Helping the healer: population-informed workplace wellness recommendations for physician well-being

Abstract

Background

The need to keep physicians healthy and in practice is critical as demand for doctors grows faster than the supply. Workplace wellness programmes can improve employee health and retain skilled workers.

Aims

To broaden our understanding about ways to help doctors coping with mental health problems and to develop population-informed workplace wellness recommendations for physician populations.

Methods

Researchers surveyed physicians to document potential warning signs and prevention strategies. A survey was issued to doctors who presented to a physician health programme with mental health complaints. The survey captured respondents’ feedback about how to identify and prevent mental health problems. Data were analyzed using simple descriptive statistics.

Results

There were 185 participants. Half of respondents believed their problems could have been recognized sooner and 60% said they exhibited signs that could aid in earlier detection. Potential warnings included fluctuations in mood (67%), increased comments about stress/burnout (49%) and behavioural changes (32%). To improve detection, prevention and care-seeking for mental health problems, doctors endorsed multiple items related to the use of interpersonal supports, personal factors and organizational dynamics throughout the survey.

Conclusions

The findings confirmed earlier work demonstrating the value of social and organizational support in maintaining physician health. It further indicated that earlier identification and/or prevention of mental health problems is not only possible, but that medical organizations are uniquely situated to carry out this work.

Introduction

The need to keep doctors healthy and practising is critical as the demand for physicians grows faster than the supply throughout the world [1]. While health care systems struggle to meet workforce needs, many doctors feel the strain of meeting their professional duties by working longer hours and spending less time with patients [2]. This is associated with high rates of stress, burnout and other mental health conditions [3]. The toll of the workforce strain is readily apparent. In a survey of doctors, 16% said they were reducing their hours to part-time, retiring or quitting medicine altogether. Half of those planning to exit the workforce within the next year were younger than 55, and 75% felt pessimistic about the future of the profession [4]. When physicians are unwell, their professional practice can be negatively compromised [5].

Workplace wellness programmes demonstrate several benefits for companies, such as reducing absenteeism and burnout, while increasing productivity, morale and patient satisfaction [6]. Promoting a healthy workforce through wellness programmes may prevent doctors from changing jobs or leaving the medical field altogether [7]. Keeping workers healthy produces an unmistakable economic incentive. One estimate to replace a physician was nearly $1 million (US) dollars when including factors such as lost revenue, recruitment and signing bonuses [8]. However, workforce wellness is not a one-size-fits-all model. The most effective programmes are those designed to the needs of the population they serve [9].

Methods

To understand how to best craft workforce wellness programmes for physician populations, researchers surveyed participants of a physician health programme to document warning signs, barriers to care and prevention strategies. Individuals responded to a modified programme evaluation survey tool developed by Peer Assistance Services, Inc., Denver, Colorado and Lori Crane, PhD, MPH, Professor and Chair, School of Public Health, University of Colorado. The survey captured respondents’ feedback about how to identify and prevent problems such as their own.

Results

Respondents (185) were primarily men (60%) aged between 40 and 69 years (77%). By design, all sought care for mental health issues. Over half were self-referred (51%) and currently practising (80%). Nearly 50% believed that their problem could have been recognized earlier. Other than themselves, respondents said spouses (51%), clergy (21%) and co-workers (20%) might detect early warnings. Sixty per cent of respondents said that they exhibited clues about their problem, such as mood changes (67%), comments about stress/burnout (49%) or behavioural indicators (irritability/outbursts: 32%). Other signs of trouble included decreased dependability, changes in physical condition and increased time to complete routine tasks (Table 1).

The most common barrier to care was physicians’ schedules (47%), followed by denial of illness (45%), embarrassment (43%) and confidentiality concerns (39%). Personal supports helped physicians overcome care-seeking obstacles. Approximately 44% of respondents said they needed a better understanding of physician health issues. Possible avenues of prevention included additional education about risk factors (59%), awareness of workplace stressors (57%) and knowledge of peer-assistance programmes (57%). Respondents also believed prevention could be aided by increased collegial interactions with their colleagues (51%), mentorship (48%), education about the benefits of socialization (45%) and work-based interventions (41%) (Table 2).

Discussion

These findings suggest that tactics aimed at improving physician wellness—particularly for those struggling with mental health issues—are well suited for workplace-based interventions. Drawing on survey findings, we recommend that organizations consider a multi-faceted approach that incorporates the four P’s—policy, practice, preparation and programmes—into their planning.

Confidentiality concerns remain a barrier to care-seeking. Policies must be refined so that they eliminate barriers to care-seeking and healthy living by their physician-employees. Organizations should make a thoughtful, objective review of internal practices that impede care-seeking, such as using in-house health care services which can foster dual-relationships and threaten privacy. We recommend regular evaluations of well-being among staff and investing in this information as an ongoing quality metric.

Organizations must encourage the practice of healthy behaviours among its staff. While companies may offer generous leave, it is of little value if doctors feel overburdened or otherwise unable to use it. Encouraging wellness practices can occur in many ways, although modelling behaviours by senior staff is particularly useful. Organizations should strive to improve their team approach to personal well-being by emphasizing positivity, maintaining balance and consciously and regularly taking time out to maintain good work–life balance.

Preparation encapsulates the educational needs of physicians and was a common request by respondents. It is particularly important to teach doctors about the practice implications associated with ill-health, including lapses in professionalism, poor patient outcomes and medical errors; managing workplace conflict; coping with a lawsuit; improving positive patient interactions; grief management; and taking time for interpersonal relationships. Implementing frequent, brief messages help to combat education fatigue. Given the importance of peers and family members expressed in this survey, organization should offer trainings to help co-workers and others learn to recognize and respond to a physician at risk. Curriculums that address one’s internal conflict about referring a physician to care, where to access help, and potential implications for care-seeking are desperately needed.

Finally, workplace wellness activities should create novel programmes. Programmes that reduce the burden of administrative tasks, allowing for more time with patients, are essential. Respondents endorsed the use of collegial supports and personal coaching, both of which can enhance performance, productivity and retention [10]. Incorporating senior staff who support and employ wellness strategies into their own personal care practices is helpful for modelling, as are mentors who can share their own stories about struggling with—and overcoming—problem behaviour. Doctor’s lounges, largely absent from hospitals today, may help provide a brief respite during the day and offer the opportunity to connect with colleagues.

Limitations of this study include the use of self-report data from a single site and lack of information about those who did not seek assistance. Further, what physicians believe may differ from what actually works.

Workplace wellness has the ability to help physicians maintain their health and, ultimately, retain valued members of the medical workforce. Many of the suggestions here are relatively quick and inexpensive to implement, while potential rewards are great.

Competing interests

None declared.

References