Most of us see burnout as a physical, emotional, and mental state that occurs when we feel depleted or overwhelmed, but it actually affects our brain.
It has been shown that when we have chronic burnout, our hippocampus gets thinner, and the prefrontal cortex is affected, making it more difficult for us to focus, make good decisions, and remember information. This impacts our physical, emotional, and mental wellness, which makes us more likely to be stressed out by non-stressor situations, very reactive, easily upset, and more irritable.
Eliminating burnout is key to optimal performance, and to achieve it, you need to make yourself a priority and re-evaluate what works for you and what doesn’t. Practicing self-care, mindfulness, and looking out for yourself can help you feel better, make better decisions and perform better.
Join the conversation with Dr. Puja Aggarwal as she shares more about mindset, meditation, and mindfulness, from a neurologist’s perspective on burnout. Dr. Aggarwal is a certified burnout and stress management coach, and a board-certified Neurologist and Epileptologist. Dr. Aggarwal experienced burnout as a physician five years ago when she was overwhelmed, overworked and tired. Through coaching, she learned how to change her mindset and became more self-aware to realize her priorities and boundaries. She now runs Zenful Brain Coaching to help female professionals overcome burnout and lead empowered lives with fulfillment, fun, and freedom. Dr. Aggarwal uses a science-based approach to help her clients to optimize the use of their brains, and she has her own podcast, Zenful Brain, where she discusses ways to optimize our brain to live a more mindful and empowered life.
During this episode, you will learn about;
[00:01] Introduction to the show
[02:14] A bit about our guest today, Dr. Puja Aggarwal
[03:37] Dr. Aggarwal’s journey in medicine and how it led to burnout
[09:04] How coaching helped Dr. Aggarwal beat burnout
[13:21] How burnout affects the brain and performance
[15:18] Using mindfulness and meditation to improve your performance
[19:28] The root cause of burnout in the healthcare system
[21:49] Dr. Aggarwal’s message to young attendants coming out of residency
[24:23] How to reach out, connect or learn more about Dr. Aggarwal
[24:44] Ending the show and call to action
- There are no golden handcuffs, and you don’t have to continue your job because of money; there are other better opportunities to make money.
- To beat burnout, you need to make yourself a priority
- Everything is open for negotiation, and there is always room for you to negotiate.
- If you don’t ask, you are never going to know.
Do you want to get home sooner from the clinic or hospital? With all your notes and charting done, too? Get your FREE PDF guide with 10 tips to maximize your clinical efficiency! https://www.mededwell.com/efficiencyguide/
Connect with Us
Dr. Ryan Stegink
Get Coaching with Dr. Stegink: https://www.mededwell.com/coaching
Dr. Puja Aggarwal
Podcast – https://podcasts.apple.com/us/podcast/zenful-brain/id1608604926
Above are the episode show notes and below is the transcript. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. See the website disclaimer if you have questions, since this is all for your education and entertainment only. Enjoy!
Dr. Ryan Stegink (00:00):
Have you felt exhausted in medicine? Like your practice is more like a treadmill than truly a calling. Is the charting weighing you down, working well past your last patient of the day, charting at home in the evenings and on weekends, the notes, paperwork, lab results, quality metrics, all the things, right. What if I told you there were some ways to make a change, to get more efficient so you can finish work at work and have the margin to intentionally choose thoughts and actions consistent with your values and priorities. You can get my free guide with 10 tips for getting work done at work more efficiently. Get yours today at MedEdwell.com/efficiency. After that, if you know, you want to take a deeper dive into your thoughts and clinical practice, check out MedEdWell coaching with Dr. Stegink, fight burnout and moral injury. Find fulfillment and create margin by examining your thoughts and actions to take that next step forward from where you are to where you want to be aligning your actions with your priorities.
Dr. Ryan Stegink (01:21):
To find out more into book a consult head over to mededwell.com/coaching. And now for the rest of today’s episode, welcome to the MedEdWell podcast, empowering physicians to get work done at work, and then be able to reflect and choose what is important for both their life and medical practice. I’m your host, Dr. Ryan Stegink general pediatrician and life coach for physicians. Welcome to another episode of the MedEdWell podcast. Thank you so much for subscribing and sharing these episodes. They are designed to help you take the next step in your wellness. I’m incorporating both guest and solo episodes, and I’m excited to have another guest with me today. Dr. Puja Geral is an MD, an MBA, a certified burnout and stress management coach and board certified neurologist and epileptologist. Dr. AAL experienced burnout as a physician five years ago, she was overwhelmed, overworked and tired through coaching.
Dr. Ryan Stegink (02:37):
Dr. Agarwal learned to change her mindset and became more self-aware to realize what her priorities were and to set boundaries. Dr. Aggarwal certified at the life coach school in 2021 as a life coach in 2021, she also started zenful brain coaching to help female professionals with overcoming burnout and to help them lead an empowered life with fulfillment, fun, and freedom. She uses a neuroscience based approach to help coach her clients to optimize the use of their brain. She also has her own podcast, Zenful Brain, where she discusses ways to optimize our brains, to live a more mindful and empowered life. Welcome to the podcast Dr. Aggarwal,
Dr. Puja Aggarwal (03:27):
Dr. Stegink, Thank you for having me.
Dr. Ryan Stegink (03:29):
Thanks so much for being here. Tell me a little bit more about your journey to medicine and how that ultimately led to some burnout.
Dr. Puja Aggarwal (03:37):
My journey in medicine actually started in high school. I decided to join a six year combined undergrad MD program. So I started literally two weeks after high school. I started undergrad. I did my undergrad in two years instead of the normal three or four years. So took a full credit to the summer, went to medical school. And so since I was a combined program, I was automatically accepted into medical school, as long as I met some basic criteria. And then in medical school, I loved the brain. I loved neuroscience. My first year of medical school, I loved dissecting the brain and looking at actual all the pathways and it really that’s what made me wanna do neurology. And so I did my neurology residency at Ohio state, and then I practiced for a year as an attending, cause I wasn’t really sure about fellowship, like what I wanted to do.
Dr. Puja Aggarwal (04:25):
And then I had an opportunity come up where I could do a fellowship at Cornell. So I interviewed, I took it and I just a seized on an opportunity. And I did a fellowship in epilepsy at Cornell. And then I was moved from there to Pittsburgh, where I was practicing at a major academic center. And I was about two years out of, out of fellowship, practicing as a full-time attending on call 14 weeks a year. And you know, you’re when you’re at attending you’re and when you’re new, you’re excited, you wanna help people and you know, you just wanna give it your all, you wanna give everything you have and just take care of patients, help them. And you know, I had that mentality and you know, it definitely still do, but I think taking 14 weeks of call year and often taking call two weeks at a time back to back was really difficult.
Dr. Puja Aggarwal (05:07):
I think in the beginning it was like all call about it. But then I was like, wow, what did I get myself into? And you know, I was on inpatient neurology calls. So you could be called in to come into the ER and then also EEG call. So EEG calls is for looking at our brainwaves or for seizures and EEG calls brutal when you don’t have anybody looking at the EEG, besides you as a physician. And I had no backup, no tax or anybody. So I was covering neuro ICUs, regular medical intensive care units for continuous EEGs. I was covering like stat EEGs. I was literally the only person available for like seven days at a time to read EEGs for like, I don’t know what it was like seven hospitals. And these are like, I mean, these are academic centers, so they’re, they’re big, you know, they have less in patients.
Dr. Puja Aggarwal (05:52):
And so that was really one of the major factors that led to my burnout, taking a lot of call. And then, you know, it wasn’t just like, it was a two weeks on call. It was brutal. It was like the dread up to it. And then the week after it’s like the decompression or, and just like trying to get over it. And so it was like literally four weeks and then another week would come a call sometimes. So it was just like this pattern, this cycle of like working, not sleeping, you know, not taking care of myself, not eating well, just eating whatever was around and was junk and then not exercising. And then I was giving all of my time to work. I wasn’t giving it to my little kids, to my husband. Who’s also a physician and I was just irritable. I’d come home, frustrated, upset, irritable, and just take it out on, you know, family.
Dr. Puja Aggarwal (06:40):
And, you know, it came to a date where I would have, I had little kids, I had a three year old and a two year old and they were wanting to read a book with me and it was at the end of the day. And I got so frustrated cause I’m like, I just don’t have anything left to give. And I like, I felt so horrible cause I, I kind of yelled at them and they’re like two or three and that I felt so horrible cause then they were like upset crying. And I, I was like, I can’t do this. I can’t continue. So I was like, this sport job is really getting to me. So I, I tried to figure out ways I could, could change the job or ways I could, you know, change. I thought, well, is there something wrong with me?
Dr. Puja Aggarwal (07:16):
And I felt like all alone. And this was before burnout came much more of a hot topic, which is within the last couple or you know, few years, I think it was always there, which just wasn’t really talked about. So I, you know, I saw a physician I’m like, well, what’s wrong with me? Well, you know, that didn’t really help me. I saw a counselor that didn’t really help me. And then I hired a coach and you know, I was new to coaching, never really heard about it, but coaching really gave me the tools to change my mindset, to learn who I was, what I wanted and to make myself a priority. And I saw the need during the pandemic for a lot of high achieving working moms or female professionals that that burnout was ever present. You know, there was a recent survey out of Ohio state university where I did my residency that looked at parental burnout. It was really high, 66% among working moms. And I mean, that’s so high. And so, I mean, I saw this need and so I decided, I thought, well I had coaching. It really helped me. I wouldn’t become a coach and help people. So I got certified the life coach school. I started my business dental for brain coaching and now I help high achieving working moms with burnout.
Dr. Ryan Stegink (08:18):
Thanks so much for your vulnerability and just really sharing this path that so many of us take in medicine, it’s like the passion for the science and for helping people and really wanting to make a difference and then getting out of training and really wanting to jump in and get started and, and to do the work. But then sometimes just the situations that we end up in are really overwhelming. And I just heard how that self care piece, when was getting lost, which is so ironic when we’re caring for others. How did you deal with that? And how did coaching really help turn that around for you?
Dr. Puja Aggarwal (09:04):
So coaching really helped me with becoming more, self-aware more mindful. So I was, you know, very pessimistic during burnout and it wasn’t, I wouldn’t say like a temper, it was more of like a chronic, I, I probably had it for at least a year or so, and I felt like I was alone and I felt like, well, why am I so irritable? And what the coaching did was like I said, changed my mindset. It made me more self aware. So I started to reframe my thoughts. I used to think, well, I hate going to work. I dread it. And then started to think that, well, I get to go to work or I want to go to work. And then that, I mean, also with that then came my ability to make the decision, do I need to stay in this job or do I need to leave?
Dr. Puja Aggarwal (09:44):
Cause you know, with that job, unfortunately they were not allowing me to, to change my contract. There were, after two years, there was no increase in salary, no decrease in call. There was nothing, nothing to try to make it better. And you know, so I, I left and I was supposed to give six months notice I gave six weeks notice cause I’m like, I can’t continue for six months. I just can’t do it. So anyway, I’ve left, I went to telemedicine, which was a huge change and I saw the coaching and then coaching helped me to practice that self care exercise eat better. And with the telemedicine I was working about 10, 12 hour shifts a month. And so I was making about what I was making full-time practice. And I had that time to, to exercise, to do other things outside of medicine. And that, that was a good change for me.
Dr. Puja Aggarwal (10:31):
And I love like telemedicine and this was before the pandemic. So telemedicine at this point, you know, in 2016 was still kind of a newer thing, but for stroke and things like that, it’s very big and very helpful. And so I did telemedicine and then I was doing some other things, some utilization management, just trying to dip my toes and some different waters to see what it was like. So I was in clinical practice. Then I, I stopped the telemedicine and then I moved to Orlando a few years ago. And then I was working with the local health system and really doing inpatient neurology consults. And then I got certified as coach. And then now I coach a female professionals, but then also I do, I am a principal investigator for clinical trials or research for neurodegenerative diseases. And so like, Alzheimer’s, Parkinson’s so it’s corporate America, but I like that.
Dr. Puja Aggarwal (11:16):
I get to still have patients or see subjects without the worry of meeting RVUs or without meeting targets. And I can form a bond with them and I know them better than I would in clinical practice cause I don’t have that time constraint. And I get to do basic science, which, you know, get back to that basic neuroscience. And you know, I really love combining that. And then I do still do a little bit of clinical practice just to, to keep up at the local hospital a shows here or there. So I really like what I do now. And especially the coaching is something that I’m very passionate about. Especially like I mentioned during the pandemic, there is a lot of burnout it’s increased significantly and I want people to know that it’s not something you need to continue to. There are no golden handcuffs, you know, you don’t have to continue in a job because the, the money that you’re getting, there’s other opportunities, other ways to make money, other jobs and things out there that will better align with who you are and what you want.
Dr. Ryan Stegink (12:07):
I think that’s really helpful because in training a lot of times you’re just not exposed to those other opportunities, whether it’s to be a clinical investigator to pursue entrepreneurship like to do locums, it’s like either you work with someone who’s potentially in an academic or community health system and maybe you work with somebody who’s in private practice and that’s about it. At least that was my experience as a general pediatrician. I didn’t have that exposure to people who were doing coaching for other physicians and professionals, people who were working in industry, but still making a difference with their medical degree.
Dr. Puja Aggarwal (12:47):
Yeah. You know, I didn’t really know much about it even in fellowship or you know, it wasn’t, you know, my husband’s a physician too. He did utilization management. He had a lot of experience with other stuff. So that really is what guided me away from the traditional clinical practice. And so really opened me up to a lot of different things and you know, like I said, really like working in research, but I really love coaching
Dr. Ryan Stegink (13:09):
So as a neurologist and epileptologist, how have you seen and how do you have a unique perspective about how burnout affects the brain itself?
Dr. Puja Aggarwal (13:21):
So yes, I think a lot of people think that burnout is more of like a physical and emotional and mental state that it affects those, but it actually affects your brain. There have been research studies that have shown and that what they’re looking at is the functional MRI are looking up, you know, how burnout affects the brain. And so it has been shown that when you have burnout and when it’s chronic burnout, then the amygdala or a feeling center for people who aren’t in medicine who are maybe listening, that, that over time gets larger in burnout. And then you’re more emotionally laid. You’re more likely to get stressed out by non stressful situations. You’re more likely to react, whether it be getting upset easily, you’re more irritable. And again, those are classic signs of, of burnout. And so, so that’s one thing that research has shown.
Dr. Puja Aggarwal (14:07):
And then also with burnout, when you are experiencing it more in a chronic situation, then your hippocampus is affected or your memory center that actually gets thinner. And so then you can’t form, you don’t remember things as well, you can’t focus as well. And then in addition to other things that are affected as our prefrontal cortex, that’s our, our judgment center or executive function. So that also thins over time makes you more impulsive, less likely to make decisions or make the right decisions for yourself. And so all of that fits with burnout, the symptoms of burnout.
Dr. Ryan Stegink (14:40):
Well, it’s especially helpful to have that context when you then think about, okay, what are those subconscious thoughts and how do those affect your feelings and then the behaviors and actions that you take. So that’s really helpful. What things have you found particularly helpful, whether mindfulness or meditation to actually make a difference in working through burnout. And in addition to some of those other changes where maybe you do need to consider whether this is the right job for you in this season, or you need to add some other interest, but what things have been helpful in your experience?
Dr. Puja Aggarwal (15:18):
So for me personally, and also with my clients, I think that mindfulness is very important and you know, I didn’t really know about that or that self-awareness till I got coaching. And as you know, you’re going through the life coach school right now, I went through it certified last year. They give you a lot of thought work, you know, really diving into what are you thinking and how is that causing you to feel and what actions are you taking because of that. And then how, what is the result of those actions? And that really then leads back to, well, this is a result and it’s because you’re thinking, you know, this thought and really delving into that with my clients is really important that bring, brought me a lot of mindfulness and selfness and I, that has helped my clients. And then, you know, with that mindfulness then comes the ability to know, you know, who am I?
Dr. Puja Aggarwal (15:59):
You know, what do I actually want? Do I wanna do this or do I wanna do that? And you know, then delving more into that and then realizing, you know, that is this job aligning with who I am, what I want or it, can I make it work? Can I change the things and see if they work or do I have to completely change jobs? And you know, sometimes people stay, you can experience burnout and get, you know, the self care, get the help that you need. And, or the other thing is you can learn to set boundaries at work. You can learn to say, no, you can learn to, you know, make people aware that, you know, you’re not gonna do all these extra tasks. You may be helpful in certain situations, but then you’re not gonna overwhelm yourself. And I really think that that’s important learning to set boundaries.
Dr. Puja Aggarwal (16:39):
I think oftentimes be as physicians, if you’re female or female are more inclined to say yes, cause you’re afraid of, you know, what people think or how you’ll be perceived. And so we’re just, we’ll say yes, more easily. So the other thing is meditation, but I, I work with my clients. So breath work and I don’t mean chanting or anything like that. All I need is simply breath work. Just paying attention to taking a deep breath in a deep breath out and just bringing your mind to focus on your breathing, doing that just even five minutes a day can really help you become calm, have better mood. It can help with burnout in addition to the mindfulness. And then the other thing I focus on with my clients is a self care. I’m not telling them what to do, but tell helping them guide what it is that they wanna do that will make them feel better.
Dr. Puja Aggarwal (17:25):
Whether that be exercise, whether it be journaling, practicing gratitude, or, you know, eating healthy, what is it that will help benefit them? And then, you know, actually like I mentioned, research has shown that burnout affects the brain. So does mindfulness and meditation. They have studies have shown again through functional MRI that when you are more mindful and you have are you’re meditating and when it’s happening on a daily basis, your is not as activated. And that amygdala does not get to that larger state as it does in burnout. And also then the prefrontal cortex where it thins and burnout, it actually, you build pathways in that prefrontal cortex. So your judgment is better. You’re able to make those decisions. You’re not more written like an overwhelmed state. And then also you’re able to, your hippocampus also forms new neural pathways. And so then you are able to think better. You’re able to re get those memories from whatever it is in the past that you, that you want to or retrieve those. And so that mindfulness and that meditation is kind of almost the opposite effect. If you wanna think about it compared to burnout,
Dr. Ryan Stegink (18:28):
That’s really helpful just to think about, okay, this is really affecting your brain and some of these chronic stress and how our training and other things have made it difficult to process some of these chronic stressors or the moral injury of saying, I know what needs to happen for this patient, but I don’t have the resources. We don’t have the medicine, the staff or whatever, but at the same time, figuring out how do we then get that outside input, whether it’s colleagues and community, whether it’s coaching, whether it’s some of these practices like mindfulness and meditation, so that you can restore some of that ability because yeah, if you’re burned out and your prefrontal cortex is impaired, you’re not gonna be able to make those decisions that are gonna be what helps you move forward. And so I think just realizing that there sometimes takes that input outside of outside of oneself.
Dr. Puja Aggarwal (19:29):
Yeah. You know, I think burnout is it, it is not just a due to a person or their situation or because of them. It is because also organized healthcare. It is because of that lack of autonomy, there’s Christina SLA or American psych or social psychologist, you know, there’s six different things that cause burnout, lack of autonomy, lack of community perceived, lack of fairness, values mismatch. There’s a couple other right now that I’m not able to plot on my own memory, but there’s a couple other. And so, I mean, it’s really a combination of wanting everything to be perfect as a physician obviously, and then also admin and things like that. And so, I mean, yeah, I mean with burnout really do need to make yourself a priority and reevaluate, is this job gonna work for you or is it not?
Dr. Ryan Stegink (20:14):
Yeah, no, I think that’s really helpful to just for those listening to say, sure, there are some of these things that we can do as individuals, but I do not want anyone to feel blamed or shamed for going through this. It is so common in medicine. And I think we’re just more aware of it now. And there are so many systems things and why I’m really passionate about using some of the opportunities. I’ve had to get some extra training with medical record optimization to say, okay, these are some things that individually we can do on the medical record side, but there are so many things that need to be addressed from the systems perspective. So it’s not limited to just medical records, but there are definitely many system factors that as we have these conversations, we’re then able to advocate for and to push for that change that’s really needed in the culture of medicine.
Dr. Puja Aggarwal (21:12):
Yeah. I mean, definitely it’s the culture of medicine that’s been like we as physicians just need to do it all, do it all. Well, we shouldn’t care about ourselves. We should put the patient first is what we’ve always been taught, but we can’t pour from .
Dr. Ryan Stegink (21:24):
Yeah. So what is one thing that if you were to go back and tell yourself, coming out of training or someone who’s listening, who’s early in their career and excited to jump in, what would you tell them as far as something to be aware of some sort of self care practice to incorporate or things to look for in the current or a future job that they might be looking at?
Dr. Puja Aggarwal (21:49):
So I would say so one self-care thing that I would recommend is meditation or breathwork, that’s very important to just help you overall your overall health and your, if you’re experiencing burnout burnout, or if you’re not experiencing burnout, it’s simple. All it takes is a few minutes, just simply paying attention to your breath. And that has really been shown to help in the long term. So in terms of people coming out of training out of residency, looking for that job, I would say, do your research, talk to the people who are, are there currently talk to them away from, you know, admin, you know, if, see if you get their phone numbers, they’re more likely to be honest, if that’s just you and them on the phone. I think that’s really important because, you know, I think with me, when I took the job where I was just out of fellowship, I didn’t really know what that I should have asked that I should have gotten their numbers.
Dr. Puja Aggarwal (22:36):
I should have learned more about the position. And I didn’t know that I could like necessarily negotiate call or things like that. And the other thing is you can negotiate. Things are open for negotiation, everything is open for negotiation. They may say it’s not, but it is at least, you know, the other thing is, is if you don’t ask, you’re never gonna know. And the worst that people can say is no, the worst answer you can get to ask you for something. And negotiations is no. So really there was always room open for negotiations. So always try to negotiate.
Dr. Ryan Stegink (23:04):
I think that’s really helpful coming out of training. I was put at two separate clinics in my system and that had its own opportunities, but also its own challenges. And I realized over time that I needed to be all at one. And so yeah. How do you advocate and negotiate and try and make your case in ways that speak to either the metrics they’re looking at or just kind of speak that, that language that they’re looking at. And I think what you’re saying about trying to get input from various people and is really helpful because you don’t know what you don’t, but both having mentors and having those contacts I think could be really invaluable.
Dr. Puja Aggarwal (23:53):
Yeah. The other thing, like you mentioned, because of having mentors like networking, networking is so important. So you can have those people to bounce ideas off of if they’re in your field or have those colleagues for any future jobs, maybe if you need a reference or if you need, you know, whatever it is, you know, networking is also very important.
Dr. Ryan Stegink (24:12):
Well, I so appreciate you coming on the podcast, Dr. Aggarwal, if someone’s wanting to learn more about your podcast, the work you do wants to work with you wherever they find you.
Dr. Puja Aggarwal (24:23):
So you can find me on my website. It’s www.zenfulbrain.com. That’s Z E N F U L B R a I n.com. You can find me on Instagram, it’s at zenful brain official and then actually on my website, they can schedule a free strategy session.
Dr. Ryan Stegink (24:43):
Great. Thanks so much everyone for joining us. I hope you’ve found value from this conversation and hearing about Dr. Aggarwal’s expertise. I want to hear from you about what you think about doing solo shows versus guests, and maybe even guests that you’d like to have be a part of the show. If you’d like to be a guest as well, please reach out. And again, I want you to take your next step. So decide what you’re gonna implement. Is that gonna be starting to do some meditation? Some breathwork just having a gratitude practice. Take that next step and then share this episode with someone, a physician, you know, a colleague, someone who really needs to hear this. Thanks so much for all you do and have a great day. And now for our important disclaimer, Dr. Ryan Stegink is a practicing general pediatrician, but the MedEdWell podcast does not reflective views, opinions or belief of his employer nor his affiliated university. Additionally, the MedEdWell podcast is for educational and entertainment purposes only, and should not be considered advice regarding financial legal student loan, medical, or any other specific topic. In such a case you should see consultation with certified professional in that particular area. Again, thanks for joining us on the MedEdWell podcast and have a great day.