How to Manage Burnout
The way burnout actually arrives
Burnout is insidious.
It starts slow. Quiet. Small enough to be mistaken for a hard week, a bad month, a stretch of poor sleep. The first symptoms are easy to explain away. A little extra fatigue on Wednesday afternoons. A flatness in the work that used to feel alive. The need for a second coffee that used to be a third on bad days. A mild resentment of the inbox that did not exist last quarter.
It builds underneath the surface of a competent professional life for a long time before it becomes visible. The clinician is still seeing her clients. The parent is still packing lunches. The founder is still showing up to the meeting. The work is, from the outside, the same work.
And then one Tuesday, the burnout becomes loud. Disabling. Chronic. The same clinician cannot bring herself to open her EHR. The same parent is crying in her car at school pickup. The same founder is staring at her laptop unable to remember what she was supposed to be doing for the last 40 minutes. The slow quiet thing has become the loud thing, and the loud thing is now running her life.
This is the part I want to write about today. The gap between the slow quiet phase and the loud disabling phase is where most of the meaningful intervention can happen, and recognizing the early signal is a learnable clinical skill that most of us are picking up on our own.
Burnout is common
The data on this is grim and clarifying.
A 2024 meta-analysis of 10 studies and over 10,000 dietitians and nutritionists found a pooled burnout prevalence of 40.43% in our profession (Hatamian et al., 2024, BMC Psychology). In Canada, over 57% of registered dietitians reported moderate to high overall burnout scores (Gingras et al., 2010). A 2025 brief from the Council on Future Practice estimated more than 6 in 10 dietitians are affected. Healthcare worker burnout overall sits at 40 to 51% in the pre-pandemic literature and surged as high as 76% during COVID (Navinés et al., 2021).
The numbers are higher inside the systems designed to maximize telehealth labor. Longer daily EHR duration is associated with a 2.43-fold increased odds of burnout (JMIR Medical Informatics, 2024). Platforms that pay per session, that auto-book the next client into a fifteen-minute gap, that algorithmically optimize for clinician throughput, are by design generating the conditions under which burnout becomes mathematically inevitable. The clinician is the variable being optimized against, and the optimization is working.
This problem extends far past clinicians. The same data signal shows up in nurses, in teachers, in social workers, in primary care physicians. It shows up in stay-at-home parents holding the full executive load of a household. In caregivers of aging parents. In partners who have become the unpaid emotional infrastructure of someone else's recovery. In small business owners. In gig workers. In anyone whose role has been quietly expanding without a corresponding expansion of resources or rest.
The World Health Organization defines burnout as an occupational phenomenon with three dimensions: feelings of energy depletion or exhaustion, increased mental distance from one's job, and reduced professional efficacy (WHO ICD-11). Those three dimensions describe an extraordinarily wide swath of modern life.
If you are reading this and recognizing yourself, you are in good company. The company is, in fact, far too large.
Burnout is treatable
This is the part I am going to take some time on, because the public conversation about burnout often stops at "you have it, here is some self-care" and the actual treatment requires considerably more than that.
Burnout is treatable. The treatment is slow. The treatment is what a dietitian colleague of mine calls a marathon mentality. You arrived in this nervous system state over many months or years, and the way out will take a similar arc.
Here is what the work actually looks like.
Give yourself permission to reset. A reset is a clinical intervention. It is the slowing-down that the system has been telling you it needs for months or years. The reset will look different for different people. For one client of mine, it was a two-week leave from work that her practice resisted and her body insisted on. For another, it was the gradual reduction of her client caseload from 38 to 22 sessions a week. For another, it was the simple decision to stop working past 6pm regardless of the inbox. The smallest reset counts as long as it actually happens.
Lower your expectations of yourself for a defined period. A nervous system in burnout cannot perform at the level it performed at before burnout, and asking it to do so is part of how it got here. Lower the bar on output, on responsiveness, on perfectionism, on the inner standard you have been holding yourself to. Let "good enough" become the operating principle for a season. The work you produce at 70% of your usual capacity, while in active recovery, is genuinely fine. The work you produced at 110% of your usual capacity while running on fumes was always costing you something, even when it looked impressive from the outside.
Take care of yourself, and figure out what has been getting in the way. This is the part I want to handle gently and firmly at the same time. If you have been unable to take care of yourself for a long time, there is a reason. The reason is almost always structural. A job that takes more hours than it gives back. A household configuration that has been quietly assigning you all the invisible labor. A financial pressure that has made every minute of your day load-bearing. An old internal rule that you do not deserve rest until the work is done, which has been laundered through years of therapy without ever quite getting dismantled.
Identify what has been getting in the way. Make a plan to address it. The plan will not be perfect. The plan is allowed to be small. The plan is allowed to take six months. What it cannot do is continue to not exist.
Be gentle, and then be firm and assertive with your boundaries. The gentleness is for the part of you that has been holding too much for too long. The firmness is for the systems and people that have come to depend on you continuing to hold too much for too long. Both are necessary. The gentleness without the firmness will keep you exactly where you are. The firmness without the gentleness will turn the recovery into another thing you are performing.
Rest is the most important tool. I want to say this clearly, because the wellness industry has muddied it. Rest is the active physiological process by which the nervous system, the immune system, and the cognitive system repair themselves. Sleep specifically is a load-bearing structure of human functioning (Walker, 2017). Rest in burnout recovery is the equivalent of a leg cast in a tibial fracture. You heal a fracture by stopping the loading, immobilizing the limb, and giving the tissue time to remodel. The same biology applies to a burned-out nervous system.
Get clear on goals and motivators. Once the acute exhaustion has lifted enough that you can think again, the next clinical question is whether the position you are burning out in is the position you actually want to be in. Sometimes the answer is yes, and the work is to renegotiate the conditions inside that role. Sometimes the answer is no, and the work is to plan an exit. Both answers are valid. Burnout in the wrong role is a different clinical event than burnout in the right role under wrong conditions, and the treatment for each one is different.
The foundational supports matter more than usual. Nutrition. Hydration. Sleep. Movement. Stress management. Social support from people who know you. Family support if it is available. Community support if it is not. These are the inputs the nervous system needs in order to do the repair work that burnout requires. They are also, predictably, the inputs that are hardest to maintain while you are inside the burnout. Which means the smallest, most accessible version of each one is the version that counts.
It is okay to only take the first step today. The rest can be figured out tomorrow.
The fantasy that burnout recovery requires a complete life overhaul, immediately, is itself a symptom of the burned-out cognitive pattern. The actual recovery is one decision at a time. The first decision is often something as small as going to bed an hour earlier tonight, or telling one person at work that you cannot take on the new project, or moving the gym back into the schedule. One decision today. Another one tomorrow. That is the whole protocol.
What I want clinicians to know
If you see clients, you are also likely to see burnout in yourself. The same nervous system you are using to co-regulate your clients is the nervous system that has been carrying their stories all day, every day, for as long as you have been practicing.
There is a body of work on vicarious trauma and compassion fatigue that names this directly (Figley, 2002). The clinician who is not actively attending to her own nervous system is the clinician who will eventually deliver an intervention out of her own activation, and her clients will feel it before she has noticed it in herself.
Your burnout is a predictable outcome of doing this work without the structural supports the work requires. Calling it a personal failing has the structural problem exactly upside down. The structural supports include rest, supervision, peer consultation, your own therapy, a financial floor that is not constantly under threat, and a caseload that has been built around your own nervous system capacity first.
If you are running your own practice, you have the unusual privilege of being able to design these supports into the structure. If you are working inside someone else's system, the work is to advocate for them, or to plan an exit toward a structure that includes them.
Either way, the burnout is information. It is information about the gap between what your nervous system needs and what your current configuration is providing. Close the gap. The work depends on it.
A reflection for your week
If any of this is landing, try this.
Choose one of the foundational supports from the list above. Sleep, nutrition, hydration, movement, social contact, or your own therapy. The one you have been most quietly neglecting. The one your last six months would tell on you about.
Take the first step toward it this week. Just the first step. Bedtime earlier on three nights. A grocery order placed on Sunday. One text to a friend you have been meaning to call. One email to a therapist whose website you have had open in a tab.
Notice what changes in the next seven days. Notice what does not change. Both data points are useful.
Where this leaves us
Burnout is insidious, common, and treatable. The insidious part is what makes it dangerous. The common part is what makes it shame-free. The treatable part is what makes the rest of this newsletter relevant to your week.
You inherited this nervous system state from a set of conditions that were poorly matched to the human you are. The work is to change the conditions, slowly, deliberately, one decision at a time, with rest as the most important tool and the first step as the only step you have to take today.
The rest can be figured out tomorrow.
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References
Figley CR. Compassion fatigue: psychotherapists' chronic lack of self care. Journal of Clinical Psychology. 2002;58(11):1433-1441. doi:10.1002/jclp.10090
Gingras J, de Jonge LA, Purdy N. Prevalence of dietitian burnout. Journal of Human Nutrition and Dietetics. 2010;23(4):367-374. doi:10.1111/j.1365-277X.2010.01062.x
Hatamian S, et al. Prevalence of emotional burnout among dietitians and nutritionists: a systematic review, meta-analysis, meta-regression, and a call for action. BMC Psychology. 2024. PMC11667849
JMIR Medical Informatics. Evaluating the prevalence of burnout among healthcare professionals related to electronic health record use. 2024. JMIR Med Inform 2024
Maslach C, Leiter MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. San Francisco: Jossey-Bass; 1997.
Navinés R, et al. Work-related psychological distress and burnout in healthcare workers during the COVID-19 pandemic. 2021. PMC10587722
Porges SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W.W. Norton; 2011.
Walker M. Why We Sleep: Unlocking the Power of Sleep and Dreams. New York: Scribner; 2017.
World Health Organization. Burn-out an "occupational phenomenon": International Classification of Diseases, 11th Revision. WHO ICD-11
Emahlea Wilcher, MPH, RD, LD, is the founder of New Approach Health and creator of the Psychonutrition framework and CPsyN™ credential.