In one month, two physician wellness programs at Stanford were featured in national press. A time-banking program in the department of emergency medicine was the subject of a Washington Post article, and the Balance in Life program for surgical residents was featured in Time. While these programs were gaining national attention, an internal group, the Stanford Committee for Professional Satisfaction and Support (SCPSS), was submitting a report to School of Medicine Dean Lloyd Minor, MD, on its recommendations to improve physician wellness.
This confluence of activity point to a national issue: physician burnout is at an all-time high. Nationally, up to 40 percent of physicians report being burnt out; and as many as 400 physicians commit suicide each year. Among medical school students, suicide is the second most common cause of death, and rates of depression soar during residency training.
This problem has a trickle down effect on patient care. Studies have linked physician burnout to an increase in unprofessional behavior, lower patient satisfaction and major medical errors.
"Physicians who are well have better patient outcomes, higher patient satisfaction and lower medical error rates," said Mary Lou Murphy, coordinator for SCPSS. "The Committee was created in 2010 to address physician wellness, and develop programs that target all stages of physician life," said Rebecca Smith-Coggins, MD, professor of emergency medicine and co-chair of SCPSS. Some of its most utilized programs include peer support for faculty and residents, litigation support, a medicine & literature group, mindfulness training and faculty flexibility. A full list of programs and services is available on the WellMD website.
"On a daily basis, faculty have multiple tasks competing for their time, such as clinical care, research, teaching, mentoring, administration, school committees and service to the discipline," said Magali Fassioto, PhD, director of research and programs in the Office of Faculty Development and Diversity (OFDD). "They have trouble juggling everything, hence this idea of 'work-work' conflict in addition to 'work-life' conflict."
To tackle this imbalance in physician's lives, OFDD developed a pilot program called the Academic Biomedical Career Customization Model. Launched in three clinical areas and five basic science departments, the pilot offered career counseling and planning and created a time-banking flexibility policy. Physicians could earn credits for time spent doing activities that support a colleague such as stepping up to cover a clinical shift at the last minute, or for a service activity that doesn't otherwise get recognized such as sitting on a university committee or an NIH study section. They could then use these credits to purchase services that would help them at home or at work such as meal delivery, housecleaning, grant writing assistance, handyman services, dry cleaning pickup, speech training, life coaching and web support.
"The program makes you feel valued," said Greg Gilbert, MD, a clinical associate professor in emergency medicine, who has used his time-banking credits for meal delivery, housecleaning, life coaching and help with grant proposals. "It gives me more bandwith at work and more time to hang out with my kids."
During the one-year pilot, the number of physicians who reported stepping up to support a colleague at the last minute rose from 44 percent to 83 percent. This increase reflected an increased willingness among teams to ask colleagues for help when needed with the knowledge that the colleague would be recognized by the progam. Participants in the study also brought in more grant money during the program than similar departments not using the time-banking system. In all, 84 percent of participants in the initial pilot said that the support mechanisms improved their work-life fit.
When the pilot ended, departments interested in maintaining the time-banking program had to assume financial and administrative responsibility for it. Only one department to date has made that call. It was an easy decision to continue the program, said Paul Auerbach, MD, former chief of emergency medicine, who said the credits cost far less than one percent of his budget. "Our faculty works very hard to take care of patients in critical clinical situations while striving to succeed academically," he said. "We have an obligation to do what we can to keep ourselves physically and mentally healthy, and at the top of our games. Work-life balance is certainly part of that."
Many of Stanford's other established wellness programs are targeted at its most vulnerable group—residents. "Resident training is the most difficult part of physician life," said Smith-Coggins, who is also associate dean in the Office of Medical Student Wellness. In fact, two such programs, Balance in Life and PRIME, were created after the suicide of a team member.
The Balance in Life program was developed to help counteract the physical and mental stress that accompanies the residents' typical 80-hour workweek. Each year, the program expands the resources and activities it offers to general surgery residents. Today, surgical residents have a refrigerator stocked with healthy, fresh food to sustain their physical well-being. They attend mandatory group therapy sessions with a clinical psychologist for their mental health. And they can participate in mentoring and social activities for social health.
In the Peer Support and Resiliency in Medicine (PRIME) program, first-year anesthesia residents attend a weekend retreat to learn techniques to manage the effects of stress and enhance their resiliency and coping strategies. Subsequent sessions are held every six to eight weeks throughout the remaining three years of residency. There is also a scholarship fund that encourages residents to do research and create projects around physician wellness.