In order to take steps forward in patient care, we all need to make great strides in physician care. Research shows that burnout is more common among physicians than any other U.S. workers. For physiatrists, the numbers are even higher with 63% reporting that they experienced burnout in 2014. The statistics are most dire for medical students, residents and fellows. Without individual, institutional and systematic changes, everyone will pay the price. Physician burnout and depression are linked to medical errors, depersonalized care and physicians leaving the field altogether. Reducing physician burnout is critical to achieving the AAP’s mission – and the sustained future of quality healthcare. Below, you'll find resources that will guide you and your institution to a path of wellness.
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Submit to our "Words of Wellness" column to share how you maintain wellness at your institution.
Submitted by Michael Boninger, MD, Professor and Endowed Vice Chair for Research at the University of Pittsburgh
I remember the resident guiding me while I was placing a central line as an intern. His words about advancing the line slowly are as embedded in my memory as the alarm of the cardiac monitor when the patient went into an arrhythmia and coded. The patient was sick, and might have died anyway, maybe it wasn’t caused by the catheter. That didn’t give me much solace. I went home, told my wife that he had died, and slept better than I would have thought possible. I fell back on something that I have repeated over and over again in my head for years; it’s likely something I told myself on the first day of internship and in every job since. They were stupid enough to hire me. I was doing my best.
I believe psychologists call this deflection. It’s really helpful. The next time I did a procedure, I was more cautious, I probably listened better. My far-from-perfect best became something better. This balance between accepting my imperfection while learning from the mistakes I make all the time is part of what keeps me well.
While we are dealing with classic psychological patterns of behavior, denial is another technique that keeps me going. If something scares me, like firing an under-achieving employee, an upcoming root canal, or hiking in and out the Grand Canyon in a day with friends, I just tell myself I can call in sick (no one argues with explosive GI problems). I have never avoided something that way, but telling myself I can, gets me through the hardest part – the waiting.
Exercise, me time, placing priority on family and friends are a given that require vigilance. I suggest adding a dose of deflection and denial.
How Kristjan Ragnarsson, MD Supports Wellness
Submitted by Kristjan Ragnarsson, MD, Chair Emeritus at the Icahn School of Medicine at Mount Sinai
After a 7-hour sleep, get up early enough to do your morning exercises, eat a healthy breakfast, finish what is not done, plan for the day ahead and then show up before you have to. Stay ahead of the game all day long!
How Dixie Aragaki, MD Supports Wellness
Submitted by Dixie Aragaki, MD, Program Director at the VA Greater Los Angeles Healthcare System and Clinical Professor at UCLA
Here are my recommendations for making little therapeutic lifestyle changes:
Talk the talk.
Walk the walk.
Walk and talk.
Nurture your nature.
Seek natural nutrition.
Nibble and nap in nature.
Read a book.
Feed the cook.
Read a cookbook.
See a free show.
Show you care freely.
See! You’re carefree!
The AAP is proud to be a part of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience, a network of more than 150 organizations committed to reversing trends in clinician burnout. The Collaborative has three goals:
Raise the visibility of clinician anxiety, burnout, depression, stress, and suicide
Improve baseline understanding of challenges to clinician well-being
Advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver
The Collaborative and NAM have launched a Clinician Well-Being Knowledge Hub, a comprehensive resource repository for those seeking to promote clinician well-being at their organizations and in their personal lives. Find articles, research studies, and other resources
The Accreditation Council for Graduate Medical Education's (ACGME) Task Force on Physician Well-Being has compiled resources for residents and faculty members for well-being, wellness, and related tools to help identify solutions that best meet local needs. This is in support of new Common Program Requirements that emphasize psychological, emotional, and physical well-being as critical in the development of the competent, caring, and resilient physician.
Find materials ranging from educational videos to toolkits to screenings.
Well-being in academic medicine is a critical priority for the Association of American Medical Colleges (AAMC). They have compiled and authored many articles, courses and resources to help explain and address the challenges.
The AAP, as the academic arm of the specialty, is uniquely positioned to influence change within training programs, medical universities and teaching hospitals. We work alongside our members to train physiatrists on how to identify burnout signs, and are continually developing resources on physician wellness for today’s and tomorrow’s leaders. Through these ongoing efforts, the AAP will help physicians adequately care for themselves so that they can safely care for their patients.
Look back on some of our featured posts since the launch of this portal!
How Allison Schroeder, MD Supports Wellness Obstacles are those frightful things you see when you take your eyes off the goal. - Henry Ford
As a high school track and field athlete, my best event was the 300m hurdles. My dad was always supportive, encouraged me to be the best I could be, and would provide me with a plethora of motivational quotes. The quote listed above was often among these. When I was running, he would frequently remind me to focus on the end goal of finishing the hurdle race and to not think about the obstacles/barrier over which I had to jump. Now, as a physician, this quote not only holds true in my life as a doctor, but also is true for my patients who are recovering from injury. I often find that it is important to keep the “big picture” and final goal in mind; to reflect on why I went into medicine: to treat others with respect and help them through the most difficult times in their lives. It is when I lose sight of this goal that I become frustrated with “obstacles,” such as slow EMR, insurance companies, and other red-tape, and I find it helpful to reflect and always remember the end goal. Additionally, helping patients to focus on the end goal in their treatment plan is also helpful. It is easy to make excuse as to why one can’t find time to complete a rehab program, for example, but continuing to encourage patients to focus on the end goal rather than the difficult obstacles in between is helpful. To help maintain wellness and avoid frustration, it is helpful focus on the end goal and see the big picture, always reflection on why that is the ultimate goal, no matter how big or small this is.
How John Whyte, MD, PhD Supports Wellness
I haven’t had a highly conscious "wellness plan" during my years of training and subsequent research career, but I was already with my partner Tom when I started medical school and was never willing to live in the library even then. I tried to make my work and studying as productive as possible during working hours but kept time for my share of the shopping, cooking and household chores. I also stayed connected to my cultural interests and political activism, so that I always had more friends outside of medicine than within, which helped me keep some perspective on what was important. From early on we prioritized living a car-less life where we could commute on foot and bike. That avoided hours in the car and helped maintain fitness, though I’ve also been a regular gym goer since medical school (these days I get up at 5:00am and hit the gym before going to work).
I’m lucky to never have experienced serious “burnout”. One reason may not be easy for everyone to replicate. I have developed a career that feels meaningful to me and that is substantially under my own control. I am able to select questions and problems that I see as important, rather than work that is assigned to me. Although I certainly don’t get every grant I apply for, I have been sufficiently successful that even the grant-writing process, while crazy-making in the moment, is rewarded sufficiently often to keep me going. Another factor is colleagues. I have been fortunate to work with a network of colleagues at home and around the world, that I find both stimulating and humane (I left my first job when that was no longer true). As the director of a research program, I have tried to create a culture of mutual support and collaboration rather than one of “me first” personal achievement. To distill all that: mental stimulation and good people!
How Carolinas Rehabilitation Supports Wellness Submitted by Administrative Chief Resident Ana Michunovich, DO, Academic Chief Resident Jordan Sestak, MD, QI Chief Resident James Kult, MD and Well-Being Curriculum Faculty Advisor Judi Campbell, MD
Studies have shown that physiatrists suffer from high levels of emotional exhaustion and work-life imbalance when compared to other highly educated individuals working similar hours. But how do we create a more supportive culture in a challenging and ever-changing healthcare environment? This academic year we created a new residency curriculum entitled Physician Resilience. The teachings center on nurturing personal and group strengths, creating a unified annual residency vision statement, connecting to purpose, and engaging in modifiable dimensions of well-being including physical fitness with weekly resident and faculty-led 7-minute workout sessions. Comments from faculty and residents regarding the curriculum have included statements such as “I look forward to participating in the 7-minute workouts with the team, I feel mentally and physically recharged afterwards”, “I think that the workouts help to foster wellness in multiple ways. The first is obvious; we as "white collar" workers tend to be sedentary during work hours so a few minutes of flexibility, balance, cardio/strength exercises, and meditation help to reinvigorate the body and the mind. The second is the benefit of socialization, which is afforded in the group setting. It is motivational and builds a sense of team spirit”, “I enjoy that our department promotes active ways to empower all healthcare professionals through wellness”, and “I was going through a hard time and the strengths assessment came at the perfect moment, making me realize that I am unique, I matter, and that even as a new resident I can make a difference”.
As Arthur Ashe said, “start where you are, use what you have, do what you can”. We hope that you join us by committing to fostering a culture of nurture and excellence, so that we can all shape individuals who are skilled not just in the art of living, but of thriving.
How Brian Davis, MD Supports Wellness
These are my 3 pillars for growing old gracefully.
We need endurance to do our daily activities and fun things with family and friends. This means that endurance activities during exercise are important in maintaining our stamina.
We need lean muscle and strength to maintain balance, prevent falls and protect our bones if we do fall. High weight, low repetition exercise may offer muscle bulk at the risk of injury. As we grow older, lean muscle is preferable over muscle bulk.
We have to keep our heart beating. Any aerobic fitness plan is likely helpful in reducing all causes of morbidity and mortality. Think 30 minutes a day, most days of the weeks.
How Gayle Spill, MD Supports Wellness
Words of Wisdom from one of my mother’s dear friends: In this life, there are so many things you have to do even if you don’t want to. If you are faced with something you don’t want to do that you don’t have to do, don’t do it! For me, there are 3 aspects to this advice.
Time is your most precious commodity. Make sure you spend it doing things that are meaningful and important to you.
Learn how to say “no” to your boss, your spouse/partner, your children and your friends. It is often difficult, especially for women, to say no. It is an important skill and one that needs to be practiced and encouraged.
The correlate to the above advice is, if there is something you want to do, do it! In other words, make time for self-care, make time to care for your relationships outside of work and don’t feel guilty about it. It will make you more productive at work and home - a better doctor, a better partner and a better parent.
How Dave Welch, MD Supports Wellness
Words of Advice: You are not as important as you may think you are.
During the first year of practice after my residency, I was feeling somewhat overwhelmed. I was a solo physiatrist in a community that never had one before. I was married and we had three children under age 5. We had purchased a home, and, while I didn't have school debt, we were certainly in significant debt at the time. My day was particularly busy. I had four or five people waiting in the waiting room, a large pile of paperwork stacked on my desk, a couple of in-patient consultation requests waiting and just felt overworked. For a reason I have never understood, after dictating the note on a patient who just left and before calling the next patient in, I stopped and paused for about 5 minutes. I pondered what would happen if I dropped dead at that moment. As I considered that possibility, I realized that the patients in the waiting room would be told I would not be able to see them and they would be assisted in setting up visits with other providers. The paperwork would either be done by a member of the staff or would be returned to the source with the explanation that I would not be able to respond and someone else would have to do it. I realized that my wife was a smart person with skills that would allow her to get a job and we had purposely purchased life insurance that would cover full costs for the family for at least two years. This would allow her to find a job. She was also an attractive woman who could probably find another husband. The kids would grow up without me but my wife would make sure that they had a home and what they needed to succeed.
In essence, I came to the realization that no matter how important that I thought I was, I could disappear and the world would continue to go on without me. From that moment on, I realized that nothing I did was so important that someone else couldn't do it. That reality allowed me to be able to walk out of the office each night and not worry that I hadn't completed everything on the table. It allowed me to spend time with patients who needed it even if that meant inconveniencing the next one. I would simply apologize and explain that there had been a complicated issue that needed to be addressed. This reality that I was just not that important made my life much easier over the next 40 years.