Burnout in Healthcare: Causes, Consequences, and Solutions with Dr. Jonathan Prousky

Working in healthcare brings a unique set of challenges and stressors. But the truth is that any of us can get to burnout through challenging circumstances of work or study. And the consequences can range from severe to devastating. Burnout still hasn’t been fully understood or recognized by the medical profession and other industries – there is still no official diagnosis classification. Along with other mental health disorders, it is often still (wrongly) stigmatized and can even sometimes be seen as a “badge of honor,” much to our detriment. Dr. Jonathan Prousky, Chief Naturopathic Medical Officer at the Canadian College of Naturopathic Medicine, joins me once again in this New Frontiers episode to explore the state of burnout in healthcare workers and beyond. Whether you work in our field or not, I guarantee you’ll find it insightful. Together we explore the challenges we all face, and practical solutions to help you maintain your own health and well-being. As always, please feel free to share, comment, and rate – and let us know your thoughts on this important topic. ~DrKF

Trigger Warning

Please be advised that this episode discusses the topic of suicide in the healthcare profession, which may be a sensitive and difficult topic for some listeners. If you or someone you know is struggling with suicidal ideation, please seek help immediately. Resources for support can be found in our show notes. Remember, you are not alone and there is always help available. We hope that this episode can provide some support and insights for those who might be struggling.

Burnout in Healthcare: Causes, Consequences, and Solutions with Dr. Jonathan Prousky

In this episode, we welcome back Dr. Jonathan Prousky, Chief Naturopathic Medical Officer at the Canadian College of Naturopathic Medicine, to discuss the challenges that healthcare practitioners faced during the pandemic, and those they still face now. Dr. Prousky’s focus has led him to address the rising prevalence of mental health disorders, including burnout, among healthcare practitioners. He shares unique stressors and challenges, including the emotional toll of caring for seriously ill patients, and how medical training paradigms have not equipped physicians for many of the circumstances they have faced. Dr. Prousky provides guidance on his preferred naturopathic treatments to help address burnout symptoms and emphasizes the importance of self-care for those struggling to regain the feeling of fulfillment in their careers. Dr. Prousky’s expertise and compassionate approach make this episode a must-listen for anyone looking to prioritize their own health and well-being while providing the best possible support for others during these challenging times.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald:  Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. Of course, today is no exception. I am thrilled to be back with the brilliant Dr. Jonathan Prousky. He and I podcasted back in 2020, and we will link to that podcast in our show notes, but I encourage you to check it out. It was one of the most, I don’t know, really kind of important and clinically actionable conversations that I’ve had. Specifically, it was on depression, anxiety, suicide, just a powerful conversation on how to approach that through a functional and naturopathic lens.

Let me tell you about Dr. Prousky now, and then we’ll jump into our topic today, which is on burnout, specifically physician burnout. Okay, so Dr. Prousky is the Chief Naturopathic Medical Officer at Canadian College of Naturopathic Medicine in Toronto. His primary responsibility is ensuring the delivery of safe and effective naturopathic medical care to patients, as well as ensuring the safety and effectiveness of the medical training in the naturopathic program. His clinical practice focus is primarily on the evaluation and management of mental health conditions. He’s spent over 20 years advocating for patients that wish to receive integrative treatment to improve their mental health.

He was the first ND to receive the Orthomolecular Doctor of the Year Award in 2010, and he was inducted into the Orthomolecular Hall of Fame in 2017. Dr. Prousky is the author of more than 60 scholarly publications and several texts including Anxiety: Orthomolecular Diagnosis & Treatment, and The Textbook of Integrative Clinical Nutrition. I just want to tell folks that his book, Anxiety: Orthomolecular Diagnosis & Treatment, is why I brought him onto the podcast. Check the podcast out and really consider getting that book. It’s a gem. It is very actionable, very clinically useful. Dr. Prousky, welcome to New Frontiers. Welcome back.

Dr. Jonathan Prousky: Hi. It’s so great to be here and I’m thrilled to have this conversation with you.

Dr. Kara Fitzgerald:  It’s an important conversation. I’m glad that you pinged me recently with the idea that we needed to talk about it and I appreciated it immediately. Burnout, physician burnout, what we might be seeing in our community, integrative and functional medicine. First of all, just define what we’re talking about here.

Dr. Jonathan Prousky: Yeah, so burnout happens only in the workplace, so it’s not something that we think of outside the workplace, though it has cascading effects in all domains of life. When we think about burnout, we think of diminished personal accomplishment, we think of emotional exhaustion and depersonalization, and those are the key three areas that happen or, I guess, get influenced in burnout. If I can explain a bit more, when we talk about emotional exhaustion, we’re feeling tired, depleted, and not, I would say, rejuvenated at all by the work that we do. When we have depersonalization, we’re disconnected, we don’t feel like ourselves anymore. We probably become cynical in regard to our work. Then, of course, if you have those two things, it’s going to be very hard to have a lot of personal accomplishment, but that’s also what is diminished in burnout.

As you can see, it’s a composite of these three domains, and as you can imagine, if you even have just one of the three domains, it makes work very challenging. If you have two of the three domains, you have burnout. If you have all three, that’s just brutal. I don’t think we are as aware as we should be about burnout. I think the public at large hears a lot about it, but they don’t hear enough clinicians talk about what it is and how it impacts them and just the consequences of burnout in general.

Dr. Kara Fitzgerald:  What’s the prevalence?

Dr. Jonathan Prousky: Yeah, so I’m going to read a bunch of statistics and then we can talk about it. I’ll just set the frame, and these are just U.S. statistics, but what’s interesting is it was certainly on the rise. During the pandemic, I think because things became a bit more insulated, it actually decreased a bit, but that’s not the whole story. I’ll get into that in a moment. Let me start with some statistics. If we think about, let’s say, and let me just sort of get a bit closer here, in 2014, burnout basically was about, I don’t know, 54.4% of all surveyed doctors. Think about that.

Dr. Kara Fitzgerald:  Wow.

Dr. Jonathan Prousky: That’s an incredible-

Dr. Kara Fitzgerald:  That’s huge.

Dr. Jonathan Prousky: … huge, right? Then, what we know, is that as the years went on, it increased and work-life integration or work-life balance, that decreased. Then, with the pandemic, there was a slight change where work-life balance got a bit better and burnout became a bit reduced. And I’ll tell you about those statistics now, so let me just get to that. Essentially what happened is burnout reached about 38% in 2020, and then work-life integration basically increased. Doctors were finding themselves a bit less burned out and having more basically work-life balance, let’s say, but that doesn’t tell the story. What really happened a lot is the doctors that were in the hot spots of COVID, burnout was exceptionally high. Whenever there was a hot spot, whether it’s New York City or elsewhere, burnout rates just skyrocketed, especially among the frontline physicians. I think, though, overall there was this nice bit of improvement.

What we failed to recognize is that really isn’t the real story. The real story is there was considerable burnout among those on the front lines, and they got significantly impacted, and the same in Canada as well. We had the same kind of ideas going on where doctors have a high degree of burnout. There was a bit of a reprieve, but then during the pandemic, certainly when you look at different types of clinicians or physicians, burnout rates increased. Overall, I would say burnout levels have increased in Canada, and I would say overall in the U.S., burnout is still as brutal as it always is.

If you think of the general population who are non-healthcare workers, their levels of burnout are much lower, their levels of work-life balance are much higher. But anybody who’s dealing in healthcare, whether you’re a physician or otherwise, your levels of burnout are higher and your work-life balance are lower. You’ll always see that among people that are physicians or clinicians relative to those that aren’t in these roles.

Dr. Kara Fitzgerald:  I’ve got a few questions. Certainly, I can see just… This is a comment and then I have a couple of questions. When COVID hit us here at our clinic, the volume dropped. We didn’t have the patient base that we usually had. We actually had to pivot and do some other work in our clinic for a period of time, so I could see that. Although that had a different kind of anxiety, it certainly was not burnout-related because we weren’t carrying the same load. Here in the States, actually, I’m sure it’s true in Canada as well, but a lot… This prevalence of burnout has prompted a lot of physicians to transition into our medicine. I’m on faculty at The Institute for Functional Medicine, I think that you know, and we’re primarily training doctors who are looking to find their passion in medicine again and that fulfillment that they were expecting when they graduated school.

In fact, one of the MDs in my office kind of personifies that. He was going to just leave medicine altogether, and because he’s a brilliant physician and I’m so grateful that he’s here, Dr. Ken Litwin, he found functional medicine and transformed his existence. I think he’s really doing quite well and he’s established some really nice work-life balance here, but are we… On one hand we are an oasis and I think we continue to be an oasis, but I want you to think about burnout in our space as well. Maybe you can talk about it now, but you can certainly sprinkle in those thoughts throughout our conversation.

You and I were talking before and you have said that we don’t have statistics on our experience, but any of your thoughts or anecdotal experience I would love to hear. For listeners to this podcast, if you’re in functional medicine, if you’re a clinician or any allied health professional, I would love in the comments to hear your own thoughts on it as well, and why. What’s the cause of burnout? There, I’ve just… I’ve thrown a bunch at you-

Dr. Jonathan Prousky: Yeah, that’s okay.  We’ll get to that. Let’s go a step back because the causes we’ll get to. But let’s think about what goes on. When someone is struggling, let’s say, with just chronic stress in general, which happens to many of us, it taxes all of our reserves, whether that’s our ability to function in life, with our family, with our relationships at work, and in so many domains. What happens is it certainly activates our neurobiological system, and in doing so, as you know, we get this heightened activation of our hypothalamic pituitary adrenal access, which puts out cortisol, and we’ll get into that in a moment. We also get this activation of our sympathetic system which puts out norepinephrine as well as epinephrine, but the norepinephrine plays a more critical part there.

What’s interesting is when we think about that, we can relate that to burnout because when you think of burnout, we get the same activation of the stress system, but it’s very specific to our work environment. In both situations, we would probably see a very similar neurobiology. For example, in chronic stress, we know that there’s a part of our brain that connects our right and left hemisphere. It’s the corpus callosum, but what sits anterior to that is this anterior cingulate cortex, and that assesses our degree to whether future events are certain or uncertain. When people are under a lot of chronic stress, they can’t find certainty, and because of that, that activates our limbic apparatus, and in doing so, we really have much more bottom-up control than top-down control through our prefrontal cortex. Essentially, we get this flipping of our regulatory system and we’re driven too much by our emotions when we’re chronically stressed.

What’s even more damaging is when we think of all the chemicals that get released, we know that within our hippocampus and our prefrontal cortex, the actual neurochemical changes cause atrophy of the dendrites, and in doing so, it undermines both memory and decision-making and all the things we see as valuable, as being human beings with this complex brain that we have. Then, what happens to our limbic system, in particular to the basal lateral amygdala, there’s this dendritic expansion that makes us more hypervigilant, more prone to anxiety, and more aggressive. And that’s with just chronic stress. A bunch of researchers said, “Okay, we know that. What actually happens in burnout? What happens if burnout is something very similar?”

Our prefrontal cortex goes completely offline. That’s also what happens in PTSD, which is extraordinarily interesting, and then what also happens as a consequence of that is that there’s an outpouring not just of norepinephrine or even cortisol, there’s an outpouring of dopamine. Apparently, the norepinephrine and dopamine, because they dysregulate our higher brain functions, they actually help our lower brain areas like our amygdala, our limbic system, our brain stem, even the striatum, they become more strengthened in burnout. As a result, again, you see too much bottom-up control, not enough top-down control, and again, the prefrontal cortex is offline.

Now, what are the implications of that? Now, that’s the scary part. When doctors are going through burnout, let me just read to you all these implications because it’s harrowing. Because your prefrontal cortex goes offline, you’re more forgetful, you have limited concrete thinking as a result. You’re more likely to make medical errors. Your concentration is more deficient. You’re more disorganized, so you find it challenging when you’re multitasking. You have diminished decision-making, so your patient care is going to be subject to that as well as more medical errors. You have limited insight, poor judgment, impaired moral conscience, so you actually have lack of professionalism, that is you’re more vulnerable to that when you’re going through burnout. Reduced empathy and compassion fatigue, so you can have communication problems with patients and coworkers. Diminished optimism and drive. As a result, you’re more cynical, reduced work engagement, and so on.

As you can see, when our prefrontal cortex goes offline from burnout, all the effects can be incredibly damaging. Then, when you couple with that the experience of burnout, a lot of doctors not only fail to meet the demands of their work environment when they’re burned out because of all of the above, they also can be subject to all sorts of other issues that only compound the problems more. If you think about COVID, a lot of clinicians had moral injury, and if we define a moral injury, what it’s defined as is you’re put in a situation of having to make ethical decisions of a moral nature that you were ill-qualified to make because your training didn’t prepare you to make them in the first place.

Imagine now you’re faced with two patients who are going to die and you have to basically triage care towards one over the other because of COVID, or you have to disallow people seeing a dying relative because they’re not allowed in hospital, or you have to disallow relatives to see the birth of a baby because, again, there’s all sorts of other requirements. COVID brought about more burnout, more moral injury, and on top of all of that, the neurobiology made everything just devastating because of what I just mentioned because you just lose that capacity to have good judgment, good reasoning, and you just don’t feel like yourself anymore.

It’s a massive issue and there’s all sorts of drivers, which we’ll get into, but I think every healthcare profession, including us that are in the integrative realm, when we’re pushed to a certain degree and we’re faced with obstacles that we weren’t really prepared for, then all of what brings joy to us from our work and from our connection to our patients can basically be more or less depleted over time. Then, what happens as a result is we have an increased capacity to make a lot of mistakes or make poor judgments, make poor calls, or even risk our own lives. For example, during the pandemic there was quite a lot of news stories about physician suicide. One in Canada, I can just read you the headline, this came from The Globe and Mail, January 12, 2021: Corona Virus: Quebec Doctor’s Death by Suicide Sends Shockwaves Through Canada’s Medical Community.

This is a young ER physician who was ill-equipped because of not only the moral imposition of having to make all sorts of calls, but just the sheer volume of patients that I’m sure she was never prepared to deal with during the pandemic. Put on that with all sorts of other vulnerabilities and moving parts that I’m sure happened in everybody’s life. I feel terrible for what happened. She took her own life. Same in New York. Here’s a headline from The New York Times. This was April 27, 2020. Top ER Doctor Who Treated Virus Patients Dies By Suicide. What we have to realize is burnout isn’t inconsequential. It’s totally consequential, and when people are pushed, they have this moral injury, they’re faced with situations they never prepared for, the end result is devastation.

When you think about the U.S. in total, and I think this may surprise you, 132 people in the U.S. die by suicide every day. That’s just horrible. One of those is a doctor every day. Every day-

Dr. Kara Fitzgerald:  Wow.

Dr. Jonathan Prousky: … in the U.S. a doctor takes their own life, and I would include naturopathic doctors in there, functional medicine doctors, any kind of doctor. That is just unbelievable when you think about it. We’re particularly vulnerable because we care so much about doing the job and we’re so vulnerable because we are going to be faced with all sorts of situations we couldn’t be prepared for.

Dr. Kara Fitzgerald:  Well, and early in COVID, we didn’t know what the heck we were doing-

Dr. Jonathan Prousky: Exactly, so-

Dr. Kara Fitzgerald:  … like at all.

Dr. Jonathan Prousky: … right. We didn’t even know what treatment to give to people.

Dr. Kara Fitzgerald:  No.

Dr. Jonathan Prousky: That wasn’t solidified, so I can only imagine what it was like for doctors that had to make calls with a lot of insufficient information.

Dr. Kara Fitzgerald:  Yeah, that’s pretty extraordinary. Yeah. Wow. All right, it sounds like a war. It just sounds like what you’ve described is a war zone, physically, emotionally, mentally. So I want to understand, and I know you’re sort of building your case for this, but COVID notwithstanding, because that was such an outlier for us, why… how this develops?

Dr. Jonathan Prousky: Yeah, so I’ll talk about that. Burnout develops because of the demands that we all face as clinicians, and I’m going to go through a bunch of them with you right now. For example, we all have time pressures, and I would say clinicians in particular have a huge amount of time pressures at their job. That always can increase our lack of personal accomplishment, that could increase emotional exhaustion and certainly increase depersonalization. We also may be forced in all sorts of healthcare situations of doing things that we don’t particularly enjoy. If doctors actually don’t do at least 20% of what they enjoy on any given day, that increases the risk of burnout, so I-

Dr. Kara Fitzgerald:  That’s not a lot-

Dr. Jonathan Prousky: … no it’s not.

Dr. Kara Fitzgerald:  … 20%.

Dr. Jonathan Prousky: I know, but if it’s not at least 20%, burnout goes up and regrettably, because of all sorts of metrics that different healthcare organizations have, all sorts of demands, all sorts of policies and rules to follow, legislation changes… it sucks some of the joie de vivre, the joy of being a clinician away from practicing people like myself and you-

Dr. Kara Fitzgerald:  Yeah, one hundred percent.

Dr. Jonathan Prousky: … and that certainly has consequences.

Dr. Kara Fitzgerald:  If you can, if you have thoughts on economics to fold in there, I would like to hear that, but certainly economics and what you’re talking about, the increased paperwork and regulation is just so challenging here. I’m sure it is true in Canada as well.

Dr. Jonathan Prousky: You hit something really, I think, important – economic. A lot of clinicians, when they do their good work, they’re not rewarded for it. But what they’re forced to do is to actually do things that save their organization money.

Dr. Kara Fitzgerald:  Yeah.

Dr. Jonathan Prousky: That’s also a very challenging thing. How do you provide good care and also save an organization money? That also increases stress and increases the vulnerability towards burnout again. Then, there’s so many other things that are related to that because clinicians often have insufficient sleep, which also pushes them more. They also work a lot of hours, and there’s been a lot of interesting data on hours. If you work 40 or more hours, basically the development of burnout goes exponentially up severalfold. Many doctors work over 55 hours a week, and in doing so that just escalates the chance of them developing burnout. The odds ratio goes up severalfold when you basically exceed, I would say, 40 hours, but then exceeds even more in terms of the odds ratio when you’re at 55 hours and up. That’s a huge thing.

Then, think about the medical culture, presenteeism is an issue. We all feel like we should never take days off. I was obsessed with never being someone who took a day off when I started my career, and basically this notion that we have to be present even we’re suffering ourselves goes against basically what good care should be all about. We should be able to take care of ourselves, but because that’s part of medical culture, that creates all sorts of problems. So does hiding weaknesses. A lot of doctors may struggle with all sorts of health problems and psychological problems as the human race does, and as a result, because they are not willing to reach out, they’ll hide their weaknesses and it will impact them considerably.

That’s another factor in burnout for doctors. The other ones is evidence-based medicine. Did you know that medical information apparently doubles every 72 maybe 73 days? So the public expects us to practice evidence-based medicine, but to keep up with the evolving literature base and just the sheer amount of information that’s being sent out on a daily basis, it’s impossible. I would have to literally stop practicing and it would probably… I’d never catch up if I just spent the rest of my life reading before I passed away. I would never be able to catch up. The demands of evidence-based medicine are huge, and there’s a lot of pressures in doing that relative to clinical experience. Yet, clinical experience, I would say, is even more vital in a sense than evidence-based medicine.

Then, what else can I say? Also, there’s maladaptive behaviors that doctors learn that increase burnout. Through our own training, a lot of doctors get mentored and their mentorship may actually encourage volatile, adversarial, even bullying type of behaviors that they’re not aware aren’t really acceptable. Of course, we know now more than ever those kinds of behaviors are not acceptable, but these maladaptive behaviors are, unfortunately, transmitted through training and education. That also increases burnout, which is not insignificant. And then there’s all sorts of interesting data that almost 50% of the time that a doctor spends on their EHR, electronic health record, or EMR, electronic medical record, occupies half their days.

Think about that. You have all these patients, but then you’re spending half your day on the computer, and then generally that translates into one to two hours outside of work just to finish notes. That’s a massive trigger because not only are you put through the ringer trying to keep up with the computer during the day so all your notes aren’t overwhelming at the end of the day, you’re probably spending another one to two hours after your hours with patients just to finalize things. It probably could be more. Those are massive triggers, and I think every healthcare professional, including naturopathic doctors, has to contend with that.

Dr. Kara Fitzgerald:  Absolutely.

Dr. Jonathan Prousky: I would say when COVID hit, I knew my job pretty well, but then I had all these other demands in my own job, and it was brutal. I’m not even a frontline healthcare worker, but just because we have more government requirements, more reporting requirements, more I would say screening, all these things came into play in a way that we never had to basically put them into action before. That just created all sorts of increased stress for me, other people in my organization.

I think everybody faced unusual circumstances, but I don’t think even since COVID is essentially over, at least let’s say the acute, now we’re in the chronic phase, let’s say, I still think we’re subject to a lot of pressures such as those I just mentioned that will always put us at risk of being vulnerable to burnout. It’s not going to get better. With all of what I said, it’s only going to exist in greater proportions given just the sheer complexity of the work we do and the challenges that we face.

Dr. Kara Fitzgerald:  Well, then what’s the solution?

Dr. Jonathan Prousky: Yeah, we’ll get there, but I do want to highlight a few other facts that I think are important. Some people think that burnout is a separate entity. I would put forth the argument that burnout is just depression within an occupational setting. When you think about depression, it’s mired in a lot of what’s known as negative affect where you just don’t think in a positive way, just to make it simple, You’re thinking very cynically, you’re thinking pessimistically, and that can all come under this negative affect. It’s like a dysphoric way of being. When you think of depression, it’s high in negative affect. Well, so is burnout. The other thing about burnout which is really interesting is there’s some good data, I would say it needs to be far more expanded, that shows that people with burnout relative to controls, they have lower levels of brain-derived neurotrophic factor. Same with depression. Isn’t that interesting?

Both are characterized by low levels of BDNF, and as you know with BDNF, it’s critical to our, basically, brain plasticity. It’s like this unbelievable soil that helps our brain function the way it ought to, and in depression and burnout, they’re both low. The other thing we see with depression is the prefrontal cortex is essentially not functioning well, executive decision-making is poor. And same with burnout, as I mentioned. It goes offline, and then the whole limbic system, particularly the amygdala, is heightened in depression, and the same in burnout.[59:57] I personally think burnout is just a form of depression that happens within an occupational setting. That’s why I think when it gets so severe and sometimes people are feeling like no hope is available, that’s why suicide can happen because depression and suicide are regrettably connected, and then because burnout to me is a form of occupational depression, therefore, that doesn’t surprise me that suicides happen.

Dr. Kara Fitzgerald:  Yeah. No, I think when you catch it like that it doesn’t surprise me either and there is a point of burnout where I would imagine intervention needs to be all-encompassing like it can be with depression. I mean, it’s beyond just get out in the sun for a day. A more aggressive approach is required when burnout really kicks in.

Dr. Jonathan Prousky: Yeah, so if you want, do you want to talk about treatment? Or do you have any other questions before we get to that?

Dr. Kara Fitzgerald:  Yeah, I do want to talk about treatment. I mean, you’ve highlighted the changes to the central nervous system that take place and correlated them to both depression and PTSD. I guess I’m curious about how we diagnose it, but also how we work with it. I’m sure that you have some ideas with your background in using an orthomolecular approach to mental health conditions, how we could go there. But I’m also interested in lifestyle and I’m interested in more broadly. How the heck do we deal with this? Start where you want and go forward.

Dr. Jonathan Prousky: All right, that’s terrific. Diagnosis, there’s a Maslach Burnout Inventory. There’s an expanded version, but a lot of studies use a short version that just essentially looks at depersonalization and, I think, emotional exhaustion. If you’re strong in one or both that’s considered enough for burnout, and often there’s a very significant correlation between the two-item inventory of the Maslach Burnout Inventory to the larger one. Essentially, you could use either one, but if someone is coming to you and they’re expressing basically all three elements, it’s probably pretty easy to say that they have burnout.

Now, it’s not a clinical diagnosis per se, but in the ICD sort of system, the International Classification of Diseases it’s called, they do have basically a criteria and a listing of burnout. Now, it’s not a formal diagnosis, but it is something that can be given to somebody in a clinician’s office. It is changing. I think eventually it should find its way into the DSM, but as of now it hasn’t. It’s very real, and I guess a lot of diagnoses may be made in lieu of burnout, like an adjustment disorder, for example, or major depression, for example, to just make sure people can get the treatment they require.

Ultimately, we should have a separate category, I think, that distills all the key elements of burnout so that we can give it as a formal diagnosis. When I work somebody up who has it, and I’ve seen quite a few people with it, I do all the things that any good doctor does, a good history, a good mental status evaluation. I dig into all the antecedents, all the things that have happened as a consequence, and we try to have a really good and useful conversation as any doctor would. Because the best thing you can do to someone who’s sitting in front of you in despair is to be available, to show humility, curiosity, compassion, and to listen.

If people aren’t given any time to talk about what’s happened to them and to process just the nature of their overwhelm, I think we’ll be underserving these people. I’m that person, so are you. It wouldn’t take much for me to become the patient who’s having burnout if enough happens in my life. And I feel I’ve had burnout before, and it’s an awful place to be because the abject depression and the abject cynicism and lack of personal accomplishment that happens is so defeating that you feel like you’re almost a pretender in your own job that you were once feeling quite skilled at. It’s just an awful feeling to return to something that you feel such a disconnect with, so I feel for anybody with burnout because I certainly understand it from a personal perspective. It’s just harrowing and awful to go through it.

Dr. Kara Fitzgerald:  I want to hear… Yeah, I’m just curious how you moved out of it, and I think I feel like I’ve had moments that I’ve touched on it with too much from all sides, too much coming in from all sides and needing to back away from my work, which I’ve been able to do at different pivotal moments in my career. I want to just note to listeners that we will link to the two evaluations that you use. Can you just say the names of them again?

Dr. Jonathan Prousky: Yeah, there’s a Maslach Burnout Inventory, and there’s even another one I should say, which is the Maslach you have to get a license for it, so-

Dr. Kara Fitzgerald:  Okay.

Dr. Jonathan Prousky: … there’s one called The Oldenburg Burnout Inventory, which you don’t, and I’ll make sure that you get that information.

Dr. Kara Fitzgerald:  Good.

Dr. Jonathan Prousky: It’s excellent as well, and they’re all very similar. They all measure similar domains and they all have cutoffs so that you would easily know that someone meets a threshold to be diagnosed in addition to your good clinical evaluation.

Dr. Kara Fitzgerald:  Okay, so we’ll just link to that content so people can read about it and have access to those evaluations should they be interested. Let me just ask you this before we start talking about the intervention. Burnout is by definition occurring within the workplace, but can your risk for establishing burnout be increased with stress outside of the workplace?

Dr. Jonathan Prousky: I would assume-

Dr. Kara Fitzgerald:  So you’re going through a divorce and then work becomes really hard. I mean, thoughts on that?

Dr. Jonathan Prousky: I think you’re right. I think it’s chicken or the egg. Either work starts becoming brutal and you have burnout, or your life outside of work is so brutal that it sort of permeates into your work, and therefore you start having all sorts of issues with your work as well, which then can clearly lead to burnout, too. I think there’s multiple ways that we can go from not having burnout to burnout, and I think everything matters. That’s why it’s important that we do have work-life balance as clinicians because there’s so many pressures on us that are unusual for a lot of people. They just don’t quite understand the different pressures. Even though I don’t deal with emergent issues or acute medical issues, it doesn’t mean that what I deal with isn’t pressure-filled and stressful and demanding, all of the above.

I just have the same EHR/EMR demands that other doctors do. I have the same pressures because patients expect a lot when they see someone like me, as they do with you, and we have a lot of moving parts, a lot of emails, phone calls, paperwork. It just doesn’t go away. If we don’t manage that well, we all are unfortunately going to lean towards this outcome, and we need to do better at managing our lives so that we can mitigate against this happening. If you want, we can talk about treatment because I think I’ll get to the lifestyle part, which I think is the most important. When you think about what stress does, we know that it certainly creates its own situation of depleting micronutrients and there’s many ways that that happens.

We get this increased oxidative stress and inflammation. We have increased urination and sweating that can happen, increased cortisol output, appetite changes… So there’s lots of things that happen when we’re stressed that compromise our micronutrient environment. If you think about Bruce Ames, the great Bruce Ames, he developed this triage theory which says that when we’re going through stress, which clearly can impede our body and our brain, our body basically mobilizes all of the nutrients towards life-saving measures, but as a result, we’re going to have cascading effects on our neurobiology.

When I think about burnout, you have to realize that because it shifts our neurobiology and because we’re thinking that we’re going through something that is almost life-threatening, all of our micronutrients are used to support our survival, but they’re not being used actually to combat what’s actually happening. That’s why, I think, micronutrients can actually be quite helpful, and the ones that I think are particularly useful are very simple ones, B vitamins, vitamin C off the bat. There’s probably now about four or five good clinical studies on just B vitamins at very low doses, sometimes combined with some minerals, sometimes combined with herbal medicines, sometimes combined even with a bit of vitamin C. They’re not high doses, but across the board, they’re all showing lower perceived levels of stress, lower symptoms of depression and anxiety.

Though these aren’t studies on people who are burned out, we can look at that information and apply it reasonably to a situation of burnout. That’s a simple thing, but then there’s even more compelling data, which I think is fascinating on broad spectrum micronutrients or broad spectrum minerals and vitamins. There’s been a lot of data on that over the last 20 years on all different types of neuropsychiatric issues, but the data that I’m particularly interested in is the data on PTSD. They’ve used broad spectrum minerals and vitamins to support people who have PTSD from natural disasters. What they found is just loading them up on broad spectrum micronutrients, just to make it simple for me to say it, actually helps considerably again in their perceived levels of stress, whether it’s 28 days of treatment or six weeks of treatment, and it reduces symptoms of depression and anxiety.

The theory behind that is when you just up-regulate all these micronutrients, because you’re not doing a one-a-day vitamin, you’re doing either four or eight pills a day. And believe it or not, four pills of broad-spectrum micronutrients did better than eight, so there-

Dr. Kara Fitzgerald:  Interesting.

Dr. Jonathan Prousky: … seems to be a sweet spot there at least from those studies. Clearly, what it’s doing is it’s probably optimizing certain biochemical pathways. It probably has its own pharmacological effects. It’s probably mitigating inflammation. It’s probably mitigating oxidative stress, and it’s probably just giving us more of what we require because when we’re under stress, we probably can’t meet the demands of our needs just from diet alone. I do think micronutrients can play a good role. I don’t think it’s the end all, be all, but simple things, B vitamins, vitamin C, broad spectrum micronutrients, all those things have value.

Dr. Kara Fitzgerald:  Let me just ask you… Broad spectrum micronutrients. Are you talking about a well-designed multivitamin?

Dr. Jonathan Prousky: Exactly, a well-designed multivitamin that you don’t take one a day.

Dr. Kara Fitzgerald:  Yeah.

Dr. Jonathan Prousky: You take four pills a day, and that seems to be the sweet spot, at least from the two studies that I think have value to translate to helping people with burnout.

Dr. Kara Fitzgerald:  I mean, it seems to be magnesium would be in this somewhere.

Dr. Jonathan Prousky: Absolutely, so either you’re going to get a reasonable amount of magnesium from four pills a day or you’re not, and I would think that you’re not, so I agree with you. You probably should be giving people extra, at least 4 to 800 milligrams at some point throughout the day or maybe at bedtime. And absolutely when you think of what magnesium does and all of the different biochemical reasons to give it, it makes complete sense, so I appreciate that. Absolutely. Then, some herbal medicines that I think are fundamentally important would be Rhodiola rosea extract, and there are actual studies on Rhodiola helping with burnout. It’s one of the few herbal medicines for which data does show that it actually can help.

There was a 12-week study where they gave 400 milligrams a day to a population of people with burnout relative to controls, and clearly that 400 milligrams a day, if I’m remembering the dose correctly, had real value with cortisol modulation and symptoms of burnout. There was another study on fatigue. I think it was only 28 days or maybe 30 days, a lot less, but again, not only did it help with fatigue, and I think the dose was closer to 600 milligrams, and these are standardized extracts, it actually helped again with symptoms of burnout. As you know with Rhodiola, it modulates the HPA access. It probably has monoamine oxidase-inhibiting effects. It probably does other things as well because it can activate us. It can take us from a low mood to probably a better mood, so it has a lot of value. I don’t think it’s poorly tolerated by most. Rhodiola seems to be well-tolerated, doesn’t cause a lot of nausea if you take it with food.

I don’t think it should be combined with SSRIs or SNRIs. There have been a few reports of tachycardias or issues where people actually had to go to the hospital when Rhodiola was combined with SSRIs or SNRIs, so I don’t typically combine the two. I’m very nervous about that. Then, ashwagandha, to me ashwagandha represents probably one of the best treatments for burnout because it modulates cortisol. There’s at least three different trials now of healthy stress people that have found that it lowers cortisol by five units from baseline. That would be basically micrograms per deciliter, I believe, and that’s incredible. You start off with a certain value and three different studies show that reproducibly it lowers it by five points at least over the course of, say, 60 days, which is amazing.

The dose of ashwagandha that does that is not a high dose. It’s usually a dose that gives at least 30 milligrams of withanolides a day. Usually with good products, that comes to two pills a day, and that’s fairly easy for most people to tolerate, but the other benefit of ashwagandha is that it brings more limbic resonance. It actually helps quiet down that area that gets overly activated in burnout and in depression. In doing so, it gives us better top-down control. It has some real value and it’s very well-tolerated. Very few people have any issues, i.e., increased transaminase levels from ashwagandha, though you have to tell your patients that’s a rare possibility. Other than that, I think it’s very well-tolerated and has good utility. But the lifestyle is what you mentioned. To me, it’s the most important, and-

Dr. Kara Fitzgerald:  Before we jump into that I just want to summarize. A protocol that you would do could be a well-designed multivitamin, additional magnesium at bedtime, you would use Rhodiola and ashwagandha together, but contraindicated if they’re on SSRIs or SNRIs?

Dr. Jonathan Prousky: Yeah, I would use them together or sometimes separately. It depends on the patient. Some patients get a bit of pill fatigue and they don’t want to take too many things. I take a lot myself. I don’t worry about pill fatigue. I’m an aggressive prescriber, I would say, of a lot of natural medicines, but I have to recognize there are differences between what I’m capable of doing and what my patients will agree to. You can combine the two, that’s a great combination, or you can try each of these herbal medicines separately. I think this represents a very good foundational plan but to me it doesn’t really help the problem.

Dr. Kara Fitzgerald:  Well, one more question before we go right into lifestyle. Magnesium, now, you’re a big fan of glycinate-

Dr. Jonathan Prousky: Yes.

Dr. Kara Fitzgerald:  … or glycine? Glycine-

Dr. Jonathan Prousky: Yes.

Dr. Kara Fitzgerald:  … as a standalone amino acid. Would you prescribe magnesium glycinate? I mean, do you have a particular magnesium you like?

Dr. Jonathan Prousky: Yeah, I always use the magnesium bisglycinate, unless someone has constipation, in which I like magnesium citrate because you can help them with their magnesium, I would say, intake as well as facilitate better bowel function and people who just find it hard to have a regular bowel movement every day. The bisglycinate is great. As you know, glycine is an inhibitory neurotransmitter. It also calms the brain. It works very much like GABA, though it’s not GABA, but it works like GABA.

When you combine magnesium with glycine, it’s a very good combination. Magnesium by itself antagonizes the NMDA receptor system, so it calms down that excitatory system in our brain. It certainly is part of all of our energy-producing reactions in the body that generate ATP, so it’s also very important. It also is good to reduce muscle tension. It has so… Because it relaxes smooth… I would say it’s a calcium channel blocker to make it simple, so it has so many benefits that I just give magnesium to literally everybody unless there’s some clear contraindications, which thankfully there are very few.

Dr. Kara Fitzgerald:  Very few. Your book, I know I have it like right over here. I kind of feel like showing it if I can find it.

Dr. Jonathan Prousky: I have an update… You know that needs a massive update. You mentioned it the first time we spoke, and I feel guilty. I mean, it would have to go through a massive revision, to be quite honest.

Dr. Kara Fitzgerald:  Well, you know what, though? I mean, I think there’s enough foundational naturopathic interventions in there, like your botanical- you talk about Rhodiola in there, don’t you? Do you mention it?

Dr. Jonathan Prousky: I think so.

Dr. Kara Fitzgerald:  You talk about ashwagandha, magnesium, glycinate-

Dr. Jonathan Prousky: I don’t think I talk about ashwagandha. That was before I was aware of all the studies and good information. But yeah, this was from, I think, 2006, so it needs a revision.

Dr. Kara Fitzgerald:  Listen, I hope that you revise it. I mean, that would be fabulous, and it’s unique in that it gives dosing instructions and how to use these different interventions in a very realistic way. I find that a lot of books out there tend to be way, way, way too conservative, but that’s… Your book is really one of my favorites for that very simple reason. I think it’s real-world efficacious instructions.

Dr. Jonathan Prousky: Thank you. That’s awesome.

Dr. Kara Fitzgerald:  Yeah, yeah.

Dr. Jonathan Prousky: I always think… I’m always a clinician first, and I’ve always thought that way, and that’s really all I care about. I’ve been involved in doing some studies like randomized studies, and to be honest, it’s not my thing. I love reading them when appropriate but doing them is just brutally hard. You have to overcome so much institutional and bureaucratic inertia and even government inertia if there’s government requirements. I’m just not a fan of conducting them, but I love, as a clinician, trying to translate information and make it valuable and useful to the people like us who really care about helping people.

Dr. Kara Fitzgerald:  Yeah, and you succeeded in doing that, so yeah, it may be a bit of a chestnut at this point, but there’s still useful information, so I want to encourage people towards looking at it.

Dr. Jonathan Prousky: Thank you.

Dr. Kara Fitzgerald:  Okay, so let’s really get to the meat and the potatoes of this, as it were. Talk about lifestyle, and that’s the heart of the treatment for burnout. What do we need to do?

Dr. Jonathan Prousky: Yeah, so I thought about this a lot, and there’s a few moving parts here. Everybody knows that sleep, exercise, eating well, and I’m sure there are other- and meditation, all those are fundamentally important. There’s no clinician out there that wouldn’t recognize that those are helpful. The problem is, no institution that I’m aware of cares enough, so they put the burden to find treatment on the actual individual. They’re so ready to punish an individual for a mistake that’s made because of burnout, but there’s very little help to prevent burnout in the beginning for the very clinicians that are doing good work for all sorts of organizations and the people they serve.

It’s a bit crazy this current situation, and I don’t know of many organizations that care enough to change the culture of how they do things to really support their doctors and their clinicians and all the hardworking people. Without question, all these foundational elements are important, but I look at it a bit differently and I look at the work of the late Dr. Viktor Frankl, who was a hero of mine. I mean, I’ve done a lot of my own work on existentialism and existential psychotherapy, and as you know about Viktor Frankl, he wrote a book called Man’s Search for Meaning.

He was a psychiatrist and neurologist and a PhD, as well as a physician, obviously. He survived the Holocaust, and what he did, though, was the Holocaust only reinforced his ideas about meaning and purpose. He didn’t develop these because of his experience and having survived the Holocaust. He came to the Holocaust with a massive amount of knowledge already solidified, and going through the experience and having survived, it only made him believe more in a lot of his ideas.

Dr. Kara Fitzgerald:  Wow.

Dr. Jonathan Prousky: When I think about helping people through burnout, it’s not just those lifestyles, it’s about helping them to define meaning and passion for the work that they once had. Let’s talk about that. When you think about Viktor Frankl, he says, “One of the ways of helping people is to remember that you’re doing a good deed.” So when you’re sitting across from somebody and they’re starting to rebuild their life again, remind them that what they’re doing is good for humanity.

They’re doing good for people. They forgot that. They become cynical. They become more depersonalized. They’re exhausted, so when we think about doing a good deed for other people, that can build our energy up. That’s a wonderful thing. That’s one thing that is incredibly helpful, just to remind people of the good work that they’re doing. They’ve lost that connection. I think that requires a really good conversation and maybe multiple visits just to help somebody to connect again with the goodness of their work.

The other thing that Viktor Frankl talked about in helping people was love, and I think what’s happened is burnout is a one-sided affair. When anybody has burnout, basically what it tells me is they’ve been more in work than in home and in love and in connection to the people that are most important. When we have love in our life, it does so many wonderful things to us. And it saddens me when I see clinicians that have burnout. They put so much work into their work, so much time to do good, and they’re depersonalized, they’re exhausted, they lack personal achievement, but what’s happened is they’re having a one-sided affair and their actual relationships have taken a dive. They’re neglected because they’ve put so much of their emphasis on their work life.

As a result, they forgot that they need to be more attentive to love and to the connections that are so important. I think the other thing that helps people, and I put this under lifestyle, is to reconnect on an emotional level to the people that are most important because at the end of the day, my family is what sustains me. If I lost everything, but I had my family, and I call them my little wolf pack, my wife, my daughters, that is what grounds me. They are going to be there through thick and thin more than anybody. They’re what’s most important to me. Everybody needs love in their life no matter how it’s defined. It doesn’t have to be defined in any traditional way. We just need relationships that fill us up, and I’ve seen many doctors lose those relationships because they’re burned out, because they’ve unfortunately committed adultery with their work. That’s devastating. That’s the other side of burnout we don’t talk about, how it basically destroys relationships.

The third thing is, let’s assume that you can change your work. Well, it would be silly if you’re burned out to go back to a toxic work environment, so it may require that sometimes people have to literally quit a current job so that they can go to something that is less likely to be torturous for them. If that can’t happen, as Dr. Frankl said, sometimes if you can’t change the circumstances of your existence, and he saw that profoundly in the Holocaust, and again, I don’t want to make burnout the Holocaust. They’re so different and I wouldn’t even say they’re proximate in any way. I’m just using Dr. Frankl and his wisdom. That’s all, but he says, “We sometimes just have to change our attitude.”

I can tell you when people are burned out, they’re cynical. They look through a lens of just negativity. They see work as just God-awful, but sometimes, if we just adjust our attitude, we can start seeing that our work isn’t as bad as we thought. We can start again finding it tolerable, and then eventually finding it enjoyable again. The three moving parts that I would say come from Dr. Frankl’s are: remember that we’re doing a good deed; remember that love is highly important and that you shouldn’t give up on that because we work so much; and that if we can’t change the circumstances of our work, we can change our attitude. All of those require a lot of energy and effort, but those are fundamentally important because organizations from my perspective are doing very little to really help clinicians of any kind manage just the demands of their work.

Until that happens, we have to take matters into our own hand. Organizations have employee assistance programs, and they may offer free meditation. That’s good. But that is not enough. If you don’t change the organizational structure, you’re not going to change how the person experiences work in the first place. I think, unfortunately, the onus goes on to us doctors. Now, there are some unique situations, and this comes back to lifestyle. Would you know, and I’m going to just find it in my notes here, there’s an actual burnout ward. I think it’s in Germany-

Dr. Kara Fitzgerald:  Wow.

Dr. Jonathan Prousky: … so if you’re burned out in Germany, you’re lucky.

Dr. Kara Fitzgerald:  Yeah.

Dr. Jonathan Prousky: You could go for six weeks to a burnout ward. I don’t know of any other country that does it. I may have the wrong country, and it’s weird that I was talking about the Holocaust and I bring up Germany. Weird coincidence, but nonetheless, what’s remarkable is they have a burnout ward. When you go there, they give you coaching. You get rest, so you get respite. It’s incredibly important. You get massage and acupuncture, and what’s fascinating is they’ve done a study on this burnout ward. When they leave, guess what happens? Well, they’re feeling better after six weeks. Their levels of BDNF go up and they feel more like themselves again.

I don’t know of any other situation where that’s possible. I would love to have called my work up when I was going through what I thought was burnout in the summer of 2021 and said, “You know, can you please send me to a burnout ward?” I continue to get my benefits and payment at the same time, well, who has that luxury, right? If I took six weeks off, I’d lose six weeks of income. There’s no way I can keep my family and the economic demands of my life going if I took six weeks off, right?

Dr. Kara Fitzgerald:  Yeah.

Dr. Jonathan Prousky: In a country like Germany, they’ve somehow done it and burnout ward-

Dr. Kara Fitzgerald:  Well, they’ve obviously placed a value on it.

Dr. Jonathan Prousky: … yeah, which is incredible and I’m sure I’m a little bit wrong here, but I think I’m also right that there is that possibility there. The study was fascinating, six weeks, all those different resources, massage, acupuncture, coaching, group therapy, you name it. To me, that’s what we need, but until we actually get resources that are there to help people who have burn out and to prevent burnout by changing organizational structures, I think we’re all going to be unfortunately vulnerable to this happening in the first place over and over again.

Dr. Kara Fitzgerald:  I’m glad that you brought up Viktor Frankl and I read his book so many years ago, but somebody recently sent it to me as a thank you for something that we did. It reminds me of just cultivating gratitude. I mean, just I love it, and it sounds like that’s what he was doing. If he had the ability to change his perspective in the Holocaust, we can change it in burnout, you know? He’s got-

Dr. Jonathan Prousky: Yes.

Dr. Kara Fitzgerald:  … the cred. If he was able to do it under those circumstances, then we can do it here. Sometimes before I see a patient, I need to get grounded, and things are just really nutty and I can I’m tell I’m in a less useful place mentally. I take a moment of gratitude, and sometimes it’ll be I need privacy. It’ll be in the bathroom. I’ll just go down into the bathroom and that’s where I can get a little bit of space away from the chaos and just a moment to breathe and just to bring myself center and to remember that I’m doing good work for this human being who’s coming to see me and asking me to walk with them on their journey and cultivating some gratitude that I’m asked to do that. Those little things go a long way, and that’s maybe 60 seconds, you know, at the most.

Dr. Jonathan Prousky: So appropriate. And I forgot, so thank you. I’m a huge fan of all different modalities, so I just want to read a bit. So, what has been found is that cognitive behavioral therapy can help with basically depersonalization, which is interesting. Actually, no, emotional exhaustion. CBT has been specifically found to help with emotional exhaustion. And then self-care. Any kind of workshop that people can do for self-care has been shown to lower depersonalization. But the best thing that I like is mindfulness self-compassion that comes from Dr. Kristin Neff. A lot of what I do with my own patients is mindfulness self-compassion, which is much like gratitude, but it’s a bit different.

What it does is it recognizes three different components. Number one, that there’s a common humanity that we all share, that we’re all imperfect, that we’re all subject to making errors and problems in our life, and we’re not perfect. The other part of mindfulness compassion or mindfulness self-compassion is to treat yourself as a good friend would treat you, and the third part is to name the emotion without getting engulfed in the emotion, so to say, “Yes, I’m feeling anxious,” and to give yourself permission to feel that way without making it more than that, without sort of letting it to be engulfed inside your whole being.

I’ll give you a sense of how it works, and there’s always a touch component to mindfulness self-compassion. You can give yourself a squeeze, you can give yourself a hug because that activates that caring system in our own body and oxytocin actually gets released when we do that, which further supports our self-regulation. When I teach people mindfulness self-compassion, I go through those three components, the common humanity part, naming your emotion, which is more mindfulness, and talking to yourself as a good friend would. It goes something like this, like, “Hey, Jonathan, you’re having a really rough time right now, and you know what? A lot people struggle. You know, I appreciate the struggle you’re going through and it’s very real and you’re feeling anxious and it’s okay. You know what? I think you can get through it.

Then, you give yourself a bit of a squeeze, but it’s like anything. If you don’t practice it and don’t really allow yourself to sort of get into that mind space, it won’t work. It is like gratitude, but it’s a bit different. It’s really showing yourself the kindness and the acceptance of your imperfection, and also some physical touch and some mindfulness, too, in a way that I think a lot of things can’t. It does work, and I can’t tell you when people are finding themselves dysregulated from burnout, just understanding these components of mindfulness self-compassion, doing a bit of work to get somewhat good at it and practicing it goes a long way to help in addition to the other things that I talked about.

Dr. Kara Fitzgerald:  I think we’re at the end of our time here, but you know, the medical system in both of our countries – they’re in distress. Talk about experiencing burnout the way that we approach health in these countries, and-

Dr. Jonathan Prousky: Well, it’s not health.

Dr. Kara Fitzgerald : That’s right. It’s deeply, deeply, deeply flawed. This will foster burnout and everything that we’re facing. There’s this massive structural overhaul that needs to happen that’s beyond the scope of this conversation, but it’s important to recognize that, and it’s also important to recognize that moment by moment, we can make choices to change our reality moment by moment. This certainly… It gives me a deep appreciation for being in functional medicine, for being a naturopathic physician, for being in something that even as we have our own challenges, because we do, and burnout exists here, as you mentioned, we have been an oasis providing a different lens to treat our patients. But also a different lens to treat ourselves.

Even as all of us can get caught up in poor self-care, there’s a strong emphasis in our communities to walk the walk, to actually be the person that you’re espousing, or that you want your patients to be there. There is an effort on that, and I think that people will call us out. If not, you know, if they… But we also do have to remember, as you said earlier, that we’re human, that we’re also human. Everything, I think, needs to be embraced, but I do, I appreciate our community and the fact that we are trying to be a solution in what’s an incredibly difficult world-

Dr. Jonathan Prousky: Yeah, and I don’t fault any physicians who are in the system because it’s a disease management system and they’re doing the best they can. If we want to change everything, as you said, it’s a different conversation. But we have to truly embrace a healthcare system, a healthcare culture, and that has to trickle down to organizations, schools, et cetera. That would be a step function change of the whole entire world in a sense.

Dr. Kara Fitzgerald:  Yeah.

Dr. Jonathan Prousky: I don’t think that’s going to happen. We can do our part, as you said, within your community, and hopefully that will impact other communities, which I believe it already has.

Dr. Kara Fitzgerald:  That’s right, that’s right, and we will always welcome people into our world with open arms. Any physician or healthcare provider interested in what we’re doing can join us and walk with us. All right, Dr. Prousky, it was great to spend some time with you and your insightful… just your wisdom and passion around these important issues that need some light on them. Thanks so much for joining me on New Frontiers.

Dr. Jonathan Prousky: Thank you. Yeah, thank you so much. What a wonderful conversation. It’s so nice to see you again. Thanks again.

Dr. Kara Fitzgerald:  Yeah, likewise.

As always, thank you for listening to New Frontiers in Functional Medicine, where our sponsors help bring the very best minds in functional medicine, and today is no exception. Not everyone can be a sponsor on my platform, and I so appreciate the good work, relentless research, and generous support from my friends at Rupa Health, Biotics and Integrative Therapeutics. These are brands I know and trust in my own clinic and can confidently recommend to you. Visit them at RupaHealth.com, BioticsResearch.com and IntregrativePro.com, and please, tell them you learned about them on New Frontiers.

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Dr. Jonathan Prousky (ND, Bastyr University, 1998; MSc, University of London, 2008; MA, Yorkville University, 2016; RP, College of Registered Psychotherapists of Ontario, 2017) is the Chief Naturopathic Medical Officer at the Canadian College of Naturopathic Medicine (Toronto, Ontario). His primary responsibility is ensuring the delivery of safe and effective naturopathic medical care to patients, as well as ensuring the safety and effectiveness of the medical training in the naturopathic program. His clinical practice focus is primarily on the evaluation and management of mental health problems. He has spent over 20 years advocating for patients that wish to receive integrative treatment to improve their mental health. He was the first naturopathic doctor to receive the “Orthomolecular Doctor of the Year” award in 2010, and later to be inducted into the Orthomolecular Hall of Fame in 2017. Dr. Prousky is the author of more than 60 scholarly publications, and several texts including Anxiety: Orthomolecular Diagnosis and Treatment, and the Textbook of Integrative Clinical Nutrition.

Website

LinkedIn

Private Practice Telephone: (416) 457-6611

Dr. Jonathan Prousky

International Suicide Hotlines

Complete list of Prousky books

Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic

Coronavirus: Quebec doctor’s death by suicide sends shockwaves through Canada’s medical community

Top E.R. Doctor Who Treated Virus Patients Dies by Suicide

Suicide Statistics

Challenges and Opportunities Facing Medical Education

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

Maslach Burnout Inventory

Oldenburg Burnout Inventory

Bruce Ames Triage Theory of Micronutrients

Massacre, Earthquake, Flood: Translational science evidence that the use of micronutrients postdisaster reduces risk of post-traumatic stress in survivors of disasters

Multicenter, open-label, exploratory clinical trial with Rhodiola rosea extract in patients suffering from burnout symptoms

Effects of Rhodiola rosea supplementation on mental performance, physical capacity, and oxidative stress biomarkers in healthy men

An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract

Man’s Search for Meaning – Viktor E. Frankl

Self-Compassion – Kristin Neff

Measuring and Addressing Physician Burnout

Take this QUIZ if you think you might be suffering from Burnout.

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