approached this personally and also with people that I've worked with and that I’ve trained is just to make sure that I feel like the work I'm doing is having a big impact on my patient’s lives. Because that’s one of the reasons I really love that distinction that you make between burnout and moral injury. Because if I look at it that way, I think, “Okay, well, that's the biggest risk is just getting to the end of the day and feeling like I'm not making a difference. Feeling like all of my efforts are for naught really. Or they’re not really having the impact that I would like them to have.” And to me, that's the greatest risk in terms of burning out. When I know that my work is making a difference, my endurance and stamina are considerable.

Akil Palanisamy:  Right.

Use Functional Medicine to prevent it

Chris Kresser:  But when I don't feel that way, it doesn't take much to make me feel tired and like what I'm doing is not worth it. So this is, I think, where a Functional Medicine approach has a lot to offer, not just as a treatment modality, but as a means of really actually making a difference in the patients’ lives. Like getting to the root cause of the problem and actually addressing the problem and helping the patient to recover and feel better without the use of unnecessary drugs and surgery. For me that was one of the most appealing things about Functional Medicine, and I think it's one of the less talked about but most important gifts that it has to offer to individual physicians who shift their practice in that direction.

Akil Palanisamy:  Yeah, I think that's what motivated me to go into Functional Medicine as well, just to get that sense of fulfillment and satisfaction when you help someone really get a permanent solution to something and by uncovering the root causes and taking that holistic approach. So I think that's what drew me to Functional Medicine as well.

Schedule a retreat

Chris Kresser:  Absolutely. So another area where I know, or a kind of antidote to burnout that I know that you and I are both passionate about is a retreat. So I've been a big believer in retreat. I’ve done annual retreats myself for many years. I’ve done meditation retreats for about 25 years and I just can't really imagine my life without that opportunity to step away from my day-to-day life and experience and to get a different perspective, to slow down, to have more spacious existence for a few days were the busyness of life is not overtaking me and where I can just hear myself think and feel my body, and just look at things from a fresh perspective. It's just crucial for me. And I've always felt like my wish has been that others can experience this. That we can, because I really believe in its transformative power.

Connect with colleagues

Akil Palanisamy:  Yeah, absolutely. I do as well, and I’ve had a number of retreats over the years in terms of individual retreats and also group retreats. And especially in the professional setting, I find that ability to connect with other colleagues and professionals in that informal, nonwork setting is so powerful because in healthcare there's so much isolation. There are so many individual silos.

Everybody's just doing their thing trying to get through the day, and you rarely have a chance to step back and step out of that situation to just really deeply connect with people who are in the same boat and really understand what they're going through, share their story, listen to their stories, and really deepen your connection and solve problems together.

So I think that sort of deep connection is so important because that's like a huge need for all human beings, and especially in such an isolating profession like in healthcare. I think it's essential.

Chris Kresser:  Absolutely, yeah. So many clinicians can just spend, we spend most of our time in a room with patients and we’re interacting with patients, but we’re not, we’re interacting with them in a certain way. We’re playing a certain role. We’re the clinician, they’re the patient, and those can be rich and rewarding interactions. But it's not the same as connecting with other colleagues and being able to talk about the issues that we face professionally and share together. So yeah I think that group experience is really powerful. And I’ve been writing about this recently.

I’ve been sharing some book recommendations, and Akil and I have actually teamed up to offer a retreat for healthcare practitioners at 1440 Multiversity in October. It’s from October 5th to 7th this year. And so it starts on Friday afternoon, Friday evening, and it goes through Sunday midday. And the retreat’s called “From Burnout to Brilliance: Rediscover Your Passion and Purpose, Reclaim Your Health, and Create a Practice You Love.” So the intention of this retreat is to address the issues that we've been talking about in the show and to help healthcare professionals explore their own situation, help them rediscover their passion for medicine and healthcare, and reconnect with a sense of meaning and purpose in their work to take some practical steps. Break those down into really doable actionable steps that they can take to reclaim their health and well-being. Rediscover parts of themselves that are not typically expressed in the course of their day-to-day work and just kind of cultivate a sense of energy and vitality that they may have been missing for many years.

And I'm really excited about doing this. I’m excited about doing this with Akil, who I've known for several years now and I really respect, and I'm excited about doing it at 1440. It's an incredible new retreat center, which I think you did a retreat there with Michelle Tam with Nom Nom Paleo last year, Akil?

Akil Palanisamy:  Yes, yes beautiful, beautiful place. Yeah.

Chris Kresser:  So this is, and for those of you who are not familiar, it's in Santa Cruz Mountains, right?

Akil Palanisamy:  Yeah, it’s surrounded by redwood trees and there's all these amazing hiking trails. And yeah, a beautiful place.

Chris Kresser:  Yeah. I haven't actually been there yet, but I know several people who’ve taught there and who’ve been there. And if you go to 1440.org, click on the stay button and check out some of the pictures. It's an absolutely beautiful campus. Really nice accommodations, gorgeous dining hall with lots of different food options. They've got daily yoga classes and massage, and a spa and other health offerings there. And they’ve got, of course, gorgeous hiking trails because it's in the redwood forest there. It just looks to me like they're really doing it right. I've been to a lot of retreat centers. I actually lived at a retreat center in Big Sur called the Esalen Institute …

Akil Palanisamy:  Oh. sure.

Chris Kresser:  … and many people may be familiar with. When I was still really sick and dealing with my health issues, I got to a point where I just decided, I kind of reached the end of the line of supplements and diets, and medications, and I decided that I would explore the psychological, emotional, psycho-spiritual aspects of what was going on for me. So I moved to Esalen and lived there for a couple of years. So I'm very familiar with retreat centers. I've been to many others around the country, both for Buddhist meditation retreats and other retreats, and I have, they're all great in many ways. But they’re, I can see that 1440 is bringing it to a different level.

So I'm excited to be a part of that. I'm excited to get together with a group of professionals that are all wanting to cultivate more meaning in their work and to find that work/life balance that can be so elusive. And I just can't wait to get together and support each other and share because that's, I mean, we all have so much to offer, and I think when we come together with a similar purpose, it's really powerful.

Akil Palanisamy:  Yeah. I am also really excited about the upcoming event, and I think for anyone who feels like they're not being true to themselves in their work or as to themselves as they would want to be, I think this is a great opportunity to really reflect. And I think our vision for that weekend is that it's going to be a very introspective weekend and really focused in small groups and interactive elements. So it’s not going to be just mostly didactic.

Chris Kresser:  Yeah. It’s not going to be Akil and I standing in front of the room talking at you the whole time. Definitely going to be the opposite of that.

Akil Palanisamy:  Right, exactly, yeah. Because I think that this work is really about looking within and then sharing and connecting with other people. And so that's the focus of the weekend, is really building that sense of community with whoever comes and really learning to deepen your own sense of meaning and purpose in work, and look within to reconnect with that vision for what drew you to this work initially. Because I think that's the ultimate goal is having that feeling like you're really being true to yourself at the end of the day and having the kind of practice that you envision.

Don’t be afraid to make changes

Chris Kresser:  Absolutely. I shared the story of Sheri in my book Unconventional Medicine, who is a clinician that was working in the VA. And she's a doctor and was mostly seeing patients with diabetes. That's the most common health challenge for veterans. And it was, she was counting the days until retirement. It was just really a factory-medicine type of situation. She often didn’t even have time to go to the bathroom during the day because she was just that busy from appointment to appointment. And as we've discussed, there was a real risk of moral injury because she didn't feel like she was making a difference. She was just handing out medications to these people and she wasn't, she knew as an athlete herself who tried to pay attention to her diet, she knew that wasn’t the best way to go about it. But what else could she do in the amount of time that she had?

And she moved into kind of a more, started incorporating more of a functional approach in her work, and then eventually left and started her own Functional Medicine practice. But for her, it was just a total game changer. She went from counting the days to retirement, to not ever being able to imagine retiring. And that's the kind of shift that’s possible, I think, when you really address the root causes of burnout and take the opportunity to step out of your current system, your current day-to-day, and really give yourself the chance to discover something new. And even if that’s maybe moving in a different direction entirely, or maybe staying in your current situation but just making a series of small changes that collectively can have a big impact.

Akil Palanisamy:  Yeah, I think for me, my whole approach has been in terms of incremental change because I know that for many people, they have gone out of the insurance model and set up their own Functional Medicine practice, and that can be fantastic. But my work is really just building change within the system. Because if the people within the system leave and do their own thing, then the system itself is going to not be changed. And so I think that a big part of this is also figuring out solutions within systems and incremental steps we can take, and I think that'll hopefully be part of what we talk about as well. Just if you do belong to a system, how you can take a leadership role and effect change within that system as well.

Chris Kresser:  Absolutely. That's why Akil and I are a good team, because I’m outside the system and he’s inside of the system, and we have different perspectives. So that's another reason I'm happy to team up with him. I mentioned this in the beginning, but I'll throw it out there again. You need not be an MD to participate in this workshop. It's really for all healthcare practitioners and providers who are experiencing burnout. And so this could be anyone from a health coach to a nutritionist to a dietitian to an occupational therapist to a chiropractor, a naturopath in addition to MDs, and DOs, and MPs, and PAs, and all of the other abbreviations and acronyms. Anyone working in healthcare really would be welcome. And we’re not even limiting it to people working in healthcare. We don't want to exclude people here, so if you're not working in healthcare and the things we've been talking about resonate with you, maybe you work in emergency services or something else, you are absolutely welcome to come.

Akil Palanisamy:  Yeah, and I would add that even if you're not feeling burned out, I think that prevention is really the best medicine.

Chris Kresser:  That’s true.

Akil Palanisamy:  So I think learning about the research and the science, because we know how to prevent it, and it's much better to prevent burnout than treat it once it happens.

Chris Kresser:  That is a very good point. Yeah, and I guess if the statistics are any indication, we know that even if you’re not feeling burnout now, chances are statistically you will at some point.

Akil Palanisamy:  Right.

Chris Kresser:  Especially without any intervention. It’s kind of like the diabetes example I used before. If you’ve got high normal blood sugar, now’s the time to get it under control rather than waiting until it turns into diabetes.

Akil Palanisamy:  Right.

Chris Kresser:  Great, well, thank you so much, Akil, for being with us. It’s a fascinating and important topic, and I’m really looking forward to leading this workshop with you. Again, in the retreat, you can go to 1440, it’s 1-4-4-0 dot o-r-g, and when you get there on the website, you just hover over Learn, and then under programs click on Professional Development. And if you scroll down there, you’ll see our program, which, again, is on the first weekend of October, October 5th to 7th, it’s a Friday through a Sunday.

And there’s a tuition for the program, and then there’s several different accommodation options available there. It’s really neat. I like what they've done with that. Everything from a private room to a suite to a really cool bunk style, kind of modern bunk-style accommodation that's much more affordable. I don’t know if you saw those last time.

Akil Palanisamy:  I did, yeah.

Chris Kresser:  Check the pictures out, they look pretty cool. They call them pods.

Akil Palanisamy:  Right, yeah, yeah. They’re pretty comfy. I’ve seen them.

Chris Kresser:  Yeah, yeah, it looks great. So lots of different accommodation options. If you’ve never been to this part of the world, the Santa Cruz Mountains are a beautiful, beautiful area, gorgeous redwood forests. You can head down to the beach before or after in Santa Cruz there. It’s a funky, cool little town. Great, great part of the world. So I hope you can make it. Those of you who have been listening to this and resonating with it, we’d love to meet you in person and have a chance to explore these topics with you.

And then Akil, is also, we haven’t talked much about his other work, but he’s also an author in addition to being a clinician. And he organizes the Paleo Symposium every year that I've been fortunate enough to be a speaker at. So why don’t you tell everyone a little bit more about your work and where they can find out more about your work.

Akil Palanisamy:  Oh sure, yeah. So I practice integrative medicine and I combine Functional Medicine with the Paleo approach and Ayurveda, which is the traditional medicine of India. And still that has led to my book which is called The Paleovedic Diet, combining Paleo and Ayurvedic medicine. And the best way to connect with me would be through my website, which is DoctorAkil.com. Just doctor spelled out, A-k-i-l dot com. And yeah, I wanted to thank you, as well, Chris, for having me on the podcast. I’m very excited to be working on this event with you, and it was really a pleasure to talk today.

Chris Kresser:  Pleasure is mine, Akil. And I'm sure we’ll be in touch before October, but I look forward to seeing you then and anyone else who's listening, who wants to join us. So 1440.org, and thanks for listening, everybody. Keep sending your questions in. I know I haven’t answered many of them recently. We’ve been doing a lot more interviews lately. But I do see that I have a few Q&A episodes coming up, and we do read all of your questions, and we also consider them for writing articles or emails.

So even if we’re not able to answer them on the show, it helps me to understand what you're thinking about and what you want me to write about and talk about. So please do keep sending them in. That’s ChrisKresser.com/podcastquestion. And thanks, everyone, for listening. And thank you, Akil, and we’ll see you next time.

Akil Palanisamy:  Thank you, Chris.

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