Internal Medicine: Open Access
Open Access

Behavioral Adaptation: Surviving Medical Practice

Alan H. Rosenstein^{* *}Correspondence: Alan H. Rosenstein, Department of Medicine, Practicing Internist and Consultant in Behavioral Management, San Francisco, USA, Email:

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Description

There’s growing chaos in today’s healthcare practice environment [1]. It all started in the late 1980s with the introduction of fixed dollar reimbursements from Medicare and Medicaid to reduce healthcare costs and unnecessary consumption through the use of utilization controls and care restrictions. This was soon followed by the introduction of managed care initiatives and health provider contracting with more external intrusion in telling us what we can and cannot do. The next injection was the introduction of value-based care and performance metrics with a greater focus on provider accountability for care efficiency, electronic documentation, and productivity ratios rather than quality outcomes. All this has resulted in a greater amount of frustration, stress, and burnout, where more than 50% of the physician population is negatively affected by these activities [2]. And now we face the covid pandemic which has significantly impacted concerns about care access, protection, physical health, and changing models of traditional care [3]. It seems like we’re being asked to do more and more yet we feel like we’re left out to dry not knowing what to do.

Fortunately, many healthcare organizations and associations have recognized the impact that this has had on its providers and have implemented several different programs to help physicians better adjust to these pressures. They recognized that we often can’t leave it up to the physician themselves to take action either because they are unaware of how it’s affecting them, think that they can take of it themselves, don’t have the time, or are afraid of the stigma attached to reaching out for help [4]. Individual hospitals or health care systems have offered courses on stress management, resiliency, and mindfulness training, and/or have offered individual coaching and mentoring programs to help their physician survive [5,6]. In more severe cases targeted behavioral counseling should be considered. There are many other additional programs offered by leading medical societies. The AMA offers a series of internet-based educational modules through their Steps Forward program [7]. The IHI offers a series of programs focusing on the joy of medicine. The National Academy of Science offers a series of programs focusing on enhancing physician well-being. All these programs have proven value but to succeed the physician needs to be open and receptive to taking action and following through.

So as a physician what do you need to do? The first thing to do is to recognize how stress and burnout are affecting your own physical and mental well-being. Remember, you’re not alone out there. Be willing to ask for help. This can come from friends, family, or peers. Be willing to accept outside help from trained coaches or counselors. Check with your organizations as to what support resources are available. Regarding those with concerns about stigma and reporting, these services are conducted in a convenient confidential environment primarily designed to help the physician succeed in practice. For those who remain reluctant to ask for help, tap into the services offered by AMA, IHI, or the National Academy of Sciences. For those who choose to do it on their own, there are many things that you can do.

So as a physician what do you need to do? The first thing to do is to recognize how stress and burnout are affecting your own physical and mental well-being. Remember, you’re not alone out there. Be willing to ask for help. This can come from friends, family, or peers. Be willing to accept outside help from trained coaches or counselors. Check with your organizations as to what support resources are available. Regarding those with concerns about stigma and reporting, these services are conducted in a convenient confidential environment primarily designed to help the physician succeed in practice. For those who remain reluctant to ask for help, tap into the services offered by AMA, IHI, or the National Academy of Sciences. For those who choose to do it on their own, there are many things that you can do.

References

1. Rosenstein AH. Helping physicians survive the mental chaos of medical practice. J Psychiatry Mental Disord. 2020;5(2):1025
2. Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94(9):1681-1694.
3. Schwartz R, Sinsky C, Anand U, Margolis R. Addressing pandemic physician mental health. Ann Int Med. 2020;173(12):981-988
4. Feist JB, Feist JC, Cipriano P. Stigma compounds the consequences of clinician burnout during covid-19: A call to action to break the culture of silence. NAM Perspectives. 2020.
5. Rosenstein AH. Hospital administration response to physician stress and burnout. Hospital Practice. 2019;47(5):217-220
6. Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: A pilot randomized clinical trial. JAMA Intern Med. 2019;179(10):1406-1414.
7. Robert J. Mills. AMA launches steps forward to address physician burnout. Press Release. 2015.