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Dynamic Chiropractic – June 17, 2008, Vol. 26, Issue 13

Primary Prevention for Career Burnout: Building Resilience

By Shelley Simon, RN, DC, MPH, EdD

You've no doubt heard the news: Chiropractors are working harder for less reward and scores within the profession are teetering on the edge of career burnout as a result. They're not alone.

Burnout is rampant in a great many occupations and studies show individuals in the helping professions are at an especially high risk for burnout.

Everywhere you turn today, chiropractors are lamenting they're burned out. Are all of these doctors really burned out? Or are they just tired, stressed or frustrated with the challenges practice presents? Either way, the situation demands attention. True burnout is not simply feeling bored or down for a day or two now and then. Burnout is a real syndrome - a collection of signs and symptoms that might include feeling overwhelmed, chronically exhausted, moody, resentful, angry, negative, cynical, hopeless, helpless and critical of self and others. Individuals experiencing burnout also might be unmotivated, have relationship troubles, sleep problems, abuse drugs or alcohol, and feel anxious or depressed.

Most chiropractors, when they are experiencing symptoms associated with burnout, turn to familiar solutions to address the problem such as taking a vacation, changing their office hours, or signing up for a motivational or practice-building seminar. These remedies might be helpful, but the relief usually is only temporary. These "solutions" do little to revitalize the doctor in a lasting way because the challenges and demands of practice are ongoing. It's impossible to have a successful, healthy practice if you are chronically stressed and using valuable resources to battle the symptoms of burnout rather than to grow your business.

The enduring remedies for chronic stress and career burnout address both the external and internal factors at play. External concerns are relatively straightforward and usually can be solved by implementing solid business practices and effective systems. The internal issues are more complex and often require some degree of "healing the healer." In this article, let's focus on the internal factors, which include developing positive self-management habits and building resilience.

Building resilience is the best primary prevention strategy available for managing the day-to-day challenges of running a practice, reducing stress, averting career burnout and building a successful business. Since working as a chiropractor is not getting any easier as health care becomes more complex, it is imperative practitioners become stronger and more personally resilient in order to thrive in the coming years.

What Is Resilience and Why Is It Important?

As a self-employed chiropractor, you know all about the constant ups and downs and ever-changing demands associated with practicing. Resilience helps you manage change, overcome challenges and endure setbacks - often described as the capacity to cope with chronic stress. This ability to bounce back after being physically or emotionally stressed increases self-esteem, which in turn helps build resilience so you can bounce back the next time something stressful happens. So, you might say resilience builds and thrives on ... resilience.

Resilience helps you view apparent problems from more than one angle, recognizing both the risks and the opportunities in challenging situations. Resilience boosts confidence, hardiness, emotional strength and hopefulness. It also combats exhaustion, depression and career burnout so you can manage your practice with greater ease and produce better outcomes.

Developing resilience is not a quick-fix proposition or a relief-oriented strategy. It's not as though you'll read this article, make the decision to be resilient from this day forward and be done. There is a little more to it, and in a moment you'll read about the characteristics of resilient individuals and learn six things you can do to anchor yourself in this way of being. As you read, keep in mind that when you build personal resilience, you are using primary prevention to ward off career burnout and the symptoms associated with it.

Innate or Learned?

Whether resilience is an innate capacity or a habit to be developed presents an interesting question: What enables some individuals to rebound and keep going despite adversity, stress and kryptonite, while others fall apart at the first sign of difficulty?

Resilience is not a genetic trait; it is our "inborn capacity for self-righting and for transformation and change."1 Knowledge that everyone has innate resilience can ground change efforts in optimism and possibility. The development of resilience is none other than the process of healthy human development, a dynamic process in which personality and environmental influences interact in a reciprocal fashion.

So, is it nature or nurture? Probably a little of both. Developmental studies following children born into seriously high-risk conditions have shown that at least half overcome the odds and go on to lead successful lives. While some people are naturally more resilient than others, even they must work at times to maintain their optimistic mindset. For individuals struggling to muster up resilience, the good news is it can indeed be developed and strengthened.

Got Resilience?

Whether they are born resilient or have to work at it, what is it about certain people that make them seemingly immune to becoming discouraged or pessimistic? Research shows individuals who have high levels of resilience share some common characteristics. These include:

Caring relationships. Resilient individuals enjoy support and encouragement from people in their lives who believe in their ability to succeed. They also have caring relationships with themselves - that is, they treat themselves with kindness and compassion.

High expectation for success. They have a belief in themselves - in their competence and in their ability to influence outcomes. This belief helps counter the negative self-talk and feelings that arise in all of us. The resilient person has an optimistic outlook and is able to keep even the most negative situations and challenging problems in perspective.

Meaningful participation and contribution. Chiropractors have this opportunity on a daily basis. However, many have lost their way and feel practice has little meaning for them. Instead of seeing the value in providing services, they question their worthiness or career choice. Resilient chiropractors keep in mind why they do the work they do and how their contributions are meaningful to the patients they serve and to themselves.

Clear boundaries. Resilient individuals know when and how to say no. They balance giving with receiving and have consistent guidelines and expectations with the people in their lives.

Life skills. Resilient people typically communicate well, have competent business practices and skills, and are able to make plans and take appropriate action to execute their plans.

You likely possess a number of these characteristics, experiences and skills in your life already. Acknowledge your strengths and resilience builders, and recognize how they provide you with hope, enrichment, satisfaction and meaning. If some of these characteristics are not present to the degree you'd like, you can devote attention to improving self-care, rebalancing your time and priorities, developing new competencies, working on emotional intelligence, or revisiting your professional and personal goals.

Choosing Your Viewpoint, Managing Your Mindset

Your mindset shapes how you view and interpret the events in your life. It determines the kinds of stories you tell yourself about what is happening around you and what your actual influence may or may not be in a situation. In work and in life, setbacks are inevitable. How you choose to view these inevitabilities determines your outcome.

When faced with a significant problem, the viewpoint you adopt can mean the difference between success and failure in resolving the situation. Although it might sound like semantics, simply reframing a "problem" as a "challenge to be managed" makes a difference. What can take the place of telling yourself things such as: I have too much to do. This doesn't work. It's too hard. No one will cooperate with me. I'm not motivated. I can't afford it. Developing resilience requires turning this self-talk around so you begin to see more right than wrong and feel more in control.

Research psychologist Carol Dweck points out the difference between a fixed mindset and a growth mindset.2 The individual with a fixed mindset has an internal dialogue focused on judging both self and others - good, bad, positive, negative - and they are overly sensitive about being wrong or making a mistake. Individuals with a growth mindset are monitoring what is going on, but without all the judgment. Typically more self-aware, they are apt to observe and learn from a situation, rather than judge and invent worst-case scenarios. Additionally, someone with a fixed mindset is most focused on the outcome in a situation, whereas someone with a growth mindset is interested in the process and learning potential, as well as the outcome.

Developing Resilience and Making It a Habit

Having read this far, you hopefully have a clear understanding of the benefits derived from building your personal reserves and resilience. But how do you actually go about becoming more resilient? Here are six actions you can take (or at least consider) today that will put you on a path toward greater resilience, stamina and stress-hardiness.

Practice self-care. You've heard it before, but it bears repeating: Doctor, heal thyself. If you're exhausted, out of shape, poorly nourished and constantly stressed you can't expect much resilience in your life. Do what you advise your patients to do: eat well, exercise regularly, practice work/life balance, maintain healthy boundaries, say no when you need to, and get enough sleep, rest, relaxation and downtime.

Manage your time. Set aside time to work on projects that matter. Prioritize, delegate and follow through. Avoid wasting time. (How many times have you checked e-mail today?)

Work on your emotional intelligence. Self-management and self-awareness are two key components of EQ. Both are closely linked to building resilience.

Balance long-term goals with shorter-term ones. When working on a complex project or a long-term goal, just completing one or two small steps may give you the boost you need to do the next one or two steps the following day. Set big goals and complete them by taking baby steps, one after the other.

Maintain perspective and a sense of humor. Don't take everything so seriously. The important projects and goals will bubble to the top and get done. Maybe not as quickly as you'd like, but if you're patient with yourself and keep working - in small steps, if needed - toward what is meaningful, eventually you will succeed.

Pay attention when resistance arises, because it will. Even with fairly high levels of resilience, especially when you're working on something not especially appealing (practice marketing, for example), you'll encounter resistance. It's normal; it's to be expected. How you choose to manage your own resistance will, in part, determine your level of resilience.

Practice any of these six actions until they become familiar and begin to deliver better outcomes, and they will eventually become habits.

If you find yourself wondering, "Could this be burnout?" take that as a signal to pay attention to how you are caring for yourself. Practice primary prevention by developing the habits associated with self-mastery, cultivating meaningful relationships, maintaining healthy boundaries and managing yourself so you can thrive personally and professionally. Resilience will give you the strength and steadiness you need to lead and manage your practice effectively during today's challenging, yet still rewarding, times.


  1. Lifton RJ. The Protean Self: Human Resilience in an Age of Transformation. New York: Basic Books, 1993.
  2. Dweck C. Mindset: The New Psychology of Success. New York: Random House, 2006.

Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.

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