by Debra Parsons, MD, FACP, President, Colorado Medical Society
Featured in the July-August 2019 Colorado Medicine Colorado Medicine.
Most of you know CMS as a policy and advocacy organization for Colorado’s physicians – and this year our advocacy work falls under the umbrella of physician wellbeing. CMS set a goal to “highlight, emphasize and promote solutions to enhance both physician wellbeing and joy in the practice of medicine.” We are achieving this goal by specifically focusing on three buckets of solutions to the burnout crisis – organizational interventions, public policy advocacy and individual wellbeing.
Burnout has major consequences for physicians, staff, patients and the entire health care system. It affects quality, patient safety, health care system performance and morale of the health care workforce. We join others in the understanding that “burnout and the absence of joy” across all health care disciplines is a brewing public health crisis.
The time to measure and discuss the problem is in the rear-view mirror. Concrete steps that are proven to reduce burnout, fatigue and suicidal ideation must be promoted and implemented across our practices regardless of type of ownership or size of practice.
The foundation for CMS’ current effort began in 2012, following an illuminating CMS member survey that showed that the majority of physicians felt they were unable to have work-life balance and time for “life outside of work.” It was a big wake-up call and CMS got to work. We established the CMS Committee on Physician Wellbeing, signed onto former Gov. John Hickenlooper’s goal to be the healthiest state in the nation, and began our work on the CMS Board of Directors’ first focus: a wellbeing toolkit aimed at reducing stress and burnout that was co-produced by CMS and COPIC and developed by the University of Colorado Behavioral Health and Wellness Program.
Recognizing that one size does not fit all, the toolkit contains a variety of evidence-based proactive activities that individual physicians can integrate into a daily routine, not only to prevent burnout but also to create more fulfilling professional and personal lives. The activity on “physician values” is fundamentally important. Values are of the utmost importance to maintaining a fulfilling and satisfying practice; values guide our life priorities and decisions. Not being able to work according to one’s values can be a significant source of dissatisfaction. This mismatch of values and practice can lead to feelings of hopelessness and demoralization, which are directly associated with burnout. As discussed below, page 9 in this issue highlights physicians who reported feeling happy in their careers, with no symptoms of burnout. It is my belief that these physicians made practice changes that were more aligned with their values rather than discovering a “secret sauce” in another practice setting. Movement to or from employed practice, private practice, academics or administrative roles were sure to reflect their values, resulting in new-found “joy in practice.”
Whether one has five minutes or an hour, the wellbeing toolkit offers strategies to improve wellbeing that can easily be integrated into the busiest schedule. It is a wonderful expression of concern for physicians on behalf of CMS. Read more about “DIMENSIONS: Work & Well-Being Toolkit for Physicians” on page 29.
Moving beyond individual resiliency, CMS’ second focus was to adopt good public policy as CMS policy. We found such policy in the American College of Physicians’ seven policy recommendations on administrative tasks – a call to mitigate or eliminate the administrative burdens resulting in adverse effects on providers, patients and the health care system as a whole. In September 2017, the board adopted all seven as CMS policy and widely distributed them to external stakeholders including payers, governmental oversight organizations and vendors. Our new stance in policy No. 300.992 was staunchly declared with the paraphrased highlights below:
CMS calls on external stakeholders who develop or implement administrative tasks to provide financial, time and quality-of-care impact statements. Tasks that are determined to have a negative effect on quality and patient care, unnecessarily question physician and other clinician judgment, or increase costs should be challenged, revised or removed entirely.
Administrative tasks that cannot be eliminated must be regularly reviewed, revised, aligned and/or streamlined with the goal of minimizing burden.
Stakeholders, including public and private payers, must collaborate with professional societies, frontline clinicians, patients and EHR vendors to aim for performance measures that minimize unnecessary clinician burden, maximize patient and family centeredness, and integrate with quality improvement and care delivery.
CMS calls for rigorous research on the effect of administrative tasks on our health care system in terms of quality, time and cost; the health care workforce; the patient experience; and, most important, patient outcomes.
CMS calls for research on best practices to help reduce administrative burden.
We are currently working diligently through our third focus – organizational interventions – which is exciting and promising, and involves a boots-on-the-ground strategy and listening to our members.
Querying “happy doctors”
In our January 2019 all-member survey on professional review and the liability climate, we included the validated “Mini Z Single Question.” This question asked members to use their own definition of burnout and provided five responses ranging from “I feel completely burned out; am at the tipping point where I may need to seek help” to “I enjoy my work; feel no symptoms of burnout.” To those who answered that they feel no symptoms of burnout, we sent a follow-up survey to determine whether these physicians have always enjoyed the practice of medicine throughout their career or if they had to make changes to get to their current state of joy in medicine. Read more about this follow-up survey and eight of the open-ended physician responses on how they achieved joy on page 9.
Querying physician practices on efforts around wellbeing and burnout
CMS conducted a phone survey of the 25 largest physician groups in the membership database, asking questions to gauge whether these organizations are taking action on physician wellbeing. Read about the phone survey on page 31.
Hosting a wellbeing summit
The CMS Board approved the recommendation of the CMS Committee on Physician Wellbeing to hold a day-long summit of physicians, chief wellness officers or other administrators in charge of wellness, to share best practices and increase wellbeing efforts on a large scale. Planning will commence during the second half of 2019. Read more on page 32.
Special issue of Colorado Medicine
And then there is this special issue of Colorado Medicine dedicated to physician wellbeing, which I hope you will take time to fully explore and share with colleagues.
Despite decades of publications documenting the problem of physician burnout and some of its causes and potential consequences, many questions remain and information on effective interventions is limited. Progress will require methodologically sound studies, better understanding of physician practice culture, adequate funding and collaboration efforts. I urge us all to move forward together.
Contact me anytime by emailing email@example.com.