A Health Resource Designed for Physicians

Mark J. Albanese, MD

Physicians have been aware of the scourge of burnout since well before COVID, which played a big role in accelerating the burnout epidemic. The health challenges of physicians resulting from burnout have been well documented. While there has been an emphasis on physician self-care, which is important, the focus has been turning to what others can do to support the health of physicians. In the words of a recent Surgeon General report, “We must shift burnout from a “me” problem to a “we” problem” [1]. I will describe one resource available to Massachusetts physicians, whose mission is to support physician health. That resource is the Physician Health Services, Inc. (PHS), a fully owned subsidiary of the Massachusetts Medical Society (MMS). PHS is a physician health program (PHP), and most states have a PHP like PHS. Now in its 30th year, PHS was preceded by the MMS Impaired Physicians Committee. The creation of PHS brought not only a more politically correct name, but a real emphasis on prevention and wellbeing. And all of the services that we provide are free of charge, thanks to the generous support of MMS, the malpractice carriers, healthcare systems, medical staffs, and many appreciative individuals.

Our staff, consisting of MDs and non-MD clinicians, provide confidential, peer-review-protected consultation to Massachusetts physicians. The population we serve includes medical students, DOs and MDs in training, as well as DOs and MDs who have completed training. While one may self-refer, most referrals are made by somebody else, usually a healthcare facility or a colleague. The focus of the consultation is to identify healthcare issues, including substance use, behavioral health, and neurocognitive disorders. Increasingly, referrals have been in the context of burnout-driven, unprofessional behavior.

In addition to assessing for the presence of a health condition, PHS may recommend health resources. Over the years, PHS has established working relationships with many healthcare providers who have experience caring for physicians. These providers, including psychiatrists, psychologists, and therapists, enjoy caring for colleagues. In addition, we work with a very experienced group of professional coaches who are especially skilled at helping referred physicians navigate the interpersonal world of healthcare.

I am frequently asked: How is PHS related to the Board of Registration in Medicine (BRM)? I am happy to say that PHS enjoys a collegial and collaborative relationship with BRM. That said, we are not “part of the BRM” and a referral to PHS is not “like calling the Board.” Recently, we worked with BRM on their initiative to include less stigmatizing language in the licensing and relicensing applications. The goal was to eliminate one of the barriers to physicians accessing care for health conditions.

I want to both briefly describe a couple of recent trends that PHS has observed and offer advice on how to counter these trends. Starting in March 2020, the consumption of alcohol increased significantly in the United States. Physicians have not been immune from this trend. One of my colleagues refers to this as “the alcohol creep”, meaning that the consumption gradually and somewhat unconsciously increased as people experienced a more restricted lifestyle. For the most part, this “creep” has not led to significant issues. What we have found, however, is that physicians who become aware of it and challenge themselves to either decrease their alcohol consumption or eliminate alcohol entirely remark about “how much better” they feel. Therefore, I encourage my colleagues to take stock of how much they drink daily or weekly. If they have any questions or concerns, PHS is available for consultation.

Another trend that we have noticed is the ongoing isolation that predated COVID but was magnified by the pandemic. Many physicians may take pride in their “rugged individualist” streak. The isolation that can accompany this individualism, however, contributes to burnout. The above-mentioned report from the Surgeon General emphasizes the importance of peer connection in mitigating burnout. The report underscores the crucial role of the healthcare system in encouraging connection: “Strengthening social connection and community enhances job satisfaction, protects against loneliness and isolation, and improves the quality of patient care. Peer and team-based models are one way to strengthen collaboration, create important opportunities for social support and community for health workers, while also mitigating burnout and moral distress.”[1] I recently had a text exchange with a colleague that demonstrates this and illustrates that connecting does not need to take a lot of time. I texted him to ask how he was doing. He responded: “I’m overworked yet not feeling like I’m doing enough!” I replied in somewhat off-color language that I felt the same way. He acknowledged: “I’m glad to hear it’s not just me feeling that way! Thanks for checking in. We’re overdue for lunch!”

Approximately one-third of those referred to PHS remain connected to us for one to three years on a formal monitoring contract. These contracts are designed to support physicians in attending to the treatment for any health condition that has been identified. The structure provided by a monitoring contract seems to be quite helpful to those physicians who participate. About 80% of physicians who successfully complete a contract are still licensed and practicing at the 5-year milestone.

I want to give the final word to one of the physicians who recently completed a monitoring contract. Shortly after completion, she wrote to PHS: “Entering a PHS contract has saved my life, my relationships with family and friends, my mental wellness and my career. I am so grateful to all of you for treating me with care and respect and keeping me afloat throughout this challenging process. I do not take for granted how fortunate I am to have had this kind of care. I am eternally grateful to all who have been a part of my journey and I am eager and honored to help others in my position. It truly takes a village and I have been blessed with a very special one.” +

Mark J. Albanese, MD, Medical Director, Physician Health Services of Massachusetts Medical Society

Reference:

1. U.S. Department of Health and Human Services, Office of the U.S. Surgeon General, “Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce,” 2022