Helping Physician Leaders Turn the Corner On Wellness

The reason he attended a wellness program in the first place, the physician leader admits, wasn’t for himself at all. It was to improve wellness within the walls of his organization.

Recruitment wasn’t keeping up with escalating turnover, which increased workloads for the remaining physicians, which resulted in more turnover and additional recruitment woes — a vicious cycle he feared was leaving his staff “truly at risk” of burnout, if they weren’t burned out already.

He remembers returning from the wellness session feeling energized, refreshed, and optimistic. So much so, in fact, that he shared the experience with his entire team and suggested they attend the program, too.

That’s when the tables suddenly turned.

“You know,” one of his staff said, “we’re really glad that you went to this conference because we were concerned that you were burning out and that you weren’t taking any time off for yourself or addressing your needs.”

Until then, the executive hadn’t mentioned his own burnout demons, “but apparently I was emitting that kind of a vibe,” he now surmises.

His was a circumstance hardly uncommon among physicians who are mired in the wallows of burnout but often are the last to recognize or admit to themselves or others the burden of their own symptoms.

With burnout among physicians reaching epidemic proportions, the American Association for Physician Leadership in 2017 committed the personnel and financial resources to launch a series of wellness initiatives aimed at easing a burgeoning problem affecting all facets of the nation’s healthcare industry, from physician wellness to workplace culture to patient care, safety, and outcomes.

“Just seeing physicians struggle and understanding that the healthcare industry is kind of at a loss about what to do about physician burnout — about the lack of physician wellness — we felt as a leadership organization that if not us to address this very complicated and troubling issue, then who?” recalls Dian Ginsberg, AAPL senior director of career and professional development.

Since then, the association has hosted live wellness events attended by more than 150 physicians. The organization also offers distance education courses and online activities, and makes available free wellness resources that are the product of a collaborative initiative with the American Hospital Association.

After two years, Ginsberg wondered if any of this is making a difference. Is it improving the lives, careers, or organizations of those physicians who attend AAPL’s wellness academies?

She sought answers by conducting interviews with several physician leaders who’d been through the program, hoping to learn what changes they had made, what improvements they had realized, and what barriers they had encountered along the way.

Here are some of their stories.

Benefits From the Burnout Experience

For Gary Roth, DO, MBA, FACOS, FCCM, FACS, the symptoms were all there: frustration, thinking about work at bedtime, waking up with no real enthusiasm to go to work, discontent with his work environment, and doubt that this was where and how he wanted to spend the rest of his career.

It was only after his 30-year run as a cardiothoracic surgeon and intensivist ended and he did a “total 180” from clinician to chief medical officer at the Michigan Health & Hospital Association that he realized he had been experiencing burnout, probably for several years.

With the benefit of hindsight, he says, “I can really appreciate where I was by knowing where I’m at with the work I now do.” Now in a leadership position, he is leveraging that personal knowledge and burnout experience to the advantage of those within his organization.

“One of the mainstays of my job as the physician executive for a hospital association,” he says, “is [that] it allows me time to reach out and spend time with physicians, literally on a daily basis, and to get an appreciation for where the struggles are, where the difficulties are, and more importantly where the opportunities are. That is truly a very rewarding part of my job.”

Following the lead of his board chair, Roth made the wellness segment of the Quadruple Aim an internal priority, including attending wellness programs that benefit him and his organization.

The result: “MHA is focusing more and more on physicians. We have become progressively more physician-centric,” he reports.

That progress includes MHA’s establishment of a council of physicians and physician leaders who meet regularly to provide insight and counsel for the organization and its boards on issues of concern to physicians. Among its initial priorities are wellness initiatives that recognize and address the frequent symptoms of provider burnout.

Roth also offers physicians who might not otherwise know where to turn, a safe outlet for difficult but confidential conversations. He also engages with chief wellness officers within the Michigan health system and provides wellness presentations to medical staffs at various hospitals, which promotes the adoption of internal wellness programs statewide.

In the area of wellness, MHA has turned the corner.

Where Is Your Focus? (It Matters)

“As CMO, I frequently found myself dealing with the worst of the worst and trying to put out fires all the time,” says Jennifer Shaer, MD, of the Allied Physicians Group, a private practice of about 35 pediatric offices in New York. “I was a bit overwhelmed trying to turn people from victims into thrivers.”

So taxing were her efforts, she admits now, that “I found myself shifting from motivated thriver to victim as I was dealing with so many negative people.”

The organization needed a culture shift, and so did she. The challenge, she explains, was getting people to grow together as a cohesive unit working toward common goals. This was no easy task, she concluded, and getting there would require outside help.

Help came in the form of a 2019 AAPL wellness program in Washington, D.C., where, among other things, Shaer learned from Dan Diamond, MD, one of AAPL’s wellness faculty, about “target fixation” — that where you focus is where you go. Diamond cites as an example, the man riding his bike down a steep descent with drop-offs. As he looks off the trail, he goes off the side.

Shaer got the message.

“I decided we should fixate on the positives and sort of ignore the negatives (negative partners) for a while and see what would happen,” she says.

She returned to the company with “a new energy” and a new plan. After implementing a pilot program that involved a series of surveys and evaluations and included collaboration among partners and office managers, she was able to identify and address the stressors ailing the organization.

“One thing that became crystal clear is that our biggest problem as a company is lack of respectful communication,” Shaer says. “And so I’ve put together what we’re calling a ‘Hold The Line’ training.”

The training entails working with a consultant and providing a two-hour webinar that teaches office managers, partners, and personnel in specific divisions how to speak respectfully to each other because, Shaer stresses, “we can’t solve problems when we’re yelling at each other.”

“We had very much this culture of fear and now we’re holding people to this communications dial,” she says. “We’re able to make small improvements; we’re starting to see some culture shift.”

After just a few months, it’s a shift in the right direction.

Overcoming ‘Us Vs. Them’

When it comes to executives and clinicians, a sometimes-pervasive us vs. them mindset can contribute to a victim mentality — and to a negative workplace environment that ultimately breeds physician burnout.

As chief quality and safety officer at Sentara Healthcare, a 12-hospital system based in Norfolk, Virginia, Joel Bundy, MD, FACP, CPE, witnessed it and wondered how to bridge that gap — how to “enable people to do better, to reclaim some of that ability to do things on their own so they don’t feel powerless, and [see] that they do have the ability to actually make changes.”

The big lift for physician leaders like Bundy, however, is this: How do you make each of 40,000 full- and part-time employees feel like they’re making a difference?

In short, he says, listen to them and be prepared to act.

“One of the reasons it’s hard for people to be resilient is they have no authority, they have no ability to make change, and they feel like no one is ever listening,” Bundy says. “We recognized that we needed to hear the voice of our physicians. And then, of course, the hard part is, ‘OK, now you’ve told us; how can we fix that?’ We’re working on that as well.”

Help came from AAPL faculty member Stephen Beeson, MD, whose “Practicing Excellence” instructional videos address workplace communication for such topics as how to deal with stressful people, patients, or difficult administrators. With Beeson’s assistance, specific programs were built — one for hospitals and one for EDs — and surveys were administered to employed and affiliated providers.

Among the early outcomes:

• Decrease in the previously high number of best practice alerts. “(Physicians) work with BPAs day and night and, unfortunately, when they go home,” Bundy says. “We’re trying to make it more palatable for them.”

• “Care for the Caregiver” employee assistance program to support providers in cases of unintended patient outcomes.

“You’ve got to learn from the things that you don’t do well and spread the things that you are doing well,” Bundy says, noting that lessons from the AAPL wellness program “energized the clinical leadership within our healthcare system.”

“It’s a journey,” he says. “Lots more to go.”

Culture Change? Not That Hard

Changing the culture of any organization can seem like a daunting, impossible task. Like it will take immediate and total buy-in from everyone to make it happen. Like change must happen swiftly and surely if it’s to work at all. But that’s not necessarily true.

Change on such a scale takes time, but it also takes only a relative few employees — about 10 percent — to make it happen. But which 10 percent?

Jennifer Shaer says employees can be categorized into three camps:

• The actively engaged: The ones driving the company.

• The bystanders: Those along for the ride.

• The actively disengaged: Those trying to sink the company.

Prior to attending a 2019 AAPL wellness program in Washington, D.C., Shaer says she had devoted too much of her time to the third category — “the worst of the worst,” as she calls them. Since then, she has shifted her focus and the company culture. It was a shift encouraged by Diamond.

“[Diamond] made the analogy that a company is like a living organism, and if you strengthen one part of the network, it spreads like a virus — that it takes only a small percent of people to have a culture shift,” Shaer shares. “So, instead of letting gossip and negativity spread, let’s let respectful communication and a positive culture spread.”

What would that take? Diamond says 10 percent of a company’s employees can affect positive change. Shaer’s dilemma? She had been focusing on the wrong 10 percent.

“I was just killing myself,” she recalls. “I was burning out working with the bottom 10 percent of the partners and decided to move up to the 50–60 percent (the bystanders) — and those people are starting to have a rippling effect.”

As part of her “Hold The Line” training that encourages respectful communication, “when we catch people doing good, we call them out on it,” Shaer says.

The result?

“At one division,” she says, “an employee who was close to quitting now says she loves working here. At another division, a biller who was known to be incredibly negative and critical is now showing empathy. There hasn’t been a major earth-shattering culture shift, but we are having rumblings of change.”

It's the kind of change she hopes will soon spread like a virus — a good virus.