I recently spoke to the new residents and fellows at orientation for their first year at the University of Louisville. There were many young faces, eager to learn. Most were new to Louisville, and they were getting tips on starting their new lives in health care. They heard from several speakers regarding the need to seek balance in their work lives to allow for a happy, productive career in medicine. I welcomed these new physicians and surgeons to the family of medicine in Louisville.
I remember those early days in my career. Can I ever learn it all?
As a profession, we are driven. We wouldn't be physicians in the first place if we weren't. We often deal with physical and emotional exhaustion as well as self-doubt. An EM colleague at Georgetown University, Dr. Joelle Borhart, wrote about the "Imposter Syndrome," the feeling that as physicians, we don't feel as smart or as competent as others think we are. It's the feeling that "Eventually, people will find out that I have no idea what I am doing." It leads to further emotional stress and can limit us in what we try to achieve. In actuality, imposter syndrome only affects high achievers. Most of us feel inadequate at some time in our lives. Dealing with the stresses of being a physician is the key to limiting burnout and its consequences such as leaving medicine, depression, or suicide. These aren't new concepts. When Sir William Osler left Philadelphia in 1889, his farewell address Aequanimitas was on the equanimity necessary for physicians.
Physician satisfaction should be our aim point. There's much being said about patient satisfaction, and while important, I don't think that should be our ultimate goal. We've heard a great deal about the triple-aim: Improving the patient experience of care, including quality and satisfaction; improving the health of populations; and reducing the per capita cost of health care. Drs. Bodenheimer and Sinsky recently published an article that suggested we should be considering a quadruple aim instead, adding the goal of improving the work life of all health care providers, including clinicians and staff. It is only by ensuring that physicians can somehow find and maintain the joy of medicine that we can achieve the fundamental goal of elevating the quality of care while minimizing its cost.
I've been concerned about physician burnout for my entire career. When I entered residency in Emergency Medicine many years ago, naysayers often told me, "This might sound good now, but there are no old ER doctors." The pace of the ER then has become what most all physicians are facing now - long hours, over-regulation, loss of autonomy and control, all of which can lead to depression and dysfunction. A recent study published in Annals of Internal Medicine showed that burnout rates were indeed highest for emergency medicine, but my specialty was closely followed by internal medicine, neurology, family medicine, and otolaryngology.
Achieving a work - life balance is important. Burnout is often characterized by a loss of enthusiasm, feelings of cynicism, and a low sense of personal accomplishment. It ultimately can influence quality of care and lead to early retirement. Burnout takes a high toll on physicians, leading to broken relationships, substance abuse, and suicidal ideation.
The rate of suicide in the physician population is enormous, estimated at more than 400 per year. As many have said, that's equal to an entire medical school - every year. If we accept the estimate that the average family medicine specialist sees about 2,400 patients each year, which means almost one million patients are losing a doctor to suicide each year. We, as physicians, must be responsible for stopping this epidemic.
How do we help physicians manage these stresses, and succeed in managing the work-life balance? Some medical societies are attacking this head on. The Lane County Medical Society in Eugene, Oregon, decided to act when their physician community suffered several suicides. The LCMS was the first county medical society to establish a physician wellness program in 2012. The LCMS program was replicated by the Medical Society of Metropolitan Portland (Oregon) within a few months, and programs like these are successfully removing the barriers that keep physicians from getting needed care. They were able to work with the Oregon Medical Board to eliminate some mandatory reporting requirements, so that only conditions that would impair a physician's ability to practice medicine safely are reportable. Confidential counseling services are provided to physicians at MSMP offices without creating an electronic medical record, giving a diagnosis, or billing an insurance company.
This is a model that I'd like to see GLMS replicate. Physician resilience is vital to keeping us healthy and productive. There have been many barriers put in place that limit our ability to seek help when needed, and I believe that we can adopt this model of service to provide help to our members when they need it most. As I told the new residents, we're all part of the family of medicine in Louisville. We need to take care of our own.