Members Only | 11.21.24
Wellness Corner: Who Do You Know? Part 1
By By Dr. Deb Roman and Dr. Ed McEachern
A Friend in Pain
As I looked around the table at my physician colleagues and friends, I didn’t recognize her. We started our meeting with introductions, and when she stated her name, I looked up, startled. The person who was speaking was unfamiliar to me. The enthusiasm and joy that she radiated so clearly a few years before had disappeared. The individual before me was distant and cautious, and in some way that I didn’t understand, traumatized. Even her voice seemed different. I looked into her eyes, but I could not find her.
What had happened? I took a chance and invited her to join me for a cup of tea. We met the next week, and remarkably, even though we did not know each other well, the conversation was easy and relaxed. We quickly omitted small talk and moved to a more pressing issue: the profound distress that she and other physicians in our community were experiencing as they practiced clinical medicine.
She did not guard her emotions; exhaustion and disillusionment had stripped away all pretense. All that remained were raw feelings, and the hope that someone would understand and care. We talked for hours. She described the wedge between her desire to help patients heal and the structures that had been put into place to “measure her value” with numbers. Number of patients seen, number of prescriptions written, number of tests ordered … Her sincere commitment to her art and compassion for her patients had been relegated to second place behind the numbers.
We met several times, first making space for the expression of pain and grief. She was not looking for answers. Yet, in some way, despite the lack of congruence between her training and the expectations of a changed system, she was still hoping to reconnect with her calling. Slowly, over time, moments of laughter crept in, and we rested in the comfort of our shared humanity. She knew that I understood, but most importantly, that I cared, and this provided a foothold, a starting point for healing.
Many physicians nationwide share similar experiences. They find it difficult to describe the dissonance between their expectations and reality. Yet, the injury is real. Research consistently confirms a critical decline in the health and well-being of physicians. The loss of physician colleagues to suicide has been devastating to our medical community and heightened our commitment to actively address this public health crisis.
A Community Responds
My colleague Ed and I often meet at a little breakfast spot to share ideas and find inspiration. Longtime physicians, we clearly remember a time when physicians shared a genuine enthusiasm for professional work. Most physicians owned their own practices. Extensive administrative demands and regulations did not disrupt the effective practice of medicine, and physicians had time to build strong relationships with patients and their families, as well as their peers, so they could navigate challenges together.
We remember when physicians, administrators and other healthcare professionals worked side by side to provide high-quality, compassionate healthcare to our patients. While we did not always agree on the best way forward, we sincerely respected the legitimacy of each person’s point of view while actively pursuing efforts to negotiate the differences. On this sunny morning in July, deeply concerned about the well-being of our colleagues, and acutely aware of the complexity of the issues, Ed and I wondered what our small community could do to effectively respond to this crisis.
We were on the cusp of a two-day “Rediscovering Meaning in Our Work” retreat conference created to explore the drivers of physician burnout and moral injury and provide a space for physicians and healthcare executives to connect, openly share their experiences, communicate concerns, and identify creative, collaborative pathways forward.
In preparation for this event, Ed and I decided to invite friends from several sectors of healthcare to come together to actively address a system-level issue with significant impact on the health of our medical community. If we could make progress in the few months before the conference, we could share the results with our peers, and, hopefully, provide inspiration. Our group became known as the Idaho Physician Well-Being Action Collaborative (IPWAC).
For our first project, we chose prior authorization, a process that significantly increases administrative demands on physicians in clinical practice and compromises patient care. Our goal was to bring prior authorization capabilities and medication costs and alternatives to physicians at time of service via the electronic health record. We invited physicians, hospital administrators and insurance company executives with whom Ed and I had established relationships to join the conversation.
While our first meeting was a bit contentious, we have come together every two months for over six years, and most of the people who started this work with us continue to participate, even after they have moved to other jobs. Each year, new friends in our local community and around the country join us. Many of the participants express that they feel nourished and inspired by our conversations, and while Ed and I facilitate, the success of this work is shared by each person who has contributed.
We have made significant progress. We have reduced prior authorizations by over 50% in some instances, coordinated prior authorization grids, and started to build the infrastructure needed to accomplish other goals. Most importantly, we have cultivated a strong network of diverse individuals who openly and respectfully share ideas, insights, and experiences with each other, and are committed to doing this work together.
New Projects
Our community circle is now viewed as a welcoming space where people with different perspectives and experiences come together to effectively address complex and potentially divisive system-level healthcare issues.
In 2023, in response to the changes in the reproductive laws in our state, we expanded our focus to include women’s health. We are collecting and organizing data to detail the impact of the current laws in our state on health outcomes, access to medical care, the physician workforce, medical costs, economic growth, and other factors that affect the health of our community. As we build an accurate and comprehensive database and identify important trends, we are sharing the results with our local community and communities nationwide.
An initial report highlighted a significant decline in our physician workforce in the 15 months after the change in laws in our state, with the closure of hospital obstetrics programs, and, thus, reduced access to healthcare for all Idahoans. The data in this report has been highlighted in television and radio interviews and included in publications nationwide. In addition, this research was referenced in a U.S. Senate report entitled “Two Years Post Dobbs: The Nationwide Impact of Abortion Bans.”
We continue to collect data and welcome healthcare and business professionals, educators, legislators, and many other community members to join us at our roundtable to explore the research, share their insights, and identify innovative solutions.
A Community Healthcare Movement
In 2019, in collaboration with a small group of friends with broad experience in education and healthcare, we extended our friendship-centered approach to our wider community by creating the Compassionate Communities Healthcare Movement (CCHM). Our multi-generational movement includes seasoned professionals as well as university and medical school students. We work together to rekindle cooperative responsibility for the health of our communities, advance health equity, and inspire compassionate action.
In October, the Compassionate Communities Healthcare Movement, Idaho Physician Well-Being Action Collaborative, and Ada County Medical Society (ACMS) — three organizations deeply committed to relationship-based work — welcomed Dr. John Paul Lederach to our community. Dr. Lederach is internationally recognized for his pioneering work in the field of conflict transformation, reconciliation, and international peace building. His experience highlights the potential for everyday people to shift the trajectory toward peace. He met with us at the Wassmuth Center for Human Rights to share insights and strategies that can be applied to current challenges.
In 2025, Compassionate Communities is offering a “Root Down Reach Out” retreat conference to organizations and individuals who are working to actively address the impact of wildfires, droughts, floods, heat waves, and other environmental events on the health of our communities. Similar to the retreat for physicians in 2018, we will welcome many voices, including those not often invited to the conversation. Local artists, musicians, poets, and others community members will help us create a nourishing space to cultivate connection, deepen understanding, inspire hope, and move forward together.
Dr. Deb Roman and Dr. Ed McEachern founded and facilitate the Idaho Physician Well-Being Action Collaborative (IPWAC) and work together on the board of the Compassionate Communities Healthcare Movement (CCHM). They share presentations and workshops on the transformative potential of friendship-centered community circles. Please feel free to connect with them at drdebroman@finding-health.com or edward.mceachern@gmail.com.
References
The Pocket Guide for Facing Down a Civil War: Surprising ideas from everyday people who shifted the cycles of violence. John Paul Lederach
Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Shanafelt, West, Dyrbye, Trockel, Tutty, Wang, Carlasare, Sinsky
The new dynamics of strategy: Sense-making in a complex-complicated world. Cynthia F. Kurtz and David J. Snowden
The Moral Imagination: The Art and Soul of Building Peace. John Paul Lederach
Building Peace: Sustainable Reconciliation in Divided Societies. John Paul Lederach