From Our CEO: More Attention Needed on Morale of Health Care Workforce

As many of our peers struggle, it’s our duty to respond and assist as we’re best able - and this includes using our association’s resources.

Without barraging us all with an excess of dismal statistics, I will simply state that worrisome data on physician workforce morale has accrued rapidly the past few years.

Peter Angood

For example, in the Medscape Life-style Report 2017, more than 14,000 physicians surveyed identified four concerns as the leading causes of burnout: too many bureaucratic tasks, spending too many hours at work, feeling like just a cog in a wheel, and the increased computerization of practice. Physicians from 27 specialties graded the severity of their burnout on a scale of 1 (does not interfere with their practice) to 7 (indicating thoughts of leaving medicine), and all but one specialty selected a four or higher.

This has reached such a sense of urgency that the National Academy of Medicine recently charged a new initiative toward this topic: the Action Collaborative on Clinician Well-Being and Resilience. Additionally, numerous influence groups within health care have recognized similar trends and are calling for action. Several professional discipline organizations also have begun rolling out a host of offerings related to symptom relief, such as providing insights oriented to resilience training, or how to develop a mindfulness practice.

The clarion call is loud and its focus is progressively sharpening.

Regardless of your own personal sense of discomfort, the data show clearly that all levels of the physician work-force are being affected to some degree and with high incidence rates — from students to the most-seasoned practitioners. Even if we don’t personally feel it, we certainly all know someone who is feeling the burden of our industry’s current complexity and is not necessarily able to live a happy, positive life.

These sets of issues fill the spectrum: from “not a problem, thanks” to “maybe I will check into it further someday” (elective) to “I recognize how it is effecting my performance” (urgent) to “I damn well better get some-thing sorted out quick or it will all unravel on me further” (emergent). And we’re all affected.

Interestingly, “burnout” is not recognized as a distinct disorder in the DSM-5. However, it is included in the ICD-10 — not as a disorder, but under problems related to life-management difficulty. As I try to better understand the issues, it seems the view of burnout as a form of depression is finding common support.

Fun fact: The phrase "burnt out" was part of the title of a 1961 Graham Greene novel, A Burnt-Out Case, about a doctor working in the Belgian Congo with leprosy patients. And so, the term likely originated within health care and subsequently gained widespread popularity outside its generalized use in psychology research.

To be sure, physicians are not the only individuals struggling with predilections for burnout or less-than-optimal job satisfaction. We all know that nursing is aware of this problem, as are several other clinical and ancillary health care professions. As well, outside our industry, there are numerous other professions or job types (e.g., dentistry, law enforcement, factory workers, etc.) with similar issues.

While individuals might find ways to cope with symptoms of burnout (e.g., resilience training and mindfulness), to truly prevent burnout there needs to be a combination of organizational (systems) change and awareness-building (education) for individuals.

Maslach and Leiter postulated that burnout occurs when there is a disconnect between the organization and the individual regarding what they called the six areas of work-life: workload, control, reward, community, fairness and values. Resolving these discrepancies requires integrated action on the part of both the individual and the organization. A better connection on workload means assuring adequate resources to meet demands as well as work-life balances that encourage employees to revitalize their energy. A better connection on values means clear organizational values to which employees can feel committed. A better connection on community means supportive leadership and relationships with colleagues rather than discord. (Maslach C; Schaufeli WB, Leiter MP (2001). ST Fiske, DL Schacter, C Zahn-Waxler, eds. "Job burnout.” Annual Review of Psychology. 52: 397–422. doi:10.1146/annurev.psych.52.1.397.)

But let’s be clear: Not everyone is a burnout, nor even on the cusp of being dissatisfied with their profession.

Most physicians remain happy with their choice of becoming a physician, and many continue to practice in environments that provide them deep levels of professional satisfaction. Let us not forget about these fine individuals who continue to excel while others struggle. We all have things to learn from these peers that can become transferrable skills and learned approaches on a broader level.

And such is the case as well for nonphysician providers — we are not in this alone. It’s just a reality that the adverse physician statistics are higher than with other providers and the general population.

SHARING STORIES

Those who listen to National Public Radio often enjoy Friday mornings because that’s when the StoryCorps features air. StoryCorps is an independent, nonprofit project that celebrates the lives of everyday Americans by sharing their stories. A recent piece caught my attention during a commute as I was thinking about the sets of issues hitting the morale of our workforce.

For 25 years, the Rev. Noel Hickie, 74, and Marcia Hilton, 70, helped families during their most trying moments. Hickie was working as a hospital chaplain and Hilton as a bereavement counselor when the two met at a hospital in Eugene, Oregon. As I listened to the segment about their work (available at storycorps.org), tears welled up and I needed to pull over from my drive for a few moments.

During my clinically active years with trauma surgery and surgical critical care, I participated in far too many end-of-life decisions and a host of individual discussions projecting the lifestyle effects of newly acquired complex disabilities. Hickie and Hilton describe caring similarly for others and how their own lives were affected, and how they both carried on in this vein for so many years because of their deep belief in the importance of helping others in difficult life situations — not for themselves as providers, but for the people affected.

I resonated with the scenarios they described, and also immediately felt a sense of deep pride in knowing that many incredibly strong individuals in our various fields continue to create highly significant impacts on others’ lives through this kind of work, and how so many are able to do so because of their intense commitments and beliefs in helping others. Fortunately for us all, numerous physicians — and nonphysicians such as Hickie and Hilton — are able to find, or keep their balance with, the six key areas of workload, control, reward, community, fairness and values.

ASSOCIATION SUPPORT

So how do we as an association obtain, replicate and disseminate similar sets of transferrable skills and learned approaches on a broad level to help create personal change and transformation of organizations?

Beginning in November, we’ll offer a new event oriented toward creating an environment and community that assertively begins to address this complexity of is-sues with a holistic, solutions-based approach. The new Beyond Burnout and Resilience program aims to maximize the potential of participants’ personal and professional leadership by helping them gain deeper levels of insight for their existing natural aptitudes and to appreciate how best to leverage knowledge, skills and experiences with constructive attitudes.

Additionally, the program is designed to create significant personal and professional transformation by help-ing participants obtain a refreshed (or new) awareness of their inherent capabilities for the potential of physician leadership that then ultimately translates to organizational transformations in all sectors of health care.

The program will enable participants to obtain familiarity with pragmatic, insightful solutions for discovering and maintaining balanced, holistic approaches to their profession while also setting the stage for positively influencing subsequent long-term change in their personal lives. These outcomes also will create the potential for sustained programmatic successes within their organizations.

An overall outcome will be recognition of how physicians can better appreciate the personal joy and satisfaction that come from drawing upon their core values of compassion and altruism. These critical values help form the tenets of the uniquely special privilege that constitutes patient-physician relationships — relationships that create the potential for spiritual healing and growth of both patients and physicians.

HOW IT WORKS

Using exceptional faculty facilitators, the program’s first phase lets participants work through interactive sessions in which content is interspersed with scenarios related to situations that individuals face in their personal lives, as well as how these affect the professional roles of physicians. The program also includes the perspective of complexity within health care organizations, the challenges faced by organizations and how physicians play positive or negative roles within those environments.

After participants experience personal, professional and organizational perspectives that provide additional insights, an important component of the program occurs in an external setting designed to augment an appreciation for how nature and spiritual connectivity can provide an improved perspective and ongoing balance when trying to manage health care’s complexities. Throughout, there will be time for team engagement on the content being reviewed and discussed, as well opportunity for personal reflection and journaling on insights gained.

The program closes by providing a conducive environment, expert facilitation, sense of community and programmatic focus for participants to pull their refreshed personal, professional and organizational perspectives together in a meaningful, relevant fashion. By doing so, participants will identify and develop solutions to be used in their daily lives. Additionally, their solutions will be placed in the context of a personal commitment statement designed to help maintain focus, balance and an improved sense of purpose for their role within meaningful patient-physician relationships.

This program is designed to be an intensely positive experience that goes well beyond individual symptom relief.

Participants will achieve significant personal transformation, obtain a new peer network and become inte-grated within a powerful community of influential physicians oriented toward creating change and transforming health care at multiple levels. The entire program will be bracketed with insightful pre-work assignments and a con-temporary technical infrastructure that augments ongoing interactions after the program among this new community of physician leaders. This initiative — short- and long-term — promises to become an incredibly powerful transformation for those involved and engaged.

ANSWERING THE CALL

As physicians, we must continually seek out the uncertain-ty in our own lives and optimize our personal situations. Personal insight and increased awareness are essential steps for achieving improved leadership — not only for the individuals and organizations we influence, but additionally for ourselves as humans.

The clarion call is loud, and our association has sharpened its focus considerably as a leading-edge industry influencer for creating positive change. We all have only one known life to live.

I encourage all of us to continue seeking deeper levels of understanding for ourselves. As physician leaders, let us get more engaged, stay engaged and help others to become engaged. Creating a broader level of positive change in health care — and society — is within our reach. Proactively helping others (including our peers) to better manage their life transitions is a critical component of our professional responsibility — in fact, it has been a professional responsibility since our beginnings.