November 30, 2018

The 2018 International Conference on Physician Health took place in Toronto on October 11 with over 500 participants from 26 countries. It is impossible to give a resume of three days of stimulating and inspiring presentations of research and programs from around the world, however I would like to share some useful highlights.

Burnout was, of course, the center of many presentations. Interestingly US statistics show a higher level of burnout than in Canada (52 % in the US vs. 30% in Canada according to the latest survey done by the CMA). To my knowledge, there is no study explaining this difference, but it is good to know that practising medicine seems to be ‘healthier’ in Canada. Thirty percent of burn-out, however, is a significant number and the consequences of burn- out are well known, decreased quality of care and decreased physician well-being (with increased risk of suicide), and the ultimate loser is the patient.

We tend to think that physician wellness depends on personal resilience. Most wellness programs focus on individual wellness, but studies show that the most detrimental factors to physician wellness are poor working conditions and practice inefficiency. Doing yoga or meditation at lunch time will not help to a great extent if the rest of the day is spent in a chaotic environment due to a too heavy workload or/and problematic workflow. Those issues have to be addressed and we need to be willing to spend time to deal with them.

Potential solutions depend on the type of practice we have and start by asking the questions: what am I doing or not doing that increases the inefficiency of my practice. One presenter urged us to follow the GROSS Program (GROSS= Get Rid of Stupid Stuff) a good way to identify the routine and inefficient activities we don’t even notice anymore.

Getting rid of those activities will not only improve our efficiency but will also improve our work satisfaction. It is essential to spend at least 20 % of our working time doing meaningful activities in order to prevent burnout.

It is not surprising that EMRs are universally associated with worsening professional satisfaction by increasing time entering data and by interfering with face-to-face patient care. Unfortunately no solutions were offered to that problem.

Besides personal resilience, practice efficiency, the third key to physician health is working in an organization with a strong culture of wellness. This means values that promote self-care, personal and professional growth, compassion and appreciation. This includes health related programs and policies associated with a deep sense of community (social events, retreats, dinners…). I have included an example of a program promoting a culture of wellness at the end of this article.

Of course, all of those activities require change, not only on a personal level but also at an organizational level, following the three paradoxical secrets for leading organization change presented by Dr. Suchman.

  • Secret 1 To make big changes you have to start small.
    It is intimidating and unrealistic to try to change the full organization, but small and consistent changes are effective and the best time to change is right now.
  • Secret 2 is not as obvious: to find the answer, you must be willing to not know. This implies humility, flexibility and openness, as well as creativity and confidence that a solution will be found.
  • We may not like secret 3: you have to feel bad to feel good. Change is not easy, but we need to trust that it will result in a positive outcome.

We don’t always realize that as physicians we have power to act and change unhealthy work conditions, but only if we choose to exercise it. Too often our own low expectations (often a sign of burn-out) is the bigger obstacle to change. We have to rise above our low expectations and be willing to refuse to work in unhealthy conditions. During the conference, I had lunch with a radiologist from the States. His schedule consisted of a straight 9-hour day with no provision for lunch or coffee breaks.

We may have similar situations in Manitoba and feel helpless about it. If this applies to you, let us know; we can be more effective as a group.

I would like to conclude with the words of the past president of the British Medical Association, Dr. Hungin: Physician health has ‘come of age’…it’s time to ‘care for the caregiver’…