COPE: A Strategy for Turning Burnout into Breakthrough

You’re driving down the road, and your check engine light comes on. “Hmm, that’s strange,” you might say to yourself. What do you do? If you’re like most of us, you probably just ignore it. Maybe it will go away, right? Then you start to hear some weird noises coming from your engine. Clonk, bonk, rattle, bump. “Hmm. So odd,” you ponder. Solution? Turn up the radio, of course. Then, a little further down the road, steam comes out from under the hood of your car, and you are forced to pull over because you can’t even drive with billowing smoke blocking your view.

So how does that look for us, the practitioners, students, business owners, and educators of complementary and alternative medicine (CAM)?

Well, just like your car, the warning signs start off soft and subtle and get louder and louder until you are forced to address the problem.

It starts when you no longer look forward to treating people or going to work. You might hear yourself say things like:

“Ugh, I have to go to work tomorrow,” instead of “I get to go to work tomorrow.”

“I hope my patient(s) cancel tomorrow,” instead of “I hope more people schedule with me tomorrow.”

You might start experiencing headaches, insomnia, or body aches and pains. Your burnout is getting worse when you find yourself complaining more frequently and making statements like these:

  • “Oh, my Gosh! My patients are driving me crazy!”
  • “I can’t stand working when so and so is in the office.”
  • “I don’t even have time to think anymore.”
  • “I’m getting so out of shape. I feel crappy.”
  • “I don’t have enough money.”
  • “I can’t remember the last time I got a treatment for myself.”
  • “I’m so tired. I’m tired all the time.”
  • “I hate these insurance companies and all the BS (bureaucratic stuff, of course) that goes along with the system.”
  • “Does this medicine even work?”
  • “Am I really making a difference?”
  • “My students are driving me insane!”
  • “These homework assignments are so stupid.”

Here’s a final test to see if you are experiencing burnout. Which one best describes you lately?

Question: When you drive to work or school, you:

  • (a) Listen to music or inspiring e-books or podcasts;
  • (b) Call friends or family to catch up; or
  • (c) Yell at drivers to “Get the F out of my way, people!”

When I was in Chinese medical school, I was a massage therapist. I worked for a chiropractor who booked me eight one-hour, back-to-back massages every Tuesday and Thursday. At first, I loved it. I had zero experience with bodywork or massage before Chinese medical school, so this was an excellent way for me to obtain practice in massage. After about six months of this, I really started to feel the toll of the excess one-on-contact with patients. I first noticed that after massaging eight people in a row I left work with headaches. Then I started having a hard time sleeping and began to become aware of many aches and pains in my neck, shoulders, and back. But I didn’t truly admit to myself that it was time to quit until…

Red Flag#1: I purposely left my eighth massage patient of the day face down for an extra twenty minutes because I couldn’t stop crying while massaging her back and I didn’t want her to see my tear-stained face; and;

Red Flag #2: One day before work, I was cutting fruits and vegetables for my lunch. The entire time I kept thinking to myself, “I honestly don’t know if I can do it today. This job is exhausting me.” That’s when I cut my finger so badly that I had to get stitches. And, since you cannot massage with stitches—guess what? No work for me.

Does any of the above resonate with you? Has your check engine light turned on, yet you have chosen to ignore it? Most likely it has, given recent statistics that suggest that more than half of U.S. physicians are experiencing professional burnout[1].

If you suspect or know without a shadow of a doubt that you have burnout, please understand that it’s ok. In fact it’s not only normal—it may just be a blessing in disguise. Despite your fellow practitioner’s Facebook and Instagram profiles showing exuberant passion flowing in all directions, burnout is more common than you may think and not many people are willing to admit it. They are afraid people will think they are a bad practitioner, or that they are a bad person who doesn’t want to help people. Let me tell you something: I have two kids that I love more than anything in this world, but there are times when I fantasize about running away to live next door to Kate Hudson and Shakira in Ibiza. These feelings or thoughts don’t make me a bad mom or mean that I don’t love my kids. They are simply gauges telling me that my system needs attention—much like the gauges of your car. When my kids and the chaos they bring make me feel like running away, that’s when I know I need to make some shifts to get myself back in balanced and aligned with my true self otherwise I am not good to anyone.

So, what do we do once we have determined that we are in a state of burnout? Well, what do you do when your car breaks down? You take it to a mechanic.

Please consider me your practice mechanic. Having been in practice nearly 20 years and counseled hundreds of students and practitioners, I am an experienced, skilled and reputable mechanic that works from a space of integrity, and with your best interest in mind and at heart.

I propose that it’s time to COPE with your burnout. In this sense, COPE is an acronym for Cause, Options, Pick/Plan, and Execute. It has been my experience that by following this 4-step process, you can transform your negative state of mind into one that re-aligns you with your passions, joys, and peak state.

Let’s break C.O.P.E down a little further and begin the transformation process. It would be helpful to record your answers to each step as we go along.

C is for Cause. What is the root cause of your burnout? Is it originating from your practice or another part of your life and bleeding into your career? Just like when we are working with a patient’s health, it’s essential that we determine the exact root cause of the problem: only then can we create an effective treatment plan.

The Mayo Clinic website (2019)[2] published a list of possible causes for career burnout, which I have summarized below. See if any of them feel like your situation.

  • Your practice or business has become monotonous or chaotic. You find that you need to exert constant energy to remain focused or engaged.
  • You feel isolated at work or in your personal life, with no sense of community or belonging.
  • Your work-life balance is more like a work+work+more work = no life equation. You no longer energize yourself with quality time with loved ones.
  • You have painted yourself into a corner and feel that you have no way out or control over your own life. You are forcing yourself to work on days or in ways that make you resentful and/or unhappy.
  • You share your office with, or rent space from, someone negative, too loud, disrespectful or toxic in such ways that it makes working with them a bummer.
  • You try to be everything to everyone and/or do too much of the things you do not enjoy.

Maybe your burnout causes are present in the list above, or perhaps you have your own specific reasons for feeling crispy. In any event, the first step is to determine and acknowledge the root cause(s).

Step 1 of the 4-step COPE process:

Write down all the potential causes of your burnout

O is for Options. Think of all the possible options for correcting each of your burnout-causing problems. Your choices can range from easy-to-implement actions to a more complicated treatment plan that will require several steps, detailed planning and a specific amount of time to implement.

The last time I got my oil changed the technician came to me in the waiting room with my dirty air filter in his hands and a readout of my car’s overall health report which listed all issues found during the inspection. He went over my options, advising that while I could safely choose to just go with the oil change and put off the air filter replacement for a year, my tire tread was dangerously low, and I was risking a blowout.

Similarly, in Step 2 of COPE — Options, you list out all of your options for each of the problems discovered and identify the “must do now” and “can wait” items.

To get you started with your own list of options, I’ve provided some options for you to consider below. I list them in order of magnitude with the quick fixes listed first and the more extreme corrections listed towards the end.

Self-Care. Get a treatment or massage, listen to motivational podcasts, read inspirational stories/books/articles, have a spa day, get out in nature, get a sub to teach your class, take a class in something that makes you happy. The idea is to engage in activities that recharge your batteries and bring you joy.

Eat Right. Diet really does make a difference in how we feel. Even hydration plays a significant role in how we think and perform. Did you know that, since our bodies and brains are mostly water, that dehydration of even 2% can have negative cognitive implications?[3] Moral of the story: drink water and eat well. Most of us have been trained in Eastern and Western nutrition. We not only understand the importance of feeding our bodies, minds, and souls, good food we preach this to our patients. Let’s be good role models and walk our talk.

Exercise. Stagnation leads to dis-ease. Move your qi. If you don’t have the disciple to exercise regularly then get a workout accountability partner and commit yourself to meeting at least once per week. A strategy that has worked for me for nearly 20 years is to teach fitness classes: I have to be there because people are counting on me, and I get free health club memberships. Can you teach yoga, fitness, or another form of exercise that forces you to get out there and exercise? It can also become another revenue source.

Say No. I love how Derek Sivers, a successful American entrepreneur, approaches his decision making: “If it’s not a ‘Hell Yeah,’ then it’s a ‘No.[4]

Hire Out. Stop doing things that you don’t want to do. It drains your energy and has also been considered a contributor to career burnout. Is it finally time for you to hire someone to do all your billing or get a house keeper? What are you waiting for? I promise you that once you hire out the tasks you hate to do, you will hear yourself think or say “darn it, why didn’t I do this sooner?” Stop waiting and start living your life the way you want now.

Create a Master Mind. When two people meet to discuss and explore an idea or topic there become three minds: The first person’s mind, the second person’s mind, and the third mind, considered the “mastermind”, that is created between them. To tap into this powerful peak state-promoting strategy, meet regularly with a colleague for collaboration and motivation. I have been doing this for several years and find it to be incredibly helpful in countless ways. Every two weeks, I meet with my practice/business mastermind colleague, and we present to each other our highs, lows, challenges, and successes while we offer insight and ideas to each other. It is often easier for someone else to see what’s going on in our blind spots. Since I tend to “over-passionate”, my practice/business mastermind colleague regularly points out that I’m taking on too much work and will inevitably crash if I don’t let some things go. It is so effective, and it helps to reduce the feelings of isolation many of us feel as private practitioners and entrepreneurs.

Stop Over-Passionating. I coined the phrase “over-passionating” after personally suffering from this dis-ease for countless years and witnessing many other people doing the same thing. I often have a hard time saying no to things—I want to do it all! The problem is that I simply cannot do all the things for which I have passion. I want to have a successful product business, be the best mother, volunteer at MOPS, read at least 40 books per year, teach fitness classes, have a successful private practice, write books, teach acupuncture classes, run workshops, speak at events, start new product businesses, coach and consult… are you dizzy yet? I am. I finally had to write a prioritized list of all the things I wanted to do and for which I had enthusiasm. I then picked the top three on the list and told the remaining 99+ items that they will have to wait for the time being. Think of juggling: typically, there are three balls in motion because any more becomes almost impossible. So why do we try to juggle more than three major efforts in our lives and then wonder why we aren’t incredibly successful in any of them?

Empower your Lists. Having huge task lists can weigh us down and contribute to the sense of burnout. Therefore, here are some strategies for having your lists empower and serve you rather than bog you down:

  1. Marie Kondo your list[5]. If it doesn’t lead you to joy, get rid of it. If you do not know about Marie Kondo’s movement of tidying up your life – following her advice alone can reduce your stress and burnout tremendously.
  2. Rename your list. Instead of a “To Do List” have a “I Get To Do This List.”
  3. Devote an entire day to your “I Get to Do This List.” Wake up and get yourself into a peak state by exercising, meditating, etc. and then turn off the outside world while you go through each item on the list and finally complete them. Get motivation by promising yourself that once you finish a certain number of the items from your list that you will reward yourself. You’ll go get a treat, have lunch with a friend, engage in something artsy, go for a hike, go to the beach, have a glass of wine, watch your favorite Netflix show – whatever is the perfect carrot to dangle in front of yourself to stop procrastinating and finally finish something that must get done and is causing you stress.

OHIO. Only Handle It Once. This is a great strategy to keep your “I Get to Do This” List short and stress levels low. If there is any chance you get something done immediately rather than placing it on the list—do it right away. Only handle it once, not twice or three times while you put it on your list and then keep procrastinating on it.

Raise your prices. A major cause of burnout is too much people contact. Another common cause of burnout is feeling as though you aren’t being paid adequately. Are you seeing too many patients or charging too little? I remember one particular Friday night as I was driving home from a week where I treated 40 patients—I cried the whole way home. I was so spent. When I arrived home, my boyfriend couldn’t understand why I was so emotionally, mentally, and physically drained. His response to me was, “You just sit and talk with patients all day. How hard can that be?” While people that aren’t healthcare providers may not ever understand how taxing it can be, you and I know the toll it takes on us. I’ve been coaching practitioners for nearly 10 years now, and 95% of them have come to me with this dilemma. They want to make the same amount of money, if not more, but not have to see more patients. You are going to have to raise your prices and/or bring additional revenue streams to your practice to correct this issue.

Additional Revenue Streams. Selling herbs, supplements, adjunctive treatment tools, instructional videos, and/or other products that you endorse or use in your treatment sessions is a great way to bring in additional revenue without having to see more patients. You can incorporate e-commerce into your website and sell these items online. If you aren’t sure how to do this, hire a consultant to help you get started. They can save you hundreds of hours and dollars from you trying to learn it all on your own.

Monetize what you are already doing for free. For many years, students, recent graduates, and even seasoned practitioners would call or email me asking for advice on how to take their practice or business to the next level. I loved helping these individuals, and it felt good to know I was being of service to a fellow practitioner. After one particular email exchange which went on for days and took up several of my hours, the prior student of mine whom I had just given a ton of helpful advice ended his email by saying “Gosh. You are so good at this. You should charge for it.” That’s when a light bulb turned on for me. What are you doing a lot of, for free, that you could start to charge for? What are people telling you should charge for?

While I have provided you with some potential options, it’s now time for you to explore all possible options for each of your burnout causes. Take a moment to write down all your options next to each cause identified in Step 1.

Step 2 of the 4-step COPE process:

Write down all possible options next to each root cause

P is for Pick and Plan. From all possible options, select those options that are both necessary and realistic for you at this time and design a plan to incorporate these remedies into your life immediately. Yes, immediately. I cannot stress enough the importance of taking immediate, massive action (thank you, Tony Robbins, for these words of motivation). I often hear my clients and/or patients say things like, “Yeah, I know I need to do that but I can’t right now because I am waiting until I make more money or I’m waiting for my kids to grow up, or I can’t do it until I lose some weight, or I just signed a lease or…(enter any and all excuses here).” To this, I’d like to offer a quote from Richard Bach, author of the book Illusions: “Argue for your limitations, and sure enough they are yours.” Circle 1 to 3 options for each burnout cause and commit to them now.

Step 3 of the 4-step COPE process:

Pick your options and make a plan

E is for Execute. Now it’s time to act on what you’ve determined is necessary if you are going to transform the burnout into an opportunity to improve your situation. We all know that engaging in activities like exercise, yoga, meditation, nature, and music will reduce our stress levels, but we must take action for them to have any effect on our situation. I give you permission to: stop working Saturdays or late nights, get a new office space, gracefully refer out the patients that aren’t willing to pay you what your services are worth, raise your prices, take some time off, leave private practice and create a product business, do whatever it takes to bring you back to your true self—the same person that eagerly and most passionately pursued a career in healthcare.

“A journey of a thousand miles begins with a single step”
-Famous Chinese proverb

Jim Collins, author of Good to Great and Built to Last, writes about the concept of the “20 Mile March” in his book Great by Choice. If you marched 20 miles every day, regardless of rain or shine, extenuating situations or outside events, you would eventually go across the entire United States. By engaging in the 20 Mile March approach to a goal you will invoke order amidst disorder, discipline amidst the chaos, and consistency amidst uncertainty. Simply stated: one step at a time. The key to all of it is in taking the steps.

Step 4 of the 4-step COPE process:

Do something every day that moves you towards your transformation

The 4-Step process of COPE can get you out of a burnout phase and recognize the incredible gift you are given when you feel burnout. It is actually an opportunity to finally reach this kind of rock bottom burnout because only then will you will take action in the direction of your heart. I often tell my clients and patients that “nobody gets off a comfortable couch.” Perhaps the universe is making your couch uncomfortable enough that you will finally make some changes in your career or life.

Remember, you were drawn to a career in healthcare for a reason. Something called to you like a songbird until you answered the summons and dedicated a good part of your life to helping others. Maybe you became a healthcare practitioner to heal yourself, or perhaps you once loved it and now find yourself out of love. It’s up to you to honor the warning signs and do what you need to do to get yourself back on track even if it means taking a serious time out, getting help or going into a different direction all together.

As your mechanic, I encourage you to pay attention to the warning signs that your body, mind, and spirit are giving you. Honor those messages because they are a blessing. They are there to provide you with the opportunity to bring yourself back into alignment and onto a track that feels right, brings you joy and a deep sense of job fulfillment. Bringing your car into the shop for occasional check-ups and to make sure you get routine maintenance is important. Take care of your vehicle. Take care of yourself. Stay aligned and turn the seeming setback of burnout into a breakthrough.

With a commitment to helping others actualize their greatest potential and wellbeing, East Phillips, DAOM, LAc, has been a licensed acupuncturist since 1999 and professor of Chinese Medicine at the Pacific College of Oriental Medicine since 2004. She currently resides in Del Mar, CA with her husband and two kids and continues to help patients, students, other practitioners, and the general public with her books, lectures, workshops, coaching and wellness related products.

[1] Herbert, Fred. L and Scheid, Mark S. (2018). Physician Burnout: Causes, Consequences, and (?) Cures. Texas Heart Institute Journal 45(4), 198-202.

[2] Accessed 6/7/19: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

[3] Carroll, Linda (2018) Dehydration Impairs Cognitive Function. Psychiatry & Behavioral Health Learning Network accessed: https://www.psychcongress.com/news/dehydration-impairs-cognitive-function

[4] Tim Ferris Podcast #371 Derek Sivers on Developing Confidence, Finding Happiness, and Saying “No” to Millions.

[5] Marie Kondo is a world-famous Japanese organizing expert/consultant and author of the bestselling book: The Life Changing Magic of Tidying Up.

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