Focus on Physician Wellness
Promoting Peer Connection and Work/Life Balance
Providers at all levels, including graduate students from the University of South Florida in residency at LVHN, join leaders to address physicians’ health.
More than half of US physicians are now experiencing professional burnout.(1) This, from a study completed in 2014 and reported by the Mayo Clinic, has mobilized health care systems and affiliates across the country, including Lehigh Valley Health Network (LVHN) and Lehigh Valley Physician Hospital Organization (LVPHO). While there can be many causes, from increased workloads to overwhelming administrative requirements, effects of this stress not only impact physicians themselves but can trickle down to patient care.
In-depth studies have indicated the problem goes beyond the medical office to encompass all aspects of a physician’s emotional and behavioral life, considering most doctors come to the profession with a mindset of “not saying no.” This adds a new perspective to potential solutions: They need to be holistic, involving life and work activities, and they depend upon significant cultural change in our institutions. LVHN and LVPHO are being proactive, and have prioritized burnout prevention and treatment.
Taking care of care providers
The Medical Staff Wellness Committee was formed in 2017 at LVHN to promote physician health in the network. It’s populated by a multidisciplinary group overseen by Joseph Patruno, President of the LVHN Medical Staff, and chaired by Suzanne Templer, DO, Chief Wellness Officer. One of the initial actions the committee is targeting is an overhaul of the physicians’ lounge.
While this might not sound like a major change, it is. Research says today’s physicians face a high degree of isolation due to busier schedules, higher productivity expectations, and more time spent in documentation (2). They have little extra to spend with each other, which had traditionally been a hallmark of the profession. “We’re interested in initiatives that build community among physicians, as socialization with peers has been shown to have positive effects on health, and specifically, burnout,” says Dr. Templer.
The plan calls for moving and updating the lounge to create a calming environment and a relaxation/dining area to enhance conversation. Unlike in the lounge’s previous location, there will be cell phone reception, so physicians don’t have to worry about missing important calls while taking a break.
The need for more interaction and less isolation is also driving an initiative to host a monthly social hour off the hospital campus. This would allow physicians the “benefit of connection,” says Joseph Habig, MD, LVPHO Medical Director and member of the Wellness Committee. “Providers can share their frustrations, and exchange ideas on how to do things better.” The idea is based on a Mayo clinic study where physicians met for happy hour, breakfast, lunch or dinner, armed with a topic to discuss as a group. The study saw improvement in burnout and new-found meaning in work just from that interaction.(1)
Personal health and wellness coaching
Local health and wellness provider BeneFIT Corporate Wellness provides a range of health services for employers throughout the region and across the country. The BeneFIT team’s four health coaches are board-certified through the International Consortium for Health & Wellness Coaches (ICHWC), denoting their adherence to evidence-based practice and expertise in behavior change. Every employee of LVHN is entitled to this professional health coaching at no cost, including all physicians who are employed by LVHN. Because of the custom format of BeneFIT’s program, it can be a valuable resource for physicians experiencing depersonalization, emotional exhaustion, or low personal accomplishment, the three pillars of burnout.(3)
Professional coaching may lessen burnout, because it involves “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential,” according to a report in the Journal of Internal Medicine. Coaching assumes people have the inner resources to tackle life challenges, and provides the guidance to harness these internal mechanisms. One study utilizing professional coaching with burnout as an outcome measure found that seven to nine coaching sessions decreased burnout and increased life satisfaction.(4)
Mindfulness: another valuable tool
While LVHN and LVPHO have been working with physicians on projects aimed at more efficient workflows and more personal time off, the rigors of EMR documentation, for example, still exist. “Burnout is a hard problem to solve because a lot of the causes are out of physicians’ control,” says Dr. Habig. “The administrative activities around medicine are being mandated. So part of the solution has to be individual. If we can’t make the stress go away, we have to learn how to manage it.”
To help in this regard, LVHN maintains and promotes The Center for Mindfulness, a collaborative effort of family medicine and psychiatry, founded in 2001 at the Cedar Crest campus. Its core is the Mindfulness-Based Stress Reduction (MBSR) course, which teaches participants to recognize how stress may be affecting their lives and ways to change it.
The value of mindfulness training such as this is also backed by research. In one case, from a 52-hour program administered over the course of year that included affirming strengths, focusing on the human side of medicine, and mindful meditation. The results were striking. The physicians who participated had significant improvements in burnout, mood disturbance, and empathy. These changes correlated with improvements in mindfulness, suggesting that enhancing physicians' attention to their own experience not only increases their orientation toward patients but also reduces physician distress(5).
Awareness is prompting action
LVHN’s Physician Wellness Committee is looking to the future and considering all initiatives that will help the network get ahead of burnout and eliminate its consequences. Some topics in discussion include flexible scheduling, increasing autonomy, and changes in physician compensation models. As awareness grows, there is a parallel understanding about solutions needing to start earlier, as stress and burnout often start in medical school.
That’s why medical students themselves are getting involved. Two third-year graduate students from the University of South Florida’s Morsani College of Medicine, who are members of USF’s SELECT Program* (Scholarly Excellence, Leadership Experiences, and Collaborative Training), are fulfilling their residencies at LVHN. They have developed a proposal for a peer-to-peer professional development coaching program that specifically targets burnout. The project is based on a similar initiative piloted at Massachusetts General Hospital that had significant success, and they will present their proposal to internal LVHN leadership in March.
“This effort is a great example of how health care providers on every level are acknowledging the seriousness of this issue,” says Dr. Templer. “All physicians, all across the nation, are experiencing it. Therefore, it calls for everyone’s cooperation and dedication, including health system leaders, to ultimately make a difference.”
References
1 Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Tait D. Shanafelt, MD'Correspondence information about the author MD Tait D. ShanafeltEmail the author MD Tait D. Shanafelt, Omar Hasan, MBBS, MPH, Lotte N. Dyrbye, MD, MHPE, Christine Sinsky, MD, Daniel Satele, MS, Jeff Sloan, PhD, Colin P. West, MD, PhD; Mayo Clinic Proceedings December 2015Volume 90, Issue 12, Pages 1600–1613
2 AMA Wire, What makes doctors great also drives burnout: A double-edged sword, JUN 21, 2016
3 Tait Shanafelt, MD, hematologist and physician burnout researcher at the Mayo Clinic.
4 Physician Burnout: Coaching a Way Out, Gail Gazelle Email author, Jane M. Liebschutz, Helen Riess; Journal of General Internal Medicine, April 2015, Volume 30, Issue 4, pp 508–513; https://link.springer.com/article/10.1007/s11606-014-3144-y
5 September 23 2009 Enhancing Meaning in Work A Prescription for Preventing Physician Burnout and Promoting
Patient-Centered Care, Tait D. Shanafelt, MD. https://jamanetwork.com/journals/jama/fullarticle/184612
*SELECT recruits and develops students with “the intellectual perspective, empathy, creativity, and passion to change patient care, the health of communities, and the medical profession.”