At a time when physician burnout is reaching critical proportions, clinicians are attempting to rebuild connections with patients and each other and strike a work-life balance.
This article first appeared January 23, 2019 on MedPage Today.
By Nicole Lou
The need to boost productivity numbers and take care of administrative matters leaves physicians no strangers to a lonesome, ever-digitizing work environment. Yet several clinicians are taking action to reclaim their connections with patients, and each other, in a time of increasing burnout and dissatisfaction with their work-life balance.
"Thanks to expanding digitization, we no longer need to engage our colleagues in the laboratory or radiology suite while on rounds or to discuss recommendations with a consultant: we can see the information we need right on our own computer screen. In the clinic, we can choose to type while taking a patient's history, rather than making eye contact," according to Richard Wenzel, MD, an infectious disease expert at Virginia Commonwealth University Health in Richmond.
"We're saving time. Yet when a patient becomes an RVU [relative value unit] statistic, when professional dissatisfaction is evident, empathy suffers and patients too are left dissatisfied," he wrote in a perspective in the New England Journal of Medicine.
Those are not the only problems with the RVU model -- it "drives competitiveness between physicians, not a sense of camaraderie. There is even competition among partners when deciding who will do cases," cardiologist Cindy Grines, MD, of Northwell Health in Hempstead, New York, told MedPage Today. "Hospitals say they want to help with physician satisfaction and burnout, but at the same time the message is to produce more. You just can't win!"
Social media and other virtual support tools can help recreate some of the early-career camaraderie felt in the residents' lounge, according to Ameya Kulkarni, MD, an interventional cardiologist at the Mid-Atlantic Permanente Medical Group in McLean, Virginia, in a separate NEJM article.
Yet it appears there is no substitution for face-to-face encounters, as Wenzel recalled how he lobbied his institution for a faculty dining room and retreat center, which subsequently had success hosting pre-rounding sessions by consulting teams in an open area.
"The resulting informal cross-talk among team members was facilitated by greater familiarity. Sustained engagement in such a retreat center between senior administrators and physicians might unexpectedly boost institutional creativity and simultaneously invigorate professional life," he suggested.
Kulkarni cited his center's own efforts to battle professional loneliness.
"We started by creating opportunities for doctors to spend time together outside work engaging in non-work-related activities," he wrote. "By spanning a range from sporting events to happy hours to activity-based events (musical jam sessions, golf outings, art classes, cooking sessions with local celebrity chefs, and subsidized playgroups for young families), we've tried to find a way to reach everyone."
Another program at Kulkarni's institution is the Pebbles Project, a structured discussion group for physicians interested in fixing the small operational problems they face every day.
Similarly, C. Michael Valentine, MD, president of the American College of Cardiology (ACC), noted a recent activity in which physicians in his group rotated around six stations giving ideas to improve practice and their lives.
"There are many studies that show that clinician wellness is directly linked to engagement in the process of process improvement. So we want our physicians to be better engaged and to be well-versed in the problems of burn-out and loneliness and dissatisfaction in practice," said Valentine, of Centra Medical Group's Stroobants Cardiovascular Center of in Lynchburg, Virginia, in a phone interview.
He said that physician loneliness is a topic that his center takes very seriously, as does the ACC. Centra is looking to hire a director of clinician wellness, while the ACC has made clinician wellness "a big part of our next strategic plan."
For their part, clinicians at Centra are generally ready and willing to have a hand in their own wellness, Valentine stated. In fall 2018, 150 signed up for a wellness retreat organized by a wellness committee. Global engagement programming, in which doctors travel as a group to areas like Vietnam and Tanzania, is also helping with their loneliness, according to him.
Some of these social programs may work better for certain fields and not others, however.
"Although our hospital has a physician lounge, it is very spartan and not conducive to meeting and developing relationships," Grines said. An afternoon tea may be more successful at getting doctors together, she suggested, adding that subsidized child care and play groups could be "wonderful."
"But will the hospitals pay for this? I find that physician benefits, administrative support, conference funds, department parties, etc. are being cut year after year," according to Grines.
Perhaps cardiology has a unique competitive and male-dominated atmosphere that isn't conducive to friendships in the first place.
"I have organized a few events (dinners, yoga) for our female cardiologists, and some female physicians attend, and others don't even respond to the invitation. Perhaps they are too busy with their job and life, or perhaps in this man's world, they are fearful to identify with a group of professional women," Grines said.
At the end of the day, she added, a friendly person who hangs out around the cath lab may be seen as lazy -- or worse yet, a spy, or a competitor "trying to steal cases."
“Hospitals say they want to help with physician satisfaction and burnout, but at the same time the message is to produce more. You just can't win!”
Cindy Grines, MD
Physicians worry that RVUs drive competition, hurt camaraderie and consultation.
Patient empathy, job satisfaction suffer for the sake of improving production.
Social media helps, but there's no substitute for face-to-face encounters with colleagues.