Portland doctor says many factors behind rising burnout, has recommendations for relief

According to recent surveys, the number of people who say they are experiencing burnout is on the rise. Dr. Zarya Rubin, who practices functional medicine in Portland, specializes in identifying and relieving burnout. She started a podcast last year that she both produces and hosts called “Outsmart Burnout.” She says burnout can manifest as physical and mental exhaustion, brain fog, an increase in anxiety and a decrease in productivity. The factors that contribute to this phenomenon can include almost every aspect of life, from work and family dynamics to national politics. We sit down with Rubin to hear more, including her recommendations for getting relief — and take your calls. Our call-in number is 888-665-5865.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Recent surveys have found that more people now say they are experiencing burnout than in the past. From work requirements to family obligations to societal fears, people are reporting increasing levels of exhaustion and overwhelm. This is what Zarya Rubin focuses on. She’s a physician who specializes in identifying and relieving burnout. She’s also the host of the podcast “Outsmart Burnout.” And she joins me now. It’s great to have you on Think Out Loud.

Zarya Rubin: Thank you so much. It’s such a pleasure to be here.

Miller: And listeners, if you are feeling burned out these days, we would love to get your calls, if it’s not gonna add too much to your plate. You can give us a call. We also want to know what, if anything, is helping you right now. You can share your experiences by giving us a call.

How do you define burnout?

Rubin: That’s a great question. It’s sort of one of those things that people often hear about, and it’s very popular in the news and trendy, but sometimes it can be difficult to put your finger on it. There are actually specific criteria that define burnout as a phenomenon. And burnout was recognized by the WHO in 2019 as a workplace phenomenon, basically relating to inadequately managed stress.

But the phenomenon itself was described in the 1970s by psychologist Christina Maslach and psychiatrist Herbert Freudenberger. And there were sort of three pillars or main criteria that defined burnout. The first one being exhaustion. And that can be a combination of physical, mental, emotional exhaustion. And it goes beyond just, “well, I’m tired and I didn’t get a good night’s sleep.” It’s this deep bone tiredness that often means you have difficulty getting out of bed in the morning.

The second criteria or characteristic that defines burnout is a little trickier to grasp, and that is cynicism. That basically stems from a feeling as though nothing that you do matters. Maybe your values are misaligned with the organization or the job that you’re in. And you kind of are not caring as much about the work that you used to do.

Then the third pillar is decreased professional efficacy or productivity. So just a feeling that you’re not as efficient or effective in what you’re doing. And again, that you know your work isn’t valued. You don’t matter. The work doesn’t matter and you’re exhausted. And it all kind of comes together in this picture of burnout.

Miller: It’s important that, at the beginning, you did say that these definitions or these criteria are workplace related. Do you think of this as necessarily tied to work?

Rubin: I actually definitely don’t. And I think that the definition of burnout and the concept is broadening over time, especially as it relates to parenting, relationships. Certainly the caregiving burden has been examined in studies. And we’re also just seeing societal burnout at a larger level based on the world that we’re living in and everything going on around us. It’s kind of unprecedented. So I think it goes beyond the workplace.

Miller: I want to play a voicemail. We asked folks in the last couple of days for their stories of what they’re experiencing. This is Curtis from Portland.

Curtis [voicemail]: I’m a boomer and I’m close to retirement. And yeah, I’ve got burnout for the regular reasons, I suppose. But in the last year, the feeling of burnout and dread, and just deep-gut sadness has been overwhelming. I suspect that it’s about what’s happening to our country and our government, how it’s turned against us, how we are losing the things that I’ve believed in and held dear my whole life – our Constitution, our freedom, our democracy. And yeah, that’s causing burnout and deep sadness.

Miller: Zarya, how much do you hear about burnout from your patients, clients or people you’re talking to who specifically, like Curtis, are talking about politics or the state of our republic?

Rubin: I would like to say it’s not common, but it is extremely common. It’s probably the most common thing that I hear these days, that people are very, very distraught about the state of the world and current politics. Curtis’s situation is not unique. He is not alone. In fact, the American Psychological Association did a study of stress in America in 2024 and looked at political stress and factors, and it actually crosses party lines. So 80% of Republicans, 79% of Democrats and 73% of Independents really did cite that political stress was a huge problem for them.

Miller: Is your advice different if the precipitating factor is something that is, to a great extent, outside someone’s control? I mean, we can talk more about family obligations and work. But it seems like, not always but in some ways, we have a little bit more ability to exert some level of control or make choices within those contexts, more so than if we’re talking about what’s happening at the governmental level.

Rubin: Sure. And I think that that is a bit of an almost paradoxical situation where, yes, it’s outside of your control, yet it affects every aspect of your life, and your desire to stay informed and engaged is at odds with your desire to maintain your mental health. So I think that it’s a very tricky balance that we try to strike between setting some boundaries around your exposure to the news and to whatever is going on politically in the world, versus staying engaged and not feeling so hopeless or helpless. Because that in and of itself can contribute to burnout.

Certainly, surrounding yourself with community and like-minded individuals, and actually taking action and taking small steps – calling your lawmakers or getting involved on some small level – really does help alleviate that feeling of hopelessness and helplessness that can contribute to what Curtis was talking about.

Miller: Let’s take a call from Bea who has called in from Portland. Bea, go ahead.

Bea [caller]: Hi, good afternoon. Thanks for taking my call. I just wanted to uplift the burnout feels and looks really different for BIPOC communities. As a woman of color, I am recognizing that there are less resources, especially when it comes to work, to support my burnout. And I often give feedback to other staff of color, acknowledging that at the end of the day, this job doesn’t care about you and your health. I don’t care what anybody says. Your employer will replace you just as quickly as they hired you. So making sure that folks are protecting themselves, because at the end of the day, no one else is going to.

Miller: Can I ask, how do you … it sounds like not only are you dealing with this yourself, but you’re also giving this advice to others. But, what techniques have you developed for yourself?

Bea [caller]: To be really transparent, I work remotely, hybrid. So one big indicator for me is if I’m about to cuss somebody out, then I need to log off.

Miller: Good sign.

Bea [caller]: It’s as simple as things like that. My body is telling me, I’m going to set off, I need to log off. And to also be OK with that, because if I’m not taking care of myself, literally no one else will.

Miller: Thanks very much for that call.

Zarya, there’s a couple of things that I’d love you to respond to. One, the first, the biggest point that she was making there about the disparate impacts societally, whether we’re talking about People of Color … we could talk about gender as well, which I want to get to. But how do you think about burnout hitting different groups of people differently?

Rubin: That’s actually a really salient point. And burnout does affect different populations and different people differently. So obviously, there is a gender difference. Women are significantly more affected than men.

Miller: Why?

Rubin: Well, that’s a great question. And there’s a number of hypotheses as to why. One of the main reasons being the second shift phenomenon. Even women who are the primary breadwinners and who go to work all day, come home and still often bear the lion’s share of all the work at home. So whether that’s childcare, housework, etc., there’s a lot of burden placed on women. There’s the unspoken, unpaid emotional labor and mental load that women take on. And then there are also, we can’t ignore all of the biological and hormonal differences that women have to go through, whether it’s pregnancy, or the elephant in the room that’s become a very hot topic these days is perimenopause and burnout. And we see a high correlation with women going through perimenopause and menopause, and increases in burnout.

And then the last population that I think maybe doesn’t get as much attention is the younger generation. So actually, it’s millennials and Gen Z who are experiencing the highest rates of burnout currently at about 83%, and they’re also experiencing burnout at a much younger age. So starting at around age 25, whereas in the past for previous generations, maybe our generation, the average age of onset of burnout was around 42.

Miller: Let me see if I can ask this question in a way that’s sensitive to younger generations than yours and mine. I think we’re about similar ages. Do you think that’s because work and the economy have changed or because younger people have changed?

Rubin: I think it’s really multifactorial. But I think that the environment that young people are being placed in has changed and not for the better in terms of job security, in terms of opportunity, in terms of the current economic situation. When it comes to the onslaught of technology and the overload, and the 24/7 availability that employees are expected to fulfill these days ... I mean, gosh, when I was a young person and working, there was no email, there was no internet, there was no 24/7. You went to work and then you went home. And you could leave your job where it was, to some extent. So I think that all of those factors combined are just not a sustainable situation.

Miller: I want to pick up one other point that we got from Bea, which is when I’d asked her how she copes and the example she gave was if she realizes she’s going to cuss somebody out, she logs off. But it seems like that comes from a level of self-awareness from recognizing maybe from previous behavior when she’s close to a breaking point. How do you recommend people get to that point, sort of paying enough attention to what they’re feeling so that they can take care of themselves in the ways that they need to?

Rubin: I mean, hats off to Bea. She’s doing an incredible job and she’s absolutely correct. I think we definitely should acknowledge that individuals of color and neurodivergent individuals do bear a lot of the brunt of burnout in the workplace, due to either microaggressions, lack of accommodations or all sorts of factors. And so she is already bearing a greater burden. And she also has the insight and the self-awareness to recognize that.

She has altered her workplace situation such that she’s figured out that a hybrid situation works better for her. And if we got anything out of the pandemic, it was the fact that we learned that we can still be productive, and in fact, often more productive when we have these hybrid work opportunities. But yeah, you have to sort of figure out what your body is telling you and listen to those signs and symptoms, and not ignore when your check engine light goes on and just carry on, because eventually it catches up with you.

Miller: Let’s take another call. This is actually a voicemail we got. This is Dylan from Bend.

Dylan [voicemail]: Yeah, burnout, man. I didn’t have a normal COVID experience. I was in the service industry and I got like two days off. And then I was right back to work immediately. I mean, that experience of never getting a day off, covering all the shortages, into the rising cost of living and the rise of the second Trump administration have been incredibly draining emotionally. And I don’t know what else to do other than just keep going to work every day. That’s kind of the only thing to do, which compounds the issue. And it makes dealing with normal life happenings, like the death of my father or natural aging process of everybody and the way that that influences the political dynamics within the family, become nearly impossible to deal with. And it’s not just me. Everybody in my family is kind of just doing their own thing.

Miller: You know, one of the things that I took from this is the very helpful reminder – that you had just talked about and we heard from Bea – the possibility of hybrid work. That’s obviously not an option for everybody. In Dylan’s case, he was saying that throughout the pandemic, he had a service sector job and he took two days off the entire time.

One of your bits of advice – this was the theme of a TED Talk you gave – is, do one less thing. But what do you say to people for whom that may not be, especially work-wise, a possibility?

Rubin: Well, I think that oftentimes there are very small microscopic ways, these micro breaks, that we need to learn to build into our lives, even if we have extremely busy lives. I made a joke in my TED Talk that as a physician, physiologically, it’s this fascinating fact that I never knew that physicians don’t go to the bathroom. We don’t pee. Now, obviously that’s not true, but that was the mindset that you had that even a physiologic need was not important. You could put that to the back burner, and you just had to push through and keep going.

Now, obviously, if we had taken breaks, small breaks throughout the day, would that have impacted patient care? Absolutely not. Would it have impacted our own well-being? Quite possibly. So even when you’re in a stressful situation, if you have a very demanding job, if there’s not a lot of opportunity for breaks, even taking five minutes to do some breathing, even going outside on your lunch break for a short walk rather than being at your computer or doom scrolling on your phone, these micro actions that we can take to take back some of the control over a very stressful circumstance, that often we can’t alter, can make some modicum of difference.

Miller: Zachary has called in from Eugene. Zachary, go ahead.

Zachary [caller]: Hi Dave. I’m a big fan of the show.

Miller: Thank you. What’s your experience?

Zachary [caller]: Well, I hadn’t heard anybody touch on the importance of exercise quite yet. I work about 50 hours a week. I’m a single parent full time and feel the specter of burnout on the horizon just about every day on my way home in the car. You’ve been on the grind and just don’t know how you’re going to just get through the chores and dinner and everything for the evening ahead. But I make it a habit to go from work to the gym, and by the time I get through just an hour of exercise, I am rebooted. It’s counterintuitive because everything in you is just telling you to go onto the couch and lay down, but if you work that into your schedule, then it’s just amazing how the endorphins, serotonin, and all that stuff carries you through the rest of the night and just in general.

Miller: Zachary, thanks very much for that call.

Sorry, Dr. Rubin, I mentioned you’re a physician as well as somebody who’s focused on burnout in recent years. Apropos of Zachary’s call, I wonder if you could tell us what burnout or chronic stress literally does to our bodies? And also why is it that, as he said paradoxically, for him and for many people, actually working your body sometimes hard can make a tired overall human existence weirdly a little bit less tired?

Rubin: Obviously as human beings, we’re complex systems and we have a lot of built-in mechanisms that help us survive and thrive in the world. And one of those systems is the nervous system and something called the HPA axis, or the hypothalamic pituitary adrenal axis, which is known as the stress axis. So we’re basically designed to be able to endure stress, withstand stress and respond to stress in short bursts. And that whole complex system has a feedback loop – you’re exposed to stress, your body responds, releases certain hormones like adrenaline and cortisol, and then the system helps turn itself off.

When everything’s working smoothly, stress, it’s actually kind of a good thing. It can help you be more productive. It can help you build muscle and things like that. And it can also help you escape from a saber-toothed tiger as these systems have evolved. But it’s when these systems get somewhat out of whack, when there’s a chronic level of stress, when the stress becomes sustained and unmanaged, those feedback loops and systems get overly stressed, and they don’t start to respond the way they’re supposed to. So there’s less tolerance for stress, the system starts to break down, and then that has a whole cascade of effect and influence on pretty much everybody’s system, but especially the cardiovascular system, inflammation in general.

So small amounts of stress, good. Large amounts of stress or prolonged stress, not so good for the body.

Miller: Let’s listen to another voicemail right now. This is Cheryl who called in from Corvallis.

Cheryl [voicemail]: I am a late diagnosed autistic parent to two autistic children, trying to manage and understand my own mental health and all the trauma that being a neurodivergent in a neurotypical world has caused me over the years. Plus navigating our health care system. I could work a full-time job just calling referrals, doctors, insurance, getting quotes, trying to figure out if there’s a provider in my area that will see them. It’s brutal. That’s what’s burning me out.

Miller: How does a health care system that is supposed to help people, itself lead to more burnout?

Rubin: Well, I think we just heard from this caller. She described it so aptly. I mean, there’s a couple of ways that our current health care system doesn’t support us. It’s a sick care system rather than a health care system. So there’s not a lot of preventative care built into what we do and we generally wait till things have gotten to a certain point before we address them or treat them. And that’s just the way we’ve set things up, but I don’t think it’s the optimal way for human health.

Then of course, there’s the system in the U.S. which ties health insurance to health care, and health insurance is often tied to your job. So no matter how difficult your work situation might be, you may have to stay in a job in order to maintain health insurance, in order to get treatment for whatever conditions that you have or whatever mental health conditions that you have. So it becomes this vicious cycle. But I think she nailed it in terms of we really need to support families and parents, and make health care more accessible and make the system easier to navigate.

Miller: Your own personal story is that you gave up what had been a dream career as a neurologist after going through all the training, years and years of training. But it seems from the outside that you traded one intense career for another version of one as still a physician, as a kind of life coach, as a podcaster, as a speaker. How much are you able to follow your own advice?

Rubin: [Laughter] You know, do as I say, not as I do. But so you’re absolutely right. I think when you have a certain type of personality and a certain childhood background, you are more predisposed to seek out high stress, high achieving environments. And I certainly did that as a physician, and then I went from the frying pan into the fire and went to work at a startup. Then I worked in corporate America, climbed the corporate ladder and became an executive, and had multiple burnouts along the way.

Then I realized there’s only so long you can blame the outside system. You have to look within and think, what is it about me that is seeking out these circumstances and situations? So I did a lot of work on myself and now of course, yes, my life is complicated and stressful, but I have a lot more control over it being an entrepreneur, working for myself, choosing what opportunities I get to pursue. So I’m extremely lucky in that regard. And not everybody has that opportunity.

So I feel very, very lucky to be doing what I’m doing, and to be very passionate about the work I do, and to be able to help other people navigate their situation. I’ve sort of walked through that fire.

Miller: Marcy has called in from Portland. Marcy, go ahead.

Marcy [caller]: Hi, yes. I was a chaplain in a hospital during the pandemic and that was a very, as you can imagine, stressful situation.

Miller: Actually, I can barely imagine it.

Marcy [caller]: Well, yeah, that’s true. That’s true. Thank you. I didn’t feel like a hero, but it was a stressful situation, obviously. But one of the things that I did during that time was certainly go for walks and all of these things, but the other thing is that I have been involved with interplay, which is an active, creative way of unlocking the wisdom of the body. We do a lot of movement, singing, playing and talking, but it’s a way of getting at our wisdom, understanding ourselves and getting rid of some of the stress during the process. So it’s been a lifesaver for me over the years and I can talk more about that if you have questions.

Miller: Well, thanks very much for that call. Zarya, I’d love to give you a chance to respond.

Rubin: Yeah, so she actually spoke to some things that are very near and dear to my heart. I studied to become an opera singer and I’ve been singing in choirs since I was very young. I currently sing with the Portland Symphonic Choir. Singing is one of the activities that actually helps regulate and calm the nervous system through activation of the vagus nerve. And when you sing in a choir, you help synchronize your breath and your heartbeat with other humans, and that can also help alleviate things like stress, anxiety, depression, dementia, burnout. So there’s lots of ways to step outside the thinking brain, because sometimes we can’t think our way out of burnout. Sometimes we have to go through the body and really try to feel our way through.

Miller: We have time for one more voicemail. Let’s have a listen.

Kelice [voicemail]: This is Kelice from Portland, Oregon. And I feel like all I can do to cope is to breathe in and breathe out, over and over. And sometimes with a dragon’s breath, like “AAAAH” [takes a loud breath] and sometimes just a deep sigh [takes a deep breath], just to make it through. I read something about ICE, and human rights abuse, and crimes against children, and United States citizens being held with no due process, and war being instigated for money. And that’s like the breath in. The breath out is my dogs, people’s kindness, just smiling at somebody again, a little bit of sunshine, friends who call and just check in to see how I’m doing mentally because we’re all struggling and it’s not easy right now. It’s actually really, really hard, and we keep going on and moving on like it’s all fine, and it’s not fine.

Miller: Kelice, thanks very much for that call.

Zarya, before we say goodbye, we have about a minute left. I’m wondering how you encourage people to deal with burnout in a way that doesn’t make it seem like dealing with burnout is another thing on their plate?

Rubin: Yeah, that’s the paradox of dealing with burnout. But I think something that this caller just said is the first step, and that is maybe acknowledging that everything is not fine. So no, everything is not fine. It is taking that step back and truly appreciating the situation that you’re in. And acknowledging that, no, this is not fine. No, this is not sustainable. Changes need to be made. And those changes, rather than potentially doing more, could be by scaling back, could be by doing less, could be by reevaluating just your role in the company, your job, perhaps it’s a different role, different job. Perhaps it’s a different career, and perhaps it’s just taking a leave of absence and some time to heal.

Miller: Zarya Ruben, thanks very much. Zarya Rubin is a physician and a burnout specialist. She’s the host of the podcast “Outsmart Burnout.”

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