COMMENTARY

Antidotes to Burnout: Fostering Physician Resiliency, Well-Being, and Holistic Development

Herdley O. Paolini, PhD; Burt Bertram, EdD, LMFT, LMHC; Ted Hamilton, MD, MBA

Disclosures

April 19, 2013

In This Article

Principles for Success

An EAP-model crisis intervention service for physicians, however successful in enlisting physician participation, is insufficient. A more comprehensive program is needed, which supports the personal and professional lives of physicians in a longitudinal and holistic way. Furthermore, the program must develop physician leadership and a medical staff culture that can intentionally foster necessary changes in the way that medicine is practiced in the healthcare organizations to which they belong.

Seven distinct but interrelated principles and commitments are essential to successfully operating such a program:

1. Embedding with medical staff. The mental health professionals must became familiar to the medical staff by providing a series of outreach programs year-round. On-boarding interviews must be part of the credentialing process. The director should be an active member of the medical staff with call duties, participation at Medical Executive Committee meetings, and other clinical responsibilities. The embedded nature of the program provides visibility and normalizes participation in the services.

2. Key working relationships. Relationships with physician leaders are formed through shoulder-to-shoulder work on medical staff-related projects and issues. Furthermore, relationships with administration are intentionally formed to facilitate mediation and advocacy on behalf of both the hospital and the medical staff.

3. Trust. Strict adherence to ethical practice in terms of safeguarding confidential disclosures will demonstrate the trustworthiness of the program. Under no circumstances can confidentiality be compromised. Segregated storage and other safeguards are essential to guard participant lists and case files from any breach or use outside the program.

4. Outcome reporting. Reporting proven outcomes is necessary to establish the competency and value of the program. Such reporting must go beyond activity measures (eg, number of clients, psychotherapy sessions, CME courses, and events) to quantify results in terms of mission, financial, and clinical impact. Measures, metrics, and data collection requirements should not be overlooked when allocating resources and setting budgets.

5. Stature. Practitioners must be trained at the doctoral level and be state-licensed and eligible for privileges. Obvious maturity, strong presence, personal integrity, and successful clinical experience in dealing with significant pathology are required attributes when working with physicians. Cutting-edge programming and professional attention to detail in preparation for events, workshops, and retreats demonstrate competence.

6. Knowledge of medicine and hospital business. Understanding the medical practice environment as well as business aspects of healthcare delivery is fundamental to interacting meaningfully with physicians and hospital administrators.

7. Champions. The service must be championed by both medical staff and hospital leadership. The active endorsement of medical staff leadership, as well as ongoing collaboration in shaping a culture that prioritizes physician well-being, is essential. Equally important is the support of institutional top management, without which the service loses its ability to influence needed change.

Given the forces shaping the training and practice of medicine today, it is remarkable that so many of our physicians have managed to persevere in the art and science of medicine. Nevertheless, clinical data and experience are pointing to the dire consequences of leaving the wellness of physicians to chance. The program described here is a hopeful beginning in successfully enlisting both physicians and the organizations where they work in meaningful and positive change.

For more information on the Florida Hospital Physician Support Services program, contact program director Herdley O. Paolini, PhD, LP.

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