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Wellness Corner: Advocating for Better Practitioner Health

By Steven Reames

I had only been the executive director at Ada County Medical Society (ACMS) in Boise, Idaho, for a few months in 2015 when the board held strategic planning sessions. The hottest topic was addressing physician burnout. Although research on the growing challenge had just started gaining traction nationally, instinctively we understood where local physicians were at: burnt out by increasing administrative and regulatory pressures in medicine and disconnections from each other and their patients.

I started searching for solutions and came across a first-of-its-kind program in Eugene, Oregon. This small medical community, home to the University of Oregon, had been rocked by four physician suicides in 18 months. Distraught doctors came to the Lane County Medical Society (LCMS), begging it to do something. The director asked her board and asked for the freedom and resources to do something “more than just another physician suicide prevention event,” which doctors were reluctant to attend.ⁱ

Physician Wellness Program

In 2012, LCMS launched its Physician Wellness Program (PWP)[i] as a member benefit, designed by physicians with the following components, similar to an employer’s assistance program:

• A part-time psychologist was hired to offer a limited number of no-cost appointments.
• Strict confidentiality procedures included no insurance record or billing by name.
• Participation was self-initiated and could not be mandated by an employer or licensing board.
• Access was made available at hours convenient for physicians.

LCMS graciously shared their program playbook with a couple dozen directors like me at the American Association of Medical Society Executive's (AAMSE) annual conference. The Medical Society of Metropolitan Portland had also successfully started a program and offered itself as a resource. Soon, ACMS and other medical societies started adopting the program.

Our Physician Vitality Program (PVP)[ii] launched in late 2016, and it has been running strong ever since. To date, we have provided over 1,400 appointments with a value of more than $180,000. We have funded this from our regular dues income and some foundation gifts. Thanks to telehealth access, in the past couple of years we have expanded access to the program statewide for the members of the Idaho Medical Association, the Idaho Academy of Family Physicians, and MIEC, a malpractice insurance provider.

Quality and Confidentiality Is King

There are a few essential keys to a program like this. First, until the day that mental health stigma for physicians completely disappears, anonymous access to the program is paramount. That means therapy session billing is submitted to us without client names; only general demographics are provided, such as age range, specialty, licensure, etc. The associated risk is we have limited ability to verify our contracted mental health providers (MHPs) aren’t just billing for fake clients.

That is why finding and vetting MHPs we can trust is the second highest priority for the program. Our vetting team includes a few volunteer physicians and a clinical social worker who retired from our program, and they interview each MHP applicant. Contractors must commit to serving our members in a way that makes it quick and easy to get to a first appointment. They must either have a known track record of serving medical licensees or have been embedded in a healthcare setting alongside clinicians and come recommended by some of the same.

Beyond Medical Societies

Since then, I have been privileged to promote this program nationally through county (and sometimes state) medical societies, associations, and foundations. Working alongside other county medical society CEOs, we published two editions of the LifeBridge PWP Toolkit,[iii] which is available as a free download. We have also trained membership associations and hospitals on how to start a program. Since 2015, we know of some 30–35 similarly designed programs that have started across the nation, all adapting to their local context and resources.

In most states, not all county medical societies are as robust as those located in metro areas. So, before our recent statewide expansion, we helped two rural Idaho hospital systems reproduce the program for their own medical staff. In at least one hospital, physicians used the service far more than the EAP that had been available for years.

However, safety-net programs are only one solution to what I’ve described as the “burnout river.”[iv] In the not-so-distant past, physicians could handle some “rapids” in their lives for a little while, with the opportunity to stop and recover in between sets. But in our increasingly volatile, uncertain, complex, and ambiguous (VUCA) world, especially in healthcare, constant change is throwing far more doctors into the churning river.

Besides mental health counseling, medical staff administrators and leaders can provide other resources and have been for many years. These “lifejackets” and “buddy systems” help to keep “rafters” safer on the raging river. A few widespread examples include:

• Peer-to-Peer Programs: These formal or informal programs can be built under peer review protections and operated as part of a medical staff wellness committee. Ideally, volunteer peers are trained to listen empathetically to distressed colleagues without trying to solve their problems. Dr. Jo Shapiro’s model started at Brigham and Women’s Hospital in Boston has been widely replicated.[v]
• Balint Groups: These group of clinicians meet regularly to discuss clinical cases to improve and better understand their relationships with patients. The facilitated sessions focus on enhancing physicians’ ability to connect with and sustainably care for their patients.[vi]
• Schwartz Rounds: Unlike traditional medical rounds, these focus on the human side of medicine. They offer healthcare providers a regularly scheduled time to slow down and openly discuss the social and emotional issues that they face in caring for patients and families.[vii]
• Physician Health Programs: Nearly all states have programs for impaired physicians, most typically to deal with substance abuse and addiction. They frequently provide statutory guarantees of not being reported to licensing boards so long as clinicians are “working the steps” toward recovery.[viii] Medical support staff do well to understand what resources their PHP can provide.

Going Further Upstream

While individual and team-based supports are critical, working upstream to attack the challenges closer to the headwaters is the long game. What is feeding so much clinician distress in the first place? While it may feel like there is not much one can do to lower the volume of industry change, I believe we can harness it to reshape the contours of the river that leaves it less of an occupational hazard.

There are many national movements and organizations to tap into to accelerate change in the right direction. Last year, ACMS brought Corey Feist, CEO of the Lorna Breen Heroes’ Foundation[ix], to Boise to host a half-day workshop[x] on changing invasive mental health questions on licensing and credentialing forms. With several leading healthcare institutions in attendance, public commitments to transform these questions were made in the hopes of reducing mental health stigma.

Like other states such as Massachusetts and Virginia, Idaho is progressively working toward aligning those questions from all health insurance and physician employers with the state’s Department of Professional Licensing “fitness for duty” attestation. The Breen Foundation issued a challenge to AAMSS members this spring to join this momentum.[xi]

Other groups like the Idaho Physician Well-Being Action Collaborative[xii] have used the National Academy of Medicine’s model[xiii] of networking healthcare leaders together to address specific burdens physicians face. Tackling tough and thorny issues like prior authorization and the criminalization of evidence-based healthcare has the potential to reduce the overall difficulty and toxicity of practicing medicine. The Coalition for Physician Well-Being hosts an annual Joy and Wholeness Summit and is an excellent resource for hospital and healthcare system leaders to plug into actionable solutions.[xiv]

What Can Medical Staff Offices Do?

MSOs can have a large impact on lowering clinician distress and supporting the well-being of the workforce. One of the first things MSOs must come to grips with is understanding it is exceedingly expensive in both the short and long term to not address the issue[xv], or to throw only pennies in the form of pizza parties and gratitude walls. These can be first steps, but by no means should be the last. The well-being of clinicians must become as important a quality marker[xvi] as hospital readmission rates and need to be part of medical executive decision-making. With everybody in the industry doing their part, we can all promote a healthier workforce which can lead to better healthcare for our nation.