• Physician Well-Being


    This Mid-Year Forum 2017 session covered physician well-being and what ophthalmologists can do to reduce stress. Following is a detailed summary of the discussion.

    Abstract

    While ophthalmologists, report a high level of satisfaction with our profession, many outside forces contribute to increased stress and reduced time caring for patients. This hearing focused on resources available and practical ways to promote physician well-being so ophthalmologists can re-connect with the passion that brought them into medicine in the first place.

    Background Information

    Of late there’s been increased focus on physician well-being. With the added administrative burdens of practice, financial concerns and increased complexities of our health care system, it’s no wonder that physician stress is mounting. There is a growing body of information on ways that physicians can address these issues and enhance his or her mental and physical well-being.

    Summary of Comments from Guest Speakers

    Introduction

    Lynn K. Gordon, MD, PhD – Vice Chair, Academy Council

    • Nationally, physician burnout rate is more than 50 percent.
    • Medical students start with a burnout rate lower than their peers but this reverses over the course of their training.
    • Physician burnout may lead to medical error, decreased patient satisfaction, staff turnover and more.

    What is the state of physician well-being?

    Brad H. Feldman, MD – Academy Secretary for Member Services

    • A 10-point illness-wellness continuum from disease to optimal health describes various degrees of well-being, which is much more than simply the absence of disease.
    • The CDC defines well-being as judging life positively and feeling good. This encompasses physical, mental and social well-being.
    • Signs of burnout include emotional exhaustion, decreased empathy, cynicism, loss of enthusiasm and feeling a lack of accomplishment.
    • Medical students and residents have a 50 – 75 percent burnout rate.
    • Practicing physicians’ burnout rate is 30-70 percent. Ophthalmologists are better than most specialists but still report a rate of 43 percent, according to the 2017 Medscape survey.
    • Some of the causes of burnout include: too many bureaucratic tasks, too many hours at work, sense of being a cog in the wheel.

    What affects physician well-being?

    Cynthia Ann Bradford, MD – Academy President

    • Characteristics of “good” physicians can also lead to burnout.
    • Loss of control can lead to disengagement.
    • This happens over time. Females have a 60 percent higher risk of burnout. Systems issues account for 80 percent of stressors; personal issues for the remaining 20 percent.
    • It’s important for physicians to take care of their own needs. Delegate. Connect with others. Schedule time for personal needs. Eat healthy. Sleep adequately.

    How do we create a culture of well-being and resilience?

    Lynn K. Gordon, MD, PhD – Vice Chair, Academy Council

    • A meeting to launch an initiative on this topic of well-being and resilience was held in July 2016 by the National Academy of Medicine.
    • Over 2,600 studies have been published on physician burnout, 15 of which were randomized and 37 were cohort studies that presented data from over 3,600 physicians.
    • Intervention strategies for physicians that were identified were: mindfulness, stress management and small-group discussions.
    • Structural interventions included, reduced duty hours, modified work practices, e.g., start meetings later, etc..
    • Interventions reduced overall burnout rates, emotional exhaustion and depersonalization, but more needs to be done.
    • A number of strategies were suggested to decrease physician stress on the institutional and national levels related to ameliorating administrative burdens and improving efficiencies.
    • Effective organizational leaders can decrease physician burnout and increase satisfaction.
    • For the individual physician, it is important to: build a work community network, participate in self-awareness activities (mindfulness, stress management, etc.) and take care of physical needs (sleep, exercise, medical care).
    • Still need to understand the long-term effectiveness of various interventions on different types of individuals.

    Mindfulness: What is it? How can it help?

    Aviad Haramati, PhD – Professor of Integrative Physiology, Georgetown University

    • Notion of personal self-care was derided in medical schools until recently.
    • Mind and body are connected..
    • Mindfulness was defined as awareness emerging by paying attention in a particular way on purpose in the present moment and without judgment to the unfolding of experience from moment to moment. Experience the present without judgment.
    • A 2009 JAMA article on mindfulness intervention showed improvement in the scores on the Maslach. Burnout scale. Empathy increased. Mindfulness increased.
    • There are multiple stressors daily. It is key to handle each stress factor and be able to return to a baseline in order to obtain an optimal pattern in dealing with stress.
    • Chronic stress impairs memory, learning, and more.
    • A little stress can make you high performing but it is not sustainable. Acute stress is okay. Chronic stress is damaging.
    • There are numerous techniques to practice mindfulness:
      • Meditation;
      • Imagery;
      • Biofeedback;
      • Autogenic training;
      • Breathing techniques;
      • Exercise;
      • Yoga Tai Chi;
      • Group support.
    • When you focus on the present you can’t be stimulated into a stress response.
    • Mindfulness brings stress hormones to baseline. It’s like a “reboot.”
    • AAMC, AACGME and NAM – all have resources on mindfulness.

    Summary of Audience Comments

    • There is no “best” way to practice mindfulness. Whatever works for the individual is the best way.
    • This session should be included in the L.E.A.P. program. Young ophthalmologists need this information.
    • Resilience and grit is a growing area of awareness among physicians. Burnout is being discussed and addressed
    • Need a group for MOs; they are at a point in their lives with many stressors. Recommend online resources. AAMC.org/wellbeing. University of Wisconsin, Massachusetts. Create well-being page on aao.org.
    • Coordinate with other societies to reduce governmental administrative stressors. This would lead to reduced costs.
    • Offer a course during the annual meeting.
    • Add something to maintenance of certification about mindfulness.
    • Pause in the OR for a mindful moment for the team.
    • Most institutions are aware of the importance of the topic and offer resources, but ophthalmology can be in a silo and miss these opportunities.
    • New ACGME requirement on wellness allow physicians to go to medical/dental appointments, make mental health services available, 24/7.
    • Checklists are “nice,” but it is only effective if it is embedded into the culture.
    • How do we get senior ophthalmologists to change culture? Lead by example. Don’t proselytize. Show by example.

    High-Priority Objectives

    • Raise members’ awareness of the importance of wellness.
    • Provide members with information and resources on wellness.

    Review more sessions in the Mid-Year Forum 2017 report.