Ohio Academy of Family Physicians
Exploring Tools and Resources for Overcoming Burnout
Wellness Wednesdays is a structured, bi-monthly webinar series focused on enhancing professional and personal wellness through the joy of medicine offered for free and scheduled on a Wednesday during the typical lunch hour, 12:15-1:00 p.m..
Participants will start each session with a brief overview of the discussion topic and then be led through a practical exercise that will help you learn through self-exploration and personal awareness. Each participant will have the opportunity to share their own insight at the end of the 45-minute program and make connections with their peers who are interested in wellness and professional satisfaction.
well thank you all for joining me today and I hope you find this discussion helpful I it's one of those things that I talk about four hours and so I'm gonna be moving quickly through the slides because I do want to get to our discussion and so the first thing I always like to do is just disclose that I have no you know conflicts from a seamy standpoint to disclose I am employed full-time by the AFP so I'm talking with you today from cloudy soon to be rainy Kansas City where it's been hot and humid and we somewhere has arrived early here but I'm employed full-time by the AFP as Kay said I practiced in Indiana for many years but I still have an Indiana license but I haven't clinically seen patients now for little over five years one is just a touch base on some learning objectives for this session first of all at the end of the session I hope that you all know some resources available through the AFP and other sources that will be useful to you in addressing family physician well-being and professional satisfaction I want you to be able to utilize the family physician ecosystem for anymore when you develop your plan to improve your personal well-being but I also want you to be stimulated to develop a plan to improve family physician because it does take all of us working on this together and you know one of the questions that comes up when you know what why is the American Academy made this a priority and and so I do think it's important to acknowledge that this is one of our top four priorities as determined by our board of directors in strategic planning sessions in 2016 so it's been just about two years ago that the academies Board of Directors decided this was on one of our top four priorities and so just so you're aware our top priorities are payment reform we believe that primary care is underpaid and and that you know that to have a healthy and improved health care system that primary care needs to be paid significantly better practice transformation we believe that you know our members need some assistance in moving away from more traditional practice towards the payment models that that we see on the horizon we want to be a seen as a leader and take a leadership role in striving for health equity and addressing social determinants of health and then improving family physician well-being is our other top four priority and the specific strategy statement that our Board adopted is that the AFP will assist members and achieving well-being in order to enjoy a sustained career in family medicine I think the key words there are well-being enjoy because we really look for family physicians to have a much higher level of satisfaction with what they're doing and you know sustained because as you all know the primary care workforce in the United States is less than it needs to be from a volume standpoint we need more primary care physicians we need more family physicians and so you know one of the things that we worry about is that burnout and dissatisfaction are causes of people leaving practice you know mid and and sometimes even early career and so we really do look for a sustained career in family medicine and I'm pleased to serve as the executive sponsor for this strategy for the Academy and so you know this is what we hear from our members is don't try to fix me fix the system yeah I'm I'm not broken it's this crazy system that I'm in and this isn't what I signed up to do I went into medicine to take care of patients and I spend like I feel like I spend my time on administrative tasks rather than really doing things that benefit my patients and at the same time we here helped me because I'm drowning in this crazy system so it's a it's it's not one or the other it's it's a broken system but that broken system is having ill effects on family physicians and so we're trying to fix the system and we're trying to help the individuals who are trying to thrive in the midst of that crazy system and just as a the point of sort of reminder when we talk about burnout the classic description of burnout that's been in place for over 30 years it was described by dr. Cristina and you may recognize that name the mass like burnout inventory is the longest-standing tool out there to evaluate for symptoms of burnout and burnout is classically described then as this triad of lack of enthusiasm or energy for work so feeling that just don't have the energy to do the work I want to do a feeling of cynicism or depersonalization or a lack of empathy and we hear this from physicians who say you know when I first started to take care of patients I felt this real connection and now I don't necessarily feel that same level of connection to my patients that same level of caring that I that I had before and then the third part is the one I think that's really distressing is that that physicians sometimes feel that despite all of the work they've put into their career the hard work of getting into medical school and of making it through medical school and then training after Medical School and you know devoting their lives to taking care of patients that they don't feel that sense of accomplishment like they're really making the difference that they thought they'd be able to to do so so this is just again as a matter of reminder these are this is what we're talking about when we talk about burnout and the AMA has done a lot of work on this and have really developed some nice resources and and you know the AMA talks about the the drivers of burnout being high workloads workload in inefficiencies increased time spent in in documentation this loss of feeling of meaningfulness and work and then these last two bullet points that I think are really important to to be aware of and and the the first there is a social social ISIL is ice the feeling of being socially isolated at work and you know this comes up when we do workshops and and we get into small groups and talk and one of the things that I hear very frequently is I thought I was the only one that felt this way or I don't have anyone that I can share my feelings of frustration with and so this is a really important concept of social isolation and then the last one there is this cultural shift that that we all are feeling about health care that health care has drifted away from being patient-centered and really focusing on the the values of putting patients first and doing the right thing for patients and improving health and healthcare and a shift to corporate values of profit and and and other things that seem to be really highly emphasized within the corporate culture and this is causing you know a significant degree of moral distress for physicians feel like their personal values and the reasons they went into medicine are not meshing with the values they're seeing now in this corporatization of health care and burnout it has repercussions at both a personal and professional level and it's important to recognize that and you know this manifests itself in the practice level because of the effect that it can have on the quality of care and the safety of patient care as well as the experience for the patient can be negatively effected it can decrease productivity and result in physician turnover and we know that physician and clinician burnout is costing health care system in the United States billions of dollars a year because of these ill effects but beyond the professional effects there are personal effects as well burnout is not a medical diagnosis it's not a you know it's not a medical condition it's a work-related phenomenon but it's certainly in extreme forms can manifest with significant personal issues including the development of depression we know that burnout is a risk factor for depression and unfortunately we are aware that that there's a high rate of suicide amongst physicians so it's important to think of this I think from the effects that it has on the populations that we take care of the effect that it has on the economic aspects of health care but then also on the personal costs that that this really results in for those physicians who experience burnout and so here's a formula for distress that we've sort of developed over the last few years from discussions with family physicians all around the country and that is that EMR x r vu equals I am sad and you know on a broad sense what the EMR represents is all of this administrative burden that doesn't necessarily increase the quality of care or the experience improve it's not it doesn't generate value for either the patient or the physician and then our views represent that increased workload and that that hamster wheel that we hear people talk about of I you know my all my incentives are to see more patients I want to take great care of patients I'm told I've got to provide a high quality experience for my patients but but I'm being judged on how many patients I see in and paid by RV use and so this is again this formula for moral distress and we know that unfortunately family medicine is one of the higher affected specialties by burnout this is data from a Medscape survey that was published in January of this year 2018 and family medicine continues to be in the top three by specialty there's a persistent gender gap related to burnout and we know that there's a 10% higher risk for women in medicine for burnout and that's across all specialties but this is a very consistent year to year in the Medscape surveys that they've done that it's been three years in a row now that there's been a 10% higher rate of burnout amongst women in medicine and then happiness outside of work you know half of family physicians and and across all specialties about half of physicians feel extremely a very happy outside of work so again that you know you can have this feeling of burnout at work but still happy outside of work but then here's one I think that's really important to look at and that is you know which physicians are happiest at work and again unfortunately family medicine is right down there at the bottom 22% of family physicians in the certain Medscape survey this year said they felt extremely or very happy at work and so the the concern is that you know you may not be burned out so 47% in this survey had symptoms of burnout but only 22% said they were happy and work so there's this big gap in between the physicians family physicians who aren't burned-out but they're not happy either and so our concern is we can work on decreasing the burnout rate let's say we've decreased the burning rate to 220 percent but if we don't increase the happy at work that basically leaves this big gap in the middle of folks again who aren't burned-out but they're not happy either and so we believe that it's important to think of well-being not as just the lack of burnout and that the lack of burnout doesn't mean happiness and so we believe it's important to focus on improving well-being and professional satisfaction not simply decreasing burnout the way we've approached this is through a five-level framework of the family physician ecosystem and I'll briefly touch on on these but you know the big level it's a Health System regulations and requirements and and you know those are the things that at the AFP we are advocating on a daily basis and in DC to try and decrease this administrative burden and I'll touch on that a little bit more then at the organization level we know the majority of physicians report that their family physicians of our members report that they're employed by a by an organization and that that has an effect on their well being a professional satisfaction we believe organizations need to make a higher priority for improving physician well-being and they need to invest in the things that will do that and there's the practice level that's where you see your patients every day it's the teams that you work on and sometimes there are frustrations there of inefficiencies and and opportunities to improve the experience of the day to day practice level and then next is at the individual level it's those individual habits beliefs behaviors that are affect your health and well-being and we certainly know that there's evidence that there are certain habits and behaviors that can increase your sense of well-being and then the harder one to really describe is the physician culture and it's a culture that we were all raised in through medical school of self-sacrifice as Noble and in fact that self sacrifices is probably more highly valued than self care and that if you are focused on taking care of yourself that you're somehow selfish and that that makes makes you a weaker doctor and leads to a real sense of shame and guilt when you are focused on trying to take care of yourself and so these are the five levels of the family physician ecosystem that we are trying to address with the resources and activities that that we've put into place and you may have seen that that the Academy has really made reducing administrative burden a significant focal point this year mic mongers our current president he's talked about this extensively as well as our Board Chair John Meigs has highlighted this and many of his communications and we've spent a significant amount of time in DC trying to help folks understand the unintended consequences of the administrative burdens that have been put in place over the last 30 years I I really believe that in my career that having practiced before the implementation of E&M coding guidelines in the 1990s that you know that was a significant watershed moment in the increase in documentation burden and so we spent a significant amount of time in d.c advocating to decrease the requirements for prior of prior approvals to simplify quality reporting to ease and documentation requirements and and CMS right now is actually open for comments on how to improve E&M coding and so we've we've made extensive suggestions on on how to do that much better advocating for EHR functionality and the EHR is basically designed to document for billing purposes for for clinical purposes and so we are emphasizing the importance of that as well as emphasizing the importance of investment in primary care and primary care services and focusing on population care and outcomes rather than the the quantity of patients that you can see and so two high level metrics that the AFP are is following these are our board metrics this is will report to our board each year in July and so this is from a survey that we did in June of 2017 and that was the question if you had your career to do over would you choose to be a family physician not only 55 percent indicated that they would choose to be a family physician again it's interesting when we look at it by demographics the demographic that stood out with the highest reported choice of being a family physician together those that have been in practice 22 years on longer so it's just an interesting thing to be aware of so we've set a short-term goal of seeing an improvement by five percent between 2017 to 2018 and we have just completed gathering that survey data and we'll be learning those results in the next few weeks but what you'll see there is that there's a big chunk 23 percent who don't know if they would choose to be family Doc's again and I think that correlates well with that gap that we saw on the not happy in practice but not burned out the other metric that we're looking at is how's the AFP doing as far as providing resources for members and what you'll see there is that 24% in the survey last year said they strongly agree or somewhat agree with the fact that the AFP provides effective resources to assist with their well-being and again the big areas they're neutral 31% and don't know at 31% and so our short-term goal when we repeat this this year is to see that jump almost double up to 40% we want to make sure that our members value the resources that were providing and so here are the resources that are either currently available or in development and again this really rolled out last year the survey was in June and we really kicked this off at FMX in September of last year and the first big part of the rollout was our physician health first portal at AFP dot o-r-g and that is something that only our members have access to parts of that portal anyone can look at at much of that but one of the things that we've made specific for members is access to the mass lock burnout of inventory and again that launched in 2017 and then in April of this year through the physician health first portal we released our well-being planning tool and I'll go through that in a bit more detail in just a minute but that's been built around the five levels of the ecosystem that we just reviewed and we've been fortunate that that much of this has been funded through the a AFP's foundation that has funded the development of this content and making these things available for our members I'm going to touch on our conferences we've we had our first conference this spring and we plan to have one again next year or in the process of developing a chain a state chapter workshop series the state chapters would be able to access we've had an ongoing series of articles in our fpm a family practice management journal we've had tracks at FMX the last couple of years and we continue to expand that we're in the process of developing a a practice improvement activity that will qualify for maintenance of certification credit through the ABF m and that is in association with the ABF m and they've generously funded development of that activity so that you would get both seamy credit as well as mo c credit as a practice improvement activity and and we plan to launch that in 2019 and then we've been a significant partner a co-sponsor of the National Academy of medicines action collaborative on clinician well-being and resiliency that kicked off in 2017 so we're in the second of four years and I'll talk a bit more about that and so you know so here's our portal the physician healthfirst portal and you can find that at a fp0 RG slash my well-being and what you'll see is there's several resources if you click on the find resources there's many articles and and interviews that we've recorded over the last year that are available there you can go in and do that Madlock burnout inventory and get a personalized report back based on your answers to the questions and the inventory you can then go to the planner here and and I'll walk through a bit of that as well and then there's information there about the conference and this is just a screenshot but you can scroll down and you'll see multiple resources and again this is organized around the five levels of the family physician ecosystem so in April of this year we did kick off our well-being planner and the idea there is that there are so many resources available on our website and the planner lets you organize those resources basically save your favorites so that you can if you if you find an article that you like and don't have time to look at it right then or explore more about it you can save that into a personalized resource list that you can go back to over time and it gives you an opportunity to set goals and make commitments to to improving both your well-being as well as the the well-being of others that you work with or others in our specialty and then it gives you an opportunity to track and measure your progress so here's what it looks like when you go to the well-being planner and again it's a four-step process of committing reflecting through what you learn off of the NBI developing your plan and then over time coming back to tracking and refine that and so this is an example of there are many sort of pre developed goals that you can go through and choose which ones you want to emphasize or if there's something that you want to do that's not on that you can create your own goals so it's been interesting to see as our members utilize the planner you know what they're prioritizing as their as their goals and and what goals they've created and so just a little bit about the utilization of these resources to this point we've had over 3,000 of our members now that have gone online since last September and completed the MBI and gotten their MBI report the planner again was just launched in April and and as of sort of the middle of May I think was the last that that I saw new numbers on that we did four hundred and eighty-eight members who had gone in and developed a plan through the planner in May we had over 15,000 page views on the physician health first portal and then these are just some examples of the most popular resources that are accessed related to well-being so that just gives you a sense of the utilization of those resources I wanted to talk a bit about our first AFP family physician health and well-being conference it was held in April this year in Naples Florida and it was three and a half days and we had 458 folks attend when we first started planning this a couple years ago we weren't sure if anybody would show up and as far as I know we're the only specialty that has developed a conference like this specific to our specialty and it was just incredibly well received it was very gratifying to get feedback from our attendees ninety-eight percent of those that completed the the survey that attended either ranked at excellent or above average only 2% ranked it as average and nobody ranked at his below average and 71% of attendees ranked it as excellent so we were really quite pleased with the feedback that we got and in fact in a in a survey that we did afterwards 50 percent of attendees said they would plan to attend every year and so that was again that's says a lot for what folks found valuable at that conference and it was interesting you know 43 percent of our members are women I and 70 percent of those that attended the conference were women and so it really just highlights I think again the appetite that folks have for you know seeking some solutions to help themselves with their well-being but also to try and improve the well-being of family physicians as a whole and so again really pleased with how that turned out and the feedback that we've gotten from those that attend attended and here's the construct that we used is you know again we're we're not trying to just help people keep from being burned out and just surviving or feeling fine we're really trying to help folks optimize their well-being and a sense of really thriving and feeling that they're growing as family physicians and so this is the approach that we take and Mark Greenawalt is our conference chairman and really did a stellar job of helping direct the curriculum and the activities at the three and a half days in the conference to really focus on that and so I'm excited to let you know that we have scheduled our second annual family physician health and well-being conference that'll be next June and that'll be in Phoenix Arizona at the Sheraton grande at Wild Horse Pass and I've been at other conferences there and it's a it's a wonderful setting it's going to be hot in Phoenix in in June but but it was interesting you know we were in Florida in April many of the folks there or from the Midwest and and you know we have people there from Wisconsin telling us they just had 20 inches of snow and the first week of April and so we encouraged people you know we knew you're very there for their health and well-being and so you know skip out on sessions go to the beach you know do things but artist sessions were all all three and a half days were we're packed and and so we know that that though it's going to be really hot in Phoenix you know the sessions will be indoors and it'll be nice and cool indoors some more resources that I really want to point out this is the most recent article in fpm that we published and this is a highlighting team-based model in Colorado and Cory Lyon it was the lead author on this and and you know I just think this is something that we need to be aware of that there are good models out there for Team documentation that really have improved physician satisfaction and decreased burnout in their study it decreased their physician burnout from fifty six percent to twenty eight percent in the group that utilized this team documentation model and what we've seen and heard from members and in discussions is that you know the team documentation or use of medical scribes there's different versions of this but in general it increases patient satisfaction because they get more eye contact with their physician it increases physician satisfaction because they're able to focus on the clinical aspects it has been shown the decreased burnout it's a cost neutral at about two additional patients per half day and it significantly decreases the work after clinic by about one to two hours a day on average and so a really good model to consider and so our practice advancement team has been developing a series of modules or tips that transform your practice and the modules that are available right now on quality improvement in your practice and impanel meant for your practice but the next one that's going to come out is on team documentation we think that's going to be a terrific resource to help folks find a way to you know to decrease the amount of time on the fingers on the keyboard and eyes on the screen and more focus on patience and letting the team do the documentation aspects of things for some of our members finding an alternative practice model is really what they've found to be most helpful about three percent of our members are now in a DPC model or direct primary care model but we know that up to forty percent of our members say they have looked into that model considering that model thinking about that and so you know we joked that when you go to a meeting you can tell which family Doc's are in a DPC model because they're the ones that are smiling and and we hear that from the folks that are in this have adopted this model and so we have a direct primary care or DPC summit coming up in Indianapolis in July and so if you want to learn more about DPC model that would be a good resource I mentioned that we're one of the co-sponsors with the National Academy of Medicine for their action collaborative on clinician well-being and resilience and I'd encourage you to look at what's just been released in April of this year and that's their knowledge hub and being one of the co-sponsors I'm fortunate to serve on the steering committee for this effort and co-chaired actually the working group that developed the knowledge hub and this is a collected resource of evidence-based and case based sort of solutions and and goes through the causes of burnout the effects of burnout but then a lot of focus on solutions to try and improve clinician well-being and so I would encourage you to check that out at na m dot edu slash clinician well-being that's the knowledge hub there a few more resources just to point out to you the AMA has a great set of resources at steps forward dot o RG that you don't have to be an AMA member to access these they develop these through her so grant and so but there are about forty some modules there most of them focused on things that you can do to improve at the practice level so steps forward dot o-r-g the Institute on for health care improvement or IHI you know who primarily focus on patient safety and quality improvement have developed a framework for improving joy and work and it really starts out with question number one there is what matters to you know why did you go into medicine why do you do what you do and then trying to build from there on you know implementing things in the practice that really highlight doing what matters most and I think this is really important for organizations to be looking at this and investing in these changes to try and improve the well-being of their workforce and then from an individual standpoint Stanford medicine well MD is a really nice set of resources again have multiple surveys that you can do to assess different aspects of well-being and satisfaction as well as multiple resources there so you know I believe that it all boils down to having a sense of meaning and purpose in what you're doing on a day to day beast basis and really feeling energized by what you're doing not beat down by what you're doing and to do that you have to have that both the ability and the resources to make a difference on a day to day basis for your patients you need to feel a sense of respect from your patients from the teams that you're part of from your colleagues from the system and part of that respect is being paid appropriately being paid well and getting the respect that primary care deserves in our system and then you know it relationships are such a big part of this and I mentioned feeling socially isolated and so we know that I think especially for family physicians those relationships with your patients with the communities that you serve with your own family with their teams that you're part of with your colleagues and trying to find ways to really strengthen those relationships and so your call to action is you know what are you going to work on and the five levels of the ecosystem you're going to try and help improve the system reforms implement fluence the organization's you're part of work on improving the practice and efficiencies and things that you can do to improve the practice level and you're going to commit to doing some things different on your own well-being behaviors and habits and you know will you role model the culture of peer support caring for each other and and helping folks not feel so isolated and and and and making it okay to focus on your own well-being and not just self-sacrifice so with that and and I like to make this point we're all in this together and the insurance companies aren't going to fix this the government's not going to fix this the hospital administrators aren't going to fix this insurance companies the pharmaceutical companies you know we can't wait for them to fix this it's got to be us so we all need to be involved in this so looking forward to answering questions hopefully I left a little time for that yes yes thank you so much dr. Knight so appreciate your time and expertise and Caitlin is going to move all of our participants over to panelists so that they can ask you questions great while she does that I'm gonna take the liberty of asking my own question if you don't mind from what you shared it looks like the aafp s well-being planner follows a traditional PDSA cycle yeah does the newly approved performance improvement activity utilized the well-being planner to satisfy its credit requirements yeah that's what we're trying to do we're working to build our practice improvement activity on the resources that are in the planner and the idea is and you know I give credit to the ABF M I was at a working party is a couple times a year the organization's had family medicine get together and so I just was having a conversation with Jim puffer who's the CEO of the ABF m and I told him about what we're doing with the well-being planner and that you know we want folks to to do something like the MBI then implement some changes and then repeat the MBI and see if if things improve and he said well you know that's a practice improvement activity that you absolutely would get credit for in the MOC world and so you know again I give them credit that they've been very willing to look at that and and support development of that and and yes we are claiming to have the well-being planner as a significant component of that activity that's wonderful thank you for doing a two-fold event there that you can do something good for yourself but also earn that valuable credit yeah wonderful hopefully we can turn this over we have several people that have participated dr. sparks do you have a question for dr. Knight or dr. casseras yes I do have a question I'm the president-elect of the mass Academy yeah I mean you know of course this is part of our strategic plan is focus on physician well-being and in our current strategy we're doing it as a kind of a PS wellness that it's the physician in the system itself that need to have wellness so my question to you is when will the first workshop won't be available for the state chapters to help us yeah the state chapter workshops we're shooting again for 2019 on that and what we're trying to do is you know we based this on for a long time the academies have the chapter lecture series which is a you know usually a one-hour lecture that there's put together and then chapters can adopt that and as we started looking at this you know one hour isn't isn't enough for this and so that's why we were calling a chapter workshop series and we would see this as a three to four hour you know kind of half-day workshop and we would take some of the best elements from the National Conference that we have and and try and you know localize that for for folks to be able to bring to their own states so I wish I had more specifics for you but that's the concept at least and and I didn't mention that you know we I think we have three of the presentations that were done at at this year's conference that will be loaded up on the portal in the next few months and it will be available for members to to see some of those same presentations that were done at the conference and they'll be eligible for seeing me for those as well okay great thank you sure great question keep them coming the only request I might have is I have some of the websites that I've written down here well wait is there a way for you guys at the Ohio Chapter to send them out by email yes part of our archive is we will also make sure that all of the resources that dr. Knight mentioned will also be available so we'll make sure that everybody who participated along with those that are joining us later will have access to those great thank you thank you any other questions for dr. Knight dr. Balester go for it oh yes how could I start even exercising you know it's like any suggestions how can you start this program it's like you know any suggestion it's like I've been very sedentary I spend too many hours competing the charge is like okay I should exercise but I'm not doing it any suggestions well yeah so you know using the format that we've got in our planner you know I think the first step is to acknowledge that you want to make that a priority and and make a commitment to that and be willing to revisit that commitment and and so I applaud you first of all on on recognizing that that's that's important and then I would say you know do something that you enjoy so I'm exercising on a regular basis which I find really helpful but I don't like to run and and the elliptical I kind of found boring and and I try and read while I'm exercising sometimes and that's hard to do but what I so what I found that I like doing this sounds kind of crazy but I like playing video games and so I have a stationary bike and I log into my ps4 and I play video games for about 40 minutes a day and I do that probably five to seven days a week travel so I don't always get to do it when I'm traveling but I've just I've found that I feel better when I do that and so I've just made it a priority and but I know that's hard because there's only so many hours in the day and you've got so many requirements you know at work and so I I don't mean to make it sound easy but my point is find something you enjoy doing and something you look forward to doing so that exercise doesn't feel like a an additional burden and so if that's walking or you know whatever that ends up being for you you know I was um it was really interesting at our conference give me about four hundred and fifty eight people at our conference we had optional yoga sessions in the morning and the first day we had two rooms set up that could accommodate about 30 people in each session and we found out right away that 60 was not enough we had so many people that we were having over a hundred physicians a day who were coming down to do yoga part of it they liked the community setting they liked being with other family Doc's but many of them because they always asked at the beginning of each session so how many of you are doing yoga for the first time you know and and there were so many people who were just trying that for the first time but lots of people who really found it enjoyable and so I would encourage you to try some things that you haven't even thought about you know doing and and find something that you enjoy doing that that again doesn't feel like a burden hope that helps thank you it's wonderful well thank you doctor night we really appreciate you leading our session today and providing such valuable insight into the tools and resources available to clinicians for combating burnout
#Exploring #Tools #Resources #Overcoming #Burnout
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