Executive office update: The evil twins of physician workplace dissatisfaction

Friday, November 01, 2013 12:05 PM
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Alfred Gilchrist

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

A growing body of research confirms what most physicians are already painfully aware of, if not routinely experiencing: there is a sharp decline in professional satisfaction correlated with burnout and its equally evil twin, the increased risk of medical errors. A great deal is being done in Colorado, at Duke University and at the American Medical Association to address these evil twins, but more attention is urgently needed at the policy, institutional, cultural and personal levels.

The Colorado Medical Society collaborated recently with the AMA and the researchers at Rand Corporation to assess the contemporary challenges physicians face and the relationship between professional satisfaction and the delivery of patient care. The report, released in October and available at www.cms.org, affirmed the common-sense notion that the same factors drive work satisfaction inside and outside the medical workplace, and include concepts like fairness, positive incentives and the removal of barriers to optimal care. Current attempts to motivate physicians may seem to favor the stick over the carrot, much like the admonishment on the poster by the office copier: “The beatings will continue until morale improves.”

The AMA-RAND study was drawn from interviews with a range of specialties and practice settings across the country, including Colorado. The report proposes actions to be taken by payers, employers, hospitals, colleagues and others to reverse the dangerous and unsustainable spiral of professional dissatisfaction:

  • Address quality concerns that simultaneously improve care to patients and improve satisfaction and make this a number 1 priority.
  • Put a laser beam focus on addressing the issues with EHRs (this is right up there with addressing quality concerns).
  • Define and confirm shared values with practice leadership.
  • Increase opportunities for collegiality.
  • Address negative consequences of what physicians see as “pressure to do more” by giving attention to work quantity and pace of work.
  • Strive for stability of well-trained, trusted and capable staff.
  • Ensure fair payment arrangements that align with good patient care.
  • Provide a knowledge base and resources for internal physician practice improvement.

At our recent annual convening of the Patient Safety Leadership Conference, a joint effort between the Colorado Hospital Association, Colorado Medical Society and our friends at COPIC (see related article on page 28), Duke psychologist and professor Bryan Sexton, Ph.D., presented a deeper analysis into the neuropsychology of burnout and why physicians suffer that risk at greater rates than other professionals. Sexton got into physicians’ collective prefrontal cortex and outlined the top five workplace triggers: condescension and lack of respect, being held to unrealistic deadlines, being treated unfairly, being unappreciated, and not being heard. One can almost hear the neurons firing and exploding.

Not surprisingly, physicians in specialties on the front lines such as emergency medicine, general internal medicine and family medicine are at greatest risk. Studies also find what every physician intuitively knows: you work longer hours and experience more difficulty balancing work and personal life than your professional counterparts. While higher levels of education and professional degrees appear to reduce the burnout risk in other professions, a medical degree increases that risk.

All of these responses translate into less sleep, which the Duke experts warn results in a significant loss of memory capacity, the retention of bad memories and the deterioration of good ones, not to mention the downstream health risks.

While the CMS board of directors and the AMA will help to address longer-term structural remedies, Sexton’s short-term recommendation is to focus on finding three positive things every day, and committing them to memory. Given all the wonderful things physicians do every day to help patients who are in pain, sick or injured, locking far more than three into the memory bank is, well, a no-brainer.

We’ll continue to focus on preserving your relatively stable liability climate, eliminating delivery system hassle factors, and advocating for fair payment that rewards good care. Be watching next year for the unveiling of our Work and Well-Being Toolkit designed just for physicians by the Behavioral Health and Wellness Program at the University of Colorado School of Medicine.

Let me know how you are doing by emailing me at Alfred_Gilchrist@cms.org. Your perspective is important to us.

Posted in: Colorado Medicine | Initiatives | Physician Wellness


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