In HealthLeaders' latest The Winning Edge webinar, a three-member panel discussed the best practices for promoting physician wellness.
With about half of physicians experiencing burnout, promoting physician wellness is a top concern for healthcare organizations across the country.
Physician burnout spiked during the coronavirus pandemic. In a 2021 survey, 62.8% of physicians reported experiencing burnout symptoms. In 2023, 48.2% of doctors reported experiencing at least one symptom of burnout, according to American Medical Association data.
With about half of physicians experiencing burnout, promoting physician wellness is a top concern for healthcare organizations across the country.
Physician burnout spiked during the coronavirus pandemic. In a 2021 survey, 62.8% of physicians reported experiencing burnout symptoms. In 2023, 48.2% of doctors reported experiencing at least one symptom of burnout, according to American Medical Association data.
An essential element of ensuring that physicians feel secure in seeking help is reducing stigma, according to the panelists.
One way to reduce stigma is to eliminate questions about mental health on physician licensing and credentialling forms, which is one of the goals of the Dr. Lorna Breen Heroes' Foundation. Getting rid of these questions takes a big step toward reducing stigma, since according to the panelists, they do more harm than good.
Reducing stigma also requires a cultural shift in the physician profession, according to the panelists. Part of physician training usually entails messaging that doctors are supposed to be strong emotionally and mentally. This messaging results in an "internal voice" that says physicians should not have to reach out for help when they are struggling, the panelists said.
The top leadership of healthcare organizations need to provide an external voice that says it is OK for physicians to not be OK and to seek help, the panelists said. It is also helpful for senior leaders to share their own vulnerabilities such as struggles with mental health and addiction.
Another way to address stigma is to provide physicians with confidentiality when they use mental health resources, according to the panelists. Doctors are often hesitant to use their healthcare organization's employee assistance program over confidentiality concerns, and it is helpful to grow partnerships with external organizations that can provide mental health services.
2. Helping physicians to remain healthy
Healthcare organizations should build structures such as well-being committees to help physicians remain healthy, the panelists said. Health systems must also consider creating a chief wellness officer position as part of the organization's senior leadership.
Establishing well-being structures and creating a chief wellness officer position provides a voice that says physician wellness is an important goal for a healthcare organization, according to the panelists.
A healthcare organization should also implement a physician wellness program with a strong structure, Campbell said. At Allegheny Health Network, the health system's wellness program follows the principles of the Stanford Model of Professional Fulfillment. The Stanford model has three core elements: a culture of wellness, efficiency of practice, and personal resilience.
To promote their own health, physicians should practice self-care, according to the panelists. Doctors often put themselves last after their patients and families, but they should be focused on building blocks of health such as nutrition and sleep. Physicians should also try to take time off as afforded by their organization.
3. Showing physicians appreciation and providing them with a voice
Doctors who feel valued are less likely to be burned out, according to the panelists.
Healthcare organizations should have formal and informal ways to recognize their doctors when they do good work, the panelists said.
For example, formal recognition can be given through an awards dinner. Informal recognition includes positive conversations on a day-to-day basis with team leaders. These conversations are a way to recognize a physician staff's unsung heroes.
Doctors should feel engaged in the direction of their organization, according to the panelists. Senior leaders and team leaders should have listening sessions with their physicians, so they feel they are being heard and get feedback on their comments.
Part of leadership development programs at healthcare organizations should include giving top leaders education on providing an environment of psychological safety for physicians, the panelists said. This education should encourage senior leaders to admit their own fallibility, to show they are willing to listen, and to be flexible.
This webinar was sponsored by the American Medical Association.
The stakes are high, with physician burnout linked to lapses in patient safety and care quality. Our next Winning Edge webinar explores how to address this crucial problem.
Physician burnout is one of the tragedies of U.S. healthcare, and it has a significant impact on patient care.
Society expects physicians to heal and comfort people when they are suffering. But about half of all doctors are themselves suffering from burnout, which includes emotional, mental, and moral injury.
Physician burnout spiked during the coronavirus pandemic. In a 2021 survey of physicians conducted by the American Medical Association, Mayo Clinic, Stanford University School of Medicine, and the University of Colorado School of Medicine, 62.8% of physicians reported experiencing burnout symptoms.
In 2023, 48.2% of doctors reported experiencing at least one symptom of burnout, according to AMA data. This was the first time the rate of physician burnout was below 50% since 2020.
There are three main symptoms of physician burnout, according to the American Academy of Family Physicians. Exhaustion is characterized by low physical and emotional energy levels. Depersonalization includes sarcasm and cynicism about patients and jobs. Lack of efficacy features doubt about the meaning and quality of providing care.
There is no silver bullet to address physician burnout and no singular approach to boosting physician well-being.
In interviews with HealthLeaders, healthcare leaders have said that efforts to promote physician well-being fall into two primary categories: system and individual approaches.
System approaches focus on barriers to well-being at the organizational level. Efforts to address these barriers include reducing administrative burdens on doctors, providing flexibility in scheduling, and optimizing electronic medical records.
Individual approaches include employee benefits, resources for physicians to seek help for emotional or mental distress, and methods for increasing personal resilience.
Focusing on solutions
For clinical care leaders, promoting physician well-being and addressing physician burnout is essential to the success of their organizations. That is why HealthLeaders is bringing together a panel of industry experts to share best practices and innovative approaches.
The next webinar in our Winning Edge series, which will be held on Tuesday, January 21, from 1 to 2 PM ET, will tackle physician well-being and burnout head-on. Discussion topics include eliminating barriers to doctors reaching out for help, designing interventions to keep physicians healthy, providing forums for doctors that offer psychological safety, and addressing workplace violence.
Our panel includes:
Thomas Campbell, chief wellness officer, Allegheny Health Network;
Christopher Cheney, event moderator and HealthLeaders CMO editor;
Jim Gilligan, VP of health system and group partnerships, American Medical Association;
Amy Jibilian, chief wellness officer, Lehigh Valley Health Network; and
Shawn Jones, medical director of provider wellness, Baptist Health Medical Group.
This is not just another webinar—it is an opportunity to learn from the best in the business and take away strategies you can implement at your organization.
Join us as we explore physician burnout and physician well-being in depth. Help your doctors avoid the tragedy of physician burnout.
Top clinical officers at NYU Langone Health and Scripps Health share what their organizations learned from the coronavirus pandemic.
It has been five years since the first case of COVID-19 was diagnosed in the United States, and a pair of top clinical officers says there are a dozen lessons learned from the pandemic.
On Jan. 20, 2020, the first case of COVID-19 in the United States was diagnosed in Snohomish County, just north of Seattle, Washington. The ensuing pandemic exacted a heavy price on the country, with more than 111 million cases and 1,219,487 deaths reported through April 2024, according to worldometer.
At NYU Langone Health, one of the lessons learned from the pandemic was the value of preparation, according to Fritz François, MD, executive vice president, vice dean, and chief of hospital operations at the health system.
NYU Langone Health has been holding tabletop exercises for disaster scenarios once or twice a year since Superstorm Sandy in 2012.
"On Jan. 8, 2020, we held a tabletop exercise for an outbreak of a respiratory virus," François says. "The question was, what would we do? The entire organization came together to think about what we would do for an outbreak. Just a few weeks later, there was an incredible outbreak worldwide and a pandemic would be declared. We had lead time to prepare."
Several aspects of that tabletop exercise were applied during the pandemic, François says.
The health system talked about having a core group of individuals who were trained to take care of respiratory virus patients. They dedicated the ICUs as areas to care for the sickest patients, and intensivists who could take care of these patients. They talked about making sure they had the right equipment and supplies, and talked about having the right protocols to support the patients.
Lessons learned at NYU Langone Health
NYU Langone Health learned six primary lessons from the pandemic, according to François.
First, health system leaders need to think about where patients are going to go during a respiratory virus outbreak. They need to think about where respiratory virus patients are going to be placed in emergency rooms and hospital inpatient units.
Health system leaders also need to think about load-balancing patients at multiple hospitals.
"You need to consider hospitals that are being overwhelmed versus hospitals that are not overwhelmed," François says. "You have to coordinate where patients are sent."
Second, health system leaders need to think about personnel. They must determine whether they have the right personnel, not only in terms of specialists who can care for individuals with respiratory illnesses but also nurses and technicians.
"You need to think about the group of individuals who need to come together to provide care for patients," François says.
Third, health system leaders need to acquire adequate supplies of personal protective equipment (PPE) for staff members.
"We had thought about it in advance, and we ensured that all of our staff had the appropriate PPE," François says.
Fourth, health system leaders need to provide the necessary products and equipment in their supply chain. In the case of the pandemic, this included respirators and monitors.
Fifth, health system leaders must implement the proper processes and protocols. For example, there should be processes for moving patients from one area to another. Treatment protocols were a challenge during the pandemic because COVID-19 was a novel virus.
"You need to have evidence-based protocols to ensure that care is being provided effectively," François says. "Our protocols were reviewed by subject matter experts. When new data came out, we updated the protocols."
Sixth, health system leaders should focus on performance. At NYU Langone Health, this meant developing a plan to respond to the pandemic and measuring how the health system performed.
"We developed a dashboard that allowed us to understand how many patients were coming through the emergency departments, how many patients were being admitted, how many patients were in the ICU, how many patients were on ventilators, and how many patients did not survive," François says.
Standardizing care is essential to achieve a high level of performance, according to François.
"By standardizing care, we wanted to make sure that anyone who came to our health system—whether it was Manhattan, Brooklyn, or Long Island—received the same quality of care," François says. "From a health equity perspective, this was critical."
Lessons learned at Scripps Health
Scripps Health also learned six primary lessons from the pandemic, according to Ghazala Sharieff, MD, MBA, corporate senior vice president as well as chief medical and operations officer for acute care at the health system.
First, Scripps learned that the health system could ramp up telehealth services.
"Before COVID hit, we saw 188 patients through telehealth in a six-month period in 2019," Sharieff says. "In the peak of COVID, we were seeing 3,000 patients a day through telemedicine."
Second, Scripps learned the value of virtual meetings for staff members.
"We have become much more efficient in our meetings," Sharieff says. "There is value to in-person meetings, but for things that are routine such as operations meetings and updates, we are doing that effectively through virtual meetings."
Third, from a CMO perspective, Sharieff learned the value of having a regional CMO group meeting regularly during the pandemic.
"We realized early on during the pandemic that there was conflicting information from the Centers for Disease Control and Prevention, state authorities, and county officials," Sharieff says. "CMOs from across our region needed to get together, so we could have a consistent message going out to our staff."
The regional CMO group was able to join forces on advocacy during the pandemic. As a group, they were able to send a letter to the state saying that weekly staff testing was not feasible.
"There was a point in time when the state wanted us to test every staff member for COVID every week," Sharieff says. "It was not practical. We didn't have enough tests for the patients who were sick."
Fourth, Scripps understood that working as a health system rather than a collection of five individual hospitals is important during a crisis. Like NYU Langone Health, Scripps used load balancing to make sure that none of its hospitals were overwhelmed during the pandemic.
"We are much more proactive now," Sharieff says. "We learned how to pivot and move quickly."
Fifth, as a CMO, Sharieff discovered the value of working closely with the health system's supply chain.
"I recommend that CMOs across the country get more involved in their supply chains," Sharieff says.
Sixth, Sharieff learned that a CMO must be intimately involved in crisis management during a pandemic.
"A CMO should be present in the command center and not delegate that work," Sharieff says. "You need to roll up your sleeves and do the work."
SSM Health has established "foundational building blocks" to support value-based care.
The chief clinical officer of SSM Health is passionate about value-based care.
Stephanie Duggan, MD, became chief clinical officer of SSM in November 2023. Prior to joining SSM, she was president and CEO of Ascension Michigan for five years.
"I love value-based care because value-based care means we as a health system are doing our job for those in the communities we serve," Duggan says. "When we think about value-based care, it is about being there for the patients every time they need care. With value-based care, we get credit for being able to give care in a more efficient manner."
SSM has four "foundational building blocks" to support value-based care that are paired with care management programs.
Rising labor costs are among the challenges at medical groups, survey finds.
Medical groups are continuing to feel the strain of internal and external pressures, including rising labor costs as well as increasing demand and access issues, according to the AMGA.
"With a stifled reimbursement environment and continued financial pressures, medical groups are forced to double down on operations and expense management," the AMGA said in a prepared statement.
The AMGA survey includes three key findings.
First, operating expense increases outpaced revenue gains. Median investment per physician eroded for system-affiliated medical groups from $249,000 to $256,000, excluding overhead allocations.
Second, to address physician shortages and access issues, utilization of advanced practice providers (APPs) such as nurse practitioners and physician assistants has increased sharply. APP utilization has grown from 36.8% of total providers (2020 AMGA survey) to 45.9% (2024 AMGA survey).
Third, the AMGA2024 Medical Group Compensation and Productivity Survey found provider compensation was up 5.3% from the prior year. The AMGA 2024 Medical Group Operation and Finance Survey found salary and benefits increased, while other operating expenses dropped.
"This finding indicates that the portion of the company's revenue being allocated towards compensation and benefits continues to grow (as a percentage of revenue)," the AMGA said, "while expense management in organizations is focused on management of non-salary spending."
Mark LePage, MD, MBA, FACHE, is senior vice president of medical groups and ambulatory strategy at Trinity Health. Photo courtesy of Trinity Health.
Increasing labor costs
Medical groups are experiencing higher labor costs "across the board," but physician compensation has become a major driver of increased salary expenses, says Mark LePage, MD, MBA, FACHE, senior vice president of medical groups and ambulatory strategy at Trinity Health.
"We have experienced increased labor costs on the physician side and the provider side," LePage says. "There is an inherent shortage of physicians and providers across the country."
At Trinity Health and many other health systems, special circumstances are putting upward pressure on compensation for some physician specialties, LePage explains.
"For example, we have increased the sites where we are providing anesthesia services, which has further increased demand on a limited supply of anesthesiologists," LePage says. "More and more imaging is being done throughout the healthcare enterprise, so we are experiencing shortages of radiologists in some markets."
There are several strategies to offset labor costs, according to LePage, including making sure all staff members are working at the top of their licenses.
"We want to make sure that staff are doing the things that only they can do," LePage says.
Technology is also part of the solution.
"We need to look at where we can off-load work to computers," LePage says. "We need to look at places where the electronic medical record can do more of the work for us than having people do the work."
Additionally, Trinity Health has deployed AI tools to boost the efficiency of clinicians, according to LePage. The health system has adopted DAX Copilot to decrease the documentation burden on clinicians. The ambient listening AI tool records the interaction between a clinician and a patient, then generates a clinical note for the EMR.
"It allows our physicians and other providers to spend more time with the patients," LePage says.
Expenses outpacing revenue
While expenses such as labor costs have been increasing at medical groups, revenue has been stagnant or even decreasing, according to LePage.
"We have had inflationary pressure that has impacted not only labor but also real estate and supplies," LePage says. "At the same time, when you look at the Centers for Medicare and Medicaid Services (CMS) conversion factor for professional reimbursement in healthcare, that has been decreasing year after year."
To make matters worse, commercial payers have been following CMS' lead in limiting physician reimbursement, LePage explains.
Advocacy must be part of the strategy to address the imbalance between expenses and revenue.
"First, the AMGA and others are doing a lot of advocacy work with the government about how we need to change the formula for the CMS conversion factors," LePage says. "Second, we need to work with commercial payers [to advocate] for reimbursement increases that more accurately reflect the inflationary pressures we are facing."
LePage recommends medical groups increase operational efficiencies and reduce operational expenses.
"We have to manage all of the components of our operating expenses much more closely," LePage says. "For example, there is an increasing threshold for physician productivity that we need to achieve to offset inflationary pressures."
Medical groups need to contain supply chain costs and manage real estate assets effectively to decrease operating expenses, according to LePage.
Revenue cycle is another area of focus.
"Looking at the revenue cycle, we need to make sure that we capture all of the dollars that we have actually provided in services," LePage says.
APP utilization
The increased utilization of APPs reflects significant trends in the healthcare workforce and the U.S. patient population, according to LePage.
"The healthcare needs of the population are increasing as the population ages," LePage says. "We need to incorporate APPs into the care delivery model because there are not enough physicians to provide care."
Leaders at Trinity Health believe the best model for APPs in care delivery is a team-based approach, where APPs and doctors work in cooperation as colleagues, LePage explains.
"We believe the best construct is a team construct in which you have physicians and APPs working together as part of a team," LePage says. "The skills of APPs and the skills of physicians as well as the experiences of both help to augment what we are trying to do in our care environments."
Duggan became chief clinical officer of SSM in November 2023. Prior to joining SSM, Duggan served as president and CEO of Ascension Michigan for five years. Her leadership experience includes serving as CMO of Ascension Sacred Heart Hospital in Pensacola, Florida.
"I love value-based care because value-based care means we as a health system are doing our job for those in the communities we serve," Duggan says. "When we think about value-based care, it is about being there for the patients every time they need care. With value-based care, we get credit for being able to give care in a more efficient manner."
To be successful in value-based care, a health system must have "foundational building blocks" that support delivering high quality care at a relatively low cost, according to Duggan, who adds SSM has four of them.
"We have our data analytics integrated, so we can see and measure the differences we are making," Duggan says. "Secondly, our value-based payer contracting is designed to manage alternative payment models. Third, we have care management programs because you cannot just suddenly expect patients to manage themselves into better healthcare. Finally, we have optimized our physician enterprise—you need doctors who are willing to go on the value-based care journey."
SSM started with seven care management programs, and recently added care management programs for congestive heart failure and diabetes care. One of the original seven is an acute transition program, where the health system has specialists who are trained to help patients when they are going from the hospital to the home or a post-acute care facility.
"Good care doesn't end when you leave the hospital or leave the emergency department," Duggan says. "Having someone guide you through care transitions has a lasting impact on how you manage to deal with the stress of an acute illness."
Data shows the care management programs are having a positive effect. In 2022, the patients who had enrolled in one of SSM's care management programs had a 17.5% lower per-member-per-month cost in 2023.
"That accounts for an annualized savings of about $16.4 million," Duggan says. "That is telling us that what we are doing is working."
Stephanie Duggan, MD, is chief clinical officer of SSM Health. Photo courtesy of SSM Health.
Attaining sufficient scale is critical to providing effective value-based care, according to Duggan, who adds that it's difficult to find success with a smaller number of patients.
"We have more than doubled the number of patients who we have attributed to our medical group that are in alternative payment models," Duggan says. "We had about 300,000 lives in 2019. At the end of 2023, we had more than 600,000 lives."
To support value-based care, SSM has also focused on annual wellness visits with patients. According to Duggan, patients who have annual wellness visits have an opportunity to talk with a provider about what's going on in their lives.
"When we are providing value-based care, we want to know what health means for the patient," Duggan says. "As clinicians, if we do not ask that question, we will do cookie-cutter medicine as opposed to individualized care."
For health systems, reimbursement is the primary challenge in providing value-based care, according to Duggan.
"Generally, when you start on the value-based care journey, you are only sharing upside risk with payers. So if you save money, you make money," Duggan says. "But as you get better and move further along the journey, you take on downside risk as well. It gets harder to capitalize on savings. What I am hoping is that as the rest of the country embraces value-based care, reimbursement will catch up."
Limiting expenses is essential in managing downside risk, Duggan explains. For SSM Health, diabetes care is one of the highest expenses.
"We are looking at how we can improve management of these patients to spend less on rescue care and more on preventative care, which not only helps the patients feel better but also keeps them out of the hospital," Duggan says. "That is how you win in value-based care programs—you must continuously be improving and helping your patients be healthier."
Texas Children's Hospital and its physician group have stepped up efforts to promote physician well-being since the coronavirus pandemic, according to this CMO.
Sapna Singh, MD, the new CMO of Texas Children's Pediatrics, has several years of experience in leading physician wellness efforts.
Singh has been a physician at Texas Children's Hospital since 2011, and she started as CMO of Texas Children's Pediatrics in October. Singh has served as medical director of physician wellness at Texas Children's Pediatrics since October 2022 and has been the chair of the Texas Children's Pediatrics Engagement and Wellness Committee since October 2021.
With 350 physicians, Texas Children's Pediatrics is one of the largest pediatric medical groups in the country.
Discussions about improving physician well-being at Texas Children's Pediatrics began in 2016, but the coronavirus pandemic galvanized the effort, according to Singh.
"Not only in our organization but also across the country burnout and moral injury increased during the pandemic," Singh says.
The Engagement and Wellness Committee was formed in 2021.
"It was comprised of physicians in the organization who had a desire to help work on improving the culture and efforts to improve wellness and engagement for our clinical teams," Singh says. "The key was not only the establishment of the committee but also partnering the committee with our leadership team."
The committee strengthened the relationship between senior leadership and the clinical staff, Singh explains.
"We moved away from what sometimes felt like a disconnected relationship between senior leadership and the clinical side of the organization," Singh says. "We tried to bring those two groups together and to work together. We have brought that partnership to fruition."
The first step to boosting physician wellness efforts was "simply asking" what physicians needed, according to Singh.
"Oftentimes when wellness initiatives are put together, there is an assumption of what is needed. Instead, we asked the physicians and the clinical teams what they needed," Singh says. "We began conducting a well-being index survey about three years ago."
Singh says she has been involved in multiple well-being initiatives over the past three years.
"A lot of what we have done in terms of our wellness programs has been off-loading work that does not directly impact patient care," Singh says, "but adds to physician burnout and adds to work physicians do outside of clinical hours."
Managing electronic in-box messages for physicians has been a focal point.
"We receive hundreds of thousands of in-basket messages as an organization every year, so it is an incredible amount of work, and we tried hard to off-load some of this work for our physicians," Singh says. "We had nurses triage questions. Now, we are working on AI to help us with the responses."
Clinical documentation in the Epic electronic medical record has been another area where work is being off-loaded from physicians, according to Singh.
"It takes a lot of time to check all of the boxes and complete clinical notes," Singh says. "We have initiated a pilot to use an AI virtual scribe, so some of our physicians are using AI technology that writes their clinical notes. Their documentation is largely done by the time they walk out of the exam room."
There have been training efforts to improve physicians' skillsets, Singh explains.
"For many physicians, burnout is not just a matter of the work we are doing," Singh says, "but also work that we feel helpless about."
For example, there is a training program with The REACH Institute for any physician who wants to get training in psychiatric care in the primary care setting.
"When we came out of the pandemic, many children were suffering with mental health issues," Singh says. "There was little we could do to improve resources for these patients, so we improved our own training. More than 200 of our physicians took the training, which helped us to help patients in real-time."
There have also been efforts to improve communication with physicians and other clinical team members, according to Singh, including an initiative to add anonymous feedback links in Epic.
"If you are in front of your computer and there is a 'pebble in your shoe'—a constant occurrence that keeps coming up—you can click on a link and send an anonymous message to me as the chair of the Engagement and Wellness Committee or the president of Texas Children's Pediatrics, Daniel Gollins," Singh says.
Anonymity is an important aspect of the feedback links, Singh explains.
"Clinical team members can freely express their concerns," Singh says. "They can reach people at the top of the leadership team who can address these concerns."
Sapna Singh, MD, is CMO of Texas Children's Pediatrics. Photo courtesy of Texas Children's Pediatrics.
Promoting patient safety and care quality
In addition to physician well-being, Singh's top priorities as CMO of Texas Children's Pediatrics include focusing on patient safety and care quality.
"The biggest thing I look at is making sure the teams that need to be involved in quality and safety are all talking with each other," Singh says. "When it comes to quality and safety in the clinic, we need our quality and safety teams engaged with not only the clinical staff members but also making sure that physicians know their role in ensuring quality and safety."
Physicians play a pivotal role in patient safety and care quality, according to Singh.
"When we discuss needle sticks, vaccine errors, or fall prevention, these are things that sometimes people assume will involve educating the nursing staff," Singh says, "but I take the position that physicians need to know about these things as leaders of the team to reinforce, educate, help spread awareness, and emphasize why these things matter."
To foster patient safety, clinical staff must feel safe to speak up when there are safety concerns or a medical error occurs, according to Singh.
"The focus cannot be placing blame on a person," Singh says. "Having worked in medicine for more than 20 years, I know that anyone is capable of making a mistake on any given day."
At Texas Children's Pediatrics, discussions about quality never stop.
"Quality is embedded in every conversation, and it is the hallmark of what we want people to think of when they think about Texas Children's Pediatrics," Singh says. "No matter which clinic they go to, and no matter which physician they see, the high standard of quality care is going to be the same."
The effort to form a primary care physician union is under arbitration with the National Labor Relations Board, and a decision is not expected for months. We talk with both sides.
In recent years, there has been a spike in physician unionization including seven residency programs voting to unionize in 2023, according to a research article published by the Journal of Surgical Education. The threat of physician strikes has grown significantly, according to the article.
Primary care physicians at Mass General Brigham (MGB) say they want to form a union because working conditions have become unsustainable, and the health system is resisting the unionization effort.
Primary care physicians (PCPs) employed by MGB filed their intent to unionize with the National Labor Relations Board (NLRB) in November. The PCPs are seeking to join the Doctors Council, the country’s oldest and largest union of attending physicians.
Working conditions at MGB's primary care practices are the main motivating factor for the health system's PCPs seeking to form a union, says Andrew Warren, MD, a PCP who is organizing his colleagues at Brigham Primary Physicians at Brigham and Women's Faulkner Hospital.
"We have gotten into a situation where the workload and the expectations are ever-expanding," Warren says. "The amount of support we are getting is never sufficient. This situation is hard on physicians and hard on the staff. We have gotten to a point where it is unsustainable."
Inadequate staffing is placing an unbearable load on PCPs, Warren explains, and it is affecting recruitment and retention.
"The workload is increasing, and at the same time we are losing staff, including doctors, nurses, medical assistants, and front-desk staff," Warren says. "People are feeling overworked, and when they are not compensated well or appreciated, we lose a lot of them, especially staff who are most experienced. Then we have trouble hiring new staff, and that adds to the problem."
The leadership of the health system is aware of the situation, but according to Warren, nothing ever seems to happen.
"We got to the point where unionizing was the best option," Warren says.
The benefits of unionizing include being able to work with the administration to find a way to establish a realistic workload, Warren explains.
"At least for me, it is about whether I am going to burn out," Warren says. "If something does not drastically change, I can't see myself doing this job for more than a couple more years because I cannot keep up this pace."
MGB and its PCPs have entered arbitration with the NLRB.
"We have gone to arbitration and are now waiting on the NLRB, which has a six-month backlog," Warren says.
As a general proposition, MGB is opposed to having doctors unionize, according to Jessica Pastore, senior director of public affairs at the health system.
"We feel that it is important to work directly with our physicians and other clinicians without an external third party," Pastore says.
MGB is resisting the formation of a PCP union because the doctors are facing challenges that are not entirely within the health system's control and a union poses an unacceptable risk, an MGB spokesperson says.
"We know that PCPs across the commonwealth are facing unprecedented volume and stress as a result of a confluence of factors that are not unique to our organization," the spokesperson says. "We share the common goal of offering world-class, comprehensive care for our patients and believe we can achieve this best by working together in direct partnership, rather than through representatives in a process that can lead to conflict and potentially risk the continuity of patient care."
Profits over patients?
MGB is putting profits over patients, according to Warren.
"MGB is prioritizing profit over patient care. I don't think there is any argument to that fact," Warren says. "They have made it clear that they are going to put money into things where they get a return on investment, and primary care has never been one of those things."
With the way the healthcare system works, a primary care office is rarely going to be a health system’s money maker, Warren explains.
"In the best-case scenario, you might break even, but because of the logistics and staff, primary care does not make money," Warren says. "For example, we do not do lucrative procedures like the surgeons do."
However, Pastore says MGB is not fixated on profits.
"We are a nonprofit, so any so-called profit goes back into our mission," Pastore says. "For example, we invest hundreds of millions of dollars to improve health in our communities. It is important for us to be able to sustain this mission."
According to Pastore, MGB recently committed a $65 million investment in housing, mental health, economic mobility, and food insecurity, and it invested $25 million in the Massachusetts Community Health & Healthy Aging Funds.
"These grant opportunities are designed to reduce housing inequities, which is a core part of our mission in communities across the commonwealth," Pastore says. "We are also addressing other social determinants of health."
Photo: Dr. Andrew Warren, center, walks an informational picket line outside Brigham and Women’s Hospital in Boston on Dec. 13.
Coping with the challenges of mergers and acquisitions has become an essential responsibility for CMOs.
Adapting to the clinical care challenges of mergers and acquisitions is part of doing business for CMOs.
"Getting comfortable working in a shifting matrix and developing the tools needed for change management are critical to being a healthcare leader in this age of modern medicine," says Andrea Fernandez, MD, CMO of the Atrium Health-Wake Forest Baptist Market, which is part of Advocate Health.
Mergers and acquisitions in healthcare have marched forward with a constant drumbeat in recent years. Atrium Health and Wake Forest Baptist Health formed a strategic alignment in 2020.
"Historically, CMOs have been facility-based, [but] their purview has changed dramatically over the past few years," Fernandez says. "With more and more mergers and acquisitions happening, it is important that CMOs adapt to the changing environment in which they lead. To that end, CMOs and healthcare organizations can best consider what integrated care might look like by getting stakeholders at the table from the start."
CMOs play a key role in integrating clinical care after a merger or acquisition, Fernandez explains.
"By understanding best practices at the local level as well as best practices and opportunities at the larger organizational level, CMOs can optimize clinical care by using the best of both worlds while not losing some of the great work that is being done prior to a merger or acquisition," she says.
Creating a unified medical staff allows each facility within a larger entity to have reassurance that the medical staff working at their facility is delivering the same quality of care across all facilities, according to Fernandez.
"One of the great opportunities around working for a larger healthcare entity is the opportunity to create standards among the medical staff," she says. "That ensures a high quality of clinical excellence, both from a quality care and patient safety standpoint."
"When patients go to a larger health system, they want to be sure that they are going to be able to get brand quality across every point of contact," she says. "A unified medical staff allows that to happen, and it allows for efficiency for credentialling and privileging, which can be tedious when done at facilities across a larger market."
Andrea Fernandez, MD, is CMO of the Atrium Health-Wake Forest Baptist Market, which is part of Advocate Health. Photo courtesy of Advocate Health.
M&A and clinical care challenges
Within a merged healthcare organization, Fernandez says, there are enterprise-level expectations that CMOs must balance with local operations.
"When a provider delivers care to a patient, they need to consider what resources they have at their disposal as a merged organization compared to the legacy organization," she says.
EMRs, testing resources, and partnerships with consulting physicians all can change, according to Fernandez.
"Often, these changes are for the better, but sometimes there is a brief window of change management that needs to happen for providers to get to a steady state and deliver excellent clinical care," she says.
Clinicians can rise to these challenges by engaging with leadership and optimizing the tools that are offered to them, Fernandez explains.
"Clinicians are leery of anything new, especially when it involves AI," she says. "However, I can tell you from personal experience that some of the AI tools that we have been empowered with by being part of a larger organization are truly state-of-the-art and have made my ability to care for patients much easier and much more efficient. This allows me to focus on the patient rather than the electronic medical record."
For example, after the merger of Atrium Health and Wake Forest Baptist Health, leadership offered DAX Copilot to all clinicians. The ambient listening technology has been transformative for many clinicians, according to Fernandez.
"DAX Copilot is an AI-enabled solution that partners with our Epic EMR to record my conversation with a patient, then assist me in creating my note within the medical record," she says. "By not having to worry about taking notes while talking with a patient, I am much more able to focus on what the patient is saying, the patient's physical condition, and any body language the patient may be demonstrating during a physical exam."
Simplifying clinician and patient experience after a merger or acquisition
Clinicians have a personal role to play in the simplification effort, according to Fernandez.
"In order to simplify the experience of clinicians in mergers and acquisitions, clinicians need to keep up to date with the changes that are occurring as part of the process," she says. "By keeping up to date with changes, clinicians will not be caught off guard or forced to double up on work."
Clinicians are also essential in simplifying the patient experience after a merger or acquisition, Fernandez explains.
"Understanding the context of how changes are happening is also helpful for clinicians so they can relay these changes to patients and help patients to have a better experience," she says. "Patients rely on their clinicians for guidance as they navigate health systems. If clinicians are up to date and understand the context of any changes, they are going to be better navigators for their patients."
A perfect example of this is the rebranding of patient portals, according to Fernandez.
"If the providers understand the change from one patient portal to another, they can help patients to log in to the new patient portal and help patients to understand the benefits of the new portal compared to the old one," she says.
Fernandez is a member of the HealthLeaders CMO Exchange.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
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Stephanie Duggan, MD, is chief clinical officer of SSM Health. Photo courtesy of SSM Health.
Sapna Singh, MD, is CMO of Texas Children's Pediatrics. Photo courtesy of Texas Children's Pediatrics.
