Physician Wellness at the Institutional Level

Over 50% of physicians report symptoms of burnout. This high level tells us that addressing wellness at the personal level is not enough. It speaks to a systemic rather than individual etiology. Organizations have begun to recognize it is in their best interest to keep their physicians happy. Losing even one physician to burnout is expensive. In addition, burned out physicians are liabilities. Mistakes increase. Productivity decreases. Patient satisfaction decreases. Ripple effects touch other members of the team, which leads to further burnout. If for no other reason, physician wellness at the organizational level matters since it affects the bottom line.

Fixes at the institutional level have primarily focused on time. Physicians have too little time to do what we need to do and to do it well. The EMR is regularly blamed as a time sink. Re-engineering the tools, environment, and systems of care delivery can help us save time. However, its not only a lack-of-time issue. What we do with our time also matters. We need systems that allow each person to work at the highest level of their training. Doctors can practice medicine while other team members do what they do best.

Finally, we  need to acknowledge the inherent conflict between the business of medicine and the practice of medicine—something physicians wear every day as we work with our patients.  Making these changes at the institutional level requires a change of institutional values to include physician wellness.

Physician Wellness at the Personal Level

Last week we introduced the idea of physician wellness at the personal, organizational and cultural levels. This framework for thinking about wellness allows us to explore its various aspects. Today we will address the first of these levels–physician wellness as an individual.

Most physicians know a fair amount about personal wellness and share information with our patients regularly. Although much of wellness is basic tenets by which we live, the demands of medical training and practice do not make it easy. Many physicians readily admit it is difficult to walk the talk. However a necessary condition of being the best physician we can be for our patients is taking care of our own health. It really isn’t–nor has it ever been–optional. Organizations and the culture of medicine are beginning to recognize what we already know.

The imaged posted above shows a wellness wheel with aspects of our personal wellness divided into wedges. Wheels roll best when they are round. And so it is with the wellness wheel. When one aspect is excessive, the wheel has a bulge and it thrown out of balance. Likewise, when one aspect is limited, it shrinks and also throws the wheel out of balance.

Of note, symmetry of the wedges is not the goal. The needs of our physical health may be represented by a bigger wedge than the needs of our financial health, for example. At other times, it may be just the opposite. Instead, our goal may be to give the “right” amount of attention to all aspects of our wellness as it is needed. Needs are constantly changing; our priorities and time will vary accordingly. Also note that the division of our personal wellness into the aspects shown in the image is arbitrary. We could make altogether different divisions or even none at all as we recognize each part of our personal wellness affects the other. Finally, we should note that no one can define your personal wellness for you. You know what your needs are and whether you are living a healthy, well–balanced life. You know what requires more attention. There is no competition. There is no judgment. Medicine is hard enough–this is a chance to be gentle with yourself.

Physical wellness addresses habits that support optimal health and functioning of our body. It means being as well as we can with what we’ve got; leading an active lifestyle, eating a healthy diet, getting adequate sleep, and balancing periods of activity with periods of rest. How do we do this given the demands on our time and energy? What works?

Research shows that our social health is also an important contributor to our overall wellbeing. Examples of the social aspect of our wellness in medicine include creating a collegial work environment; enjoying time with friends and family; and developing professional and personal support networks. We all have stories of the toxic work environment. How do you recognize unhealthy situations and what did you do to distance yourself without causing professional suicide? What have you found that helps? How do you balance your social needs with the need for quiet, uninterrupted personal time?

Other aspects of our personal wellness will be explored in upcoming weeks and months. In the meantime, share with us your thoughts about the various aspects of physician wellness at the personal level.

Join us next week as we move ahead in our series to take a deeper look at physician wellness at the organizational level.

Physician Wellness 101

 Is physician wellness about meditation and yoga? Do wellness classes benefit physicians if they are mandatory? What if they are scheduled at a time that conflicts with family obligations? Are today’s physicians simply entitled complainers? What about physicians being victims of an abusive system? An overview of physician wellness starts with a discussion at three levels: personal wellness, organization wellness and wellness within the culture of medicine.

Physician wellness at the personal level includes what we all know and preach: Get adequate sleep. Eat healthy foods, mostly vegetables. Lead an active lifestyle. Surround yourself with healthy people. Set healthy boundaries. Develop a support network. Establish care with a primary care physician. Manage your finances. Care for your spiritual needs. Maintain intellectual pursuits across your lifetime. Physician wellness at this level focuses on life skills and habits that support our resiliency and promote our overall well-being.

It is well known that greater than 50% of physicians report symptoms of professional burnout. (1)  When a group of highly resilient and dedicated physicians report that they are suffering, we must give pause. This level of burnout speaks to a systemic rather than individual etiology.

Physician wellness at the organizational level is gaining remarkable traction in the past few years.   Organizations recognize it is in their best interest to keep their physicians happy. The costs and consequences of physician turnover are substantial and may include financial consequences, patient satisfaction, and effects on the organization whole. (2)

Focus on the organizational level leads to many questions and potential solutions, all of which will vary with local circumstances. National physician organizations, international conferences, and smaller meetings with leaders across the country are focusing on physician wellness at the organizational level.

Wellness within the culture of medicine is the third level of physician wellness to examine. Western medicine has its own set of customs, traditions and values that are learned early in the course of medical training. The value of sound scientific methods, the importance placed on logic and reason, and the significance of professional integrity are examples. When examining physician wellness at the cultural level, we must also address discrimination in its many forms. For example, overt racism and misogyny are everyday occurrences for many physicians and surely affect everyone within the culture of medicine.

Yes, mindfulness in medicine is important. Very important. But physician wellness is more than practicing mindfulness. It is complex and changing. Some attempts at progress might prove to be a step-backward. Nevertheless, physician wellness is essential if we are to provide optimal care to our patients. Follow-up next week as we continue our series on a closer look at physician wellness.

1. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Shanafelt, Tait D. et al. Mayo Clinic Proceedings , Volume 90 , Issue 12 , 1600 – 1613.

2. A Review of Physician Turnover: Rates, Causes, and Consequences . Misra-Hebert, Anita D. et al. American Journal of Medical Quality, Vol 19, Issue 2, pp. 56 – 66.

The Institute for Physician Wellness: Dr. Kathy Stepien

Dr. Kathy Stepien is a pedicatrician who came to medicine as a second career after many years as a physical therapist. During her journey from experiencing burnout as a physical therapist through graduate school, medical school, residency and her practice as a pediatrician, Dr. Stepien learned many strategies and lessons that she shares with other physicians through the Institute for Physician Wellness.

In today’s episode, we discuss Dr. Stepien’s journey, the founding of the Institute, and its mission and offerings for physicians who are seeking wellness at the individual, institutional, and culural levels.

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Physician Wellness in Turbulent Times

Many physicians have been struggling following the results of this week’s national election. You are not alone if you have felt shocked, fearful or angry. It may be difficult to know how to make sense of the news in the midst of the demands on your work. Many of your patients may experience increasing discrimination based upon race, gender, ethnicity, religious beliefs, and sexual orientation. They need reassurance that they can still turn to you for excellent medical care. There is comfort in knowing that your commitment to medicine is longstanding and will remain constant despite any turmoil that lies ahead.Continue reading

A Mother in the House

As recently seen at the Huffington Post:

Dear parents,

Congratulations on your daughter’s acceptance into medical school. Like the first day of kindergarten, this launch is notable for parents as well as children.

You may have some concerns about the stresses she will face. Having been there, I can tell you there will be many. Not to worry, though. Times are changing. You daughter is free to learn among the brightest of the bright while avoiding the harassment women before her have faced. She will be pushed hard and much will be expected of her. However, she will not be discriminated against simply because she is a woman or may someday become a mother.Continue reading

Taps

They played Taps at my dad’s funeral. Two teenagers on trumpets. First the girl, positioned to the back and left of the crowd. Ta-ta-dah, she starts boldly, without the unease of her youth. Each simple note pierces the dry winter air.

Yes, you have our attention. Not another sound. Not even a breath by gathered friends and family.Continue reading

Living the Oath

“I solemnly pledge to consecrate my life to the service of humanity.”  Standing  with my medical school colleagues, we continue; “I will respect and hold the secrets that are confided in me. I will exercise moral integrity.” I easily agree. But then, “The health of my patient will be my first consideration.”  I’m 40 weeks pregnant, with swollen feet and raging heartburn. My baby kicks wildly. With certainty, I know that living this part of the oath will be much more difficult than saying it.Continue reading

It’s not (only) about the starfish

I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:

A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again the boy kept hurling things into the ocean.Continue reading