Annual Education Program: Restoring the Art of Medicine: The Power of Physician Wellness

By Vicki Ritterband, Interim Vital Signs Editor

An all-star cast of experts shared their expertise and insights on a topic that was a major focus of the Medical Society over the past year: physician burnout. The experts gathered at the 2019 Annual Education Program and Shattuck Lecture — the latter which was delivered by John H. Noseworthy, MD, president and CEO emeritus of the Mayo Clinic.

The other speakers were:

• Tait Shanafelt, MD, chief wellness officer, Stanford Medicine
• Marie T. Brown, MD, MACP, senior physician advisor of the American Medical Association’s Physician Satisfaction/Practice Sustainability Group
• Stephen J. Swensen, MD, MMM, FACR, professor emeritus, Mayo Clinic College of Medicine; senior fellow, the Institute of Healthcare Improvement; and theme leader, NEJM Catalyst
• Humayun J. Chaudhry, DO, MACP, MACOI, president and chief executive officer, The Federation of State Medical Boards of the United States, Inc.

Michelle A. Williams, SM, ScD, dean of the faculty at the Harvard T. H. Chan School of Public Health, and Jeff Drazen, MD, editor-in-chief, New England Journal of Medicine, served as moderators. Dean Williams also presented the results of the seminal report, A Crisis in Health Care: A Call to Action on Physician Burnout, to the audience. The report was a collaborative effort of the MMS, the Massachusetts Health and Hospital Association, the Harvard T.H. Chan School of Public Health, and the Harvard Global Health Institute. Interwoven into the program were scenes from a one-man play written and performed by Michael Milligan depicting a physician in crisis.

“It is just absolutely heartbreaking for me to hear of physicians who leave their practice or retire early because the time-consuming administrative burdens that are part of a broken system have stripped these doctors of face time and relationship-building with patients,” said Then-President Alain Chaoui, MD, as he introduced the program. He cited a recent survey of MMS members that asked about the biggest stressors in their practices. Electronic medical records (EHRs), prior authorizations, and health plan coverage issues topped the list. “The system must change,” he declared.

What follows are some highlights from each ­speaker's presentation:

Tait Shanafelt, MD

The Top Five Areas Organizations Need to Focus On

Dr. Shanafelt talked about some of the consequences of burnout that go beyond the impact on individual physicians, including decreased quality of care and patient satisfaction, reduced productivity, and increased staff turnover. The level of burnout today predicts the turnover at an institution over the next 24 months, he maintained.

He called the EHR the biggest “visible demon,” but not the whole story, as studies have shown that only about 20 percent of physician dissatisfaction is attributable to it. Too much administrative work and documentation and too little patient-physician interaction are other important factors, he said. “We are not victims and this is not an intractable problem,” he asserted.

He listed five domains that organizations should focus on to combat burnout:

1. Leadership: Spend more time developing the junior leaders who work most directly with physicians. And these leaders must keep their staffs informed, ask their opinions, focus on employee career development, and recognize a job well done.
2. Efficient practice environment: Engage work units in conversations about how to make their jobs more efficient, then implement pilot studies to test their solutions. Turn people from construction workers into architects.
3. Meaning in work: Build effective teams by finding out what people love to do and ensuring they are spending more time on that. Spending less than 20 percent of one’s day on the activities that are most meaningful to physicians is strongly associated with burnout.
4. Community of colleagues: Present opportunities for physicians to reconnect with each other by doing things like paying for shared meals.
5. Safety nets: Provide safe harbors for physicians experiencing distress by offering coaching, support, and bridges to mental health care. Make sure seeking help is psychologically safe.

Marie T. Brown, MD

Reduce Work That Doesn't Add Value

We must think like efficiency experts, which will help reduce the unnecessary work that wastes physicians’ time and doesn’t add value. Dr. Brown cited numerous ways to do this, including:

• Simplify the computer logon process
• Shorten mandatory education
• Reduce coding queries to stave off performance measurement fatigue
• Stop the over-interpretation of regulatory rules
• Institute pre-visit planning to increase the efficiency and effectiveness of patient encounters
• Automate refills and write scripts for chronic illness medications for one year instead of six months to save physicians’ and nurses’ time
• Triage requests in physicians’ inboxes so they see only the emails they need to act on

Stephen J. Swensen, MD, MMM, FACR

Good Leaders Can Help Reduce Burnout

Leaders who are able to create a culture that inoculates employees against burnout have the following five qualities, said Dr. Swensen:

1. They recognize a job well done and their gratitude is authentic.
2. They inform their employees about what is going on in the organization and how decisions are made.
3. They query them about their ideas for improving how things are done.
4. They take an interest in staff members’ careers and help them develop plans for growth and careers.
5. They include everyone on the team, making them feel trusted and welcomed.

Dr. Swensen stressed that the solutions to burnout can be found within the collective wisdom of the medical staff, not in the reports of outside experts. “Ask, listen, and empower,” he said. “Leaders should ask the nurses, the doctors, and the social workers about their frustrations, stratify by what’s in their sphere of control, and then fix those broken processes.”

Humayun J. Chaudhry, DO, MACP, MACOI

State Medical Boards Must Support Physician Wellness

Forty-five of the 52 states’ medical license applications have questions about physicians’ history of mental illness or addiction and that deters people from seeking help, according to Dr. Chaudhry. “Physicians often make the worst patients, but we should practice what we preach. If you’re stressed and anxious, you should seek care. But there is a stigma associated with that. And physicians are fearful of losing their license and livelihood.”

The Federation of State Medical Boards created a workgroup on physician wellness in 2016 and two years later issued 35 recommendations. The first one asks state medical boards to review their medical licensure and renewal applications to evaluate “whether it is necessary to include probing questions about a physician applicant’s mental health, addiction, or substance use, and whether the information these questions are designed to elicit in the interests of patient safety may be obtained through means that are less likely to discourage treatment-seeking among physician applicants.”

To date, nine state medical boards have already made changes to their application process, eight have begun considering revisions (including Massachusetts), and 27 have indicated that they’re going to make this a top priority, according to Dr. Chaudhry.