5 Reasons Physician Wellbeing MUST be a PRIORITY
Recently on the blog, we’ve been discussing the emerging scientific field of wellbeing. Thus far, we’ve mostly discussed this in general terms -- the two types of wellbeing needed to thrive and the ladder of wellbeing. The research is typically applied in two ways -- to organizations or individuals.
Organizations can utilize knowledge of wellbeing in several ways: conducting surveys, creating wellbeing programs and incentives, improving income through increased employee satisfaction and much more.
We, however, will focus on individual wellbeing, particularly as it relates to physicians, though other clinicians can make use of it too. While organizations certainly have a responsibility to provide resources and encourage the wellbeing of all employees, physicians in particular are in a unique position.
Let’s look at five reasons why physicians don’t fit into the “usual employee” category.
The Ripple Effect
First, organizations such as National Academy of Medicine (1), ACGME (2), AMA (3), and others have identified physician wellbeing as a priority to improve physician health, patient care, and organizational stability. Improving physician wellbeing not only affects individual physicians, but also ripples outward to improved patient care and organizational stability.
The National Academy of Medicine’s 2019 report contains a six-item agenda to improve physician wellbeing. Item five, about providing support to clinicians and learners, states the necessity to “reduce the stigma and eliminate the barriers associated with obtaining the support and services needed to prevent and alleviate burnout symptoms, facilitate recovery from burnout, and foster professional wellbeing among learners and practicing clinicians.” ACGME has added resident and faculty wellbeing as part of training program requirements (3).
Self-Employed Status
Second, though organization-employed physicians now outnumber self-employed physicians, many physicians are still self-employed. AMA’s 2018 Physician Practice Benchmark survey showed that 47% of physicians were employed by an organization, and 46% were self-employed (4). Self-employed physicians must be served appropriately with teaching and training programs for their individual wellbeing. Furthermore, physicians often are individually responsible for their own wellbeing, as they aren’t considered employees of the organization they partner with and therefore aren’t eligible to participate in programming the organization offers.
Lack of Access
Piggybacking on this, when it comes to organizational interventions, the majority of employed physicians do not have access to wellbeing programs from their employer (5). The data for employed physicians shows that 71% of healthcare organizations have no engagement program to reduce burnout. Only 10% offer programs for all staff, 9% for physicians only, and 10% are in the process of creating a program. Note that this survey did not study the quality or effectiveness of the programs, merely the presence or absence. Employed physicians must find outside teaching and training in individual wellbeing if their organization does not provide effective services.
Organization-Focused
The focus of organizational programs and interventions is often narrower and focused on organizational prerogatives such as physician turnover, physician productivity, and patient satisfaction. These programs are primarily focused on what benefits the organization, not the individual physician. The responsibility for an individual physician’s wellbeing continues to fall on the individual physician’s own shoulders.
Stigma
Finally, there continues to be stigma about seeking help among physicians. Physicians as a group tend to hold themselves to high standards, and seeking help can be seen as a sign of weakness (6). Many medical boards still include questions about the physician’s mental health history on their applications despite new recommendations to the contrary by the Federation of State Medical Boards, American Medical Association, and American Psychiatric Association (7).
To wrap up, it is clear that while organizational change is necessary, it will likely be clunky and slow to come into its full power. For now and the foreseeable future, a physician’s best tool against illbeing and burnout is to consider their individual wellbeing of the utmost urgency.
Next time, we’ll start to examine the four domains of wellbeing that, when properly tended to, work together to allow an individual to thrive, no matter what challenges they face.
Sources:
National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Wellbeing. Taking Action Against Clinician Burnout: A Systems Approach to Professional Wellbeing. Washington (DC): National Academies Press (US); 2019 Oct 23. Available from: https://www.ncbi.nlm.nih.gov/books/NBK552618/ doi: 10.17226/25521
Common Program Requirements. ACGME Main Page. https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements. Accessed June 8, 2020.
Creating the Organizational Foundation for Joy in Medicine™. Creating the Organizational Foundation for Joy in Medicine™ | Professional Wellbeing | AMA STEPS Forward | AMA Ed Hub. https://edhub.ama-assn.org/steps-forward/module/2702510. Accessed June 8, 2020.
Kane, C, 2018, Policy Research perspective, Updated data on physician practice arrangements, AMA https://www.ama-assn.org/system/files/2019-07/prp-fewer-owners-benchmark-survey-2018.pdf
Practices are slow to adopt staff engagement programs. MGMA. https://www.mgma.com/data/data-stories/mgma-stat-poll-practices-are-slow-to-adopt-staff. Accessed June 8, 2020.
Physician Mental Health and Suicide: Combating the Stigma in Medicine. Combating the Stigma in Medicine -- Physician Health First. https://www.aafp.org/membership/benefits/physician-health-first/phf/mental-health-suicide.html. Published August 20, 2018. Accessed June 8, 2020.
Jones JTR, North CS, Vogel-Scibilia S, Myers MF, Owen RR. Medical Licensure Questions About Mental Illness and Compliance with the Americans With Disabilities Act. J Am Acad Psychiatry Law. 2018;46(4):458‐471. doi:10.29158/JAAPL.003789-18