Physicians routinely overcome so much in a day, a week, a year—from overstuffed patient panels to electronic records documentation, preauthorization headaches, and conflicting insurer metrics. So when something goes wrong—whether it’s a simple, inadvertent mistake or a patient fatality—it can be overwhelming when added to the other stresses of the job, especially when the proper support is lacking. Sometimes that results simply in a loss of well being or increase of family stress; sometimes it can lead to early retirement, even at the peak of a career, due to burnout.
It’s critical for physicians to be supported during such times, no matter where they are in their careers, says Dr. Claudia Finkelstein, director of faculty wellness programs for the University of Washington School of Medicine in Seattle. Dr. Finkelstein, an internist, specializes in physician wellbeing, and she fervently believes that well-adjusted, resilient physicians provide better care to patients and better teaching and mentorship to doctors-in-training, and are better, more positive family members.
“Everyone in health care, from doctors to nurses to therapists, should be operating under conditions that allow them to reach their maximum potential,” says Finkelstein, who also co-chairs the UW’s Faculty Wellness Committee, heads its Peer Support Program, and directs an educational outreach program. Her outreach series includes workshops and two extended-training series: Mindfulness and Compassion Cultivation Training.
STRESS, DEPRESSION, EVEN SUICIDE
Too often, balance doesn’t come easily to physicians, according to Stanford Health Care, which is also tackling the problem. Nationally, according to Stanford experts, up to 40 percent of physicians report being burnt out. As many as 400 physicians commit suicide each year; among medical school students, suicide is the second most common cause of death. And it’s clearly more than simply a personal problem for physicians and their families: such distress can lead to major medical errors, poorer patient care, and more lawsuits against physicians, Finkelstein says.
"There are so many things that just feel like hoops to jump through, as opposed to patient care. People say to me, ‘I used to be a doctor—now I’m just a typist.’"
- Dr. Claudia Finkelstein
It also drives up the cost of health care. The Mayo Clinic estimates that physician burnout adds more than $3.4 billion annually to the U.S. health-care system’s expenses. Within the Mayo Clinic’s own Department of Medicine, it costs an estimated $1.5 to $2.5 million a year in decreased productivity.
The problem is not a lack of dedication on the part of physicians. “It’s the circumstances under which one works,” Finkelstein says. “It’s about the prior authorizations, and feeling every day like you’re typing forever. There are so many things that just feel like hoops to jump through, as opposed to patient care. People say to me, ‘I used to be a doctor—now I’m just a typist.’ In what other profession do the highest-paid workers do the data entry? Adding to the pressure on physicians is the fact that the whole concept of the chart has gone from a narrative of a patient’s experience by a doctor to a billing document. It’s nonsensical.”
LIVING AND WORKING WITH SATISFACTION AND SUPPORT
At the heart of professional fulfillment in medicine, there are three key areas, Finkelstein says:
- Professional fulfillment—finding your life’s purpose in healing
- Practice efficiency—ensuring your day isn’t eaten by clerical tasks
- A culture of wellness—ensuring your personal needs are met
Individual professional fulfillment can mean many different things to different people. For many physicians, it can mean having the time and support to care for their patients in the way they think is necessary and effective.
As for practice efficiency, “If you need to type for three hours a day after seeing patients, well, that is going to impact you,” Finkelstein says. “When I go to work and my only ambition is to finish my charts on time, I likely will have a crappy time. But if I go to work and my goal is to relieve suffering, and I’m given the space to do that, I will have a great day.”
What constitutes a culture of wellness might well depend on where physicians are in their career. “It can mean that if you announce you’d like a parental leave, your colleagues offer their congratulations and you’re not worried about everyone having to cover for you,” Finkelstein says. “It also means you’re allowed to call in when you’re sick, and not feel that you’re putting undue pressure on colleagues. The culture of bravado in medicine simply doesn’t work anymore, that way of working through every obstacle. We all know that.”
WHY SHOULD YOU CALL?
In her work supporting physicians, Finkelstein is especially proud of having developed the UW’s Peer Support program, which she modeled after a similar program at the famed Brigham and Women’s Hospital in Boston.
“Sometimes, when something hasn’t gone exactly the way it should, whom can you talk to about it as a physician?” she asks. “We offer a peer to talk to, another physician with whom you can discuss the emotional impact of a problem. Sometimes it’s something difficult, like helping you understand not to expect absolution from a family. Our program is about being able to sit with someone and know you’re not alone, to have someone help with guilt and shame and depression. I frequently meet and chat with physicians after issues crop up, and give them a list of resources, including a list of physicians and counselors they can draw upon. It’s very private. I meet people all over the place, and I’ve been around here for a long time, so other people don’t know why I’m meeting the people I meet. I’ve even met physicians at Starbucks.”
She adds that these meetings are always confidential. “I don’t report anything to anyone,” she says. “Only if it’s a mandated report—I would have to report someone I knew was impaired and unable to care for patients, for instance.”
For information about Physicians Insurance’s Peer and Provider Support Resources, see “Responding to Adverse Events: Implications and Resources for Providers”.
LIFE AND WORK IN BALANCE
At the end of the day, Finkelstein says, what physicians need is a sense that their best self is showing up to work, so they can flourish in the office and at home. “It is such a great joy to have a profession with a purpose that is to connect with and help people,” she says. “When your own light goes out a bit, though, it’s much harder to provide that connection with patients. I’m just so passionate about this because it’s a big, big problem affecting not only individual physicians, but also their patients and families, and workplaces. Everyone needs some form of support.”
"The culture of bravado in medicine simply doesn’t work anymore, that way of working through every obstacle. We all know that.”
- Dr. Claudia Finkelstein