BEHAVIORAL HEALTH
An Epidemic Within a Pandemic System-Level Changes for Physician Wellbeing BY MICHELLE D. SHERMAN, PHD LP ABPP, ADAM SATTLER, PHD LP, BARBARA CARVER PSYD, LP, ROSEAN BISHOP, PHD LP, JENNIFER NELSON ALBEE, MSW, LICSW
I
n recognition of research showing over 50% of United States physicians report significant symptoms of burnout, in 2017 the National Academy of Medicine created the Action Collaborative on Clinician Well-Being and Resilience. This program aimed to increase attention to the epidemic of clinician burnout and to advance researchbased solutions to provide support. Similarly, conceptual models have been offered (e.g., Shanafelt & Noseworthy, 2017; Shapiro et al., 2018) identifying key drivers of burnout, organizational strategies to mitigate burnout, and systems-level interventions. Efforts such as these are important and necessary, but broad application to everyday practice and measurable impacts have yet to be seen. Then, the COVID-19 pandemic suddenly and intensely hit our world in March 2020, therein exposing many societal issues (e.g., health/wealth inequities along racial lines) that adversely impact physician well-being and the patients they serve. Medical school did not prepare anyone for the challenges 2020 would bring to the healthcare system and our patients.
Specialists in Musculoskeletal Pain Treatment
Effective Non-Opioid Treatment Evidence-based Biopsychosocial Approach Active Therapy Multidisciplinary Care Team Quality Outcome Reporting
PDR Outcomes
• 67% of patients rate their pain reduction between 50-100%
• 74% of patients rate their headache reduction between 50-100% • 64% of patients rate their use of medications decreased 50-100% • 109% increase in Lumbar Extension ROM & strength • 165% increase in Cervical Rotation ROM & strength
Scheduling 952.908.2750
Edina | Chanhassen | Burnsville Coon Rapids | Maplewood
www.PDRclinics.com 24
DECEMBER 2020 MINNESOTA PHYSICIAN
As psychologists/social workers embedded in family medicine residency programs at four large healthcare systems across Minnesota, we see and truly hurt for our physician colleagues serving on the front lines of the COVID pandemic. The levels of stress are palpable. Emerging research is documenting healthcare providers’ elevated rates of insomnia, anxiety, and depression (Pappa et al., 2020). Anecdotally, we hear some colleagues questioning if they want to continue their careers as physicians. Many have taken pay cuts over the past year due to financial challenges faced by healthcare. Witnessing such high rates of illness and death can be traumatic, and we worry about short-and long-term trauma-reactions including but not limited to PTSD, increased rates of self-harm and suicide, increased rates of substance use disorders and overdose, moral injury, and more. So, we see and honor physicians’ exhaustion, fear and anxiety, anger, sadness, sense of feeling overwhelmed and inability to do their jobs due to shortages of resources, and grief at lost colleagues, family, and friends. Of note, these struggles are not exclusively due to the pandemic, and they will not spontaneously remit once this virus is under better control. We thank physicians for their sacrifices, commitment, and courage during this incredibly stressful time.
Well-intended efforts Across our healthcare systems, we have seen many well-intended efforts to support the healthcare workforce. EAP services, webinars, free pizza, resource toolkits teaching coping skills, emails offering appreciation….many of these individual efforts are important and definitely may be helpful to some people. However, for many physicians, these efforts are not only falling flat but are actually offensive. For example, a wellness guide was emailed to physicians in one of our systems; residents found the suggestions of deep breathing and exercise to be really missing the mark in light of their current levels of stress and pain. Instead of experiencing the well-intended resource as helpful, it was a source of derision and mockery. Offering such resources without acknowledging the broader systemic issues affecting physician well-being has backfired; efforts such as this may be inflaming physicians’ longstanding and deeply held frustrations with the system. Further, many overwhelmed physicians experience resilience suggestions (e.g., exercise more, meditate more) as something else that they aren’t doing well – thereby worsening their well-being rather than improving it.
Steps for making change We are committed to work alongside our physician colleagues in the journey ahead to build the healthcare system back to a place that is better than prepandemic time. This rebuilding may provide an opportunity to thoughtfully examine some long-standing systemic issues that impact well-being. The solution is NOT more resilience training focused at the individual level. Physicians are resilient people. Below are some specific systemic steps we urge healthcare leaders to consider to effectively support physicians. Ensure all healthcare providers have sufficient PPE, regular testing, and early access to the vaccine. Allocation of sufficient resources to help keep our frontline providers safe is essential. A recent article (Chin et
