Physician Well Being: Survival Strategy for Working With Underserved Populations

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Physician Well BeingSurvival Strategy for
Working With Underserved Populations
Martha Sosa-Johnson M.D. UCI- Division of General
Internal Medicine April 9, 2008
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Presentation Objectives

• Discussing factors that positively and negatively
  affect physician well being
• Understanding the deleterious consequences that
  can occur when physicians sense of well being is
  negatively affected.
• Identifying positive coping mechanisms for
  working with underserved populations

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Background

• Olive View Medical Center/VA Sepulveda
• Internal Medicine Residency
• Internal Medicine Attending
• 1990-1995
• Pacoima/Granada Hills, San Fernando Valley
• Private Practice 1995-1999
• UCI-
• Anaheim Family Health Center,1999 July 2007
• Pavilion 3 at UCI Medical Center , 8/07 to
  present

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What factors are negatively related to physician
well being?

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Studies on Physician Well Being

• Increased paperwork and red tape
• Lack of perceived control among physicians was
  the best predictor of burnout
• (Western Journal of Medicine, 200117413-18)

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Studies on Physician Well being

• 1998 Physician Resource Questionnaire by Canadian
  Medical Association indicated a serious decline
  in physician morale
• Volume of work
• Sleep deprivation
• Teaching and research demands
• Potential for litigation
• Increased demands of the public

West J Med.20011745-7
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Studies on Physician Well being

• In-depth interviews with 54 members of the
  Department of Medicine (DOM) at the University of
  Calgary
• Short questionnaire sent to all members of the
  DOM and residents (N275) and 182 surveys
  returned
• Questions about quality of life, job
  satisfaction, stress and coping

• Negative determinants of physician well being
• excessive work hours and work to family conflict
• Work overload and emotional stress/demands of
  patient care

Jean E. Wallace (Department of Sociology) and
Jane Lemaire (Department of Medicine)University
of Calgary, 2005
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• The hours. My youngest son when he was about
  three-years old, he said to me one day Mommy, I
  wish you were just a mommy and not a doctor.

Jean E. Wallace (Department of Sociology) and
Jane Lemaire (Department of Medicine)University
of Calgary, 2005
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• Oh, being at three places at once, so the
  time pressure of, you know, being late in clinic,
  having patients waiting. Youre an hour behind,
  theyre getting grumpy, you have to take a phone
  call, you cant stay on schedule. Then the
  unpredictability of the workday, on the ends, so
  getting home on time, I find that most stressful.

Jean E. Wallace (Department of Sociology) and
Jane Lemaire (Department of Medicine)University
of Calgary, 2005
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Physician Well Being and Professional Behavior
Minnesota Medicine. Physician Well-being and
Professionalism Colin P. West, M.D.,PhD., and
Tait D. Shanafelt, M.D.
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Consequences of Physician Distress

• Substance related disorder 8-12 of health
  professionals
• Physician addiction is usually advanced before
  becomes noticeable in workplace
• Addiction often shielded by code of silence
  among physicians who often do not confront
  colleagues exhibiting symptoms of addiction
• Suicide rates alarming
• Male physicians 2 times more likely to commit
  suicide than average Americans
• Female physicians 3 times more likely

Annals of Internal Medicine.2001135145-148
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Consequences of Physician Distress

• On average, the United States loses the
• equivalent of an entire medical school class
  
• each year (approx 250 physicians) to
  suicide.
• Physician Suicide. Emedicine March 14, 2007
• Louise B. Andrew, MD, JD, Medical-Legal,
• Risk Management and Trial Consultant

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Does support from others buffer the negative
determinants on physician well being?

• Yes, especially support from spouse and
  coworkers, but also from positive patient
  interactions

Jean E. Wallace (Department of Sociology) and
Jane Lemaire (Department of Medicine) University
of Calgary, 2005
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What constitutes well being for practicing
physicians?

• to have a quality of life, you have to have a
  life outside of medicine. Thats the bottom line!
  
• Jean E. Wallace (Department of Sociology) and
  Jane Lemaire
• Department of Medicine) University of Calgary

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Identifying positive coping mechanisms for
working with underserved populations
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Familiarize yourself with scope of services

• UCI FAMILY HEALTH CENTER, ANAHEIM
• Internal medicine
• Family Medicine
• OB/GYN
• Pediatrics
• Classes offered diabetes
• Nutrition consultation
• Comprehensive prenatal services
• Specialty programs available Family PACT, Every
  Woman Counts Program

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Familiarize yourself with the different health
plans accepted and the health services covered by
each health plan

• MSI (Medical Services for the Indigent)
• Medicare
• Monarch One Care
• Medicare only
• Cal-Optima
• Managed Care
• Direct
• Cash

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Administrative Assistance

• Outside Resources
• Radiology Centers
• List of community board certified specialists
• Dental Referrals
• Services available at sister clinic, UCI Santa
  Ana Family Health Center, and the Coalition of
  Community Clinics of Orange County

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Knowing limitation in resources

• www.needymeds.com - good source of information on
  patient assistance programs
• Knowing community resources (Walgreens
  Prescription Club 20/individual/yr or
  35/family/yr- 12.99/90 day supply of generic
  meds or Target s 4/month of selected generic
  meds).

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Knowing limitations in resources

• Important to realize when patients medical
  concerns can not be addressed in clinic setting.

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Prioritize your time

• Get to work on time
• Address messages/refill requests in between
  patient visits
• Set a specific time for leaving each day
• Be comfortable saying No
• when you just dont have
• the time

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Taking care of yourself
Scheduling vacation every 3-4 months
Taking off birthdays Taking a few days off for
wedding anniversary Remembering special
relationships Making time to attend special
events
Exercise
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Taking care of yourself

• Taking care of your own medical needs as they
  arise
• Self care is not a part of the physicians
  professional training
• Typically low on list of priorities
• 1/3 of physicians did not have a doctor
  themselves according to a recent study that
  examined graduates of John Hopkins SOM
• (Arch Intern Med.20001603209-14)

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Maintaining Relationships

• Date night with significant other, (including
  parent and me dates)
• Regular communication with family members and
  friends
• Relax and be yourself with someone who knows
  and likes you
• Isolation makes it harder to get the support
  that is essential for the very emotionally
  demanding job you have chosen
• Dedication and excellence not only during your
  workday but also with your family/friends

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THE PHYSICIANSBALANCING ACT
Jean E. Wallace (Department of Sociology) and
Jane Lemaire (Department of Medicine) University
of Calgary, 2005