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The Neurotransmitters: Clinical Neurology Education
Burnout with Dr. Lauren Bojarski
Dr. Lauren Bojarski joins us to talk about our current understanding of burnout in the medical field as well as some of her own experiences.
We talk about symptoms such as:
- depersonalization
- emotional exhaustion
- the need for personal achievement and others
Check out some of the resources mentioned below:
ACGME Well-Being Tools
Top 10 physician specialties with the highest rates of depression
THRIVING IN YOUR NEUROLOGY CAREER
RESIDENCY PROGRAM WELLNESS
WELLNESS RESOURCES FOR ORGANIZATIONS
Find Dr. Lauren Bojarski on X/Twitter
A bi-monthly podcast where we share the stories of our Caregivers, patients and...
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The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.
All right and we're gone. Hello, this is Dr Michael Kentris, the host of the Neurotransmitters, and welcome back to your source for everything about clinical neurology. We are coming to you from the American Academy of Neurology annual meeting and I am very happy to introduce today's guest, dr Lauren Bojarski from the University of Kentucky. Welcome.
Lauren Bojarski:Thank you for having me, Dr Kentris. I'm really happy to be here.
Michael Kentris:Please call me Michael.
Lauren Bojarski:Okay, will do so, you, you, for having me.
Michael Kentris:Dr Kentris, I'm really happy to be here. Please call me Michael. Okay will do so. You know you were so kind to agree to my request for an interview with you. I saw that you'd been doing some work on burnouts in medicine recently, so tell me a little bit about what kind of piqued your interest. What drew you to that?
Lauren Bojarski:It's a great question. I originally started thinking about it in medical school. I had been on a small committee that was trying to make medical students' lives just a little bit better like maybe having snacks after tests and they had already had the committee and so I just kind of hopped onto it and heard what they had to say.
Michael Kentris:The pizza party strategy.
Lauren Bojarski:That was exactly right. It was a lot of pizza, not the highest quality either, but it was still good it was incentive.
Lauren Bojarski:And we really appreciated the sentiment behind it. And the more I thought about it, the more I thought, you know, that just seemed like a good thing to do. I did go to a Christian medical school and it seemed like a good thing, just in general, to be good to other people, and so it originally started there. And then after medical school, when I went to residency, I noticed that it just kind of continued to expand in my intern year. So I, I started intern year during COVID. Um, it was very rough, um, and it was even more difficult because, um, I was supposed to get married a month after COVID hit, so like March 20th was the day, and then I was supposed to get married a month after COVID hit, so like March 20th was the day.
Lauren Bojarski:And then I was supposed to get married the 24th and we were supposed to have a match ceremony and a graduation and none of that happens. So no wedding, no match, no graduation. And I was at a very low point in my life and when I started intern year it became even lower because with COVID, there was no social interaction and I had realized that I really thrived in an environment where we were talking to each other and supporting each other. So a couple months after that had happened, I realized that I needed help and so, thankfully, our residency was really good about providing resources. So I reached out, I got counseling, I talked about how I felt not good and after I had finally improved in my own mental wellbeing, I realized that so many people had been advocates for me, not even from neurology.
Lauren Bojarski:When I was an intern, it was medicine who was advocating for me and different people, you know, would see me and they would talk to me and I was very open about how I was feeling and they would talk back and we would have conversations that no one was having, like someone had mentioned to me that they were on a path of severe alcohol abuse and that they had someone who reached out to them, who really changed their life around. And you know, now he's doing great things and he's very successful and he's happy. But in that moment I realized that we all need an advocate and then I asked the almost impossible question how can I be an advocate for everyone?
Michael Kentris:Right.
Lauren Bojarski:And that's what started it all. I realized PGY2 year they asked us to do a research project like a QI project, and so I started working on a virtual handbook that helped the residents on the services for stroke and our general neurology and patient wards. We were able to give that to them to help them learn the paces quicker, so that they wouldn't feel useless or that they didn't know everything. And then so we really got that on the ground. We came up with a committee to keep that sustainable and then, past that, I found myself doing a lot of validity with ACGME. So I've done research on that and seeing how that correlates to actual resident burnout in trainees. And as time went on, I realized, well, trainees aren't the only ones who have burnout. I realized, well, trainees aren't the only ones who have burnout.
Lauren Bojarski:We don't have a whole lot of literature for neurology faculty and you know, attendings in their early, mid and late career we just we don't have that data yet and I asked myself, well, why not? And it's because we're not having the conversations, and so that's why I was so happy that you were able to have me on today is because we do need to have that conversation, and I think there's been maybe like a generational gap where that, you know, we're talking about things that just weren't talked about 20 years ago.
Michael Kentris:And I'm so glad you brought up that generational gap because it does seem, you know, for those of us who are perhaps quote too chronically online, we do see this discourse every few months crop up where someone talks about how, you know, work conditions are, let's just say, less than ideal, whether that's due to duty hours or the amount of sleep deprivation it engenders or various other aspects of medical training. And then you inevitably get someone of an older generation, let's say who's like I did so-and-so and it made me a better physician. And gosh, golly, darn it. These kids these days, which I love that there's this one stream and it talks about kids these days going back to like the 1890s, and it's just like news clippings about how kids these days they don't want to work hard, like nobody wants to work right, and so this is a perennial discussion that has been going on since like basically the printing press in America, at the very least, 100% yes.
Michael Kentris:So, that being said, we do know while we don't have the perhaps granular level of data, we do know that job dissatisfaction amongst practicing neurologists is fairly high. Do we have any inkling as to? Does that correlate with? Oh, I guess, before I go any further as I change midstream mid-sentence, when we say burnout, for those who are maybe more junior in their career, who have not heard burnout, to the point that they are burned out about hearing burnout. What is burnout?
Lauren Bojarski:So burnout in in my understanding. I don't have the official definition in front of me, but my perception of burnout is the ultimate end of the stress continuum. There's this theory called the Yerkes-Dodson law. That was theoretical in mice and the theory was that it's a bell curve and early on in the curve you are stress-free and you don't have a lot of stress. Uh, or your, your focus is not optimal but you don't need it because you're not under a lot of stress. There is a certain point on that curve where your focus and or your, your stress level is at peak, to where you're able to function appropriately, where you have maximal efficiency with optimal stress levels. So my interpretation of burnout is the end curve where you've been stressed for so long you no longer care, so your energy levels have come back down and your efficiency is very low, and we've seen that.
Lauren Bojarski:The burnout rate you were asking earlier about, like you know, we have rough estimates. I think the most recent Medscape article said that it was around 50% for neurologists and that's across all training you know. So I can't imagine having that much burnout and us not talk about it. In regards to your earlier question, we have three main symptoms that we talk about in burnout. We have depersonalization, we have emotional exhaustion and we have personal achievement. There's some conflicting evidence on whether personal achievement is actually protective versus you know whether it's part of the burnout itself, whether you have decreased. You know personal achievement, whether that contributes to burnout or can protect it. But those are the three main categories that are assessed.
Michael Kentris:Would it be fair to link personal achievement to personal agency or decision-making that causes a perceivable effect in your environments?
Lauren Bojarski:I think you could absolutely see it like that. They all kind of intertwine in my opinion. I think you could absolutely see it like that. They all kind of intertwine in my opinion because they all of them kind of focus on questions of, for example, do you need more time at the end of the day to feel renewed? Another question could be do you feel like your job is giving you purpose, like, do you feel like you're in control of your job? Do you feel cynical when you're in the field and someone says, oh, we can do X, y, z. Are you the person who's stepping back and be like no, you can't. Now, you know that's barring, you know experience and you know exposure to the field. However, is it something that you really know for sure? Or is it just that you're so cynical that you have been in this role that you don't feel reinvigorated by what you continue to do, and so that's really, you know, the main components to burnout that we look into.
Michael Kentris:And would you expand a little bit on depersonalization? So I feel that's one of the more insidious things.
Lauren Bojarski:It is.
Lauren Bojarski:It is very insidious and I probably wouldn't even be the best person to discuss it because I, like I said, I feel like they all intermingle, and with depersonalization it's like do you feel like you're just showing up to do a purpose? Are you having days where you just go to work and you feel like you're just on autopilot? It could be, you know, anywhere from you going to work and you feel like you don't have purpose in your job, like you're just writing notes, and who's going to write, who's going to read these notes? And I'm just a pencil pusher at this point and you know, a lot of people get stuck in that grind and they don't think that there's a way out of it.
Lauren Bojarski:And thankfully, here at the AAN it's. I feel like it's a burnout preventer or at least a burnout dissuader, because you're finding people who are like-minded like you and that adds to that sense of community which we know can help with burnout, that social interaction is really helpful and so ultimately you know, being here at the AAN, you don't have to physically be here to have that sense of community.
Lauren Bojarski:It can be in your department, it can be with your co-residents, it can be with your colleagues and the people you work with. It doesn't even have to be in neurology, it can be family. It could be your dog that you love at home, it could be your rowing team that you really enjoy. It doesn't have to be that. You just have to find your sense of community and culture and that can help bring you in from that symptom.
Michael Kentris:I think those are great points. The community is such a neglected aspect. When we talk about it and I know you are about to start a cognitive fellowship soon, and that is one of the key things we talk about with our more elderly patients in particular is what does their community structure look like? Are they active in a faith life, a community life, activities, et cetera, et cetera? And it's something that perhaps for us as younger people, that we don't necessarily identify because, well, we're here in the hospital or the clinic and we're surrounded by people every day.
Michael Kentris:Right, that's literally we're talking to people all the time, how could we feel lonely?
Lauren Bojarski:and isolated right.
Michael Kentris:And it really does speak to that, to those conversations that you're talking about. So, that being said, let's say, hypothetically, we have a colleague of ours that we're concerned might be showing some signs of burnout. What's one of the better ways to perhaps approach them?
Lauren Bojarski:That's an excellent question ways to perhaps approach them. That's an excellent question and I've had that question before when I gave a talk about burnout and imposter syndrome and the question actually further subdivided into how can I tell if they have depression or a mental illness? Because we don't know the direct correlation between burnout and depression yet. We think we know, but based off of the literature so far. Is it on a spectrum? Maybe Are they related? Probably, but we don't know how they're related yet. And so asking someone at first to do some introspective work is very difficult, because maybe you've identified those symptoms in someone and they're so burnt out they don't know. So, for example, when we give all of these surveys to evaluate well-being, no one wants to take those and also the people who are so burnt out they're not taking the survey Are you saying that paperwork is not a protective factor for burnout?
Lauren Bojarski:Certainly not, but that's the point. It's like how are you going to assess burnout when the people who need the most help are so burnt out? They probably don't even know themselves that they need help.
Lauren Bojarski:Not even showing up in our data not even showing up in our data, and our data is not great. So how bad is it really? And you know that's what a lot of research you know that I'm trying to work on is figuring out. Where are we at? That's the number one basis of professional fulfillment. Is your assessment of burnout. Where are we at? We don't know yet. We're still working on it. Burnout in general is a fairly new field, and so we need to keep working on that and having the conversations you had asked.
Lauren Bojarski:How to identify a person with burnout. There is something that the American Medical Association actually does. It's called Stress First Aid and we have it at our institution and we were trained in it, you know, after I had brought it up in a grand rounds. It's an excellent resource and it enables someone to have the opportunity to reach out to whoever that might be. Um, you know it's. It's observing the person's behavior. It's identifying that they might be in that area of burnout, like in those symptoms, and identifying in them like hey, are you okay and not? You know, don't do it on rounds Like don't you know? If you think a private setting is at a bar having a drink? At a coffee shop having a tea, what have you? As long as it's private, that is the most important thing that you can do, and just having a conversation and sometimes you being open about your own feelings can help other people to open up for you.
Lauren Bojarski:Like I had mentioned earlier, I was very, very open about how I was feeling, where I was at emotionally, with my friends and my colleagues around me, because I felt like it was a disservice to them to not know where I was, if I wasn't going to show up the next day. They should know where I'm at and thankfully that never happened. But there's so many people who, for example, I believe up North there was just a suicide in a residency and it makes me wonder like where was he at emotionally? Was he able to have those resources to reach out? You know every residency has those resources or some variation, but do they know about them? Are we doing a good enough job? I can't tell you how many modules I've done for everything when I start out and I don't remember. I need that reminder. And so having a colleague, a co-resident, a mentor, even to help you understand where you're at, those semi-annual evaluations can also be really helpful, especially when you especially when you're in attending and you're in your academic career, you have a mentor and you meet with them.
Lauren Bojarski:It's really good to be open about how you're feeling because that burnout the the rate of burnout is so bad now in neurology that most neurologists are leaving their career within two or three years. And the the rate of burnout of two to three years is increasing the cost to the healthcare system. It's two to three times that physician's salary to replace that person and just in healthcare alone it's $4.6 billion in healthcare costs and that's insane to me because we're just not having the conversation. So, just reaching out and talking to them and just having a conversation, and if they don't want to tell you, that's okay, they are allowed to feel their feelings. It's just you want them to know that there is someone who cares about them. But ultimately they have to do the introspective work themselves to identify where am I, where am I right now, in this moment, and is it where I want to be?
Michael Kentris:Great points, and I do wonder, as all of us in neurology know, there is a massive shortage of neurologists and it is anticipated to worsen over the next 20 years or so. I'm sure we don't have any data, but to what extent do you feel that the worsening shortage of neurologists and the increasing patient care demands play with burnout or mental health in large, and like this rapid turnover of neurologists?
Lauren Bojarski:I think it's a very interesting point because there's two sides to that coin. There is one point where we have the EMR. That is a time sucker. Between all of the view alerts that we have to address, between all of the patient messages, between the documentation, between the extra time that you need to code so that you can fill your RVUs, it's becoming increasingly difficult to meet those targets and we're not getting any more time to do it. So becoming really efficient has become essential in our careers. How can you be efficient if we just said, if you have burnout, you're not working at your maximum efficiency? So really we need leadership buy-in to understand that this is crucial, not just for our wellness but to mitigate turnover of physicians, to improve patient efficiency and seeing patients and having the ability to have good Press Ganey scores and all of those extraneous variables that need to be factored in to the problem that is the healthcare system today.
Michael Kentris:That's a lot to unpack.
Lauren Bojarski:It is.
Michael Kentris:So I do wonder, for instance yourself and for many neurology subspecialties, but cognitive, I think, could be the poster child for the opposite of quick visits.
Lauren Bojarski:Yes, certainly the opposite.
Michael Kentris:So when we talk about efficiency, maybe we have a patient who maybe their spouse also has a mild cognitive decline. They get lost on their way to clinic. They show up for their appointment 15 to 20 minutes late. It takes them they're not walking so quickly. Another 10 minutes. Now we're 30 minutes into their scheduled appointment and well, you know, they're having some. They've been paying their bills incorrectly and, gosh, I don't know if they should be driving anymore. And you know the list goes on. And how do we efficiently address these problems in half the time that we had slated for a patient, which I'm sure barely ever happens?
Lauren Bojarski:Barely happens, never happens.
Michael Kentris:Never, ever. You know. I know administrators say like well, you should double book those patients and I'm sure that never causes any issues whatsoever. No one's ever staying late in clinic or dealing with irate patients and their families Like we've been sitting here for an hour. Our appointment was an hour ago. I'm not expecting an answer, but I'm just curious what your thoughts are.
Lauren Bojarski:And you know it was. It was funny that you say that, because the answer is I don't know, and I think the best answer is that you have to work on it with a team. You have to have that community, you have to be open with your leadership and say these are the barriers that we're encountering, barriers such as my patients aren't showing up on time. Okay, well, can we have someone in the main office to call patients that day, because you know if, like you were saying, if they have dementia, maybe they forgot, maybe you know calling their caregiver that day and reminding them of the appointment or reminding them to be, you know, an hour early, because getting them into the car is going to take, you know, half an hour and sometimes, like at our academic institution, it can take up to 20 minutes to walk just at my normal speed from one side of the campus to the other. So, and how is leadership going to help if they don't know? You know they.
Lauren Bojarski:You have to be on the front lines advocating for your patients, your colleagues and the nurses and MAs and techs in the clinic as well. They all have insight, they all have a part to play in the efficiency of the clinic. But guess what, if they're so burnt out, they're not going to make that first step. So maybe it's up to you. You identify the problem and maybe your first step in advocacy is saying, hey, let's have a meeting, let's have a meeting with the practice manager, let's have a meeting with the techs, and, granted, it will take time, but the amount of efficiency you will gain from that time invested is phenomenal. In addition to you're boosting morale because you are sitting there.
Lauren Bojarski:Don't do it on zoom. Don't do it on zoom. We all have zoom fatigue. Do it in person. We have some literature that shows that in-person communication is so incredibly beneficial to camaraderie, to morale, to just enhancing your relationship, and so it's really important to have that in the community, like that community sense, because a lot of people have no sense of control and that, in my opinion, can also pretend burnout.
Michael Kentris:Yeah, absolutely. And it's funny you say that about all the different elements of staff. Right, it's not just the physician, it's everyone involved. And I was talking with a friend of mine, just you know, in the last day highly trained neurologist, large well-known academic institution, large well-known academic institution. They room their patients themselves.
Lauren Bojarski:Oh, interesting.
Michael Kentris:No medical assistant helping them out and I'm like you, have a highly trained physician, not to demean the role, but that doesn't really seem like a good use of that person's time. And to your point, right, we all, I think, when we go through training, we all have academic stars in our eyes. You know, the prestige is a real thing. We all have our egos, are there? Right? We sacrifice certain things at the altar of that ego, like money and being more independent.
Michael Kentris:Right, there's that time, the hierarchical structure remains, whereas I know one of my former residents, she's currently practicing up in Montana as the only neurologist in a hundred miles and there's nobody telling her how to conduct her practice essentially. So there certainly are those options out there for those neurologists who are, let's say, have a more adventurous spirit. But it's a two-way street. Right, we go in to provide this higher, what we perceive as this higher level of care, this highest level of care, and then we run into all of these nitty-gritty things that logistically it's like well, why don't we have a medical assistant rooming the patients? Why don't we have someone making those phone calls on the same day?
Michael Kentris:And you wind up right in this bureaucratic nonsense nest of tangled hiring structures and all these things, and it is just the hardest thing in the world to find who is the actual person with any decision-making authority in this structure, which I would argue in and of itself.
Lauren Bojarski:Yes, can contribute to burnout. To burnout yes, Exactly.
Michael Kentris:And again I also do not have an answer. But it does make us wonder, right, because I am not at an academic institution, I'm in a larger hospital, but I still run into some of these bureaucratic roadblocks from time to time and I still get frustrated by them. And I think it's a universal thing, unless you are setting up your private practice direct pay, not dealing with insurance.
Lauren Bojarski:Concierge service. Yeah, and everyone's different. Everyone has different ideas of what they want in their life.
Michael Kentris:Yeah. So what are the small steps that we can take? So let's say there isn't any money to be had, there's no staff to be had. What can we, as a physician perhaps embedded in a large, uncaring, heartless organization I'm using some exaggeration here do to help benefit ourselves and our patients?
Lauren Bojarski:I think that's a great question and I'd have to think on that. I think ultimately it ends up being you have to ask for what you need and if the place that you're at can't provide that, there's so many other options that might fit with your needs and your goals and your mission and your vision, because everyone's going to be different. We compare ourselves quite a bit to other people, but I've met so many people here at the AAN at this annual meeting that they didn't do the cookie cutter version. And if it's getting to the point where you're getting burnt out and you're feeling like I hate my job or I don't feel fulfilled in my job not saying that that's anyone's concept now in this area but if you have those concerns, then addressing them with the people who have the uns, say, and if you can't get to them, then maybe if that truly means something to you to have meaning in your work and in your job, and if you feel that it's that strongly, you should consider talking to other people and seeing if they have other options. Like I keep harping on the American Medical Association, but they have a organizational biopsy, actually that you can request their services where they will survey your team and I don't know the specifics on like how little or how large, but they, I believe, will do anything from like a small practice to a large academic multi-system center and they will help you understand what the pitfalls are within your own organization. And so if you can't get that within your own system, like within your own practice, then maybe asking for help from them can be helpful. It's just at the AMA website. You can just search organizational biopsy and it'll pop up along those same lines. There's also articles that they give to help with your own efficiency.
Lauren Bojarski:So say you can't do, you're just at a point where you can't do view alerts anymore. Like you feel like you just it's too much. Like you keep getting requests for refills and you're like I just I can't do view alerts anymore. Like you feel like you just it's too much. Like you keep getting requests for refills and you're like I just I can't. Like I'm seeing 80 billion patients a day and these requests are too much. You know they make recommendations of like maybe changing your workflow on the front end. So, for example, when you see someone, just immediately you know the minute you see them refill their medicines, like when they check in and make sure that you have that sent as they're leaving. That way you know you're not having to deal with those refill requests, cause you know the clinic visit can go so quickly and it can be very easy to forget. And so I think you know doing small things like that, changing your workflow a little bit more. You know doing simple things like that. It really can make a difference.
Michael Kentris:I'd like to get your thoughts on mindset, I think more broadly, beyond just medicine, where people talk about a lot of change in their mindsets in terms of, especially, things like stoicism are very much having a moment in the sun amongst certain segments of the population. What kind of data do we have or anecdotal experiences do you have with respect to mindset and let's say, these things that we cannot change in our environment?
Lauren Bojarski:I will tell you a personal story that leads into this topic very well. So our, our residency was having a lot of difficulty with burnout several years ago, to the point where we knew that it was not sustainable to have that mentality of the program. And it was pervasive. You know, it wasn't just one resident, it was multiple people openly saying I am burnt out, I don't even know if I want to go into neurology after training. I want to take a lot of time off and see if this is something that I want to do. And that was really difficult for me to hear because I was coming in as an intern and I have not been in the field for 35 years like some of these people have, and so I had this mentality of well, why not do this and why not, you know, do that? And I am very lucky to have been placed in an institution with a wonderful program director who actually came in around the same time that I did a year before, and he gave the residents a sense of control that we had never had before. And it wasn't huge, it didn't need to be. He asked us how many didactics do you want to have? Point blank, how many? And when I talked to my co-residents in the AAN, they're like what? Like you were asked how many didactics? But that was it.
Lauren Bojarski:That was the perceived control where we knew we need didactics right, we, we need it for right, we need it for our in training exam, we need it to be good doctors. So he asked us. He was like do you want morning didactics and noon didactics or do we just consolidate and do really good quality noon didactics, acknowledging that you'll have less but that there'll be more quality forward. You know, more high yield, more. You know more of our attendings will be able to give good quality because they won't be giving them so quickly. And so that sense of perceived control in my opinion, enhanced our group resilience. You know, resilience can be multiple different things, there's multiple different factors, but I think that was one of the main things that really helped us. And then that in turn gave us a sense of responsibility and it gave us a sense of passion and drive that they had not had before, because beforehand there was no concept of I want to be able to change things, because they couldn't, no one cared. And so for us to be given that really changed the mentality of the program. And now we, you know, our, our interview meet and greets weren't very well attended by the residents because they were so burnt out. It took them more energy to recover when they were at home, so they didn't have the energy to go to the meet and greets. And now, within our program, our meet and greets are the highlight of our week because we have several of them, you know, during interview season.
Lauren Bojarski:And it's again that sense of community where we get to come together and we have control over who we get to talk to and hang out with. And so even that little bit and that extends to physicians in practice as well Like what gives you joy, what fills your tank, is it that sense of control, perceived control, because you know we don't have control over very much. You know you don't have control over how not always of how often you have to see patients, like, oh, it's 15 minutes for a follow-up, that's it, that's all you get. Sometimes we don't have that control.
Lauren Bojarski:But having a sense of perceived control, what? What can you identify in your personal practice? Can you get up 30 minutes earlier and meditate? I know that's, like you know, taboo, like meditate more, and that's not what I mean. But I just heard someone at the AAN. They said they get up at 4.30 to row. They're on a rowing team and that is in their control and that fills their tank. Dr Orbe Austin is great at talking about owning your greatness and everything, but you should own what fills your tank as well. She talks about that and it's really important to figure that out. It doesn't have to be necessarily at work, but if there's something else that will fill your tank to fulfill that, I think that also will help with your mentality.
Michael Kentris:Very true and I think that swing back around to that generational gap. Right, it was that expectation that medicine is a calling and it should be the thing that fills your tank, that should provide you with purpose. And so we see this change when we go from the baby boomers to Gen X, to you know, I'm a millennial myself, I think you probably are.
Michael Kentris:I just hit the cutoff, you're not quite in the Gen Z territory I'm an elder millennial but we see this thing where, from Gen X onwards, we aren't seeing that level of fulfillment, right. We don't see where people go to a company and work there for you know, 40, 50 years, get a gold watch at the end of that and retire, Exactly right. We are seeing people. There is a lack of, let's just say, perhaps perceived loyalty on the side of the corporate organization to the physician, and so you kind of get this, what I kind of refer to as like the widgetization of physicians, where you do feel like you don't matter, if I drop dead, they'll just replace me, and it's very hard to find purpose in a position where you perceive your role as such, in a position where you perceive your role as such. But we are still trained by these older physicians, some of whom obviously, are very good and understand these things.
Michael Kentris:But there is this in many parts of the country, this perceived role of like well, why are you depressed? You have a good job, You're making good money, You're providing good care to your patients, Everything's great right, it's all roses and sunshine, and perhaps those stresses. You are not getting that fulfillment that perhaps was there in decades past, because the practice of medicine is constantly evolving, sometimes for the better, many times not. And so these kind of little you a thousand cuts, a thousand paper cuts, if you will do build up, and so we are dealing with things that past generations didn't. And so it's really hard to find that fulfillment for many people in medicine when it's like, oh, I've got an inbox that never goes empty, or I've got all these patient phone calls and you know I'm doing the so-called pajama paperwork at the end of the day, when I go home and maybe I put my kids to sleep and all these things right.
Michael Kentris:So I think that's an excellent point where finding something even if it is not work to be fulfilling is so important, and I think, also something that the younger generation I'm including myself in this, even though I'm pushing forward- the younger generation.
Lauren Bojarski:We're all young, it's fine, that's right.
Michael Kentris:Young at heart, yes, young at heart Is that, you know, many of us are graduating medical school with hundreds of thousands of dollars in student loan debt.
Lauren Bojarski:Don't remind me yeah.
Michael Kentris:But so we do. Right, we have these handcuffs where we have to practice clinical medicine. Right, we can't go part-time because then we won't qualify for these government forgiveness programs. And so we do feel there is this feeling of being trapped. I have no options. I can only do this one thing. This is the only thing I know how to do. Right, I don't have any other marketable skills and there are lots of podcasts and other resources out there talking like Dr Sarah Schaefer's Neurology Nuts and Bolts podcast. I think is great, fantastic, different forms of neurology careers and other different resources out there talking about how you can change your career. But I think those are all important things to know. It's like you aren't trapped, right. Even we. We often do feel that way because there is this you said earlier cookie cutter pathway. Right I, I go to medical school, I get the good grades. I go to residency, I get the good evaluations. Maybe I do a fellowship, I do good there yeah, what's next?
Michael Kentris:I get the shiny academic you know appointments as assistant professor, associate professor, full professor. Now I'm, you know, 60 years old and I hate my job.
Lauren Bojarski:Yeah, and what do I have?
Michael Kentris:Exactly, I'm on my second marriage. You know I'm paying alimony. My kids hate me. You know worst case scenario.
Lauren Bojarski:Yeah, worst case.
Michael Kentris:Absolutely worst. But there, but for the grace of God, could go any of us right.
Lauren Bojarski:Oh yeah.
Michael Kentris:So I think it's great. You know, a lot of us aren't trained to be self-reflective, to apply that insight that we direct so often in our patients to ourselves. Absolutely, it's become such a stereotype in personal statements, right, but self-reflective practitioner of medicine, right, where we do want to reflect, like I had this experience with a patient and I reflect on it, but not just how it affects my patient. But but what would that experience do to me if it had occurred to me right To to really like practice true empathy and and apply that to my own future life?
Lauren Bojarski:Absolutely yeah.
Michael Kentris:It can be very scary to do.
Lauren Bojarski:Yeah, going on that generational gap, dr Orbea Austin said it best. She said people would say like, oh, I walked uphill both ways in the snow and back in my day we did this and that, and I've heard attendings say that. But the way she says it is best, it's enforcing this mentality of rugged individualism which is not. It's not medicine. Medicine is a group sport. Neurology is a group sport. We can't do it alone. You need if you've ever watched Scrubs I'm no Superman, I can't do it on my own.
Lauren Bojarski:It's so important to keep that understanding. Where we need cohesiveness, we need like-minded individuals to be open, and I think that you know we talk about the generational gap again. Back then you didn't really talk about that, like it just wasn't culturally accepted. Um, and I find that, as you know, we get more diverse in our careers. We have all of these wonderful DEI initiatives and we're getting more of the population involved in neurology and multiple aspects of it In the pipeline. We're hearing more people say I want this and I believe we should do this, and those are ideas we've never heard before.
Lauren Bojarski:And the best part about being a neurologist right now is that there's so many good ideas. We just have to be accepting of them and we have to hear them and listen to them. And sometimes we have to seek them out because they're sometimes it's the littlest voice that has the most meaning, because sometimes it's the littlest voice that has the most meaning and that is so important. The best experiences of my life because and it was and it was just a one-time thing, like it wasn't even, but I had a say among these neurologists, you know, early, mid, late career neurologists, and they wanted to hear me, they wanted to hear what I had to say, and I think that's absolutely true. Now we have to hear what everyone has to say. You know, that might not have happened years ago.
Michael Kentris:I'm sure it wouldn't have.
Lauren Bojarski:It probably wouldn't have. And if we're going to combat this burnout situation, it's not going anywhere fast. It's not going anywhere, you know, anytime soon. Maybe it's important we establish these symptoms and establish maybe preventative measures and more of that culture as far back as medical school, maybe even college. You know you were talking earlier about how we're going to have a shortage of, you know, doctors in general, but neurologists specifically. That pipeline subcommittee, you know, was so great because that can be your legacy, is helping with neurophobia. You know, reinvigorating your career by helping others understand that. Oh, you know what I chose neurology for a reason. I'll ask you do you remember why you got into neurology?
Michael Kentris:So I got into neurology as an accident, so I don't know if I've shared this on the podcast before, but I originally applied to physical medicine and rehab and I did not match into it and, as you can imagine, I was crushed.
Lauren Bojarski:Devastating yes.
Michael Kentris:And so the next year I applied to neurology, I applied to actually a PMR again and I didn't match again.
Lauren Bojarski:Oh my gosh.
Michael Kentris:And I soaped into neurology and I was very fortunate that there was a program who thought my resume looked good enough. I remember specifically it was a—because I had an intern position. I took a phone call with the program director of this program, Wright State, and I thought it was just the worst interview of my life.
Michael Kentris:Oh, no, oh no, so it's one of those things where I kind of fell backwards and just got the biggest heaping of luck, because I do think that I temperamentally am much more suited to neurology as a career than I would have been to PM&R.
Lauren Bojarski:We're very happy to have you in neurology.
Michael Kentris:Thank you, yes, but it is one of those things where it's like you don't know what you do, like I was exposed to a certain form of neurology and actually I work with the neurologist who I worked with as a third year medical student and he's a little crazy. He'll never listen to this, so I can say that I would say that to his face. But it was a different kind of career and it wasn't one necessarily. I saw myself in right and that's what you were saying earlier, like seeing different types of people as neurologists. Modeling that career for younger generations is really important and I think you know, obviously I am I'm a white guy, but I like to think that I can at least model the enthusiasm for the specialty and for learning and for passing on education and I mean that's partially why I started doing this podcast.
Lauren Bojarski:I was going to say you have always had that want for teaching.
Michael Kentris:Yes, and you know, I was at an academic center for several years. We moved to be closer to family in the middle of the pandemic the best time to move really Right, could you think of a better time? And so I didn't have neurology residents, I had internal medicine residents, I had emergency medicine residents. There was a nearby psychiatry residence program in a local medical school. So, like, well, I have new, different kinds of learners now and a different, less resource rich arena, exactly. And so what can I do?
Michael Kentris:So I thought, well, I like podcasts. You know a lot of our students because it's, you know, the NeoMed where I'm affiliated with. They have to commute a lot to different hospitals and different practice and all that. So, like, well, you know they could always listen to this while they're driving on their commutes and we do something with that. And so it's and, selfishly, it's been a way for me to meet other people in the field as well and have good conversations like this and maintain my own sanity by by having maintained this community, even if it is mostly virtual, although we are very blessed today. We for those who are hearing the background noise we are practicing what we preach. We're outside, on the balcony, outside the convention center in the sun. It is a little shady at the moment, but 86 degrees.
Lauren Bojarski:I don't know how what the temperature is 71. Yeah, which is a beautiful day.
Michael Kentris:Yes, it is a beautiful day out today. We have some weird bird in the background now, but it is great, and this is one of the few face-to-face neurotransmitter interviews, probably like the third or fourth ever.
Michael Kentris:So honored I know, and it's such a great opportunity for me as well Because, as you said right, there are just so many nuances in communication that we don't get via a screen right. We use telemedicine, we use telecommunications and they are a blessing in many ways, but it's very hard to replicate the in-person. You know I talk with my hands a lot, as you can tell. You know I talk with my hands a lot, as you can tell, but it's one of those things where there's just this ineffable quality to in-person interactions that really enrich the experience.
Lauren Bojarski:Yeah, and COVID kind of took that away.
Michael Kentris:Yes, yes, it really did, and you know we're getting pieces of it back, but in many ways it's still lacking. You know, I know in a lot of areas of areas, masking is still needed in some situations and some people have health conditions that lend to it. But human faces are so important to the way we communicate with one another and it is something that suffers for sometimes what is a medical necessity.
Lauren Bojarski:Yeah, I think you're absolutely right. It can be very difficult. And I think with COVID, you know, everyone learned to do life with COVID and to do things on telehealth and everyone became very comfortable with doing Zoom. And when I say comfortable with doing Zoom, it's comfortable with doing Zoom, writing notes, putting in orders, doing Zoom, it's comfortable with doing Zoom, writing notes, putting in orders. We ended up doing didactics on Zoom because we couldn't have in-person meetings and I know personally I do not do well with didactics.
Lauren Bojarski:Now I will say I've been very intrigued with the AAN didactics or the conferences that they're doing. I do enjoy those, but it's very difficult for me because I want to be typing my notes, I want to get out on time, but because I'm not getting as much of a fulfillment as if I had gone in person. Because if at least I'm in person, I have that cohesiveness, I'm establishing that culture and rapport with my comrades in arms, as it were. And so I personally am of the ilk that we should have more not all in-person communication, which is why the AAN annual meeting is so important. It's why Neurology on the Hill is so important. A lot of my stuff surrounds advocacy and like advocating for everyone in neurology whether it's APPs, medical students, trainings you know faculty everyone needs to be advocated for, and with Neurology on the Hill, that's your moment. If you're feeling burnt out and you feel like what you do doesn't matter, go to Neurology on the Hill and you will see what you do does matter to a lot of patients. Even within Kentucky, we have an epilepsy foundation and we went to Governor Beshear's office and advocated, and seeing the patients advocate for themselves and us advocate for them to the government was fascinating, and so I encourage anyone who is feeling particularly burnt out, who feels like what they're doing doesn't matter or who feels like they need that extra spark, like the spark you were talking about with teaching. If you haven't found your spark yet, try neurology on the hill, see what happens. Maybe that's your next step in your career. And don't compare yourself to other people Like don't say that you know I need to stay in academics for the rest of my life.
Lauren Bojarski:Neurology I tell my medical students this all the time and I feel it within my bones. It is a pick-your-own-adventure. You want to do surgery? Go. You want to talk to the elderly all day? Come with me, join me in my geriatric fellowship If you want to do some procedures, you know you can have an LP clinic, you can do Botox, you know, and I hope you know any medical students listening to this would have that sense of adventure and just exploring all the things that neurology has to offer. And maybe that's what you know, that's what we need. Maybe we need that new non-cynical mentality. We were talking about it a little bit before the podcast.
Lauren Bojarski:That cynicism runs rampant, and as well it should. You know I, I don't. I don't blame people. I'm new to the field. I have new ideas that haven't been cut down yet. I have wants for the field that I haven't seen happen yet and I don't know if they ever will. But having people with that drive, that's reinvigorating. It helps with that spark.
Lauren Bojarski:And along those lines too, on your career, you can pick your own adventure. You do whatever you want. You can go here, go there, do whatever, but has anyone for you? Has anyone asked you, where do you see yourself in two, five, 10 years? Everyone always asks med students like where are you? You know, where do you want to fellowship in? And that's like the small talk question. But you have been doing this for a little bit of time, a few years, a few years, just a few and has anyone asked you where you want to see yourself in that amount of time? And maybe that's the spark. That's what you need to trigger. This is what I need to change. This is what I don't like and this is what I want.
Michael Kentris:You know you are. You're absolutely correct. It is one of those questions that once you're out of training, unless you have, like an excellent mentor, you probably aren't getting asked that question very much anymore. I don't think I've been asked that question in a few years, which is why I'm like chuckling to myself, which is why it's so important. Yes, and it is, but it is something that I do reflect on, like because, just as a again an anecdote, if you permit me, so where I was down at Wright State, where I was an academic physician, I was part of the epilepsy division there, you know, doing subspecialty epilepsy surgery, all that good stuff, like you do after an epilepsy fellowship.
Michael Kentris:As one does, as one does good stuff, like you do after an epilepsy failure, as one does as one does. So I moved back to this community teaching hospital and here I am a neurohospitalist.
Lauren Bojarski:Oh, I see Now.
Michael Kentris:I went into this position knowing I did not want to remain a neurohospitalist and so, as of next month, which will be May as of this recording, I will be going back to a more general neurology type thing. But I have the hope People talk about. Are you an optimist? Are you a pessimist? To your cynicism question, of course and I'm going to paraphrase someone else I heard say this I like to think that I'm a realist, but that I maintain a certain degree of hope that things will get better, maintain a certain degree of hope that things will get better, and it is really.
Michael Kentris:You know, it's where it goes all the way back to. You know Greek mythology, you know where the last thing in that box is hope, which is this fragile little creature, and we do have to keep that alive within our breast or else, you know, everything else becomes very dark, very quickly. Yes, and what do I hope for? Well, I hope, you know I work with a good friend of mine from residency, and I'm very fortunate for that, and I hope you know any future neurologists who are looking for work in Northeast Ohio send me an email.
Michael Kentris:But I hope that we recruit more good neurologists who also have this desire to build a higher quality of neurology in an underserved area, and I hope that we'll build an epilepsy monitoring unit and all these nice things that would be nice to have so we can provide care for our population of over a half million people. But for the present we persevere with what we have and it is, I think, one of the things we didn't really touch on very much but is important. We kind of skirted around the edge. We're boundaries.
Lauren Bojarski:Oh yes.
Michael Kentris:And many of us again, this whole medical training. We are brought up, we are I'm not going to say stop short of saying brainwashed but I mean it's a good pun.
Michael Kentris:Yes, but we are brought up to say yes to so many things. Like you know, like someone higher in the hierarchy tells you like you need to do X, you need to do Y. The next step, if you want to move your career ahead, is to do this thing. And we say yes, yes, yes. Like how many times? Uh, I know again right here, early in your career, but I'm sure it's happened already.
Lauren Bojarski:Oh yes.
Michael Kentris:You have overcommitted and it's like now I'm losing sleep and now I feel unwell and my mental health is starting to suffer. And I've said yes to all these things and I want to do them, but perhaps I shouldn't be.
Lauren Bojarski:Yes, I heard a very good quote about that exact thing, and they said everyone has the same 24 hours in a day, and if you're saying yes to one thing, you're saying no to something else. And then I heard someone else say if it's not a hell, yes, should you really be doing it? And I took that to heart because you're exactly right. As a trainee, I was in a position where I said yes to everything, but I liked doing everything. And so I was at an impasse where I was in a position where I said yes to everything but I liked doing everything, and so I was at an impasse where I was getting so much anxiety because I had so much on my plate.
Lauren Bojarski:And you know how it happens when it all just happens all at the same time, it's even worse. And so I realized I had to compartmentalize and decide what I wanted, like what were my values, what did I want out of my career and what was going to get me there? Were my values, what did I want out of my career and what was going to get me there? And, honestly, I was approached about a lot of different things and you know, pending time, commitments and what have you. I think that was the best advice that I received was, you know, does it work for you Like? Take the time, decide if it's right for you and you know you're allowed to say no. No is a full sentence.
Michael Kentris:I like that one.
Lauren Bojarski:No is a full sentence. You do not have to justify or qualify your response. Um, if they don't like it, then that may not be the right system. That's in line with your values, and I'm not here to tell you whether it is or isn't, but it's something that you should definitely think about and wonder, and I found that my life got exponentially better once I made that decision. I made it about a year ago.
Lauren Bojarski:It was kind of like a hard stop. I was saying yes to too much and it was yes to too many things that I didn't want to do, and when I started saying no to those things, I realized I had more excitement to say yes to the other things. So, like all of this advocacy stuff that I enjoy doing, I I love giving these talks. I I just gave a talk to the association of continuity professionals in Dallas.
Lauren Bojarski:Uh, actually, last week, um, about a similar topic and we talked about imposter syndrome and you know, doing a lot of introspective work and they are, um, business resiliency. They are business resiliency. They are different focus. They're not healthcare, still high stress jobs, but everyone can have hope and everyone can have that spark that you talk about, which gives you life, which gives your life meaning, which fills your tank, and so it's really special to have that. And so I found that by saying yes to the things that really mattered to me and what I wanted out of my life and my career and my two five, 10 year plan, it really made my life really worth living. I wasn't working anymore, or I'm not working as much anymore. It's not a grind as much as it's a I get to, and that is the mentality that you really want to get to in your life.
Michael Kentris:Right, I've heard that said. Right, I don't think of it as I have to do it, I get to do the thing and that does, I think, help a lot of people with dealing with, especially something that may be stressful.
Michael Kentris:Right, it's like oh, 100% I don't have to deliver this bad news to someone I get to deliver this bad news and hopefully change the way they perceive that or help them through this challenging time. Yeah Right, Because a lot of what we do is difficult, Difficult. You know there's a lot of hard conversations in medicine. Now I would be a very poor host if I did not ask you a little bit about your research. So tell us kind of what avenues are going on, what kind of projects are in the pipeline.
Lauren Bojarski:Well, so my research right now. I actually just presented a poster downstairs about it. So when we talk about burnout, we need to talk first and foremost about assessment of your burnout. There's a lot of different ways to do it. The most validated that I've seen is the Maslach Burnout Inventory, and it's really nice because then it's subdivided into health services and then further into medical personnel, so it has a really niche evaluation. It's been very well validated in the literature. Unfortunately, dr Maslach sold it a couple years ago, and so, unfortunately, it's a very expensive way to have validated burnout information, but that's key.
Lauren Bojarski:I do believe, though, that we can't do anything about burnout until we get a good grasp on what's the prevalence, what's the incidence, where are we at? How is our trainees different from our attendings versus our APPs, versus our nurses versus our medical students? And so my research was looking at the ACGME. They give out a yearly wellbeing survey, and I was wondering is it valid? There had been. In my literature search, I hadn't found any validity measures that said yes, this is a good measure of wellbeing and burnout in the residents, and the power of that survey is astronomical thousands of residents and fellows all across the country, and I'm like we keep doing this. You know survey fatigue. Should we keep taking a survey if it doesn't tell us anything? So I was like let's validate it.
Lauren Bojarski:And so me and my close mentor, dr Anger, and Dr O'Connor as well, they kind of formed this idea of maybe we should, you know, give our own, like the MBI. We should give it to our residents. And so we did. And we took 29 adult and child neurology residents as well as psychiatry residents and we gave them the MBI, which was the Maslach Burnout Validated Survey, and we also gave them the ACGME Wellbeing Yearly Survey and we were like they're, they're taking the exact same survey at the same time. We did it both in the fall and the spring and we looked at whether they were close in numbers and I can tell you that they you know I don't have the confirmed metrics at this point with P values and everything but they were different. You know, emotional exhaustion was fairly equivocal, so that was so. That was reassuring.
Lauren Bojarski:You know that was good. Personal achievement was a little. There was a little discrepancy. The personal achievement of ACGME was a little higher so people thought that they had better, more personal achievement on the ACGME serving um than we thought that they would have on the MBI. But the one that was most discordant was the, the depersonalization.
Michael Kentris:Interesting.
Lauren Bojarski:Yeah, it was a 50% difference.
Michael Kentris:What year did you say the students were in?
Lauren Bojarski:All years.
Michael Kentris:One through four.
Lauren Bojarski:And then child neurology, um, neurology had, you know, five as well. They were a five-year program for us, so that was really interesting to us. We were like it seems like we you know the ACGME did a pretty, pretty decent job. You know, until this, this one evaluation, and that can completely throw off the numbers, because you're only dealing with three symptoms and burnout, and if one of them is that discordant and it was, and obviously the ACGME thought there was less depersonalization and the MBI said that there was a lot more. And so our wonder is why did that happen? You know, I I don't know for sure. Maybe it's because the ACGME, they do it at the end of the year and everyone's got their graduation goggles on of residency fellowship. You know, like for me, right now I am six months, basically no call Cause I did all of my call between two and three. I'm on an elective outpatient rotation getting to learn all of neurology. I feel more well by a lot than I did when I was, you know, two years ago, and so maybe there's a component of that. I don't know. So that will require more research.
Lauren Bojarski:But what I did find interesting was that, you know, I can't expect the ACGME to spend millions of dollars to give an MBI to everyone. That was never the idea. Regardless, I think ultimately, you know, like I said, I'm not going to ask them to give the validated Maslach burnout inventory to every resident and and I understand, you know they they do have money, but I also understand how corporations work and I'm not I'm not so ignorant of how life works that I would ask that. I think that would not be fair. But what I would ask is that we continue to work towards a more accurate and valid measure so that we can have a better understanding of burnout.
Lauren Bojarski:My project also showed that there was 51.6% of participants who had signs of depression. They had depressive symptoms. Is that an extension of the burnout Like? Is that the end stage? We don't really have the data yet to say what exactly is the interaction between the two, but surely it's multifactorial and could totally be related. And I find it interesting that it was so high, with these perceived measures of the ACGME surveys being relatively OK. So that was a very interesting component too. So I don't know, you know, I don't know how we would fix it. I don't claim to be part of the ACGME. You know organization committee and leadership, gme. You know organization, committee and leadership. But I do offer a request. You know that we put more stock into validating the measures that we're putting out, so that we can have a better understanding.
Michael Kentris:Yeah, it kind of goes back to that. That old quote, uh who I forget to attribute it to, but uh, what gets measured, gets managed. So we, should.
Lauren Bojarski:we should like that yeah.
Michael Kentris:It's from business, uh, talking about, you know, like key performance indicators, but it is medicine's a business. Yeah but we need to know, like you said, it, does what I measure actually matter? Like if I'm going to make decisions based off that, then we need good data. So, yeah, very, very happy to hear that you're out there trying to make sure that what we're trying to do actually means something.
Lauren Bojarski:Well, and everyone's got survey fatigue. Don't give me a survey. That doesn't work, or you know, and I don't know, maybe, maybe, things will change, you know, and I look forward to that. I hope that they would change.
Michael Kentris:Yes.
Lauren Bojarski:And you know I'm not going to be a trainee for very much longer, but that still translates over to, you know, in your career too Right, because we have to think right.
Michael Kentris:We're relatively young at this point in our lives, but 20, 30 years from now we will need well, actually me, sooner probably I will need physicians, and I would like for them not to be depressed and burned out.
Lauren Bojarski:Exactly. I would like them to enjoy their job.
Michael Kentris:Yeah, the people who will care for us, who will care for our family and other loved ones. So I think it is definitely in all of our interest to make sure that the people who are going to be caring for us and those we love are not hating their jobs and want to get out of there as quick as possible, right, and aren't making decisions under less than ideal mental health situations. So I definitely am glad to see that there's a lot of urgency towards addressing some of these issues.
Lauren Bojarski:I think, yeah, it's important, and I feel like the conversation hasn't quite picked up enough. You know, I hope that it will pick up and we'll see how it goes.
Michael Kentris:Absolutely Well, if you want to find out more, where can they find you? What kind of resources would you recommend checking out?
Lauren Bojarski:Oh, that's a great question. Well, I'm on Twitter. I'm very active on Twitter.
Michael Kentris:I've forgotten my Twitter handle but I'm We'll add it in the show notes.
Lauren Bojarski:Yes, that'd be perfect. Um and uh, I would say the biggest resources are, you know, checking your local institution. If you're a trainee, um, certainly look up the ACGME. Um, the national website. They have some resources there. Um, within your own department at your institution, um, you can have both like department of neurology and GME wellness things that you probably got in your orientation that you forgot about so you can go back to those websites. Usually it's GME wellness or you know GME resources and then whatever your institution is For, you know, people who are post-training, the AAN has fantastic resources as well.
Lauren Bojarski:You can type in wellness and it will come up with like a list and there is a PowerPoint presentation actually in there that you can give to your constituents and to your colleagues and help them understand. The last resource I would recommend is the American Medical Association. I talked about them quite a bit, but they do offer fantastic resources. They have really good articles as well that can help you improve your efficiency. If you're looking for something like that, they'll tell you, actually, even how long it takes to read the article at the top. So if you know that you have a four-minute bus ride from here to there, you know you're going to the AAN party and you have four minutes, you can just read that article and it's very quick, and so I would recommend that. And yeah, those are, those are probably the best resources for everyone. Perfect.
Michael Kentris:And you can, of course, find me on X, formerly known as Twitter.
Lauren Bojarski:Oh yeah, Sorry.
Michael Kentris:That's OK. I feel like we always have to say it that way, these days Back in my day. I'm at D-R-K-E-N-T-R-I-S, Dr Kentris, and you can, of course, find the Neuro Podcast channel at neuro underscore podcasts and check out our website theneurotransmitterscom. Thank you once again for coming on and having this very educational discussion about burnout with us.
Lauren Bojarski:Thank you so much for having me, Michael. I really appreciate it. I had a great time.
Michael Kentris:Awesome, me too.
