Michigan Medicine®, Volume 120, No. 6 by Michigan State Medical Society

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 120 / NO. 6

November / December 2021

SAFEHAVEN™

A better approach to managing burnout and restoring wellness

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p resident 's Colleagues, The subject of physician burnout is nothing new to the readers of this magazine. Much ink has been spilled over the topic and its adjacent themes in this publication in recent years, and for good reason. Nearly 50 percent of physicians suffer from burnout. Nearly 30 percent of those suffering want to quit the practice of medicine all together. Most troubling of all, suicide rates among physicians are twice that of the general population. Clearly, few problems in medicine are more universal or pressing. Statistics like those demand more than just our attention—they demand solutions.

PINO D. COLONE, MD (GENESSEE COUNTY) MSMS PRESIDENT

Thankfully, that’s exactly what we have to offer in this November/December 2021 edition of Michigan Medicine®. In this edition, we introduce you to SafeHaven™—the Michigan State Medical Society’s new, comprehensive, and confidential health care pro-

“Nearly 50 percent

vider well-being program offering clinicians a host of resources designed to

of physicians suffer from

aid in addressing career fatigue and behavioral health concerns. And with a pandemic still raging, a physician shortage looming, and the stressors and

burnout. Nearly 30 percent

burdens on providers only growing, it’s an offering that couldn’t have come

of those suffering want

at a better time.

to quit the practice of

You’ll hear about to tools and resources SafeHaven™ provide to its clients,

medicine all together.”

what makes the SafeHaven™ approach to physician wellness unique, and most importantly, what makes it successful. Sincerely,

PINO D. COLONE, MD, MSMS PRESIDENT

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FEATURES & CONTENTS November / December 2021

12 SafeHaven™ – A better approach to managing burnout and restoring wellness

More and more physicians find themselves suffering from burnout. With COVID raging and burdens on our providers only growing, answering the question of how we are taking care of the people who take care of us grows. (Story begins on page 12.)

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Can a court order medical treatment be provided to a patient?

Activism in action MICHIGAN STATE MEDICAL SOCIETY

MICHIGAN MEDICINE® VOL. 120 / NO. 6 Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org

DANIEL J. SCHULTE, J.D

Publication Design STACIA LOVE, REZUBERANT! INC. rezudesign.com Printing FORESIGHT GROUP staceyt@foresightgroup.net

Protect your adult patients from COVID-19, influenza and other vaccine-preventable diseases

Publication Office Michigan Medicine® 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org

All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast.

Burnout from COVID-19: How health care professionals can manage stress ROBERT MORTON, MAS, CPPS

MICHELLE DOEBLER, MPH

Managing COVID-related absences JODI SCHAFER, SPHR, SHRM-SCP

STAY CONNECTED!

Postmaster: Address Changes Michigan Medicine® Kevin McFatridge 120 West Saginaw Street East Lansing, MI 48823

Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine® and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine® reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine® are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2021 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA.

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ASK OUR LAWYER

Can a court order medical treatment be provided to a patient WHEN THE PATIENT’S PHYSICIAN DEEMS IT UNNECESSARY OR POTENTIALLY HARMFUL? By Daniel J. Schulte, J.D., MSMS Legal Counsel

I have been reading about courts ordering physicians/ hospitals to administer Ivermectin to COVID-19 patients.

My understanding is that these court cases follow the physician/ hospital refusing to do so based on the lack of approval of the use of Ivermectin under these circumstances and/or their particularized finding that this use of Ivermectin is unnecessary, potentially harmful, or otherwise not in accordance with the standard of practice. Can a court practice medicine by ordering a physician/ hospital to provide medical care to a patient that the physician/ hospital deems unnecessary or potentially harmful?

“

There is no law authorizing a court to order a physician/ hospital to provide medical treatment when that treatment has been deemed by the physician/hospital to be unnecessary, potentially harmful or not in accordance with the standard of practice.

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ny discussion of the use of Ivermectin or any other drug, whether in connection with the treatment of a COVID19 patient or otherwise, is beyond the scope of this column. I will address only whether a court can order medical treatment (whether it be administering Ivermectin or any other drug or treatment) be provided over the objection of a physician/hospital. Courts cannot legally order medical treatment be provided over the objection of a physician/hospital. With few exceptions, physicians/hospitals are not required to provide medical care. These exceptions include rendering aid in certain emergency situations, complying with the Emergency Medical Treatment & Labor Act, complying with medical ethics, treatment necessary to avoid patient abandonment and other negligence claims, etc. There is no law authorizing a court to order a physician/hospital to provide medical treatment when that treatment has been deemed by the physician/hospital to be unnecessary, potentially harmful or not in accordance with the standard of practice. It is true that courts have broad equitable powers arising from

statutes and case law. However, there is no statute or case law providing courts the authority to practice medicine through their orders. You may have heard about a recent Oakland County Circuit Court case (Ford v. Beaumont, Case No. 2021190083-CZ) where a temporary restraining order was entered ordering Beaumont to administer “a course of Ivermectin” to a COVID-19 patient in its Royal Oak hospital. Whether the court had the authority to do this and where that authority came from was not considered until the end of two days of hearings. When asked, the plaintiff stated it was relying on the court’s equitable power and Michigan’s “Right to Try Act”, MCL 333.26451. Section 3 of the Right to Try Act provides that a hospital is not required to provide a treatment unless it has been

approved by the hospital (Beaumont has not approved this particular use of Ivermectin). Due to the application of section 3 and the court not exercising any equitable power (it is unclear whether the court found it did not have equitable power or declined to use it) to order this medical treatment, the temporary restraining order was terminated and dissolved 4 days after it was issued. Despite what its title might suggest, Michigan’s Right to Try Act does not give patients the right to receive any medical treatment nor does this law require physicians/hospitals to provide any medical treatment. Instead, it law provides only that a manufacturer of an “investigational drug, biological product, or device” may make it available to an “eligible patient” when certain requirements have been met.

The Right to Try Act further provides: 1. That private and governmental payers are not required to pay for any investigational drug, biological product, or device; 2. That debts of deceased patients arising from receiving an investigational drug, biological product or device are forgiven; 3. Immunity against licensing actions arising from use of or advice relating to an investigational drug, biological product, or device; 4. A prohibition on state officials, employees and agents blocking eligible patients access to investigational drugs, biological products, or devices; and 5. For the elimination of private causes of action against a manufacturer of an investigational drug, biological product, or device or those involved in their use when have complied in good faith with the Right to Try Act’s requirements and have exercised reasonable care.

ROBERT S. ANDERSON, JD, MSMS LEGAL COUNSEL, IS A MEMBER OF KERR RUSSELL.

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MDHHS UPDATE

Protect your adult patients from COVID-19, influenza and other vaccine-preventable diseases Alyssa Strouse, MPH, Adult and Adolescent Immunization Coordinator, MDHHS Division of Immunization

Universal vaccination is a critical part of quality health care and should be accomplished through routine and catch-up vaccination provided in physicians’ offices. Vaccination rates among adults are considered suboptimal.

ll health-care providers, whether they provide immunizations or not, should assess for vaccination status, strongly recommend needed vaccine(s) and either administer vaccine(s) or refer patients to a provider who can immunize, stay up-to-date on, and educate patients about vaccine recommendations, and understand how to access

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and document immunizations in the Michigan Care Improvement Registry (MCIR). (3) Every year thousands of adults in the United States become seriously ill and are hospitalized because of diseases that vaccines can help prevent. It is imperative that health care personnel provide strong recommendations for all Advisory Committee on Immunization Practices (ACIP)-recommended vaccines at every age.

The risk of severe illness from COVID19 increases with age. CDC strongly recommends that adults 65 years and older receive COVID-19 vaccines. Currently, COVID-19 vaccination is recommended for all people aged 12 years and older. Further, CDC recommends administration of an additional dose (i.e., a third dose) of an mRNA COVID19 vaccine after an initial 2-dose mRNA COVID-19 primary vaccine series for certain moderately and severely immunocompromised people (i.e., people who have undergone solid organ transplantation or have been diagnosed with conditions that are considered to have an equivalent level of immunocompromise). (1) CDC strongly recommends COVID19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks. Health care providers should strongly recommend that people who are pregnant, recently pregnant (including those who are lactating), who are trying to become pregnant now, or who might become pregnant in the future receive COVID-19 vaccine as soon as possible. (1) Further, CDC recommends people aged 65 years and older, adults 50–64 years with underlying medical conditions, and residents aged 18 years and older of long-term care settings should get a booster dose of Pfizer-BioNTech vaccine. CDC also recommends

Adults aged 65 years and older are at increased risk for influenza and COVID-19 due to weakened immune systems. people aged 18–49 years with underlying medical conditions, and people aged 18–64 years at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting, may get a booster shot of Pfizer-BioNTech vaccine based on their individual benefits and risks. Adults aged 18–64 years who work or reside in certain settings (e.g., health care, schools, correctional facilities, homeless shelters) may be at increased risk of being exposed to COVID-19, which could be spreading where they work or reside. The risk of severe illness from COVID-19 increases with age and can also increase for adults of any age with underlying medical conditions. (1) COVID-19 vaccines may be administered without regard to timing of other vaccines. This includes simultaneous administration of COVID-19 vaccine and other vaccines on the same day. Therefore, if a patient is eligible, both influenza and COVID-19 vaccines can be administered at the same visit. If a patient is due for both vaccines,

Between 70% and 85% of seasonal flu-related deaths, and 50% to 70% of seasonal flu-related hospitalizations have occurred in people 65 years and older, according to the CDC.

providers are encouraged to offer both vaccines at the same visit. Coadministration of all recommended vaccines is important because it increases the probability that people will be fully vaccinated. (2) Adults aged 65 years and older are at increased risk for influenza and COVID19 due to weakened immune systems. According to CDC, between 70% and 85% of seasonal flu-related deaths, and 50% and 70% of seasonal flu-related hospitalizations have occurred in people 65 years and older. (2) The best way to protect against flu and its potentially serious complications is with a flu vaccine. CDC recommends that almost everyone 6 months and older get a seasonal flu vaccine each year, ideally by the end of October. Vaccines are not just for children. It is crucial that all persons, especially adults, are protected against vaccine-preventable diseases. Routine vaccination prevents illnesses that lead to unnecessary medical visits, hospitalizations, and further strain on the health care system. Now is the time to assess the vaccination status of all your adult patients to ensure they are up-to-date on all recommended vaccines. Please note information in this article is current as of October 1, 2021. REFERENCES 1. Centers for Disease Control and Prevention (CDC). 2021, Sep 27). Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Retrieved from https://www.cdc.gov/vaccines/ covid-19/clinical-considerations/covid-19-vaccines-us.html 2. Centers for Disease Control and Prevention (CDC). (2020, September 22). Seasonal Influenza (Flu): Flu & People 65 Years and Older. Retrieved from https://www.cdc.gov/flu/ highrisk/65over.htm 3. Centers for Disease Control and Prevention (CDC). (2017, July 12). Vaccination Programs: General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP). Retrieved from https://www.cdc.gov/vaccines/hcp/aciprecs/general-recs/programs.html

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ASK HUMAN RESOURCES

Managing COVID-related absences By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC

I have a small staff and lately there have

been grumblings around a few employees who have been out a lot. Some of these days off were planned vacations, but many were

his is a challenging situation that many practices are dealing with. While you don’t have control over some of the issues you raise, there are some things you can

do to minimize the impact of unscheduled COVIDrelated absences.

unscheduled absences, either directly or indirectly related to COVID. The Delta variant continues to impact community spread, and I don’t want my staff coming to work if they don’t feel well, but even if their symptoms turn out to be something other than COVID, I’m still losing a day while they get tested. On top of that, schools are back to in-person learning and there have already been quarantines due to exposure. The unpredictability of it all is starting to tax my remaining team members and I don’t know what to do.

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Start by assessing your current stance on incentivizing or mandating vaccination in your practice. Data continues to show that even against the current Delta variant the COVID vaccine is highly effective in preventing serious illness, hospitalization and death. This has obvious benefits for both your employees’ wellbeing and the predictability of your staffing. Another benefit of having high vaccination rates among staff is that fully vaccinated staff aren’t subjected to the same quarantine requirements as unvaccinated staff; reducing absences for precautionary reasons.

may be suddenly forced home due to an exposure in the classroom or at daycare. While this cannot always be avoided, it can be planned for to some degree. Encourage employees to begin thinking about alternative childcare arrangements now in the event that something like this occurs rather than waiting until it happens to put a plan in place. Likewise, you may be able to plan for the inevitability of a staffing shortage during this time of year by building up a sub/ per diem pool or temporarily overstaffing to ensure coverage for situations like this.

Unfortunately, being vaccinated isn’t a golden shield when it comes to preventing unscheduled absences during the COVID-era. As mentioned in the question above, childcare issues continue to plague some staff members; especially those with younger children who

Another area that you can exercise some control is tracking the frequency and legitimacy of employee call-ins. Determine if you have employees taking advantage of the current situation and abusing your time off policy by using COVID as a smokescreen to mask an

unrelated reason for their absence. This may be difficult to sniff out initially, but if you begin to see a pattern of behavior or you hear other team members question the validity of the employee’s excuse, it’s worth paying attention to. You can ask the employee to produce documentation such as a doctor’s note or the results of a COVID test if you think they are being less than honest with you. It is important to note that if the employee is off for a legitimate COVID-related reason (tested positive, has principal COVID symptoms and/or is required to self-isolate or quarantine) they cannot be discharged, disciplined or otherwise retaliated against for missing work. Doing so would be a violation of state law – Public Act 238, amended by Public Act 339.1 I would also encourage you

It is important to note that if the employee is off for a legitimate COVID-related reason (tested positive, has principal COVID-19 symptoms and/or is required to self-isolate or quarantine) they canno be discharged, disciplined or otherwise retaliated against for missing work.

to monitor vacation requests. If an employee has been out a lot lately, staff may be less willing to cover for an additional vacation request from that same employee. As the saying goes, ‘timing is everything’. Just because a vacation request is made, doesn’t mean you have to approve it. Finally, you might consider upping the level of appreciation for the team members who step in to cover for these unscheduled absences. While you can’t fully prevent these kinds of staffing disruptions from occurring, you can make the situation less frustrating for your remaining staff by rewarding them for their additional efforts. Consider financial rewards like a bonus or adding time to their vacation bank for use at a later date or a gift certificate to their favorite

place as a way of saying thank you. It’s amazing how far staff are willing to go for you and for each other when they feel like their efforts are recognized and appreciated. Finally, I encourage you to keep the lines of communication open with your team. Let them know where your struggles are and ask for their help. They may have additional ideas on this topic that I haven’t thought to address. Getting team buy-in will also encourage staff to be more cognizant of their own use of unscheduled time off in the coming weeks and months.

REFERENCES 1.http://www.legislature.mi.gov/documents/2019-2020/ billengrossed/Senate/pdf/2020-SEBS-1258.pdf

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FEATURE

SAFEHAVEN™

A better approach to managing burnout and restoring wellness

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Imagine a scenario…

octor A is a highly skilled and experienced surgeon. But not every surgery goes exactly to plan. Thankfully, that’s exactly what Doctor A has trained for, and they are prepared for those moments. That’s why they're in the room—to safely navigate their surgical team, and their patient, through whatever unique challenges may arise. Yet still, sometimes—through no fault to anyone—lasting and consequential complications arise. Everyone involved is adversely affected. However, Doctor A is the one who is ultimately shouldered with the blame. The trauma shakes their confidence. The threat of a lawsuit looms. Their wellbeing starts to suffer. As the stressors pile higher and higher, so does their caseload. There’s no time to process their grief. No time to talk through their challenges with anyone. No time to rediscover the purpose and joy medicine used to bring them. And even if there were time, they’d never feel comfortable voicing these problems to anyone anyway. The risks seem too great. There might be consequences to face from their employer or perhaps their medical board. It may even be used against them in a medical malpractice trial. So instead, they swallow their stress and feelings of fatigue and carry forward. This is what burnout looks like and, at an increasing rate, through countless other avenues, more and more physicians find themselves suffering from it, costing physicians, their employers, and their patients in the process.

With COVID raging and burdens on our providers only growing, answering the question of how we are taking care of the people who take care of us grows more pressing every day. Luckily, an answer is beginning to take form.

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To better serve and support clinicians struggling with stress, burnout and the effects of COVID-19, the Michigan State Medical Society (MSMS) recently launched SafeHaven™, a comprehensive and confidential health care provider well-being program offering clinicians a host of resources designed to aid in addressing career fatigue and behavioral health concerns. And while physician burnout and efforts to address are nothing new, the SafeHaven™ approach is. The key word: confidential.

Building a Better Foundation to Support Physician Wellness Overly stressed. Unrelenting exhaustion. A growing sense of apathy. There are several common symptoms of burnout, and more and more physicians are exhibiting at least one these days. In fact, the number are startling.

ccording to a national survey conducted by the American Medical Society, 42 percent of physicians, across specialties, have suffered from burnout to some degree.

“Like plenty of others, we saw a tsunami of burnout coming our way, and we were doing our best to find and implement some solutions,” says Terri Babineau, MD, chief medical officer of SafeHaven™. “Before SafeHaven™ got its start, I had been doing a lot of work with the Medical Society of Virginia on physician wellness, and despite all our early efforts with creating resources and holding workshops, we continued to observe growing burnout rates. At

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that point, we realized there were some big institutional drivers to burnout and some systemic changes needed to be made if we hoped to have any real success.” To better understand the challenges health providers were facing, Doctor Babineau and other from the Medical Society of Virginia had discussions with hundreds of physicians and PAs across the state in hopes uncovering some answers. Early in that process, a common theme emerged: providers feared consequences from their employers or licensing board if they admitted to feeling symptoms of burnout. “Our physicians just didn’t feel protected—that was the lightbulb moment for us,” says Doctor Babineau. “A lot of these providers had Employee Assistance Programs (EAPs) and other resources available to them, but they just weren’t being utilized over concerns of it somehow affecting their employment or license status.”

Realizing that, the Medical Society of Virginia set out to change the state’s laws and succeeded in implementing the confidentiality, immunity and privileged legal protections physicians and PAs needed to feel comfortable seeking help with addressing personal burnout concerns. The SafeHavenTM bill passed unanimously through the Virginia legislature and, one year later, the program was expanded to protect nurses, pharmacists, and medical students. “It was a monumental moment when that first SafeHavenTM bill was officially signed into law by the Governor,” says Doctor Babineau. “We went from a world where physicians only had access to EAPs with minimal confidentiality protections to the potential for full protection through SafeHaven™. We just knew this was an innovation that was going to make a real difference in getting physicians more activity engaged in seeking out the help they need. The SafeHaven™ program offers necessary mental health resources that are truly confidential and actually support health care workers.” To help administer the program, SafeHaven™ selected VITAL WorkLife—a national behavioral health consulting practice with over twenty years of experience committed to improving physician wellbeing. The SafeHaven™

Program includes VITAL WorkLife’s comprehensive suite of resources designed specifically for physicians to help mitigate the effects of stress and burnout and allow for better work/life integration, including:

physicians and other providers, sometimes that’s a short 10-minute window at 2 am. They just had the most in-depth experience with physicians and that mattered, because it’s a population that comes with some unique challenges.”

Face-to-face and virtual counseling and peer coaching sessions

Soon after its implementation, other state medical societies across the country began to express interest in the SafeHaven™ program, including MSMS.

Legal and financial consultations and resources Access to a virtual assistant

“Physician burnout has been a growing problem for years now, so we’ve known for some time that we needed In-the-moment 24/7 behavioral to find a better way to care for our phyhealth support sicians,” says Kevin McFatridge, MSMS “We considered a Chief Operating Offinumber of other “Physician burnout has cer. “When we first providers to help learned about Safewith providing Safebeen a growing problem Haven™, it was clear Haven™ services, for years now, so we’ve this was the answer but VITAL WorkLife we had been seeking, was clearly the best known for some time and thankfully it was fit for our program that we needed to find something we were and physicians in able to bring to our general,” says Melina a better way to care for state relatively quickly Davis, CEO and execour physicians.” being that we already utive vice president have a lot of the necof the Medical Sociessary foundational ety of Virginia. “And protections already in that was reflected place here in Michigan. Now that it’s offiin a lot of the services they had to offer cially up and running here, we’re sure it’s like the 24-hour call line and app-based an offering that going to provide a lot of resources. People could get the care they relief to our members.” needed when they needed it, and for VITAL WorkLife app and online resources

“It was a monumental moment when that first SafeHaven bill was officially signed into law by the Governor. We went from a world where physicians only had access to EAPs with minimal confidentiality protections to the potential for full protection through SafeHaven™. TM

TERRI BABINEAU, MD, CHIEF MEDICAL OFFICER OF SAFEHAVEN™

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Solutions in Action – Peer Coaching Sometimes, just talking through things with someone who has been in your shoes is enough to make a difference.

t’s a claim that might sound flimsy, but there’ a growing body of evidence to suggest the intervention known as peer coaching can have a significant positive impact on physicians’ well-being. According to recent research from the Mayo Clinic, physicians receiving peer coaching sessions experienced a 17 percent decrease in burnout compared to a five percent increase in burnout for physicians who went without coaching. Through SafeHaven™, physicians are eligible to participate in up to six sessions per incident of confidential peer coaching with one of VITAL WorkLife’s highly-vetted, certified coaches, many of whom are also physicians from a range of specialties. “The challenges physicians face are unique and intense,” says Mitchell Best, CEO of VITAL WorkLife. “Being able

to talk through those difficulties with “We’re asking clinicians to tell us where they are now and where they want to another clinician who has been there be,” says Robert Leschke, MD, an emerand understands the unique pressures gency medicine physician and certified of practicing medicine makes a real difcoach based in Madison, Wisconsin. ference in getting physicians in need “Peer coaching is of help to buy in to about helping clinithe coaching process “Peer coaching is cians look at their sitand the value it can uation from a different about helping clinicians provide.” perspective and then look at their situation And that process is giving them the tools simple. Working in from a different they need to progress collaboration with a in their life and career perspective and then coach of their choosand ultimately go on giving them the tools ing, physicians work to become happier they need to progress in to define their valand more productive.” ues, such as doing a their life and career... It’s a process that good job, enjoying works according to their work, or having the nearly fifteen time for their famyears of quantitative and qualitative ilies. Once those values are defined, data VITAL WorkLife has collected clinicians and coaches work together on the impact coaching has on clinito set goals based on those values, and cian well-being. According to pre- and then identify action steps and troublepost-coaching surveys, 92 percent of shoot any obstacles on the way towards participants reported an improvement achieving those goals. in overall well-being with an average improvement of 58 percent across specialties.

“The challenges physicians face are unique and intense. Being able to talk through those difficulties with another clinician who has been there and understands the unique pressures of practicing medicine makes a real difference in getting physicians in need of help to buy in to the coaching process and the value it can provide.” MITCHELL BEST, CEO OF VITAL WORKLIFE

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For physicians, it’s a great way to simply get back on track and reconnect with the joy they once found in medicine. And for organizations, it’s a proven investment in heading off potential problems before they bubble into real ones. “You don’t need to wait until a clinician is in crisis to activate the coaching process,” says Doctor Leschke. “Any suggestion that a clinician’s attitude or mood might be taking a little dip is an opportunity to be proactive and preventative rather than to be reactive to a crisis.”

Solutions in Practice: Counseling and In-the-Moment Behavioral Health Support Invariably, medicine and trauma go together. However, it’s not always the patient who is suffering. In fact, the clinicians providing the care are just as vulnerable.

“W

e realized early in the process of developing SafeHaven™ that a number of our member physicians were suffering with some really deep trauma and were in need of counseling to help resolve it,” say Melina Davis. “They wanted help but felt uncomfortable pursuing it for a variety of reasons. Part of that was related to concerns about confidentiality, but another part could definitely be attributed to physicians’ tendency to put their needs and their own well-being on the very back burner.”

“It’s a challenge because most physicians just won’t take the time to ever ask themselves how they’re doing,” says Davis. “That just goes against how they were trained. You’re taught to just dig in and keep going without giving yourself and how you’re feeling much thought at all”

For many, it’s an unsustainable To help address this growing problem, approach. The stressors on physicians SafeHaven™ offers are just too extreme. clinicians access to “These are people that “We need doctors face-to-face or virtual don't eat during the counseling sessions to get more comfortable day. They don't go to with an experienced, the bathroom during with taking a moment licensed behavioral the day. They don't to say to themselves, health professional drink water during the who can help clients ‘I’m not broken, but I day, all because they're navigate any emonot sure they'll get a do need some help. I do tional turmoil or menbreak. And some of need someone to talk tal health issues that these shifts are 12 to may be impacting with about this stuff.’ ” 14 hours long. Think them. Along with that, about that level of lack they’re also working of care for yourself. It’s to normalize the act of seeking out help no wonder they’re getting burned out,” when it’s needed and raising awareness Davis says. of the importance of self-care among the health care provider community.

And with a global pandemic only serving to amplify these stressors and straining hospitals and providers to the brink in the process, it’s more important than ever that clinicians seek out the care they need when they need it. To account for this, SafeHaven™ also provides clients with access to a 24-hour, in-the-moment behavioral help call-in service with a master’s or doctorate level counselor to address concerns or immediate needs when they occur. The key is to first recognize the value in seeking help. “It really has to be a personal opt-in,” says Davis. We need doctors to get more comfortable with taking a moment to say to themselves, ‘I’m not broken, but I do need some help. I do need someone to talk with about this stuff.’ And when they can get to that place, SafeHaven™ is there with the all the resources they need.”

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Solutions in Practice – WorkLife Concierge, Financial and Legal Consultations Sometimes the most helpful resource may just be a helping hand that can assist with all the other everyday tasks and responsibilities physicians must juggle along with delivering quality patient care. To help in those instances, SafeHaven™ offers clients access to the WorkLife Concierge—an all-purpose virtual assistant that can assist with a variety of everyday tasks and chores.

he WorkLife Concierge service is available 24/7 and can assist with any number of errands and obligations such as tackling “todo” lists, handling childcare and school pick-up duties, scheduling appointments and a whole host of other standard daily responsibilities, allowing clients to better maximize their professional and personal time.

“The demands on a physician’s time plan for retirement, deal with family are great—that’s just the way it is,” says issues, you name it,” says Best. “To help Bestp. “However, the WorkLife Conwith those realities, we provide specific cierge makes a real resources through difference for overSafeHaven™ that are burdened providers “The WorkLife Concierge designed to make by tackling a lot of the these unavoidable service is available 24/7 everyday responsibilitasks and responsibiland can assist with any ties that can be easily ities easier to handle.” delegated. It’s about number of errands… To help manage those giving time back to allowing clients to sorts of everyday our providers so they issues, SafeHaven™ better maximize their can recharge, feel less offers clients free and stressed and ultimately professional and unlimited confidential be more present with personal time.” phone consultations both their patients and with financial counloved ones.” selors to help address In that same vein, any finance-related problems or quesSafeHaven™ also offers providers tions. Additionally, SafeHaven™ proaccess to a host of financial and legal vides clients with free, over-the-phone consulting services. legal advice and can help with in-per“Physicians are just like everyone son referrals to those who may need to else—they have to budget their money, retain an attorney.

“Everything we provide through SafeHaven™ in partnership with VITAL WorkLife is in some way aimed at relieving the stresses and burdens that are weighing down our providers and working to replace those feelings of burnout and fatigue with that sense of vitality and joy so many once found in medicine but have since lost.” TERRI BABINEAU, MD, CHIEF MEDICAL OFFICER OF SAFEHAVEN™

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“Everything we provide through SafeHaven™ in partnership with VITAL WorkLife is in some way aimed at relieving the stresses and burdens that are weighing down our providers and working to replace those feelings of burnout and fatigue with that sense of vitality and joy so many once found in medicine but have since lost,” says Doctor Babineau. “Physicians’ well-being matters, and we all need to get serious about strengthening and protecting that.”

The Cost of Doing Nothing Suffering clinicians aren’t the only ones who gain from an investment in their wellness—it’s an outlay benefiting the whole health care system, paying dividends to patients, providers and the health systems that employ them.

rom the health system side, the math is simple: burnt out providers often work less or just leave entirely and that lost productivity and potential turnout costs health systems tremendously. Between recruitment costs, the lost revenue during recruitment and onboarding and the time it takes a physician to reach maximum efficiency, replacing a

physician costs upwards of a $1 million. And considering that 31 percent of stressed physicians indicate a desire to retire early with 29 percent expressing a desire to leave medicine altogether according to a survey conducted by VITAL Worklife, the cost of burnout hospitals and health care organizations is vulnerable to an extreme spike without intervention. “A health care organization like a hospital system’s most valuable assets are the physicians and care team providing patient care,” says Best. “Investing in their wellbeing isn’t just the right thing to do—it’s the financially savvy thing to do.” According to a 2017 Gallup Survey, physicians who feel cared for report

26 percent higher productivity levels, give hospitals three percent more outpatient and 51 percent more inpatient referrals, have a more engaged patient base, and perhaps most importantly, are dedicated to their patients and committed to the improvement of their organizations. “The bottom line is this: when clinicians feel cared for, they do better job for their patients and their employers,” says Doctor Babineau. “That’s the kind of environment and culture all health systems should be striving to cultivate, and SafeHaven™ can help get you there.” LEARN MORE To learn more about the SafeHaven™ program and what it can offer you and your organization, please contact Kevin McFatridge, MSMS COO, at kmcfatridge@ msms.org or visit http://MSMS.org/SafeHaven.

Driven by results. As counsel to the MSMS community for over 70 years, we know how to help physicians.

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NOVEMBER / DECEMBER 2021 |

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ADVOCACY CORNER

Activism in action By Michigan State Medical Society

One of the most effective ways of letting elected officials know an organization’s views on issues is through personal meetings. In political terms, this is called lobbying. The MSMS Government Relations team provides elected officials with the information they need to make the best decisions for their constituencies.

e also try to connect legislators directly with their constituents. Elected officials pay attention to mass numbers. When a group of people from a lawmaker’s district request a meeting, email, or call about a particular issue, the lawmaker wants to hear their point of view. As experts in their field, physicians in mass numbers can truly help officials understand the benefits or pitfalls of a piece of legislation. That is why it is so important for all MSMS members to be up to date on what’s happening in Lansing and have a relationship with their legislators. Getting involved can sound vague and overwhelming, especially when physicians are already overworked and overwhelmed. However, there are many different ways to make your activism fit your schedule. Read on to learn about just a few of the ways your fellow physicians have used to connect with their legislators.

Small Group Connections On August 9, 2021, MSMS Government Relations staff and three local physicians from the Grand Traverse area hosted a roundtable with Representative John Roth of the 104th House District. As a member of the House Health Policy Committee, Representative Roth is tasked with examining legislation that affects health care in many ways and the physician roundtable

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served to be an excellent opportunity for Representative Roth to not only meet physician leaders in his community, but also discuss the many issues physician practices are facing today. Coming together in a forum like this not only allowed the group to discuss matters pertinent to medicine, but also to make specific connections to Representative Roth. In future, he now has specific contacts who can meaningfully inform him how potential legislation would impact his constituents directly.

One-on-One in District One of the physicians who participated in the roundtable was Leah Davis, DO, a radiologist at Grand Traverse Radiology. As a newer member of MSMS, Doctor Davis expressed an interest in getting more involved in the legislative process and over the last several months, she has proven to be a highly effective advocate for physicians. With a genuine passion for health care and the preservation of physician-led care, Doctor Davis made it a point to meet her local elected officials and begin developing the personal connections that allow her to have a direct influence on the way her elected officials look at health care issues. Today, Doctor Davis is a member of the MSMS Legislative and Regulatory Committee and hopes to soon join the MDPAC Board of Directors. With more legislative battles on the horizon such as scope of practice expansion for advanced practice professionals, prior authorization

benefits she experienced, the benefits to her patients, and the potential barriers stopping other physicians from practicing in this way.

Getting involved can sound vague and overwhelming, especially when physicians are already overworked and overwhelmed. However, there are many different ways to make your activism fit your schedule. reform, and more, we encourage physicians who have a passion for advocacy to get involved.

One-on-One in Lansing After hearing about direct primary care offered by Belen Amat, MD, Senior Director of Government Relations Josiah Kissling thought legislators in Lansing should hear about this alternate way to provide care. After ascertaining her interest, he reached out to Representative Bronna Kahle, Chair of the House Health to set up a time to talk. At a lunch with Chair Kahle and the MSMS Government Relations team, Doctor Amat was able to tell her about this model of primary care. The Chairwoman had not heard of direct primary care and was very enthusiastic about an affordable alternative that could meet patients’ needs. She was able to ask Doctor Amat many questions about the

These more casual, less agenda-driven meetings were low-pressure opportunities to provide information about a less-known topic and build relationships with important legislators. It lays the foundation for them to think of MSMS and our members first, particularly when an unfamiliar topic comes up. In the future, we hope to build on that and truly be the go-to for important information about the practice of medicine.

Lobby Day A number of physicians came together in Lansing on October 14 for a Health Can’t Wait Lobby Day, joining in a push for action on prior authorization. This group met with 15 different legislators for 30 minute meetings to discuss the dangers of delayed care and the importance of streamlining the prior authorization process. While we must wait to see the ultimate results, the conversations had were all productive and affirm the policy is sound and has bipartisan support. This more formal and focused manner of involvement shows our power in numbers. It allows MSMS to reach multiples legislators quickly and ensure they are getting the important message of how this legislation would positively impact both physicians and patients.

Take action now! Visit https://MSMS.org/engage and become a “virtual lobbyist.”

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Burnout from COVID-19: How health care professionals can manage stress Robert Morton, MAS, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company, and Jennifer Perla, RN, LPC-S Medical Advantage, Part of TDC Group

Despite the personal risk, health care professionals have shown great courage during the COVID-19 pandemic by adapting to unprecedented conditions and laboring tirelessly to provide patient care. These extreme circumstances have frequently led to burnout, depression, and even suicide.

he conditions that have created stress vary for different providers, specialties, and care settings. Some professionals have been conscripted into unfamiliar specialty settings, creating uncertainty about their skill sets. Volunteers have come out of retirement with a renewed esprit de corps to give back, still answering their highest calling. Those in overwhelmed settings with a frantic work pace take few or no breaks. Fear remains about bringing the virus home to family, and some have experienced the death of family and friends. Many individuals have experienced separation

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from family, pay cuts, layoffs, and childcare challenges. Shortages of medicines, personal protective equipment, ventilators, and other equipment created ethical dilemmas without the training or support to resolve these issues—which resulted in moral injuries. Vaccine hesitancy persists. Although we have witnessed great triumphs and small victories—exhaustion, anger, sadness, and tears continue. The struggle has been beyond overwhelming, and this crisis is not over.

Contributed by The Doctors Company

thedoctors.com

NOVEMBER / DECEMBER 2021 |

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At Risk of Burnout

Strategies for Reducing Burnout

As a health care professional, you are trained to help others but may ignore your own well-being. To determine if you are at risk of burnout or even experiencing it now, try reflecting on whether you are:

If the answer to any of the above points is yes, keep in mind the flight attendant’s instruction to “remember to put on your oxygen mask first.” You must first help yourself before aiding others. Here are some strategies to reduce burnout during these highly stressful times:

Just going through the motions, feeling like a zombie, and working extra hours.1 Becoming cynical, disconnected, less caring, or distanced from your team. Sleeping too little or too much, avoiding exercise outside of work, and not eating healthy food or hydrating enough. Also increasing usage of tobacco, alcohol, or drugs.1 Experiencing feelings of being overwhelmed and worrying that you will fall sick. Not able to perform your daily tasks.

Use personal self-efficacy skills or self-care strategies. Take that needed break, even if it is only for two minutes. Stay connected with a support system by talking with family and friends. Use calming techniques like positive self-talk, affirmations, gratitude, meditation, connecting with your higher power, yoga, or being in nature. Show yourself the same compassion you would a friend or patient. Maintain boundaries and limit news and social media. Discuss the emotional and social challenges with your team of coworkers. Their support is key to avoiding mental health challenges or moral injury..2 Access your organization’s wellness program or Schwartz rounds,3 if possible. Set up a decompression room at work with snacks and calming music or a sound machine. Remove obstacles to practicing self-care. Be patient with yourself. Make sure to check in with yourself regularly.2 Do something easy to give yourself a sense of accomplishment. Use calming strategies, such as meditation apps or online videos. Take things one minute, one hour, and one day at a time.

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Contributed by The Doctors Company

thedoctors.com

REFERENCES

The following resources can also assist in reducing stress: National Academy of Medicine, Resources to Support the Health and Well-Being of Clinicians During the COVID-19 Outbreak Resources About Health care Worker Wellbeing During COVID-19 (main- tained by Sam Van Horne, PhD, Senior Research Associate at the ChristianaCare Center for WorkLife Wellbeing)

1 Substance Abuse and Mental Health Services Administration. Warning signs and risk factors for emotional distress. Updated December 22, 2020. https://www. samhsa.gov/find-help/disaster-distress-helpline/warning-signs-risk-factors 2 Substance Abuse and Mental Health Services Administration. Tips for disaster responders: preventing and managing stress. September 2014. https://store.samhsa.gov/product/Preventing-and-Managing-Stress/ SMA14-4873 3 Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced

Physician Support Line Medicine is a blend of science and compassion. We urge you to extend your compassion to yourself. The entire nation is grateful for the care you are providing. For additional assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or patientsafety@thedoctors.com.

IHI Leadership Tool Addresses Physician and Staff Burnout

by health care workers during COVID-19 pandemic. BMJ. 2020;368:m1211. March 2020. https://www. theschwartzcenter.org/media/BMJ-Moral-Injury-inHealth care-Workers-Greenberg-et-al-Mar-2020.pdf

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

The Institute for Health care Improvement (IHI) released Conversation and Action Guide to Support Staff Wellbeing and Joy in Work During and After the COVID-19 Pandemic, a tool that builds on its Framework for Improving Joy in Work white paper. The tool allows leaders to test actionable ideas to reduce anxiety and stress, create opportunities to learn what matters to frontline staff during this time of intense demands, and find solutions to problems.

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NEW & REINSTATED MEMBERS ALPENA-ALCONA- PRESQUE ISLE COUNTY

KENT COUNTY MEDICAL SOCIETY

Doris Coca-Soto, MD

Brian Giersch, MD

Ashley Kaatz, DO

Joseph Taylor, MD

John Mac Master, DO Lauren Meisel, MD Adrienne Westphal, DO

CALHOUN COUNTY Edrick Ferguson, MD

CLINTON COUNTY Joshua Takagishi, MD

GENESEE COUNTY MEDICAL SOCIETY Jennifer Baker, MD Bara Zuhaili, MD

GRAND TRAVERSE-BENZIE- LEELANAU COUNTY MEDICAL SOCIETY Olivia Juntila, MD

INGHAM COUNTY MEDICAL SOCIETY

MACOMB COUNTY MEDICAL SOCIETY

Hemalata Nandi, MD

Dev Nandamudi, MD Amit Nandi, MD

Amanda Moraska Benson, MD

ST. JOSEPH COUNTY

NORTHERN MICHIGAN MEDICAL SOCIETY

Elena Lewis, MD

Karen DenBesten, MD Rhonda Marvar, MD Michele Squires, MD

OAKLAND COUNTY MEDICAL SOCIETY Alan Cutler, MD Zaiba Mapkar, MD Miles Neumann, DO Heather Ruppel, MD Xeres Yasmin Sanchez, MD Jason Shellnut, MD

Tony Tran, DO

Sara Simons, MD Anastasia Stevens-Chase, MD

Agatha Bogard, MD

Jessica Grace, MD

MARQUETTE-ALGER COUNTY MEDICAL SOCIETY

Travis Lee, DO

KALAMAZOO ACADEMY OF MEDICINE

Sharanya Golagabathula, MD Patricia Kindsvater, MD

Scott Schwartz, MD

Ravinder Polasani, MD

ST. CLAIR COUNTY MEDICAL SOCIETY

Mindy Raminick, DO

Lee Coleman, MD

JACKSON COUNTY MEDICAL SOCIETY

SHIAWASSEE COUNTY Jeffrey Messenger, MD

WASHTENAW COUNTY MEDICAL SOCIETY Bakul Parikh, MD

WAYNE COUNTY MEDICAL SOCIETY OF SOUTHEAST MICHIGAN Diane Baranowski, MD Mona Fakih, DO, RPh, FACOG Jeffrey Johnson, MD John Leahy, MD Christopher Mann, MD Samantha McPharlin, MD Abby Nowakowski, MD Mariko Shelton, MD

Bradford Walters, MD

Brendan Sullivan, DO

SAGINAW COUNTY MEDICAL SOCIETY

Harold Moores, MD

George Carty, MD Clark Headrick, DO

WEXFORD-MISSAUKEE COUNTY

Thank you for your ongoing support of organized medicine in Michigan. JULY / AUGUST 2021 | michigan MEDICINE® 27

MSMS ON-DEMAND WEBINARS The MSMS Foundation has a library of on-demand webinars available, many of which are free, making it easy for physicians to participate at their convenience to meet their educational needs.

Webinars that Meet Board of Medicine Requirements:

A Day of Board of Medicine Renewal Requirements Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Confidentiality: An Ethical Review Medical Ethics – Decision Making Capability Medical Ethics – Eliminating Disparities in Health Care What Can You Do? Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Medical Ethics – Racial Disparities in Maternal Morbidity and Mortality: A Persisting Crisis Medical Ethics – Reclaiming the Borders of Medicine: Futility, Non-Beneficial Treatment, and Physician Autonomy Pain and Symptom Management Series

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Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System (MAPS) Update Naloxone Prescribing Pain and Symptom Management 2020 Prescribing Legislation Tapering Off Opioids The CDC Guidelines The Current Epidemic and Standards of Care The Role of the Laboratory in Toxicology and Drug Testing Treatment of Opioid Dependence Update on the Opioid Crisis 2019

COVID-19 Webinars:

OTHER WEBINARS:

2020 Fall Symposium on COVID-19 Day One

24th Annual Conference on Bioethics

2020 Fall Symposium on COVID-19 Day Two

Coding Update for 2021

24th Annual Conference on Bioethics

Evaluation Management Updates for 2021

AMA Advocacy and Physician Resources

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities

Best Practices for Implementation of Telemedicine CARES Act Impact

HEDIS Best Practices In Search of Joy in Practice: Innovations in Patient Centered Care

CARES Act Impact: Q&A with CPAs CARES Act Impact: Q&A with CPAs Part 2 Leading Through Crises: Financial Guidance and Strategies Medical Practices and Employment/ HR FAQs New Employment Policies for Practices

Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

Race Inequalities and COVID-19: Contagion, Severity, and Social Systems

Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media

Safe and Innovative Office Procedures for Seeing Patients

Medical Marijuana Law

Telemedicine and Other Technology Codes in a COVID-19 Environment

Medical Necessity Tips on Documentation to Prove it

Testing, Tracing and Tracking

Non-Pharmacologic Management of Musculoskeletal Pain Syndromes

New Waivers and Billing Changes for Telemedicine

The Changing Health Care Landscape: Preventing Diabetes During and Beyond the Pandemic What Physicians Need to Know as Employers During the COVID-19 Pandemic

Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting

Grand Rounds Webinar Series:

Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS

A Review of COVID-19 Variants Coronavirus Relief – Overview and Updates

Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS

To register or to view full course details, visit: MSMS.org/OnDemandWebinars

Once registered, you will receive an email within 15 minutes with links to watch the on-demand webinar and to complete the survey evaluation. Contact: Beth Elliott at 517/336-5789 or belliott@msms.org NOVEMBER / DECEMBER 2021 |

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2021 CONFERENCE SCHEDULE

2021 Live Virtual Conference Schedule Monday Night Medicine Dates: November 1, 2021 Time: 6:30 – 8:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Grand Rounds Dates: November 10, and December 8, 2021 Time: 12:00 – 12:45 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

2021 Live In-Person Conference Schedule

Annual Scientific Meeting

A Day of Board of Medicine Renewal Requirements

Virtual Conference Dates: November 17-18, 2021 In-Person Conference Dates: October 20-21, In-Person Location: The Westin Southfield Detroit Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Date: November 12, 2021 Time: 9:00 am – 1:15 pm Location: Sheraton, Ann Arbor Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

24th Annual Conference on Bioethics For more information or to register, visit MSMS.org/EO or contact Beth Elliott: email belliott@msms.org or call 517/336-5789

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Date: November 13, 2021 Time: 8:45 am – 3:00 pm Location: Sheraton, Ann Arbor Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

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Tirelessly defending the practice of

GOOD MEDICINE. We’re taking the mal out of malpractice insurance. By constantly looking ahead, we help our members anticipate issues before they can become problems. And should frivolous claims ever threaten their good name, we fight to win—both in and out of the courtroom. It’s a strategy made for your success that delivers malpractice insurance without the mal. See how at thedoctors.com

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