Improving Physician Wellness
Carol Bernstein, MD
Physician well-being is increasingly becoming the focus of discussion, research, and programming within the medical community.
Studies have shown that physicians who care for themselves provide better care to patients and may be less likely to make medical errors. In addition healthier physicians are more likely to remain in the profession. However, because of the prevalence of burnout and depression among doctors, the lack of physician well-being is increasingly seen as a public health problem.
To help residency and fellowship program directors better address burnout among their trainees, Carol Bernstein, MD, spoke in late October 2016 to Partners program directors on “Physician Well-Being: Challenges and Opportunities”. Dr. Bernstein is the Vice-chair for Education and director of the residency training program in the Department of Psychiatry at New York University School of Medicine. She is also the co-chair of the recently established ACGME Task Force on Physician Wellbeing.
Dr. Bernstein first reviewed common causes of depression and burnout among trainees. Studies show that at the beginning of medical school, students have a better sense of well-being than their age-group peers who are not attending medical school. Early in medical school, this reverses and burnout continually increases through medical school and trainees’ intern year. Burnout begins to decline as trainees advance and become practicing independent physicians. However, burnout still remains higher than the general population and higher among female physicians than among males. While physicians have a lower rate of death due to other medical diseases, they have a higher rate of suicide than the general population beginning in mid-life.
In an effort to enhance resident health as well as patient safety, in 2003 the ACGME instituted duty hour restrictions. Unfortunately, though studies have shown that there is a direct association between the number of hours trainees work and depression, reducing the number of hours trainees work has not by itself reduced burnout.
What can be done?
Dr. Bernstein stated that the first step is to raise awareness, increase resilience and reduce stress. The ACGME is making physician well-being, along with patient safety, the primary focus of upcoming CLER institution visits. Faculty modeling of self-care is one of the best ways to promote the establishment of self-care routines in the lives of all residents and fellows. Mentoring is another. The MGH Department of Medicine’s positive psychology coaching program (see http://www.partners.org/Graduate-Medical-Education/GME-At-Partners/Home-Page-Stories/2016-MGH-IM-Prof-Dev-Coaching.aspx)
teaches residents skills to help them identify their stressors and develop problem-solving skills to deal with them. MGH also has a SMART-R (Stress Management and Resilience Training for Residents) curriculum that was adapted from the Benson-Henry institute for Mind Body Medicine. Institutional policies can be examined and revised if necessary to ensure that they reduce rather than increase stress. Providing resources to trainees to help them manage their busy lives is another way of preventing burnout.
Screening of trainees for burnout is an important next step, Dr. Bernstein said. Trainees should be educated to recognize burnout in themselves and others. Some institutions have peer leaders or “buddy programs” to help trainees identify stress in each other.
Lastly, providing counseling and crisis management strategies are important for those trainees for whom the stressors become overwhelming.. The primary barrier for residents seeking help is time though some residents have indicated that they avoid treatment due to stigma. One study showed that marketing psychological services to residents helps. In 2004-2005 in one institution, only 5% of residents took advantage of these services. In 2009-2010 while after marketing, 12% participated*. The EAP program at Partners is totally confidential and allows residents and fellows to seek a variety of types of help from advice on financial planning to help finding childcare to help for family members. A list of such benefits to Partners trainees can be found at http://www.partners.org/Graduate-Medical-Education/Residents-Clinical-Fellows/Salary-Benefits/default.aspx.
Dr. Bernstein gave her presentation twice, once at BWH and once at MGH. Forty-nine program directors attended. A copy of Dr. Bernstein’s slides can be found at http://www.partners.org/Graduate-Medical-Education/Policies-Resources/Program-Management/Physician-Wellness.aspx.
* Guille, et.al, JAMA Psychiatry, 2015