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Action Needed: Structural Change for the Wellbeing of Medicine.

I am starting a three-week series called Action Needed for the Wellbeing of Medicine. You would think since I've read, researched, written about, and coached around burnout for long enough, that I wouldn't continue to listen, read, and learn. I mean – I experienced it firsthand as a mid-career physician before I had words to describe it. I healed from it. I learned tools to prevent and treat it. And yet, I am still learning – for myself, my patients, my physician clients, and the future of healthcare. 


Last week, I was fortunate to listen to Dr. Lex Von Hafften, an Alaska psychiatrist. He continues positively impacting patients and physicians statewide in various leadership and service roles. He presented an excellent overview of healthcare burnout pre-Covid and now.


You don't need me to tell you all the contributors, fallouts, or even how widespread it has become. I know you see it. It often arises as I coach residents, faculty, and non-academic attendings. While I have been encouraged by seeing some health systems invest in meaningful wellbeing initiatives, I have also witnessed others expecting physicians to work more with less for a sustained period. I have been encouraged by organizations such as the ACGME requiring wellness initiatives and programs integrated into residencies. But I've also watched as some academic institutions and sponsoring entities devalue the academic and resident support time and efforts of core faculty members and behavior health scientists. They are demanding more direct patient care time to increase their revenue. This takes them away from the curricular and well-being time needed to create a robust training experience. All of this while trainees' morale is low, skill sets are delayed with COVID19, and they're in desperate need of such support and education. 


The good news is that many academic leaders such - as Dr. Tait Shanafelt at Mayo, GME wellbeing leaders such as Dr. Saadia Akhtar at Mount Sinai, and prominent leading academies in healthcare such as the National Academy of Medicine - have been researching this serious issue. They have been actively educating and spreading the word of practical solutions.


There is a clear shared responsibility for burnout between the individual physicians and the healthcare organizations and stakeholders. Even the concept of resilience requires an understanding of shared responsibility, as outlined by Dr. Michael Cavanaugh out of Sydney. The systems must provide resource-rich supportive environments for the individuals physicians to leverage their own resiliency. In her webinar for the AMA's Taming the EHR presentation, Dr. Mary Brown references that 80% of physician burnout is due to system issues (half of that is related to efficiency barriers and half to the organization's culture).


We all know the US healthcare delivery system needs an overhaul to improve communication, efficiency, quality, equity, respect, and caregiver wellbeing. And most of us know that will not be an easy, quick fix. I applaud all the people with the knowledge, experience, energy, and research that are stepping up. If that's you – THANK YOU!


In the meantime, patients need care, and physicians want to continue meaningful work. How do we begin the renovation?


First, the US Surgeon General's Office has given every healthcare sector a charge. Dr. Vivek Murthy lists practical steps to mitigate the inevitable worsening of healthcare workforce shortage for every sector -  from academic settings, healthcare organizations, and governmental agencies, to insurance and tech companies. The deficit involves the aging population which increases the demand for physicians to manage chronic disease. At the same time, many physicians have hit retirement age, and many younger physicians are pivoting out of medicine for various reasons - burnout and the conditions leading to burnout being the significant factors.  


If you or someone you know has influence in any of those sectors, please show them the advisory and encourage action. Click HERE to download the easily digestible, well-organized, actionable items for each type of organization.


Second, the AMA also has a robust and easy-to-navigate website STEPS Forward - with meaningful videos for organizations and physicians to transform their workplace – including the culture and EHR utilization, They also have a podcast with useful information. 


The magnitude of change can appear overwhelming, but it can be done by assessing the state of each office, system, and institution, prioritizing those meaningful action steps and dedicating time and funding to intentionally and systematically address each one. This will provide a sizeable stop-gap measure for mitigation of the shortage of healthcare. In the future, there will need to be a well-choreographed and all-encompassing overhaul.


Instead of being overwhelmed by all the moving pieces – we can approach this the same way one eats an elephant - one manageable bite at a time. In case that doesn't resonate, let me paint another example – the best time to plant an oak tree was 20 years ago, but the next best time is now.


Start by starting.


If we change nothing, nothing changes.


Now for you, the individual physicians, what can you do for your and your colleagues' wellbeing? Tune in next week for practical tips. 


I leave you with the words of Dr. Vivek Murthy, US Surgeon General, "…we have a moral obligation to address the long-standing crisis of burnout, exhaustion, and moral distress across the health community. We owe health workers far more than our gratitude. We owe them an urgent debt of action."


Have a joy-filled day! Tonya


Download the first three key steps I recommend to increase your joy now in your life and career. Click here 


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