Expert Forum: For physician well-being, leadership needs to lead

  | December 17, 2018

With so much focus on physician burnout, many healthcare organizations have turned to physician wellness programs to assist and support their employees. Often these include mindfulness tools, resiliency training, and other tactics designed to help address what Kevin Ban, M.D., athenahealth's Chief Medical Officer, refers to as “the PTSD of a broken healthcare system manifesting itself as physician burnout."

athenaInsight spoke with a panel of healthcare leaders and frontline physicians to understand how organizations can go beyond band-aids to make the organizational and systemic changes required to ensure a sustainable medical workforce.

Here are edited excerpts from our conversations; please add your observations in the comments section, or tweet us your thoughts @athena_Insight.

On burnout and leadership

Ban, athenahealth. Providers are smart people. If this were solvable with mindfulness or a yoga class, we would have solved the problem already. It's simplistic to think that doing any of those things in isolation will matter if they're the only things that are done. We need leadership to recognize there's a serious problem and to be dedicated to fixing it. That's really where it starts.

Joseph DeVeau, M.D. family medicine physician at First Georgia Physician Group, a Privia practice. Resiliency and meditation are great, but when you are told these are the skills you need to muster through our dysfunctional healthcare system, you start to think “there must be a weakness with me as a physician." But, when the organization comes forward and says, “Okay, this is much bigger. This is not about you. This is about our fragmented, silo'ed, crazy healthcare system," it's validating for physicians and critical to the success of a wellness program. It signals that leadership knows this is vital to the organization financially, strategically, and to the health of the organization overall.

Ruth Ann Parish, pediatrician and medical director at Community Health Center of Snohomish (a county just north of Seattle). For about five years, Community Health Center of Snohomish (CHCS) has been taking the approach that the onus of preventing burnout should not always fall on the physician. That the organization bears some of the responsibility and should be stepping up to fix it.

On wellbeing tactics

Parish. It starts with finding out what's going on. We do a quarterly survey of providers rating them on a standardized burnout scale. It is good information for the organization, but we also want people to monitor themselves, and figure out, “Am I burning out here?" Or, “What can I do to change my life a little bit?" - things like that.

DeVeau. At Privia, they're really relying on us physicians to lead the charge, because when it's physician-led and physician-driven that creates instant credibility and buy-in. Physicians understand that this isn't just window dressing.

Parish. Support from colleagues can be critical. At CHCS, we do a mentoring program for our mid-level providers, the physician assistants, and ARNPs. We've got a one-on-one physician mentor for each one of our mid-level folks. It's mostly clinical practice, but in reality, it ends up being whatever the person needs it to be.

Ban. Simply knowing that people have a shared experience is helpful. Knowing that there are people out there just like you who are struggling with the same questions in and of itself is therapeutic and may become the impetus for seeking help.

DeVeau. We need to build that sense of community and collaboration as physicians. I'm a proponent of allowing physicians to work together in meaningful, different ways to improve our wellness and experience. We solve problems for a living, so let doctors use those skills to fix this issue and reignite our passion for taking care of patients.

On organizational and cultural support

Ban. We need to understand what is causing burnout – it's too easy to blame technology or overwork. When we really dig into it, words like isolation and support come up a lot. So, how do organizations listen to physician voices about the moment of care and what they actually need in it? How do we structure schedule flexibility? How do we make sure that we build team-based care? We ought to be focused on giving physicians the resources they need and allowing them, wherever possible-whether by technology or through the design of care teams-to be at the top of their license.

Michael Harris, internist and oncologist at Multicare Regional Cancer Center. We have a close-knit, team approach, which helps with provider wellness. Last week was a particularly bad week for me, I had a lot of outlier patients with mental health issues. So, I needed help and my team stepped up. Having the social worker back me up, and the nurse navigator back me up, was important for me.

DeVeau. For that to happen, there's a lot that we need to do to let go and just trust our team and really be able to just focus on taking care of patients. We need to let go of our Lone Ranger mentality, delegate paperwork and clerical work, and get back to 'doctor work.' And we really need to take advantage of tools like optimized EHRs, virtual scribing and AI. That's going to be really helpful, too, when it comes to physician wellness.

Harris. We also have a fair amount of flexibility to accommodate people's schedules. For instance, maternity leaves are usually granted and are flexible, according to the individual mother's needs. And Multicare has given me the flexibility to regulate the numbers of patients that I can see and provide good care to – for me, that's no more than 18 patients per day. I see very sick oncology patients and this lets me see them for more than 7-8 minutes. It makes a big difference in my stress level.

On behavioral health support

Ban. Until we fix the system, we do need to support physicians, especially those who are really struggling with physician burnout. Physicians are notorious for suffering in silence. We need to find a way to acknowledge these feelings of burnout and provide behavioral health services to clinicians that are accessible in a way that is palatable.

Ken Bachenberg, recently retired Chief Medical Officer of Peace Health. There are so many unique issues when trying to provide behavioral health support to physicians. You need to find someone who deals with physician issues, specifically burnout.

Parish. At CHCS, physicians can have time carved into their schedule for counseling services available through their physician compensation package.

Bachenberg. In the state of Washington, we set up a program where physicians can access telehealth behavioral health resources. We've assembled a panel of real experts in physician issues. It also keeps it anonymous, so a physician's organization doesn't even have to know they reached out for help, and they're not sitting in a waiting room where they might run into patients. Plus it's so much more convenient to just get online and do a telehealth visit.

Closing thoughts

As athenahealth's panel makes clear, physician burnout has put HR-issues top of mind for leading healthcare organizations. The good news is that visible efforts by leadership do have an impact. A recent athenahealth survey of 1,391 practicing physicians found that when an organization had taken concrete steps to address physician burnout in the last 12 months, its physicians were more than twice as likely to say they felt less burned out than last year (15% vs. 33%), bucking the trend seen in the rest of healthcare.

athenahealth's Ban offered these closing thoughts to the panel's discussion:You don't have to hit a home run right away. You can start with some small victories – and celebrate them among the people who are involved. The best solution for burnout and physician wellness is for clinical staff to think, “My leadership takes this seriously, they're trying to understand it, they're empowering me to be a part of the solution, and then they're going to take steps to try to change the work environment such that this can be what I had always hoped it might be."

Lia Novotny is a Contributing Editor to athenaInsight

Expert Forum: For physician well-being, leadership needs to lead