Aspirations for an Ideal Future in Medicine: The Big Picture

I’d love to use this month to spur you to dream again. Not like seeing the back of your eyelids, sawing the zzz’s dreaming - though I hope you prioritize sleep. Also, not the type of escapism-type dreams that sounds so alluring when we are exhausted: “I wonder what it would be like to be the Walmart greeter….”  But the type in which you imagine how rich life can be moving forward – the dreaming you have likely done off and on since childhood, but less and less as you’ve aged.

We have the reality that we must live in and its challenges that we would never have chosen. We also have an inherent negativity bias – that served us well once upon a time to tune into threats. If left unchecked, however, accepting reality as is and giving too much airtime to our negativity bias prevents us from seeing the positives and robs us of optimism.  And hope is too powerful to give up.

We must embrace the concept of polarities – seemingly polar opposites that can coexist simultaneously. We do have a broken healthcare system; there is no need to argue with reality. The stressors we face now are real and unprecedented. And at the same time, if you look, you will find examples of healthcare going well, even now.  Most of the time, you can find it inside your own practice.

An MA spends a few extra minutes with a distraught patient on the phone. The front office person helped someone fill out their paperwork whose vision had declined. The fact that you helped in meaningful ways a person struggling with anxiety, another with their lifestyle change, and yet another with their finding cancer early when it is still amenable to treatment.

And amongst your colleagues – the cardiologist who called your family member to explain the next steps in evaluation if surgery is necessary. The ENT who did a thorough workup on that locally recurrent squamous cell carcinoma and put together an optimal treatment team and plan for a mutual patient. The ID doc who fielded a complex situation via phone to guide your next moves. The system is broken at the same time it’s working. The individuals that go into healthcare are just stupendous human beings. Those individuals (YOU) have found ways to use skills, effort, and compassion even in the current environment – even, dare I say, despite it.

Further, we can have hope for the future. We can believe we will find a way for excellent, accessible healthcare, quality medical training, superb communication, and supportive, fulfilling environments to exist. Our current reality doesn’t have to lead to pessimism.

The US Surgeon General, The National Academy of Medicine, AMA’s Steps Forward, and some Hospital and Healthcare organizations have done a great deal of leg work. There are recommendations for all industries that affect healthcare, including hospital and healthcare organizations and individual physician practices. They’ve identified a multi-pronged approach laid out in these key documents to improve our system.

Many are investing in valuable interventions and strategies to enhance the system for patients AND healthcare workers by walking through these action items (and we know healthcare worker wellbeing translates into better patient care). Other systems are tuning in, considering how to work through the solutions, and best integrate them. Some are considering hiring a Chief Wellness Officer (CWO).  Stanford and The Institute for Physician Wellness offer CWO training. If a CWO is appropriately supported, they can begin a team approach to working through these tasks. Here is the foundational article on what a CWO is and is not. Dr. Dike Drummond offers Wellbeing Champion training, a consultant service for healthcare organizations, and several other training arms.

Dr. Atul Guwande, the famed surgeon, author, speaker, and champion of public health, now the Assistant Administrator for Global Health at USAID, along with his brain trust, are tackling primary care access worldwide. (Read his take on primary care.)

The AAFP has partnered with employer coalitions and published practical approaches to improving the wellbeing of family physicians. The ACGME is emphasizing the importance of trainee wellbeing (though there are some hurdles to overcome when something so large is mandated without the necessary means to make change within sponsoring institutions). The Family Medicine Education Consortium (FMEC) is working on improving the nation's health by strengthening family medicine and primary care to meet its full potential and being innovative in delivering care, including Direct Primary Care. (As an aside, I now know of a few DPC physicians who also care for the underserved in unique ways). The Society of Teachers in Family Medicine (STFM) are academic leaders committed to developing an accomplished family medicine workforce prepared to serve as the foundation of America’s health care system. They continually seek ways to improve and collaborate within the education system. CHARM (Collaborative for Healing and Renewal in Medicine) is a collaborative effort of leaders in medical and academic training and wellbeing experts leading initiatives to improve the culture for the next generation of physicians. 

Many others are working with new models of delivering effective and rewarding care. Nneka Unachukwu, M.D (aka Dr. Una) helps doctors learn to practice medicine on their own terms by taking back some agency in various iterations, such as private practice insured models and direct primary and specialty care models, among others. This is so important as physicians crossed the 50% mark of being employees and no longer owners of their practices in 2017. And I just learned that 73% of family physicians are now employed. Finding ways to access autonomy and control to deliver care that aligns with our values is critical.

(I know that many of these models may decrease the number of patients that are able to be served. However, compare that to what's happening - currently, 60% of the physicians are practicing while being burned out and in settings that severely limit their time with patients. Finding ways around that will, in the interim, yield more doctors staying clinically active and, while still not meeting the need, better off.)

Value-based care models are also continuing to roll out which can serve larger populations. Some offer a meaningful team approach that frees physicians up to give excellent clinical patient care instead of the many additional roles that have been moved to their plates over the past few decades. They also utilize a different reimbursement model. Those with the best reputations do an excellent job of not trying to squeeze every patient possible into the schedule as they know that physicians can’t deliver the best care that way, and they burn out quickly. They give the physician some autonomy. We must feel good about the care we deliver!

Physician coaches, in many iterations, are making personal financial and time investments in learning tools, engaging in research and impacting their colleagues and trainees to navigate the system, thereby finding ways of working within it that are meaningful and sustainable. They empower physicians to ask for the resources they need, employ boundaries, influence the leaders, innovate, and become the change-makers we need. Fortune 500 companies have used coaching for executives that face untoward pressures for decades for good reasons – it’s effective! Physicians, especially trainees, deserve that kind of support in our demanding climate, which is even more consequential than that of the business sector. Many medical schools and some residencies offer coaching early in the career path (I’ll post a blog in a few weeks on all the possibilities). And some also offer coaching to faculty. A few healthcare organizations are beginning to pay attention to the data and offer coaching in addition to making systemic changes. Many physician coaches have used their newfound skills and mindsets to make adjustments or complete pivots to practicing in a way that aligns with their values. For example, Kara Pepper is an internist who now owns her own practice, which focuses on the areas of medicine she is most passionate about - such as patients who deal with eating disorders. And serves several states via telemedicine. 

Many other individuals and medical organizations are involved in educating elected officials on how their decisions or indecisions impact healthcare and the valuable role they can play in improving the system. They work long and hard on policies to make meaningful change in medicine. And some are throwing their hats into the political ring to effect change from that standpoint.

I honestly believe we need these multipronged approaches to support physicians in various ways, i.e., offering many paths, to deliver excellent healthcare to all people. 

What role, if any, do you want to play in shaping the future of healthcare? What sounds energizing to you? There are so many brilliant minds out there. I can't wait to see where we go. 

Okay, so today, I hope I gave you a glimpse of the larger-scale beginnings of momentum in a positive direction. And maybe even have you feeling hopeful and starting to dream again - what is possible from a national healthcare standpoint. I’d love to hear any ideas you have. We need them all: makeovers, outside-the-box approaches, tweaks, demolition and rebuilding, and national initiatives involving all the stakeholders that are driving medicine in ways contrary to patient and healthcare worker wellbeing. Collectively, we can move toward a greatly needed direction in medicine.

Over the next few weeks, I’ll bring the dreaming down to you, the individual level, and walk you through exercises to help you foster your ideal future. 

Until next time, Have a joy-filled week!  Tonya

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