Someone to Stand Up for the Doctors

Physicians are being pulled in many directions. Now over 50% of physicians report at least one symptom of burnout. Feeling responsible for things out of your control, not enough time to get everything done with deadlines by the end of the day, wanting to return phone messages but also wanting to be home before the baby’s bedtime, a desire to carefully review all the old records received pitted against enough time to take a long walk in the fresh air during lunch break, wanting to spend more time with the patient you are in the room with now, but knowing that doing so will make you late for the rest of the patients scheduled this morning. These dilemmas become so much a part of our days that we cannot imagine “work” without them.
There are many reasons that our health care system is not getting the outcomes that are theoretically possible from a perfect system: a procedural/cognitive payment ratio that favors doing more over thoughtful communication, insurance requirements that pit the doctor against the patient by requiring prior authorizations and limits on referrals to specialists, and a structure that promotes short, frequent visits rather than appropriate communication by phone, email, and longer in person visits. All of these working conditions for doctors add to the stresses that we anticipated when we chose to enter the field of medicine, which in and of themselves, are substantial. These include being with people in the times of their lives with the greatest stress: serious illness, disability, and death; discerning how to communicate bad news to people and help them sort through very complicated decisions about treatment options; and advising patients on ways to maintain health in environments that challenge.
Since entering medical school over 25 years ago, I have lived with these stressors and observed what they can do to my colleagues and friends. I was blessed enough to have role models who worked part-time and kept relationships with families and friends at the forefront of their lives. I also chose a specialty, Family Medicine, that believes in looking at the person in the context of family and society. By studying health care ethics, medical anthropology, and medical economics before entering the profession, I entered somewhat more hesitantly than many, with my eyes open to some of the flaws and challenges that we as a profession face.
I believe we are at a critical time for medicine in the United States right now. Systems are changing faster than outcomes can be predicted. No one really expects a small private practice to exist in the same way it does today twenty or thirty years from now. Do we encourage our kids to study medicine? Do we try to figure out how early we can afford to retire? Are we able to stand tall with the decisions we make in how we care for our patients? There is much advocacy in medicine that needs to happen. We need fellow doctors that will stand up and represent us in our professional societies, to businesses, to Congress, and to patient groups. But I believe we also need someone to stand up for the doctors. And that is what I try to do in MD Mentors. Physicians are extremely talented professionals that have been tested in the fires of residency and have learned to deal with many different stressors over the years. We are in charge of so many things and people, we get our required CME units, keep our licenses and Board certifications up to date, get our CLIA certificate or our waiver-of-CLIA-certificate certificate. Sometimes we are raising our kids at the same time we are dealing with our parents’ aging and health problems. Some of us have our own serious health problems. Is it no wonder that we don’t take time to process the emotional and spiritual impact of it all on ourselves? While we may sometimes feel we don’t really need support from our peers, I would argue that it is one of the most important gifts we can give ourselves, our patients, and our health care system: time with other physicians to develop our resilience and support system. While researching how this could be possible, I discovered that the AMA, CMA, and BMA co-sponsor a conference on physician well being every other year. In 2012, some researchers from the Mayo Clinics presented some interesting findings: 90 minutes every other week over 9 months in a structured, facilitated small group with other physicians led to greater job satisfaction and happiness than the equivalent 90 minutes “off”? This is an exciting finding for someone like me, who prides herself on being “evidence based.” Since learning of this study, I have developed a similar program for doctors in small practices, who may not have the resources of a large institution, but who want to thrive as physicians in our health care system. If you are a physician who is basically emotionally and spiritually healthy, and who wants to grow a support network and develop greater resilience, an MD Mentors Village may be what you are looking for. Stay tuned.

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