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Cancer-battling breath, Zombie Bambi, and hops as health food
Does my breath smell like reduced cancer risk?
Cancer prevention just got a whole lot more ... fragrant. Allium vegetables – garlic, onions, leeks, chives, and shallots – have been found to decrease the risk of colorectal cancer (CRC), according to a Chinese study published last year. Very good news for Italians, but it looks like the risk of CRC in the vampire population might continue to rise.
The study authors reported that high allium intake correlated with lower CRC risk in both men and women, in the northeast Chinese population sampled. Bioactive compounds in these vegetables have anticarcinogenic properties, and researchers found that eating at least 35 pounds of allium vegetables per year could reduce cancer risk.
Unclear if this study was secretly funded by Big Onion, but as fans of delicious and anticancer flavor, we here at LOTME support these findings. However, we strongly advise against going the Tony Abbott route of chomping into whole onions.
An IPA a day keeps the doctor away
After you’re finished eating your annual 35 pounds of garlic and onions (sure, do it all in 1 day if you want), you might be a little thirsty. And we’ve got good news for you – have a brewski, it’s good for ya! Turns out, hops might have some health benefits, so drink up.
Hops contain a class of compound called isohumulones, which gives them that bitter taste. There have been multiple studies showing the metabolic effects of isohumulones, including cell inflammation suppression, reduced weight gain, reduced hyperglycemia, and increased glucose tolerance.
These isohumulones (try typing that 10 times in a row) interact with the bitter taste receptors in the gut, and researchers are hopeful that this could lead to isohumulone-esque drugs to treat metabolic disorders. In the meantime, maybe just chug a few IPAs a day.
My kingdom for a helmet
Most people like to root for the underdog. You know, the whole David vs. Goliath thing, the little guy who goes against overwhelming odds to take on some form of the Big Establishment.
But what if the little guy happens to be a fairly normal-sized lacrosse player with a very large head?
Alex Chu, a freshman at Division III Wheaton College in Norton, Mass., is just such a guy. “My head is wide,” he told WJAR TV. He wants to play goalie for the school’s lacrosse team, but he can’t because no current helmet will fit on the 25-inch-circumference head that sits atop his 6-foot-tall, 265-pound body.
He’s up against Big Sports Equipment in the form of Cascade-Maverik and Warrior, the two major manufacturers of lacrosse helmets, which won’t build him a custom helmet. It would be too expensive, they say – but the Boston Globe reported that there is a lacrosse player at a Division I school who wears a very large helmet “that was produced after [his] coaches and Cascade ‘huddled up.’ ”
We wish Mr. Chu well, and perhaps one day he will be mentioned with such large-skulled high achievers as Jay Leno, LeBron James, Jennifer Garner, Tyrannosaurus rex, Rihanna, Napoleon Bonaparte, SpongeBob SquarePants, and Simon Cowell.
We’ll just have the salad
Zombies, beware: You might want to eat us, but now, we can eat you.
Okay, “zombie” deer aren’t actually zombies, but they are infected with something almost as terrifying. Chronic wasting disease is a prion disorder similar to bovine spongiform encephalopathy, or mad cow disease, and has been found in deer across 24 U.S. states as of January 2019.
While venison is less commonly eaten than beef, if mad cow disease can make the jump to humans, can people who eat meat infected with chronic wasting disease also become infected?
Thanks to an Oneida County, N.Y., fire company and a 2005 Sportsmen’s feast we’re sure someone’s never heard the end of, we know the answer to be “no.”
The fire company accidentally served meat from a deer that was infected with chronic wasting disease, and more than 200 people were exposed. A group of about 80 of these individuals have been monitored since then by a research team from the Oneida County Health Department and the State University of New York at Binghamton. At the most recent follow-up, no individual had developed the disease.
Experts do caution that it’s entirely possible chronic wasting disease will make the jump to humans eventually, despite the species gap. But for now, you can enjoy without fear your sweet ironic revenge on those zombies.
Does my breath smell like reduced cancer risk?
Cancer prevention just got a whole lot more ... fragrant. Allium vegetables – garlic, onions, leeks, chives, and shallots – have been found to decrease the risk of colorectal cancer (CRC), according to a Chinese study published last year. Very good news for Italians, but it looks like the risk of CRC in the vampire population might continue to rise.
The study authors reported that high allium intake correlated with lower CRC risk in both men and women, in the northeast Chinese population sampled. Bioactive compounds in these vegetables have anticarcinogenic properties, and researchers found that eating at least 35 pounds of allium vegetables per year could reduce cancer risk.
Unclear if this study was secretly funded by Big Onion, but as fans of delicious and anticancer flavor, we here at LOTME support these findings. However, we strongly advise against going the Tony Abbott route of chomping into whole onions.
An IPA a day keeps the doctor away
After you’re finished eating your annual 35 pounds of garlic and onions (sure, do it all in 1 day if you want), you might be a little thirsty. And we’ve got good news for you – have a brewski, it’s good for ya! Turns out, hops might have some health benefits, so drink up.
Hops contain a class of compound called isohumulones, which gives them that bitter taste. There have been multiple studies showing the metabolic effects of isohumulones, including cell inflammation suppression, reduced weight gain, reduced hyperglycemia, and increased glucose tolerance.
These isohumulones (try typing that 10 times in a row) interact with the bitter taste receptors in the gut, and researchers are hopeful that this could lead to isohumulone-esque drugs to treat metabolic disorders. In the meantime, maybe just chug a few IPAs a day.
My kingdom for a helmet
Most people like to root for the underdog. You know, the whole David vs. Goliath thing, the little guy who goes against overwhelming odds to take on some form of the Big Establishment.
But what if the little guy happens to be a fairly normal-sized lacrosse player with a very large head?
Alex Chu, a freshman at Division III Wheaton College in Norton, Mass., is just such a guy. “My head is wide,” he told WJAR TV. He wants to play goalie for the school’s lacrosse team, but he can’t because no current helmet will fit on the 25-inch-circumference head that sits atop his 6-foot-tall, 265-pound body.
He’s up against Big Sports Equipment in the form of Cascade-Maverik and Warrior, the two major manufacturers of lacrosse helmets, which won’t build him a custom helmet. It would be too expensive, they say – but the Boston Globe reported that there is a lacrosse player at a Division I school who wears a very large helmet “that was produced after [his] coaches and Cascade ‘huddled up.’ ”
We wish Mr. Chu well, and perhaps one day he will be mentioned with such large-skulled high achievers as Jay Leno, LeBron James, Jennifer Garner, Tyrannosaurus rex, Rihanna, Napoleon Bonaparte, SpongeBob SquarePants, and Simon Cowell.
We’ll just have the salad
Zombies, beware: You might want to eat us, but now, we can eat you.
Okay, “zombie” deer aren’t actually zombies, but they are infected with something almost as terrifying. Chronic wasting disease is a prion disorder similar to bovine spongiform encephalopathy, or mad cow disease, and has been found in deer across 24 U.S. states as of January 2019.
While venison is less commonly eaten than beef, if mad cow disease can make the jump to humans, can people who eat meat infected with chronic wasting disease also become infected?
Thanks to an Oneida County, N.Y., fire company and a 2005 Sportsmen’s feast we’re sure someone’s never heard the end of, we know the answer to be “no.”
The fire company accidentally served meat from a deer that was infected with chronic wasting disease, and more than 200 people were exposed. A group of about 80 of these individuals have been monitored since then by a research team from the Oneida County Health Department and the State University of New York at Binghamton. At the most recent follow-up, no individual had developed the disease.
Experts do caution that it’s entirely possible chronic wasting disease will make the jump to humans eventually, despite the species gap. But for now, you can enjoy without fear your sweet ironic revenge on those zombies.
Does my breath smell like reduced cancer risk?
Cancer prevention just got a whole lot more ... fragrant. Allium vegetables – garlic, onions, leeks, chives, and shallots – have been found to decrease the risk of colorectal cancer (CRC), according to a Chinese study published last year. Very good news for Italians, but it looks like the risk of CRC in the vampire population might continue to rise.
The study authors reported that high allium intake correlated with lower CRC risk in both men and women, in the northeast Chinese population sampled. Bioactive compounds in these vegetables have anticarcinogenic properties, and researchers found that eating at least 35 pounds of allium vegetables per year could reduce cancer risk.
Unclear if this study was secretly funded by Big Onion, but as fans of delicious and anticancer flavor, we here at LOTME support these findings. However, we strongly advise against going the Tony Abbott route of chomping into whole onions.
An IPA a day keeps the doctor away
After you’re finished eating your annual 35 pounds of garlic and onions (sure, do it all in 1 day if you want), you might be a little thirsty. And we’ve got good news for you – have a brewski, it’s good for ya! Turns out, hops might have some health benefits, so drink up.
Hops contain a class of compound called isohumulones, which gives them that bitter taste. There have been multiple studies showing the metabolic effects of isohumulones, including cell inflammation suppression, reduced weight gain, reduced hyperglycemia, and increased glucose tolerance.
These isohumulones (try typing that 10 times in a row) interact with the bitter taste receptors in the gut, and researchers are hopeful that this could lead to isohumulone-esque drugs to treat metabolic disorders. In the meantime, maybe just chug a few IPAs a day.
My kingdom for a helmet
Most people like to root for the underdog. You know, the whole David vs. Goliath thing, the little guy who goes against overwhelming odds to take on some form of the Big Establishment.
But what if the little guy happens to be a fairly normal-sized lacrosse player with a very large head?
Alex Chu, a freshman at Division III Wheaton College in Norton, Mass., is just such a guy. “My head is wide,” he told WJAR TV. He wants to play goalie for the school’s lacrosse team, but he can’t because no current helmet will fit on the 25-inch-circumference head that sits atop his 6-foot-tall, 265-pound body.
He’s up against Big Sports Equipment in the form of Cascade-Maverik and Warrior, the two major manufacturers of lacrosse helmets, which won’t build him a custom helmet. It would be too expensive, they say – but the Boston Globe reported that there is a lacrosse player at a Division I school who wears a very large helmet “that was produced after [his] coaches and Cascade ‘huddled up.’ ”
We wish Mr. Chu well, and perhaps one day he will be mentioned with such large-skulled high achievers as Jay Leno, LeBron James, Jennifer Garner, Tyrannosaurus rex, Rihanna, Napoleon Bonaparte, SpongeBob SquarePants, and Simon Cowell.
We’ll just have the salad
Zombies, beware: You might want to eat us, but now, we can eat you.
Okay, “zombie” deer aren’t actually zombies, but they are infected with something almost as terrifying. Chronic wasting disease is a prion disorder similar to bovine spongiform encephalopathy, or mad cow disease, and has been found in deer across 24 U.S. states as of January 2019.
While venison is less commonly eaten than beef, if mad cow disease can make the jump to humans, can people who eat meat infected with chronic wasting disease also become infected?
Thanks to an Oneida County, N.Y., fire company and a 2005 Sportsmen’s feast we’re sure someone’s never heard the end of, we know the answer to be “no.”
The fire company accidentally served meat from a deer that was infected with chronic wasting disease, and more than 200 people were exposed. A group of about 80 of these individuals have been monitored since then by a research team from the Oneida County Health Department and the State University of New York at Binghamton. At the most recent follow-up, no individual had developed the disease.
Experts do caution that it’s entirely possible chronic wasting disease will make the jump to humans eventually, despite the species gap. But for now, you can enjoy without fear your sweet ironic revenge on those zombies.
Commentary: Physician burnout: It’s good to complain
Burnout among vascular surgeons and other physicians is a serious national epidemic that needs immediate attention by senior policy makers and health care leaders. Not only is maintaining an appropriate supply of fully qualified surgeons important to the medical demands of our country, the underlying causes of physician burnout clearly point to increased personal pain and suffering within the physician community.
While it is quite clear that a serious response to physician burnout requires immediate action, the most pressing and urgent question for senior leadership is exactly what can be done to best address the causes of this epidemic.
This commentary reflects an approach and strategy for building an effective response to physician burnout deeply rooted in the broad discipline of health care management theory and research. Our understanding of the problem starts with the simple and common observation that our thoughts about our job are deeply embedded in the conditions and “lived reality” of doing our job. We can see this link in everyday conversations when they quickly turn to detailed complaints about all things work related.
Listening to people complain about their jobs can sometimes sound like unfounded “whining.” But if we dig deeper into such complaints, we can start to see some common elements giving credence to such grievances. For example, if we step back a little from our current preoccupations and look at the history of work over the last 100 years or so, we can see the outline of a long and generally progressive arc of change aimed at improving the conditions for making a living.
This arc of change has allowed us to stop complaining so much about the risk of losing life and limb from industrial accidents because those complaints helped to create new laws that imposed strict regulations, making the conditions of working with big machines much safer. From the 40-hour week, paid vacations, and tenure to workplace discrimination, harassment, and abuse, there are many examples of how complaining about the conditions of one’s job has led to major changes in how people work together in an organization.
Coming back to the present, the big, clamoring machines that caused many to complain years ago have now been replaced by the clicking and hum of computers used by knowledge-based workers. But while the tools, physical environment, workforce, and other key characteristics of what people do for a living change over time, serious complaints about job conditions remain important sources of information about how to make those conditions job safer and healthier.
The importance of complaining
One of the primary goals of every health care organization should be to consciously create safe and healthy working conditions for physicians and everyone else involved in the daily production of health care services.
At present, there is considerable interest in developing new programs for addressing physician burnout by using therapeutic interventions. This approach is focused on mediating the severity of an unhealthy workplace by helping physicians better cope with personal frustrations and other psychological difficulties related to their job.
Personal counseling, yoga at noon, and other tools for building personal resilience can certainly improve coping skills but fundamentally miss the point for addressing the underlying causes for burnout.
The problem here is that a reliance on therapeutic interventions alone can mask and reflect the cause of the problem from their source in the conditions of the workplace back onto the physicians who must do their job under those conditions. This is roughly equivalent to providing therapeutic counseling to a factory worker who loses an arm to a machine in an industrial accident with no mention or effort to fix the dangerous machine that workers were loudly complaining about before the accident.
In order to develop an effective response to burnout, attention needs to be given to the specific content of what physicians are complaining about as existential threats to their personal health and safety in the environment in which they do their work as physicians.
A clear-eyed assessment of the real-life structures and processes that define how the work of physicians is routinely carried out every day is needed in every modern health care organization. Such an assessment is not a call for simply “whining” about everyday annoyances and bothers that are encountered as part of most people’s jobs. Rather, a thoughtful cataloging of what physicians are complaining about is required.
This examination needs to carefully listen to complaints to better understand two highly related factors. First: What do vascular surgeons and other physicians “want to do” in order to be personally “satisfied” with their job? And second: How does the organization (structure) and established “flow” (processes) of their given work environment encourage, help, hinder, or prevent them from being satisfied as a regular part of being a physician?
Such an assessment of complains will not be easy. Important methodological considerations will need to be made to make conceptual and measurable distinctions between complaints about major threats to physician health that are part of the current work environment and ongoing and rapid changes affecting the overall profession of medicine. For example, new and ongoing developments in medical technology, health informatics, generational shifts in the attributes of the workforce, evolution of state and federal policy, shifting patient and epidemiological profiles, and other major trends will continue to affect the workplace of physicians. Such changes are part of the current dynamics of the workplace of physicians and may be major components of the conditions of work that are generating complaints and contributing to burnout.
Viewing physician complaints as important tools for improving the working conditions of physician does not mean that such changes can be stopped. More directly, it means that physician complaints can become a critical part in the policy debate and management discussion about what changes in the physician workplace need to change to eliminate burnout.
From a health care management perspective, physicians should take the lead and keep complaining. It is an essential window for senior leadership to see exactly what needs to be done to create a safer and healthier workplace for physicians to be physicians.
Dr. Zimmerman is a professor of health care management at the University of New Orleans.
Burnout among vascular surgeons and other physicians is a serious national epidemic that needs immediate attention by senior policy makers and health care leaders. Not only is maintaining an appropriate supply of fully qualified surgeons important to the medical demands of our country, the underlying causes of physician burnout clearly point to increased personal pain and suffering within the physician community.
While it is quite clear that a serious response to physician burnout requires immediate action, the most pressing and urgent question for senior leadership is exactly what can be done to best address the causes of this epidemic.
This commentary reflects an approach and strategy for building an effective response to physician burnout deeply rooted in the broad discipline of health care management theory and research. Our understanding of the problem starts with the simple and common observation that our thoughts about our job are deeply embedded in the conditions and “lived reality” of doing our job. We can see this link in everyday conversations when they quickly turn to detailed complaints about all things work related.
Listening to people complain about their jobs can sometimes sound like unfounded “whining.” But if we dig deeper into such complaints, we can start to see some common elements giving credence to such grievances. For example, if we step back a little from our current preoccupations and look at the history of work over the last 100 years or so, we can see the outline of a long and generally progressive arc of change aimed at improving the conditions for making a living.
This arc of change has allowed us to stop complaining so much about the risk of losing life and limb from industrial accidents because those complaints helped to create new laws that imposed strict regulations, making the conditions of working with big machines much safer. From the 40-hour week, paid vacations, and tenure to workplace discrimination, harassment, and abuse, there are many examples of how complaining about the conditions of one’s job has led to major changes in how people work together in an organization.
Coming back to the present, the big, clamoring machines that caused many to complain years ago have now been replaced by the clicking and hum of computers used by knowledge-based workers. But while the tools, physical environment, workforce, and other key characteristics of what people do for a living change over time, serious complaints about job conditions remain important sources of information about how to make those conditions job safer and healthier.
The importance of complaining
One of the primary goals of every health care organization should be to consciously create safe and healthy working conditions for physicians and everyone else involved in the daily production of health care services.
At present, there is considerable interest in developing new programs for addressing physician burnout by using therapeutic interventions. This approach is focused on mediating the severity of an unhealthy workplace by helping physicians better cope with personal frustrations and other psychological difficulties related to their job.
Personal counseling, yoga at noon, and other tools for building personal resilience can certainly improve coping skills but fundamentally miss the point for addressing the underlying causes for burnout.
The problem here is that a reliance on therapeutic interventions alone can mask and reflect the cause of the problem from their source in the conditions of the workplace back onto the physicians who must do their job under those conditions. This is roughly equivalent to providing therapeutic counseling to a factory worker who loses an arm to a machine in an industrial accident with no mention or effort to fix the dangerous machine that workers were loudly complaining about before the accident.
In order to develop an effective response to burnout, attention needs to be given to the specific content of what physicians are complaining about as existential threats to their personal health and safety in the environment in which they do their work as physicians.
A clear-eyed assessment of the real-life structures and processes that define how the work of physicians is routinely carried out every day is needed in every modern health care organization. Such an assessment is not a call for simply “whining” about everyday annoyances and bothers that are encountered as part of most people’s jobs. Rather, a thoughtful cataloging of what physicians are complaining about is required.
This examination needs to carefully listen to complaints to better understand two highly related factors. First: What do vascular surgeons and other physicians “want to do” in order to be personally “satisfied” with their job? And second: How does the organization (structure) and established “flow” (processes) of their given work environment encourage, help, hinder, or prevent them from being satisfied as a regular part of being a physician?
Such an assessment of complains will not be easy. Important methodological considerations will need to be made to make conceptual and measurable distinctions between complaints about major threats to physician health that are part of the current work environment and ongoing and rapid changes affecting the overall profession of medicine. For example, new and ongoing developments in medical technology, health informatics, generational shifts in the attributes of the workforce, evolution of state and federal policy, shifting patient and epidemiological profiles, and other major trends will continue to affect the workplace of physicians. Such changes are part of the current dynamics of the workplace of physicians and may be major components of the conditions of work that are generating complaints and contributing to burnout.
Viewing physician complaints as important tools for improving the working conditions of physician does not mean that such changes can be stopped. More directly, it means that physician complaints can become a critical part in the policy debate and management discussion about what changes in the physician workplace need to change to eliminate burnout.
From a health care management perspective, physicians should take the lead and keep complaining. It is an essential window for senior leadership to see exactly what needs to be done to create a safer and healthier workplace for physicians to be physicians.
Dr. Zimmerman is a professor of health care management at the University of New Orleans.
Burnout among vascular surgeons and other physicians is a serious national epidemic that needs immediate attention by senior policy makers and health care leaders. Not only is maintaining an appropriate supply of fully qualified surgeons important to the medical demands of our country, the underlying causes of physician burnout clearly point to increased personal pain and suffering within the physician community.
While it is quite clear that a serious response to physician burnout requires immediate action, the most pressing and urgent question for senior leadership is exactly what can be done to best address the causes of this epidemic.
This commentary reflects an approach and strategy for building an effective response to physician burnout deeply rooted in the broad discipline of health care management theory and research. Our understanding of the problem starts with the simple and common observation that our thoughts about our job are deeply embedded in the conditions and “lived reality” of doing our job. We can see this link in everyday conversations when they quickly turn to detailed complaints about all things work related.
Listening to people complain about their jobs can sometimes sound like unfounded “whining.” But if we dig deeper into such complaints, we can start to see some common elements giving credence to such grievances. For example, if we step back a little from our current preoccupations and look at the history of work over the last 100 years or so, we can see the outline of a long and generally progressive arc of change aimed at improving the conditions for making a living.
This arc of change has allowed us to stop complaining so much about the risk of losing life and limb from industrial accidents because those complaints helped to create new laws that imposed strict regulations, making the conditions of working with big machines much safer. From the 40-hour week, paid vacations, and tenure to workplace discrimination, harassment, and abuse, there are many examples of how complaining about the conditions of one’s job has led to major changes in how people work together in an organization.
Coming back to the present, the big, clamoring machines that caused many to complain years ago have now been replaced by the clicking and hum of computers used by knowledge-based workers. But while the tools, physical environment, workforce, and other key characteristics of what people do for a living change over time, serious complaints about job conditions remain important sources of information about how to make those conditions job safer and healthier.
The importance of complaining
One of the primary goals of every health care organization should be to consciously create safe and healthy working conditions for physicians and everyone else involved in the daily production of health care services.
At present, there is considerable interest in developing new programs for addressing physician burnout by using therapeutic interventions. This approach is focused on mediating the severity of an unhealthy workplace by helping physicians better cope with personal frustrations and other psychological difficulties related to their job.
Personal counseling, yoga at noon, and other tools for building personal resilience can certainly improve coping skills but fundamentally miss the point for addressing the underlying causes for burnout.
The problem here is that a reliance on therapeutic interventions alone can mask and reflect the cause of the problem from their source in the conditions of the workplace back onto the physicians who must do their job under those conditions. This is roughly equivalent to providing therapeutic counseling to a factory worker who loses an arm to a machine in an industrial accident with no mention or effort to fix the dangerous machine that workers were loudly complaining about before the accident.
In order to develop an effective response to burnout, attention needs to be given to the specific content of what physicians are complaining about as existential threats to their personal health and safety in the environment in which they do their work as physicians.
A clear-eyed assessment of the real-life structures and processes that define how the work of physicians is routinely carried out every day is needed in every modern health care organization. Such an assessment is not a call for simply “whining” about everyday annoyances and bothers that are encountered as part of most people’s jobs. Rather, a thoughtful cataloging of what physicians are complaining about is required.
This examination needs to carefully listen to complaints to better understand two highly related factors. First: What do vascular surgeons and other physicians “want to do” in order to be personally “satisfied” with their job? And second: How does the organization (structure) and established “flow” (processes) of their given work environment encourage, help, hinder, or prevent them from being satisfied as a regular part of being a physician?
Such an assessment of complains will not be easy. Important methodological considerations will need to be made to make conceptual and measurable distinctions between complaints about major threats to physician health that are part of the current work environment and ongoing and rapid changes affecting the overall profession of medicine. For example, new and ongoing developments in medical technology, health informatics, generational shifts in the attributes of the workforce, evolution of state and federal policy, shifting patient and epidemiological profiles, and other major trends will continue to affect the workplace of physicians. Such changes are part of the current dynamics of the workplace of physicians and may be major components of the conditions of work that are generating complaints and contributing to burnout.
Viewing physician complaints as important tools for improving the working conditions of physician does not mean that such changes can be stopped. More directly, it means that physician complaints can become a critical part in the policy debate and management discussion about what changes in the physician workplace need to change to eliminate burnout.
From a health care management perspective, physicians should take the lead and keep complaining. It is an essential window for senior leadership to see exactly what needs to be done to create a safer and healthier workplace for physicians to be physicians.
Dr. Zimmerman is a professor of health care management at the University of New Orleans.
Michigan Medicine launches effort to make wellness a cultural norm
CORONADO, CALIF. – Officials at staff, and learners.
“If you look long and hard at your hospitals, health centers, and medical schools, you would find incidences of depression, near-miss suicide, opioid addiction, substance abuse addictions, and suicide,” Carol R. Bradford, MD, said at the Triological Society’s Combined Sections Meeting. “Another component of this is that we all struggle with our work or learning communities where people don’t take care of each other. People don’t treat each other with respect and civility. Promoting a healthy and civil work environment are essential components of a supportive environment.”
According to Dr. Bradford, executive vice dean for academic affairs at the University of Michigan, Ann Arbor, the complexities and stress of the health care environment compromises the well-being of its workforce with a myriad of time-consuming tasks, including navigating electronic records and ever-populating email inboxes. “We are all connected to devices 24/7, and it has become more and more difficult to maintain a healthy work-life balance,” Dr. Bradford said. “The more accepted term now is integration, because it’s almost impossible to achieve balance. Burnout and other physical and health problems are the result of all of these challenges.”
In late 2017, she and her colleagues used two different validated survey questionnaires to assess the health of Michigan Medicine faculty physicians. They found that about 40% of faculty members in both clinical and basic science departments met criteria for burnout. The top 10 stressors based on the survey were email, clerical activity, time worked outside of regular hours, workload time pressure, work expectations, insufficient time for meaningful activities, in-basket messages, lack of decisional transparency, inadequate compensation, and too many work hours. The top 10 coping strategies were finding meaning in work, using all vacation time, paying attention to healthy/balanced eating, engaging in exercise, seek personal/professional balance, protecting time away from work, protecting sleep time, using a social support network, nurturing spiritual aspects, and engaging in recreation or hobbies.
Results of the survey prompted development of a task force to examine wellness and civility at Michigan Medicine, and to devise strategies and tactics to conquer these challenges. “The goal is to help all human beings who are suffering in our work environment,” said Dr. Bradford, who is also chief academic officer for Michigan Medicine. “What we learned initially is that there is a bit of an overlap. Some lack of wellness is due to a lack of civility, but there are wellness issues and civility issues that are independent of one another.”
Members of the task force formulated several recommendations, the first being to create a Michigan Medicine Wellness Office. Dr. Bradford is currently negotiating with a finalist to serve as its faculty director. She characterized the office as a “hub and spoke” model that will partner with existing entities, including human resources, the office of medical student education, the program in biological sciences, graduate medical education, the office of health equality and inclusion, the office of clinical affairs, and the office of counseling and workplace resilience. “The idea is to create a strategic wellness plan,” said Dr. Bradford, who is also a professor of otolaryngology–head and neck surgery. “One key strategy is to endorse the health and well-being of our faculty, staff, and learners as a core value and cultural norm of Michigan Medicine. In other words, the leadership has to make health and well-being a priority and a value.”
Another goal of the office is to improve the overall workplace environment and experience of Michigan Medicine’s faculty, staff, and learners. “You’re not going to have a well workplace if people are not treating each other with respect,” she said at the meeting, jointly sponsored by the Triological Society and the American College of Surgeons. “One of the many challenges is that there is great stigma in our profession for those who are suffering from mental health challenges such as stress, anxiety, depression, and perhaps substance abuse. We need to reduce the stigma, because it’s very dangerous if people who are struggling are unwilling to seek help. We don’t ask people that we supervise or work with how they’re doing, so we have adopted an optional wellness check-in that is incorporated into mid-year and annual evaluations for faculty, staff, and learners to enable leaders to address any challenges that may arise.” In addition, a group of residents is piloting the use of meditation and mindfulness applications such as MoodGym and Headspace to see if they affect resident wellness.
Ultimately, Dr. Bradford and her associates plan to use a standardized benchmark instrument to measure well-being, and include the measure in the institutional performance dashboard. “Administrative burden is a growing problem,” she said. “We’re going to address this for health care professionals, particularly as it relates to the electronic medical record. Our primary care colleagues sometimes spend as many hours outside of clinic documenting as they do in clinic. We want to develop and implement strategies to lessen or remove this burden in order to improve provider efficiency and satisfaction.”
In the course of helping to develop the wellness initiative, Dr. Bradford said that she learned the importance of addressing moral distress in the workplace. “We sort of lose our humanity if we don’t show emotion when tragedies happen. There is really good literature around terminal event debriefings, so if somebody dies unexpectedly in the operating room or in the CT scanner, rather than just walking away and pretending nothing happened, we’re supposed to pause and gather, and reflect on the sadness of the loss. Because if we don’t grieve our losses we become more like machines than human beings. It’s important to provide emotional support for all individuals involved.”
She reported having no relevant financial disclosures.
CORONADO, CALIF. – Officials at staff, and learners.
“If you look long and hard at your hospitals, health centers, and medical schools, you would find incidences of depression, near-miss suicide, opioid addiction, substance abuse addictions, and suicide,” Carol R. Bradford, MD, said at the Triological Society’s Combined Sections Meeting. “Another component of this is that we all struggle with our work or learning communities where people don’t take care of each other. People don’t treat each other with respect and civility. Promoting a healthy and civil work environment are essential components of a supportive environment.”
According to Dr. Bradford, executive vice dean for academic affairs at the University of Michigan, Ann Arbor, the complexities and stress of the health care environment compromises the well-being of its workforce with a myriad of time-consuming tasks, including navigating electronic records and ever-populating email inboxes. “We are all connected to devices 24/7, and it has become more and more difficult to maintain a healthy work-life balance,” Dr. Bradford said. “The more accepted term now is integration, because it’s almost impossible to achieve balance. Burnout and other physical and health problems are the result of all of these challenges.”
In late 2017, she and her colleagues used two different validated survey questionnaires to assess the health of Michigan Medicine faculty physicians. They found that about 40% of faculty members in both clinical and basic science departments met criteria for burnout. The top 10 stressors based on the survey were email, clerical activity, time worked outside of regular hours, workload time pressure, work expectations, insufficient time for meaningful activities, in-basket messages, lack of decisional transparency, inadequate compensation, and too many work hours. The top 10 coping strategies were finding meaning in work, using all vacation time, paying attention to healthy/balanced eating, engaging in exercise, seek personal/professional balance, protecting time away from work, protecting sleep time, using a social support network, nurturing spiritual aspects, and engaging in recreation or hobbies.
Results of the survey prompted development of a task force to examine wellness and civility at Michigan Medicine, and to devise strategies and tactics to conquer these challenges. “The goal is to help all human beings who are suffering in our work environment,” said Dr. Bradford, who is also chief academic officer for Michigan Medicine. “What we learned initially is that there is a bit of an overlap. Some lack of wellness is due to a lack of civility, but there are wellness issues and civility issues that are independent of one another.”
Members of the task force formulated several recommendations, the first being to create a Michigan Medicine Wellness Office. Dr. Bradford is currently negotiating with a finalist to serve as its faculty director. She characterized the office as a “hub and spoke” model that will partner with existing entities, including human resources, the office of medical student education, the program in biological sciences, graduate medical education, the office of health equality and inclusion, the office of clinical affairs, and the office of counseling and workplace resilience. “The idea is to create a strategic wellness plan,” said Dr. Bradford, who is also a professor of otolaryngology–head and neck surgery. “One key strategy is to endorse the health and well-being of our faculty, staff, and learners as a core value and cultural norm of Michigan Medicine. In other words, the leadership has to make health and well-being a priority and a value.”
Another goal of the office is to improve the overall workplace environment and experience of Michigan Medicine’s faculty, staff, and learners. “You’re not going to have a well workplace if people are not treating each other with respect,” she said at the meeting, jointly sponsored by the Triological Society and the American College of Surgeons. “One of the many challenges is that there is great stigma in our profession for those who are suffering from mental health challenges such as stress, anxiety, depression, and perhaps substance abuse. We need to reduce the stigma, because it’s very dangerous if people who are struggling are unwilling to seek help. We don’t ask people that we supervise or work with how they’re doing, so we have adopted an optional wellness check-in that is incorporated into mid-year and annual evaluations for faculty, staff, and learners to enable leaders to address any challenges that may arise.” In addition, a group of residents is piloting the use of meditation and mindfulness applications such as MoodGym and Headspace to see if they affect resident wellness.
Ultimately, Dr. Bradford and her associates plan to use a standardized benchmark instrument to measure well-being, and include the measure in the institutional performance dashboard. “Administrative burden is a growing problem,” she said. “We’re going to address this for health care professionals, particularly as it relates to the electronic medical record. Our primary care colleagues sometimes spend as many hours outside of clinic documenting as they do in clinic. We want to develop and implement strategies to lessen or remove this burden in order to improve provider efficiency and satisfaction.”
In the course of helping to develop the wellness initiative, Dr. Bradford said that she learned the importance of addressing moral distress in the workplace. “We sort of lose our humanity if we don’t show emotion when tragedies happen. There is really good literature around terminal event debriefings, so if somebody dies unexpectedly in the operating room or in the CT scanner, rather than just walking away and pretending nothing happened, we’re supposed to pause and gather, and reflect on the sadness of the loss. Because if we don’t grieve our losses we become more like machines than human beings. It’s important to provide emotional support for all individuals involved.”
She reported having no relevant financial disclosures.
CORONADO, CALIF. – Officials at staff, and learners.
“If you look long and hard at your hospitals, health centers, and medical schools, you would find incidences of depression, near-miss suicide, opioid addiction, substance abuse addictions, and suicide,” Carol R. Bradford, MD, said at the Triological Society’s Combined Sections Meeting. “Another component of this is that we all struggle with our work or learning communities where people don’t take care of each other. People don’t treat each other with respect and civility. Promoting a healthy and civil work environment are essential components of a supportive environment.”
According to Dr. Bradford, executive vice dean for academic affairs at the University of Michigan, Ann Arbor, the complexities and stress of the health care environment compromises the well-being of its workforce with a myriad of time-consuming tasks, including navigating electronic records and ever-populating email inboxes. “We are all connected to devices 24/7, and it has become more and more difficult to maintain a healthy work-life balance,” Dr. Bradford said. “The more accepted term now is integration, because it’s almost impossible to achieve balance. Burnout and other physical and health problems are the result of all of these challenges.”
In late 2017, she and her colleagues used two different validated survey questionnaires to assess the health of Michigan Medicine faculty physicians. They found that about 40% of faculty members in both clinical and basic science departments met criteria for burnout. The top 10 stressors based on the survey were email, clerical activity, time worked outside of regular hours, workload time pressure, work expectations, insufficient time for meaningful activities, in-basket messages, lack of decisional transparency, inadequate compensation, and too many work hours. The top 10 coping strategies were finding meaning in work, using all vacation time, paying attention to healthy/balanced eating, engaging in exercise, seek personal/professional balance, protecting time away from work, protecting sleep time, using a social support network, nurturing spiritual aspects, and engaging in recreation or hobbies.
Results of the survey prompted development of a task force to examine wellness and civility at Michigan Medicine, and to devise strategies and tactics to conquer these challenges. “The goal is to help all human beings who are suffering in our work environment,” said Dr. Bradford, who is also chief academic officer for Michigan Medicine. “What we learned initially is that there is a bit of an overlap. Some lack of wellness is due to a lack of civility, but there are wellness issues and civility issues that are independent of one another.”
Members of the task force formulated several recommendations, the first being to create a Michigan Medicine Wellness Office. Dr. Bradford is currently negotiating with a finalist to serve as its faculty director. She characterized the office as a “hub and spoke” model that will partner with existing entities, including human resources, the office of medical student education, the program in biological sciences, graduate medical education, the office of health equality and inclusion, the office of clinical affairs, and the office of counseling and workplace resilience. “The idea is to create a strategic wellness plan,” said Dr. Bradford, who is also a professor of otolaryngology–head and neck surgery. “One key strategy is to endorse the health and well-being of our faculty, staff, and learners as a core value and cultural norm of Michigan Medicine. In other words, the leadership has to make health and well-being a priority and a value.”
Another goal of the office is to improve the overall workplace environment and experience of Michigan Medicine’s faculty, staff, and learners. “You’re not going to have a well workplace if people are not treating each other with respect,” she said at the meeting, jointly sponsored by the Triological Society and the American College of Surgeons. “One of the many challenges is that there is great stigma in our profession for those who are suffering from mental health challenges such as stress, anxiety, depression, and perhaps substance abuse. We need to reduce the stigma, because it’s very dangerous if people who are struggling are unwilling to seek help. We don’t ask people that we supervise or work with how they’re doing, so we have adopted an optional wellness check-in that is incorporated into mid-year and annual evaluations for faculty, staff, and learners to enable leaders to address any challenges that may arise.” In addition, a group of residents is piloting the use of meditation and mindfulness applications such as MoodGym and Headspace to see if they affect resident wellness.
Ultimately, Dr. Bradford and her associates plan to use a standardized benchmark instrument to measure well-being, and include the measure in the institutional performance dashboard. “Administrative burden is a growing problem,” she said. “We’re going to address this for health care professionals, particularly as it relates to the electronic medical record. Our primary care colleagues sometimes spend as many hours outside of clinic documenting as they do in clinic. We want to develop and implement strategies to lessen or remove this burden in order to improve provider efficiency and satisfaction.”
In the course of helping to develop the wellness initiative, Dr. Bradford said that she learned the importance of addressing moral distress in the workplace. “We sort of lose our humanity if we don’t show emotion when tragedies happen. There is really good literature around terminal event debriefings, so if somebody dies unexpectedly in the operating room or in the CT scanner, rather than just walking away and pretending nothing happened, we’re supposed to pause and gather, and reflect on the sadness of the loss. Because if we don’t grieve our losses we become more like machines than human beings. It’s important to provide emotional support for all individuals involved.”
She reported having no relevant financial disclosures.
EXPERT ANALYSIS FROM THE TRIOLOGICAL CSM
Raymond Barfield Part I
Now, he joins the Postcall Podcast to discuss why he’s back, what he’s working on to prevent burnout, and how he wants to remake pre-med education. You can read more from Dr. Barfield’s story here.
Apple Podcasts
Google Podcasts
Spotify
Now, he joins the Postcall Podcast to discuss why he’s back, what he’s working on to prevent burnout, and how he wants to remake pre-med education. You can read more from Dr. Barfield’s story here.
Apple Podcasts
Google Podcasts
Spotify
Now, he joins the Postcall Podcast to discuss why he’s back, what he’s working on to prevent burnout, and how he wants to remake pre-med education. You can read more from Dr. Barfield’s story here.
Apple Podcasts
Google Podcasts
Spotify
The SVS is working for you on burnout
Following a series of Vascular Specialist pieces highlighting the crisis of surgeon burnout and the unique challenges that face vascular surgeons, the SVS Wellness Task Force was formed in 2017. Recognizing that burnout may compromise recruitment and retention into our specialty, a particular threat at a time when our specialty faces projected increasing physician workforce needs, and that data suggests physician burnout compromises both patient quality of care and overall satisfaction, the task force was charged with proactively addressing vascular surgeon burnout. Our task force, comprising 21 engaged SVS members from across the country, has been working with strong support from leadership and administration to identify potential SVS targets for meaningful change.
The year 2018 was one of information gathering as we attempted clarify the severity of the problem and perceived member needs. We are grateful to our membership that have helped with this effort – for their time, for their insight, and for sharing their stories (some of which have been deeply personal). Two large-scale surveys were circulated to active SVS membership, both created with the assistance of the Mayo Clinic’s Division of Health Policy and Research.
The first survey was designed with a framework of validated wellness tools and well-described risk factors for burnout, then further “personalized” to incorporate unique challenges to the vascular surgeon. About 32% of our membership responded to this survey and alarmingly, when considering nonretired active SVS members, approximately one-third self-described depressive symptoms, 35% met criteria for burnout, and 8% self-reported suicidal thoughts in the last 12 months.
The second survey has only recently closed, focusing on the ergonomic challenges that we face across the spectrum of complex open and endovascular cases. Recognizing existing data that chronic pain and physical disability are associated with burnout, this data will be linked back to the original survey responses for association. Certainly there is more to come.
Concurrent with our survey initiatives, many of you participated in a Wellness Focus Group during VAM 2018. These focus groups intentionally considered the diversity of our membership across age, gender, practice setting, and region, revealing several important themes that threaten our wellness. It was no surprise that the EMR was identified as a clear threat to vascular surgery well-being and that this is not unique to our specialty. Importantly, our membership collectively feels “undervalued” at an institutional level. Specifically given the scope of comprehensive vascular care that we provide patients, a large part of our work includes both unpredictable acute vascular surgical care (such as intraoperative consultations for vascular trauma) and remedial salvage operations to manage vascular complications inflicted during care received from other physicians. This effort leaves us with little control over our time, often without perceived reciprocal clinical support, institutional support, or compensation.
Given this data, the Wellness Task Force is now strategizing efforts for change and supporting ongoing SVS initiatives. Our Task Force is currently:
- Collaborating with key EMR stakeholders with the goal of creating tools that can be shared across the specialty and addressing best practices for system-level support.
- Drafting a “public reply” to the Office of the National Coordinator for Health Information Technology’s “Strategy on Reducing Burden Relating to the Use of Health IT and EHRs” initiative.
- Collaborating with national experts to establish peer support tools and SVS networking opportunities that may help members cope with adverse outcomes and strategize the delivery of complex care.
- Identifying institutional best practices for surgeon wellness for broad dissemination.
- Supporting existing SVS initiatives that include the PAC/APM task force, branding initiatives through the PPO as we work to “own our space” and leverage our specialty and the community practice committee as the Society works proactively to optimize workload, fairness, and reward on a larger scale for membership.
We encourage everyone to stay tuned for periodic Vascular Specialist “Wellness Features” and to attend the Wellness Session at the 2019 VAM for interim progress that will feature the following discussions.
- (Re)Finding a meaningful career in vascular surgery.
- Ergonomic challenges to the vascular surgeon and strategies to mitigate the resulting threat of disability.
- EMR best practices to optimize efficiency.
- The role of peer support in vascular surgery, including the mitigation of second victim syndrome.
Surgeon burnout is a real threat to our workforce and the well-being of our colleagues and friends. Risk factors are multifactorial and will require broad, system-level change. The SVS remains fully committed to enhancing vascular surgeon wellness and this Task Force is grateful for your ongoing engagement and support.
Dr. Coleman is an associate professor of vascular surgery at the University of Michigan, Ann Arbor.
Following a series of Vascular Specialist pieces highlighting the crisis of surgeon burnout and the unique challenges that face vascular surgeons, the SVS Wellness Task Force was formed in 2017. Recognizing that burnout may compromise recruitment and retention into our specialty, a particular threat at a time when our specialty faces projected increasing physician workforce needs, and that data suggests physician burnout compromises both patient quality of care and overall satisfaction, the task force was charged with proactively addressing vascular surgeon burnout. Our task force, comprising 21 engaged SVS members from across the country, has been working with strong support from leadership and administration to identify potential SVS targets for meaningful change.
The year 2018 was one of information gathering as we attempted clarify the severity of the problem and perceived member needs. We are grateful to our membership that have helped with this effort – for their time, for their insight, and for sharing their stories (some of which have been deeply personal). Two large-scale surveys were circulated to active SVS membership, both created with the assistance of the Mayo Clinic’s Division of Health Policy and Research.
The first survey was designed with a framework of validated wellness tools and well-described risk factors for burnout, then further “personalized” to incorporate unique challenges to the vascular surgeon. About 32% of our membership responded to this survey and alarmingly, when considering nonretired active SVS members, approximately one-third self-described depressive symptoms, 35% met criteria for burnout, and 8% self-reported suicidal thoughts in the last 12 months.
The second survey has only recently closed, focusing on the ergonomic challenges that we face across the spectrum of complex open and endovascular cases. Recognizing existing data that chronic pain and physical disability are associated with burnout, this data will be linked back to the original survey responses for association. Certainly there is more to come.
Concurrent with our survey initiatives, many of you participated in a Wellness Focus Group during VAM 2018. These focus groups intentionally considered the diversity of our membership across age, gender, practice setting, and region, revealing several important themes that threaten our wellness. It was no surprise that the EMR was identified as a clear threat to vascular surgery well-being and that this is not unique to our specialty. Importantly, our membership collectively feels “undervalued” at an institutional level. Specifically given the scope of comprehensive vascular care that we provide patients, a large part of our work includes both unpredictable acute vascular surgical care (such as intraoperative consultations for vascular trauma) and remedial salvage operations to manage vascular complications inflicted during care received from other physicians. This effort leaves us with little control over our time, often without perceived reciprocal clinical support, institutional support, or compensation.
Given this data, the Wellness Task Force is now strategizing efforts for change and supporting ongoing SVS initiatives. Our Task Force is currently:
- Collaborating with key EMR stakeholders with the goal of creating tools that can be shared across the specialty and addressing best practices for system-level support.
- Drafting a “public reply” to the Office of the National Coordinator for Health Information Technology’s “Strategy on Reducing Burden Relating to the Use of Health IT and EHRs” initiative.
- Collaborating with national experts to establish peer support tools and SVS networking opportunities that may help members cope with adverse outcomes and strategize the delivery of complex care.
- Identifying institutional best practices for surgeon wellness for broad dissemination.
- Supporting existing SVS initiatives that include the PAC/APM task force, branding initiatives through the PPO as we work to “own our space” and leverage our specialty and the community practice committee as the Society works proactively to optimize workload, fairness, and reward on a larger scale for membership.
We encourage everyone to stay tuned for periodic Vascular Specialist “Wellness Features” and to attend the Wellness Session at the 2019 VAM for interim progress that will feature the following discussions.
- (Re)Finding a meaningful career in vascular surgery.
- Ergonomic challenges to the vascular surgeon and strategies to mitigate the resulting threat of disability.
- EMR best practices to optimize efficiency.
- The role of peer support in vascular surgery, including the mitigation of second victim syndrome.
Surgeon burnout is a real threat to our workforce and the well-being of our colleagues and friends. Risk factors are multifactorial and will require broad, system-level change. The SVS remains fully committed to enhancing vascular surgeon wellness and this Task Force is grateful for your ongoing engagement and support.
Dr. Coleman is an associate professor of vascular surgery at the University of Michigan, Ann Arbor.
Following a series of Vascular Specialist pieces highlighting the crisis of surgeon burnout and the unique challenges that face vascular surgeons, the SVS Wellness Task Force was formed in 2017. Recognizing that burnout may compromise recruitment and retention into our specialty, a particular threat at a time when our specialty faces projected increasing physician workforce needs, and that data suggests physician burnout compromises both patient quality of care and overall satisfaction, the task force was charged with proactively addressing vascular surgeon burnout. Our task force, comprising 21 engaged SVS members from across the country, has been working with strong support from leadership and administration to identify potential SVS targets for meaningful change.
The year 2018 was one of information gathering as we attempted clarify the severity of the problem and perceived member needs. We are grateful to our membership that have helped with this effort – for their time, for their insight, and for sharing their stories (some of which have been deeply personal). Two large-scale surveys were circulated to active SVS membership, both created with the assistance of the Mayo Clinic’s Division of Health Policy and Research.
The first survey was designed with a framework of validated wellness tools and well-described risk factors for burnout, then further “personalized” to incorporate unique challenges to the vascular surgeon. About 32% of our membership responded to this survey and alarmingly, when considering nonretired active SVS members, approximately one-third self-described depressive symptoms, 35% met criteria for burnout, and 8% self-reported suicidal thoughts in the last 12 months.
The second survey has only recently closed, focusing on the ergonomic challenges that we face across the spectrum of complex open and endovascular cases. Recognizing existing data that chronic pain and physical disability are associated with burnout, this data will be linked back to the original survey responses for association. Certainly there is more to come.
Concurrent with our survey initiatives, many of you participated in a Wellness Focus Group during VAM 2018. These focus groups intentionally considered the diversity of our membership across age, gender, practice setting, and region, revealing several important themes that threaten our wellness. It was no surprise that the EMR was identified as a clear threat to vascular surgery well-being and that this is not unique to our specialty. Importantly, our membership collectively feels “undervalued” at an institutional level. Specifically given the scope of comprehensive vascular care that we provide patients, a large part of our work includes both unpredictable acute vascular surgical care (such as intraoperative consultations for vascular trauma) and remedial salvage operations to manage vascular complications inflicted during care received from other physicians. This effort leaves us with little control over our time, often without perceived reciprocal clinical support, institutional support, or compensation.
Given this data, the Wellness Task Force is now strategizing efforts for change and supporting ongoing SVS initiatives. Our Task Force is currently:
- Collaborating with key EMR stakeholders with the goal of creating tools that can be shared across the specialty and addressing best practices for system-level support.
- Drafting a “public reply” to the Office of the National Coordinator for Health Information Technology’s “Strategy on Reducing Burden Relating to the Use of Health IT and EHRs” initiative.
- Collaborating with national experts to establish peer support tools and SVS networking opportunities that may help members cope with adverse outcomes and strategize the delivery of complex care.
- Identifying institutional best practices for surgeon wellness for broad dissemination.
- Supporting existing SVS initiatives that include the PAC/APM task force, branding initiatives through the PPO as we work to “own our space” and leverage our specialty and the community practice committee as the Society works proactively to optimize workload, fairness, and reward on a larger scale for membership.
We encourage everyone to stay tuned for periodic Vascular Specialist “Wellness Features” and to attend the Wellness Session at the 2019 VAM for interim progress that will feature the following discussions.
- (Re)Finding a meaningful career in vascular surgery.
- Ergonomic challenges to the vascular surgeon and strategies to mitigate the resulting threat of disability.
- EMR best practices to optimize efficiency.
- The role of peer support in vascular surgery, including the mitigation of second victim syndrome.
Surgeon burnout is a real threat to our workforce and the well-being of our colleagues and friends. Risk factors are multifactorial and will require broad, system-level change. The SVS remains fully committed to enhancing vascular surgeon wellness and this Task Force is grateful for your ongoing engagement and support.
Dr. Coleman is an associate professor of vascular surgery at the University of Michigan, Ann Arbor.
Physician value thyself!
The Merriam-Webster dictionary defines value as “the regard that something is held to deserve; the importance, worth, or usefulness of something” and “relative worth, utility, or importance.” We usually assess our professional worth by how we are treated at work. In social valuing framework, we are given social status based on how others regard us for who we are, what we do, and what we are worth. This is described as “felt worth,” which encapsulates our feelings about how we are regarded by others, in contrast to self-esteem, which is more of an internally held belief.
Our power came from our relationship with our patients and our ability to communicate and influence our patients, peers and administrators. As owners of our practices and small businesses, our currency with hospitals and lawmakers was our ability to bring revenue to hospitals and patient concerns directly to legislators. Practicing in more than one hospital made us more valuable and hospitals battled with each other to provide us and our patients the latest tools and conveniences. In return, we gave our valuable time freely without compensation to hospitals as committee members, task force members, and sounding boards for the betterment of the community. If I were a conspiracy theorist, which I am not, and wanted to devalue physicians I would seek to weaken the physician-patient bond. The way to implement this would be for a single hospital employer to put us on a treadmill chasing work relative value units, give us hard-to-accomplish goals, and keep moving the goalpost. Like I said, I do not believe in conspiracies.
The tsunami of byzantine regulations, Stark laws, and complicated reimbursement formulas has sapped our energy to counter the devaluation. Some are glad to see physicians, particularly surgeons, get their comeuppance because we are perceived as having large egos. This may be true in some instances. Yet, it turns out that the top three job titles with the largest egos are: private household cooks, chief executives, and farm and ranch managers.1
Physicians are also reputed to be possessing dominant leadership styles and seen as bossy and disruptive. Hence, we are made to have frequent training in how to ameliorate our disruptive behavior tendencies. Again, this may be true in a few cases. However, while reports mention how many people witness such unacceptable behavior, there is no valid data about the incidence in practicing physicians. Research also does not support the view that physicians have dominant and aggressive personalities leading to such behavior.
One of the leading interpersonal skills model is Social Styles. We happen to teach this to our faculty at the Ohio State Medical Center’s Faculty Leadership Institute. Turns out that physicians and nurses are almost equally placed into the four quadrants of leadership styles: driving, expressive, amiable, and analytical. I found similar findings in our society members participating in a leadership session I moderated. Indeed, we rank very high on “versatility,” a measure that enables us to adapt our behaviors to fit with our patients and coworkers.
Reported burnout rates of 50% in physicians may or may not be accurate, but burnout is real and so is depression and so are physician suicides. I have witnessed six physician suicides in my career thus far. Teaching resilience, celebrating doctor’s day, and giving out a few awards are all interventions after the fact. Preventive measures like employers and hospitals prioritizing removing daily obstacles eliminating meaningless work, providing more resources to deal with EMRs, and making our lives easier at work, so we can get to our loved ones sooner would help.
Physicians have been largely excluded themselves from participating in the health care debate. We want to see empirical evidence before we sign on to every new proposed care model. Otherwise, we cling on to the status quo and therefore, decision makers tend to leave us out. More important, value-based payment models have not thus far led to reduction in the cost of health care. Despite poor engagement scores at major health systems, physicians are “managed” and sidelined, and mandates are “done to them, not with them.”
In my 40-year career, our devaluation has been a slow and painful process. It started with being called a “provider.” This devalues me. Call me by what I am and do. Physician. Doctor. That is what our patients call us. But, we have been pushed to acquiesce. So, why do physicians undervalue themselves and are unable to be confident of their value to employers and hospital executives?
Some have theorized that physicians have low self-esteem and that denial and rationalization are simply defense mechanisms. The low self-esteem is traced back to medical student days and considered “posttraumatic” disorder. In one study of 189 medical students, 50% reported a decrease in their self-esteem/confidence. The students blamed their residents and attendings for this reaction. Some degree of intimidation may continue into training and employment where it may be part of the culture. We need to change this cycle and treat our students, residents, and mentees with respect as future peers.
Another aspect is related to our own well-being. Most physicians value their patient’s health more than their own. That concept is drilled into us throughout our life. Our spouses complain that we care more about our patients than we do for our families. We often ignore warning signs of serious issues in our own health, always downplaying textbook symptoms of burnout, depression, and even MI. Being too busy is a badge of honor to indicate how successful and wanted we are. This also needs to change.
Sheryl Sandberg in her book “Lean in” discusses the “tiara syndrome,” mainly referring to women. I would suggest that this applies to a lot of physicians, both men and women. Physicians tend to keep their heads down, work hard, and expect someone to come compliment them and place a “tiara” over their head. We may be wary of being called “self-promoters.” Sometimes it is cultural baggage for immigrant physicians who are taught to not brag about their accomplishments. It may behoove us to judiciously make peers and leadership aware of our positive activities in and outside the health system.
Some see physicians not as “pillars of any community,” but as “technicians on an assembly line” or “pawns in a money-making game for hospital administrators.” This degree of pessimism among physicians in surveys is well known but there is good news.
In a 2016 survey based upon responses by 17,236 physicians, 63% were pessimistic or very pessimistic about the medical profession, down from 77% in 2012.2 In another poll, medical doctors were rated as having very high or high ratings of honesty and ethical standards by 65%, higher than all except nurses, military officers, and grade school teachers.3 When the health care debate was at its peak in 2009, a public poll on who they trusted to recommend the right thing for reforming the healthcare system placed physicians at the very top (73%)ahead of health care professors, researchers, hospitals, the President, and politicians. Gallup surveyed 7,000 physicians about engagement in four hierarchical levels: Confidence, Integrity, Pride and Passion. Physicians scored highly on the Pride items in the survey (feel proud to work and being treated with respect).4 In other words, if we are treated well, we feel proud to tell others where we work.
Finally, like many I may consider myself an expert in all sorts of things not relevant to practicing medicine. Yet, I respectfully suggest we stay away from political hot potatoes like nuclear disarmament, gun control, climate change, immigration, and other controversial issues because they distract us from our primary mission. I would hate to see us viewed like Hollywood.
References
1. www.chicagotribune.com/business/ct-payscale-ego-survey-0830-biz-20160829-story.html
2. www.medpagetoday.com/primarycare/generalprimarycare/60446
3. https://nurse.org/articles/gallup-ethical-standards-poll-nurses-rank-highest/
4.https://news.gallup.com/poll/120890/healthcare-americans-trust-physicians-politicians.aspx
Bhagwan Satiani, MD, MBA, is professor of clinical surgery in the division of vascular diseases and surgery at Ohio State University, Columbus. He blogs at www.savvy-medicine.com . Reach him on Twitter @savvycutter.
The Merriam-Webster dictionary defines value as “the regard that something is held to deserve; the importance, worth, or usefulness of something” and “relative worth, utility, or importance.” We usually assess our professional worth by how we are treated at work. In social valuing framework, we are given social status based on how others regard us for who we are, what we do, and what we are worth. This is described as “felt worth,” which encapsulates our feelings about how we are regarded by others, in contrast to self-esteem, which is more of an internally held belief.
Our power came from our relationship with our patients and our ability to communicate and influence our patients, peers and administrators. As owners of our practices and small businesses, our currency with hospitals and lawmakers was our ability to bring revenue to hospitals and patient concerns directly to legislators. Practicing in more than one hospital made us more valuable and hospitals battled with each other to provide us and our patients the latest tools and conveniences. In return, we gave our valuable time freely without compensation to hospitals as committee members, task force members, and sounding boards for the betterment of the community. If I were a conspiracy theorist, which I am not, and wanted to devalue physicians I would seek to weaken the physician-patient bond. The way to implement this would be for a single hospital employer to put us on a treadmill chasing work relative value units, give us hard-to-accomplish goals, and keep moving the goalpost. Like I said, I do not believe in conspiracies.
The tsunami of byzantine regulations, Stark laws, and complicated reimbursement formulas has sapped our energy to counter the devaluation. Some are glad to see physicians, particularly surgeons, get their comeuppance because we are perceived as having large egos. This may be true in some instances. Yet, it turns out that the top three job titles with the largest egos are: private household cooks, chief executives, and farm and ranch managers.1
Physicians are also reputed to be possessing dominant leadership styles and seen as bossy and disruptive. Hence, we are made to have frequent training in how to ameliorate our disruptive behavior tendencies. Again, this may be true in a few cases. However, while reports mention how many people witness such unacceptable behavior, there is no valid data about the incidence in practicing physicians. Research also does not support the view that physicians have dominant and aggressive personalities leading to such behavior.
One of the leading interpersonal skills model is Social Styles. We happen to teach this to our faculty at the Ohio State Medical Center’s Faculty Leadership Institute. Turns out that physicians and nurses are almost equally placed into the four quadrants of leadership styles: driving, expressive, amiable, and analytical. I found similar findings in our society members participating in a leadership session I moderated. Indeed, we rank very high on “versatility,” a measure that enables us to adapt our behaviors to fit with our patients and coworkers.
Reported burnout rates of 50% in physicians may or may not be accurate, but burnout is real and so is depression and so are physician suicides. I have witnessed six physician suicides in my career thus far. Teaching resilience, celebrating doctor’s day, and giving out a few awards are all interventions after the fact. Preventive measures like employers and hospitals prioritizing removing daily obstacles eliminating meaningless work, providing more resources to deal with EMRs, and making our lives easier at work, so we can get to our loved ones sooner would help.
Physicians have been largely excluded themselves from participating in the health care debate. We want to see empirical evidence before we sign on to every new proposed care model. Otherwise, we cling on to the status quo and therefore, decision makers tend to leave us out. More important, value-based payment models have not thus far led to reduction in the cost of health care. Despite poor engagement scores at major health systems, physicians are “managed” and sidelined, and mandates are “done to them, not with them.”
In my 40-year career, our devaluation has been a slow and painful process. It started with being called a “provider.” This devalues me. Call me by what I am and do. Physician. Doctor. That is what our patients call us. But, we have been pushed to acquiesce. So, why do physicians undervalue themselves and are unable to be confident of their value to employers and hospital executives?
Some have theorized that physicians have low self-esteem and that denial and rationalization are simply defense mechanisms. The low self-esteem is traced back to medical student days and considered “posttraumatic” disorder. In one study of 189 medical students, 50% reported a decrease in their self-esteem/confidence. The students blamed their residents and attendings for this reaction. Some degree of intimidation may continue into training and employment where it may be part of the culture. We need to change this cycle and treat our students, residents, and mentees with respect as future peers.
Another aspect is related to our own well-being. Most physicians value their patient’s health more than their own. That concept is drilled into us throughout our life. Our spouses complain that we care more about our patients than we do for our families. We often ignore warning signs of serious issues in our own health, always downplaying textbook symptoms of burnout, depression, and even MI. Being too busy is a badge of honor to indicate how successful and wanted we are. This also needs to change.
Sheryl Sandberg in her book “Lean in” discusses the “tiara syndrome,” mainly referring to women. I would suggest that this applies to a lot of physicians, both men and women. Physicians tend to keep their heads down, work hard, and expect someone to come compliment them and place a “tiara” over their head. We may be wary of being called “self-promoters.” Sometimes it is cultural baggage for immigrant physicians who are taught to not brag about their accomplishments. It may behoove us to judiciously make peers and leadership aware of our positive activities in and outside the health system.
Some see physicians not as “pillars of any community,” but as “technicians on an assembly line” or “pawns in a money-making game for hospital administrators.” This degree of pessimism among physicians in surveys is well known but there is good news.
In a 2016 survey based upon responses by 17,236 physicians, 63% were pessimistic or very pessimistic about the medical profession, down from 77% in 2012.2 In another poll, medical doctors were rated as having very high or high ratings of honesty and ethical standards by 65%, higher than all except nurses, military officers, and grade school teachers.3 When the health care debate was at its peak in 2009, a public poll on who they trusted to recommend the right thing for reforming the healthcare system placed physicians at the very top (73%)ahead of health care professors, researchers, hospitals, the President, and politicians. Gallup surveyed 7,000 physicians about engagement in four hierarchical levels: Confidence, Integrity, Pride and Passion. Physicians scored highly on the Pride items in the survey (feel proud to work and being treated with respect).4 In other words, if we are treated well, we feel proud to tell others where we work.
Finally, like many I may consider myself an expert in all sorts of things not relevant to practicing medicine. Yet, I respectfully suggest we stay away from political hot potatoes like nuclear disarmament, gun control, climate change, immigration, and other controversial issues because they distract us from our primary mission. I would hate to see us viewed like Hollywood.
References
1. www.chicagotribune.com/business/ct-payscale-ego-survey-0830-biz-20160829-story.html
2. www.medpagetoday.com/primarycare/generalprimarycare/60446
3. https://nurse.org/articles/gallup-ethical-standards-poll-nurses-rank-highest/
4.https://news.gallup.com/poll/120890/healthcare-americans-trust-physicians-politicians.aspx
Bhagwan Satiani, MD, MBA, is professor of clinical surgery in the division of vascular diseases and surgery at Ohio State University, Columbus. He blogs at www.savvy-medicine.com . Reach him on Twitter @savvycutter.
The Merriam-Webster dictionary defines value as “the regard that something is held to deserve; the importance, worth, or usefulness of something” and “relative worth, utility, or importance.” We usually assess our professional worth by how we are treated at work. In social valuing framework, we are given social status based on how others regard us for who we are, what we do, and what we are worth. This is described as “felt worth,” which encapsulates our feelings about how we are regarded by others, in contrast to self-esteem, which is more of an internally held belief.
Our power came from our relationship with our patients and our ability to communicate and influence our patients, peers and administrators. As owners of our practices and small businesses, our currency with hospitals and lawmakers was our ability to bring revenue to hospitals and patient concerns directly to legislators. Practicing in more than one hospital made us more valuable and hospitals battled with each other to provide us and our patients the latest tools and conveniences. In return, we gave our valuable time freely without compensation to hospitals as committee members, task force members, and sounding boards for the betterment of the community. If I were a conspiracy theorist, which I am not, and wanted to devalue physicians I would seek to weaken the physician-patient bond. The way to implement this would be for a single hospital employer to put us on a treadmill chasing work relative value units, give us hard-to-accomplish goals, and keep moving the goalpost. Like I said, I do not believe in conspiracies.
The tsunami of byzantine regulations, Stark laws, and complicated reimbursement formulas has sapped our energy to counter the devaluation. Some are glad to see physicians, particularly surgeons, get their comeuppance because we are perceived as having large egos. This may be true in some instances. Yet, it turns out that the top three job titles with the largest egos are: private household cooks, chief executives, and farm and ranch managers.1
Physicians are also reputed to be possessing dominant leadership styles and seen as bossy and disruptive. Hence, we are made to have frequent training in how to ameliorate our disruptive behavior tendencies. Again, this may be true in a few cases. However, while reports mention how many people witness such unacceptable behavior, there is no valid data about the incidence in practicing physicians. Research also does not support the view that physicians have dominant and aggressive personalities leading to such behavior.
One of the leading interpersonal skills model is Social Styles. We happen to teach this to our faculty at the Ohio State Medical Center’s Faculty Leadership Institute. Turns out that physicians and nurses are almost equally placed into the four quadrants of leadership styles: driving, expressive, amiable, and analytical. I found similar findings in our society members participating in a leadership session I moderated. Indeed, we rank very high on “versatility,” a measure that enables us to adapt our behaviors to fit with our patients and coworkers.
Reported burnout rates of 50% in physicians may or may not be accurate, but burnout is real and so is depression and so are physician suicides. I have witnessed six physician suicides in my career thus far. Teaching resilience, celebrating doctor’s day, and giving out a few awards are all interventions after the fact. Preventive measures like employers and hospitals prioritizing removing daily obstacles eliminating meaningless work, providing more resources to deal with EMRs, and making our lives easier at work, so we can get to our loved ones sooner would help.
Physicians have been largely excluded themselves from participating in the health care debate. We want to see empirical evidence before we sign on to every new proposed care model. Otherwise, we cling on to the status quo and therefore, decision makers tend to leave us out. More important, value-based payment models have not thus far led to reduction in the cost of health care. Despite poor engagement scores at major health systems, physicians are “managed” and sidelined, and mandates are “done to them, not with them.”
In my 40-year career, our devaluation has been a slow and painful process. It started with being called a “provider.” This devalues me. Call me by what I am and do. Physician. Doctor. That is what our patients call us. But, we have been pushed to acquiesce. So, why do physicians undervalue themselves and are unable to be confident of their value to employers and hospital executives?
Some have theorized that physicians have low self-esteem and that denial and rationalization are simply defense mechanisms. The low self-esteem is traced back to medical student days and considered “posttraumatic” disorder. In one study of 189 medical students, 50% reported a decrease in their self-esteem/confidence. The students blamed their residents and attendings for this reaction. Some degree of intimidation may continue into training and employment where it may be part of the culture. We need to change this cycle and treat our students, residents, and mentees with respect as future peers.
Another aspect is related to our own well-being. Most physicians value their patient’s health more than their own. That concept is drilled into us throughout our life. Our spouses complain that we care more about our patients than we do for our families. We often ignore warning signs of serious issues in our own health, always downplaying textbook symptoms of burnout, depression, and even MI. Being too busy is a badge of honor to indicate how successful and wanted we are. This also needs to change.
Sheryl Sandberg in her book “Lean in” discusses the “tiara syndrome,” mainly referring to women. I would suggest that this applies to a lot of physicians, both men and women. Physicians tend to keep their heads down, work hard, and expect someone to come compliment them and place a “tiara” over their head. We may be wary of being called “self-promoters.” Sometimes it is cultural baggage for immigrant physicians who are taught to not brag about their accomplishments. It may behoove us to judiciously make peers and leadership aware of our positive activities in and outside the health system.
Some see physicians not as “pillars of any community,” but as “technicians on an assembly line” or “pawns in a money-making game for hospital administrators.” This degree of pessimism among physicians in surveys is well known but there is good news.
In a 2016 survey based upon responses by 17,236 physicians, 63% were pessimistic or very pessimistic about the medical profession, down from 77% in 2012.2 In another poll, medical doctors were rated as having very high or high ratings of honesty and ethical standards by 65%, higher than all except nurses, military officers, and grade school teachers.3 When the health care debate was at its peak in 2009, a public poll on who they trusted to recommend the right thing for reforming the healthcare system placed physicians at the very top (73%)ahead of health care professors, researchers, hospitals, the President, and politicians. Gallup surveyed 7,000 physicians about engagement in four hierarchical levels: Confidence, Integrity, Pride and Passion. Physicians scored highly on the Pride items in the survey (feel proud to work and being treated with respect).4 In other words, if we are treated well, we feel proud to tell others where we work.
Finally, like many I may consider myself an expert in all sorts of things not relevant to practicing medicine. Yet, I respectfully suggest we stay away from political hot potatoes like nuclear disarmament, gun control, climate change, immigration, and other controversial issues because they distract us from our primary mission. I would hate to see us viewed like Hollywood.
References
1. www.chicagotribune.com/business/ct-payscale-ego-survey-0830-biz-20160829-story.html
2. www.medpagetoday.com/primarycare/generalprimarycare/60446
3. https://nurse.org/articles/gallup-ethical-standards-poll-nurses-rank-highest/
4.https://news.gallup.com/poll/120890/healthcare-americans-trust-physicians-politicians.aspx
Bhagwan Satiani, MD, MBA, is professor of clinical surgery in the division of vascular diseases and surgery at Ohio State University, Columbus. He blogs at www.savvy-medicine.com . Reach him on Twitter @savvycutter.
Guest editorial: Best of both worlds
Within 3 minutes of the car engine rumbling to a roar in the morning air, cruise control is set, freshly ground coffee is in hand and NPR is playing on WOSU 90.5. I settle in for the morning news on my 45-minute commute to the hospital. Sure, I could’ve found a hospital closer to shorten my commute, especially since I live in the 14th largest metropolitan city in the country.
If I’d wanted, I could be knocking out carotid endarterectomies at a level 1 trauma center, three blocks away from my front door. But no, that’s not what does it for me. What does? It’s having the opportunity to be my own boss and care for salt-of-the-earth folks in rural America.
You see, 5 years ago when I finished my vascular surgery fellowship at Good Samaritan Hospital in Cincinnati, I opened my own solo private practice in a rural community: population 30,000. Yep, that’s right, you heard it. I hung a shingle and went old school. And now as I reflect over the lessons learned during the first half-decade of my practice at Ohio Vein & Vascular Inc., I can tell you it has been a hell of a ride, and boy have we learned a lot.
The better half of the ‘we’ is my wife, Crystal, who doubles as my practice administrator, with her own solid foundation coming from a doctorate in physical therapy. We have successfully built a small company with four full-time employees, one contract registered vascular technologist, and two therapy dogs who serve more than 3,500 patients to date.
From the first day I opened my doors to this small-town rural community, I realized that it’s not what you know, but rather who you know. Well frankly, I didn’t know a soul!
Fortunately, my front office manager was born, raised, and still lives in Wilmington and knows everyone’s mother, brother, sister, niece, and grandchild in what felt like a 60-mile radius. She gave this young, slick city kid from Columbus instant street cred despite all the fancy credentials behind my name. I ditched the tie and fancy shoes and embraced my new ‘work’ home with open arms.
In a community such as Wilmington, Ohio, it’s the little things that count. I wear my own scrubs on days when I operate. Not only do they have my practice logo embroidered on the chest pocket, but they are also adorned with the brown leather symbol for Carhart, a clothing brand. In rural America, Carhart denim clothing – overall bibs, jackets, gloves, etc., are considered king. When my patients see that symbol, there is an instant point of mutual appreciation and it almost always results in some good laughs – who knew Carhart made scrubs?
As a result, I’ve been offered opportunities to ride combines, go drag racing, and go hunting for the infamous morel mushrooms. Just to be clear, I haven’t found a morel yet, so I guess I will stick to my day job as a surgeon.
Having a good laugh and connecting with my patients was something I was not accustomed to in my training. I was there to operate, and rarely participated in office days. At times this routine left me feeling unappreciated by my patients and their families. I was just a surgeon delivering bad news. I now find myself fortunate to have the opportunity to get to know my patients and participate in their health care, and I know they appreciate me for it.
A recent malpractice survey cited a finding that the more patients ‘like’ their physicians, the less likely they are to file malpractice lawsuits against them.1 Other reports have suggested that the relationship a physician has with a patient is a critical factor, more so than any single medical mistake, in determining whether or not a lawsuit is filed.2,3
While I feel appreciated and ‘liked’ by my patients, I’ve learned that I am not necessarily their favorite employee in the office. This honor is most often bestowed upon Claire and Whitney, aka “The Girls” – our two, miniature Labradoodles who serve in the capacity of therapy dogs and have perfected the ability to nap in nearly any situation. Try as I may to convince patients that what I am saying is important, they never lose focus on The Girls. They are the first thing patients ask about, I swear they receive more gifts than I do, and they always are on the receiving end of some good ‘pets’ as my patients leave the office. Despite any bad news they may have been told, very rarely do patients leave my office without smiles on their faces. It keeps me humble, as I think most of my patients aren’t really here to see me; after all I am just a fancy plumber.
Speaking of plumbing, I could’ve sworn that the ginormous two-volume Rutherford edition always gave me the impression that vascular disease is composed of 75% venous disease and 25% arterial disease. However, our fellowship training in the United States makes Rutherford seem like he had his numbers flipped – 99.8% was arterial with a splash of venous as an afterthought. Truth be told though, I see roughly 55% venous, 25% dialysis, and 20% arterial. I guess that wasn’t made up after all.
If my practice name, Ohio Vein & Vascular, didn’t give it away, I admit that I focus marketing efforts toward venous pathology. This has significantly improved my work-life balance. Let’s face it, not everything we do as a surgeon is fun and can certainly carry a large amount of stress. I devote an honest amount of time to developing what ‘type’ of practice I desire. I communicate regularly with my referring docs about the types of disease I focus on, write press releases to the local paper, and always have my elevator speech handy when speaking with fellow physicians and potential patients about what I do as a surgical subspecialist.
In such a small community, the more my vascular surgery practice grows, the more likely the podiatrist and his wife (also a podiatrist) across the hall will grow their practice. Same holds true of the cardiologist upstairs and the nephrologist down the hall. It’s not rocket science that the more I help their businesses thrive, the more likely they are to do the same for mine. We are all one large family working together with the common goal to stay independent, a rarity these days amongst the conglomerate of hospitals taking over.
Wait, did I mention that I have never run a business before? Well, let me tell the most important lesson I have learned ... some days it is really hard. I remember having to let go my first medical assistant after her 90-day review. All of my medical training never prepared me for a how hard that conversation was going to be, and she wasn’t even losing her leg. My wife, a trained physical therapist, jumped right in until we eventually got the gusto to hire another MA. Fortunately, we found a remarkable individual who is worth her weight in gold. The same holds true for our other employees and we aren’t about to let them leave so we pay them well, fund 80% of their health insurance premiums, established a 401K with matching funds, and profit share with each employee. We foster an environment that makes our employees want to work hard, although like my patients, sometimes I think they come to work just to see The Girls.
All in all, we treat our staff with respect and provide a significant monetary carrot to each of them at the holidays; this is unmatched in our area. Happy employees are instrumental to my work life and have a direct impact on the success of my practice. All boats rise with the rising tide, and we are sailing smoothly.
Despite all the challenges and hard work, nothing is better than being your own boss. Nothing. I don’t know a single physician whose desire was to trek through grueling medical school and years of residency and fellowship to ultimately become an employee of an overly glorified postgraduate degree holder in health care administration. I cannot recall having had a single conversation with any surgeon or physician who is 100% happy with his or her working situation who isn’t self-employed. Do I work now more than I ever thought I would? Absolutely. But the work I am doing isn’t simply waking up at all hours to operate or trudge through countless hours in a lab or clinic. No, the work I do is running a successful small business – and even better yet, it is great!
Here I am on a Saturday morning writing a guest editorial for publication in the official newspaper of the Society for Vascular Surgery and I am loving it. Life is short and I’m trying to enjoy every minute that I have on this planet by spending my time working in a manner that I find enjoyable.
Being the fancy plumber in rural America provides me that opportunity. I hope others realize that it is still possible to navigate health care’s oftentimes unknown waters as a solo private practitioner and be successful. That they too could be taking the bull by the horns and changing up their work-life balance for the betterment of themselves, the care they provide to patients, and their families.
And in the meantime, I’ll jump back in my car and head due north for a 45-minute decompressing drive, chat with family and friends, dictate the last case of the day, and continue to enjoy the best of both worlds living in the big city and working with the most genuine folks in rural America. You should try it.
Dr. Santin is a vascular surgeon in private practice at Ohio Vein & Vascular, Wilmington.
References
1. Medscape Malpractice Report 2015: Why Most Doctors Get Sued, by Carol Peckham, Dec. 9, 2015.
2. Decrease Your Risk of Being Successfully Sued, by Nancy Young, Crozer-Chester Medical Center.
3. To Be Sued Less, Doctors Should Consider Talking to Patients More, by Aaron E. Carroll, New York Times, June 1, 2015.
Within 3 minutes of the car engine rumbling to a roar in the morning air, cruise control is set, freshly ground coffee is in hand and NPR is playing on WOSU 90.5. I settle in for the morning news on my 45-minute commute to the hospital. Sure, I could’ve found a hospital closer to shorten my commute, especially since I live in the 14th largest metropolitan city in the country.
If I’d wanted, I could be knocking out carotid endarterectomies at a level 1 trauma center, three blocks away from my front door. But no, that’s not what does it for me. What does? It’s having the opportunity to be my own boss and care for salt-of-the-earth folks in rural America.
You see, 5 years ago when I finished my vascular surgery fellowship at Good Samaritan Hospital in Cincinnati, I opened my own solo private practice in a rural community: population 30,000. Yep, that’s right, you heard it. I hung a shingle and went old school. And now as I reflect over the lessons learned during the first half-decade of my practice at Ohio Vein & Vascular Inc., I can tell you it has been a hell of a ride, and boy have we learned a lot.
The better half of the ‘we’ is my wife, Crystal, who doubles as my practice administrator, with her own solid foundation coming from a doctorate in physical therapy. We have successfully built a small company with four full-time employees, one contract registered vascular technologist, and two therapy dogs who serve more than 3,500 patients to date.
From the first day I opened my doors to this small-town rural community, I realized that it’s not what you know, but rather who you know. Well frankly, I didn’t know a soul!
Fortunately, my front office manager was born, raised, and still lives in Wilmington and knows everyone’s mother, brother, sister, niece, and grandchild in what felt like a 60-mile radius. She gave this young, slick city kid from Columbus instant street cred despite all the fancy credentials behind my name. I ditched the tie and fancy shoes and embraced my new ‘work’ home with open arms.
In a community such as Wilmington, Ohio, it’s the little things that count. I wear my own scrubs on days when I operate. Not only do they have my practice logo embroidered on the chest pocket, but they are also adorned with the brown leather symbol for Carhart, a clothing brand. In rural America, Carhart denim clothing – overall bibs, jackets, gloves, etc., are considered king. When my patients see that symbol, there is an instant point of mutual appreciation and it almost always results in some good laughs – who knew Carhart made scrubs?
As a result, I’ve been offered opportunities to ride combines, go drag racing, and go hunting for the infamous morel mushrooms. Just to be clear, I haven’t found a morel yet, so I guess I will stick to my day job as a surgeon.
Having a good laugh and connecting with my patients was something I was not accustomed to in my training. I was there to operate, and rarely participated in office days. At times this routine left me feeling unappreciated by my patients and their families. I was just a surgeon delivering bad news. I now find myself fortunate to have the opportunity to get to know my patients and participate in their health care, and I know they appreciate me for it.
A recent malpractice survey cited a finding that the more patients ‘like’ their physicians, the less likely they are to file malpractice lawsuits against them.1 Other reports have suggested that the relationship a physician has with a patient is a critical factor, more so than any single medical mistake, in determining whether or not a lawsuit is filed.2,3
While I feel appreciated and ‘liked’ by my patients, I’ve learned that I am not necessarily their favorite employee in the office. This honor is most often bestowed upon Claire and Whitney, aka “The Girls” – our two, miniature Labradoodles who serve in the capacity of therapy dogs and have perfected the ability to nap in nearly any situation. Try as I may to convince patients that what I am saying is important, they never lose focus on The Girls. They are the first thing patients ask about, I swear they receive more gifts than I do, and they always are on the receiving end of some good ‘pets’ as my patients leave the office. Despite any bad news they may have been told, very rarely do patients leave my office without smiles on their faces. It keeps me humble, as I think most of my patients aren’t really here to see me; after all I am just a fancy plumber.
Speaking of plumbing, I could’ve sworn that the ginormous two-volume Rutherford edition always gave me the impression that vascular disease is composed of 75% venous disease and 25% arterial disease. However, our fellowship training in the United States makes Rutherford seem like he had his numbers flipped – 99.8% was arterial with a splash of venous as an afterthought. Truth be told though, I see roughly 55% venous, 25% dialysis, and 20% arterial. I guess that wasn’t made up after all.
If my practice name, Ohio Vein & Vascular, didn’t give it away, I admit that I focus marketing efforts toward venous pathology. This has significantly improved my work-life balance. Let’s face it, not everything we do as a surgeon is fun and can certainly carry a large amount of stress. I devote an honest amount of time to developing what ‘type’ of practice I desire. I communicate regularly with my referring docs about the types of disease I focus on, write press releases to the local paper, and always have my elevator speech handy when speaking with fellow physicians and potential patients about what I do as a surgical subspecialist.
In such a small community, the more my vascular surgery practice grows, the more likely the podiatrist and his wife (also a podiatrist) across the hall will grow their practice. Same holds true of the cardiologist upstairs and the nephrologist down the hall. It’s not rocket science that the more I help their businesses thrive, the more likely they are to do the same for mine. We are all one large family working together with the common goal to stay independent, a rarity these days amongst the conglomerate of hospitals taking over.
Wait, did I mention that I have never run a business before? Well, let me tell the most important lesson I have learned ... some days it is really hard. I remember having to let go my first medical assistant after her 90-day review. All of my medical training never prepared me for a how hard that conversation was going to be, and she wasn’t even losing her leg. My wife, a trained physical therapist, jumped right in until we eventually got the gusto to hire another MA. Fortunately, we found a remarkable individual who is worth her weight in gold. The same holds true for our other employees and we aren’t about to let them leave so we pay them well, fund 80% of their health insurance premiums, established a 401K with matching funds, and profit share with each employee. We foster an environment that makes our employees want to work hard, although like my patients, sometimes I think they come to work just to see The Girls.
All in all, we treat our staff with respect and provide a significant monetary carrot to each of them at the holidays; this is unmatched in our area. Happy employees are instrumental to my work life and have a direct impact on the success of my practice. All boats rise with the rising tide, and we are sailing smoothly.
Despite all the challenges and hard work, nothing is better than being your own boss. Nothing. I don’t know a single physician whose desire was to trek through grueling medical school and years of residency and fellowship to ultimately become an employee of an overly glorified postgraduate degree holder in health care administration. I cannot recall having had a single conversation with any surgeon or physician who is 100% happy with his or her working situation who isn’t self-employed. Do I work now more than I ever thought I would? Absolutely. But the work I am doing isn’t simply waking up at all hours to operate or trudge through countless hours in a lab or clinic. No, the work I do is running a successful small business – and even better yet, it is great!
Here I am on a Saturday morning writing a guest editorial for publication in the official newspaper of the Society for Vascular Surgery and I am loving it. Life is short and I’m trying to enjoy every minute that I have on this planet by spending my time working in a manner that I find enjoyable.
Being the fancy plumber in rural America provides me that opportunity. I hope others realize that it is still possible to navigate health care’s oftentimes unknown waters as a solo private practitioner and be successful. That they too could be taking the bull by the horns and changing up their work-life balance for the betterment of themselves, the care they provide to patients, and their families.
And in the meantime, I’ll jump back in my car and head due north for a 45-minute decompressing drive, chat with family and friends, dictate the last case of the day, and continue to enjoy the best of both worlds living in the big city and working with the most genuine folks in rural America. You should try it.
Dr. Santin is a vascular surgeon in private practice at Ohio Vein & Vascular, Wilmington.
References
1. Medscape Malpractice Report 2015: Why Most Doctors Get Sued, by Carol Peckham, Dec. 9, 2015.
2. Decrease Your Risk of Being Successfully Sued, by Nancy Young, Crozer-Chester Medical Center.
3. To Be Sued Less, Doctors Should Consider Talking to Patients More, by Aaron E. Carroll, New York Times, June 1, 2015.
Within 3 minutes of the car engine rumbling to a roar in the morning air, cruise control is set, freshly ground coffee is in hand and NPR is playing on WOSU 90.5. I settle in for the morning news on my 45-minute commute to the hospital. Sure, I could’ve found a hospital closer to shorten my commute, especially since I live in the 14th largest metropolitan city in the country.
If I’d wanted, I could be knocking out carotid endarterectomies at a level 1 trauma center, three blocks away from my front door. But no, that’s not what does it for me. What does? It’s having the opportunity to be my own boss and care for salt-of-the-earth folks in rural America.
You see, 5 years ago when I finished my vascular surgery fellowship at Good Samaritan Hospital in Cincinnati, I opened my own solo private practice in a rural community: population 30,000. Yep, that’s right, you heard it. I hung a shingle and went old school. And now as I reflect over the lessons learned during the first half-decade of my practice at Ohio Vein & Vascular Inc., I can tell you it has been a hell of a ride, and boy have we learned a lot.
The better half of the ‘we’ is my wife, Crystal, who doubles as my practice administrator, with her own solid foundation coming from a doctorate in physical therapy. We have successfully built a small company with four full-time employees, one contract registered vascular technologist, and two therapy dogs who serve more than 3,500 patients to date.
From the first day I opened my doors to this small-town rural community, I realized that it’s not what you know, but rather who you know. Well frankly, I didn’t know a soul!
Fortunately, my front office manager was born, raised, and still lives in Wilmington and knows everyone’s mother, brother, sister, niece, and grandchild in what felt like a 60-mile radius. She gave this young, slick city kid from Columbus instant street cred despite all the fancy credentials behind my name. I ditched the tie and fancy shoes and embraced my new ‘work’ home with open arms.
In a community such as Wilmington, Ohio, it’s the little things that count. I wear my own scrubs on days when I operate. Not only do they have my practice logo embroidered on the chest pocket, but they are also adorned with the brown leather symbol for Carhart, a clothing brand. In rural America, Carhart denim clothing – overall bibs, jackets, gloves, etc., are considered king. When my patients see that symbol, there is an instant point of mutual appreciation and it almost always results in some good laughs – who knew Carhart made scrubs?
As a result, I’ve been offered opportunities to ride combines, go drag racing, and go hunting for the infamous morel mushrooms. Just to be clear, I haven’t found a morel yet, so I guess I will stick to my day job as a surgeon.
Having a good laugh and connecting with my patients was something I was not accustomed to in my training. I was there to operate, and rarely participated in office days. At times this routine left me feeling unappreciated by my patients and their families. I was just a surgeon delivering bad news. I now find myself fortunate to have the opportunity to get to know my patients and participate in their health care, and I know they appreciate me for it.
A recent malpractice survey cited a finding that the more patients ‘like’ their physicians, the less likely they are to file malpractice lawsuits against them.1 Other reports have suggested that the relationship a physician has with a patient is a critical factor, more so than any single medical mistake, in determining whether or not a lawsuit is filed.2,3
While I feel appreciated and ‘liked’ by my patients, I’ve learned that I am not necessarily their favorite employee in the office. This honor is most often bestowed upon Claire and Whitney, aka “The Girls” – our two, miniature Labradoodles who serve in the capacity of therapy dogs and have perfected the ability to nap in nearly any situation. Try as I may to convince patients that what I am saying is important, they never lose focus on The Girls. They are the first thing patients ask about, I swear they receive more gifts than I do, and they always are on the receiving end of some good ‘pets’ as my patients leave the office. Despite any bad news they may have been told, very rarely do patients leave my office without smiles on their faces. It keeps me humble, as I think most of my patients aren’t really here to see me; after all I am just a fancy plumber.
Speaking of plumbing, I could’ve sworn that the ginormous two-volume Rutherford edition always gave me the impression that vascular disease is composed of 75% venous disease and 25% arterial disease. However, our fellowship training in the United States makes Rutherford seem like he had his numbers flipped – 99.8% was arterial with a splash of venous as an afterthought. Truth be told though, I see roughly 55% venous, 25% dialysis, and 20% arterial. I guess that wasn’t made up after all.
If my practice name, Ohio Vein & Vascular, didn’t give it away, I admit that I focus marketing efforts toward venous pathology. This has significantly improved my work-life balance. Let’s face it, not everything we do as a surgeon is fun and can certainly carry a large amount of stress. I devote an honest amount of time to developing what ‘type’ of practice I desire. I communicate regularly with my referring docs about the types of disease I focus on, write press releases to the local paper, and always have my elevator speech handy when speaking with fellow physicians and potential patients about what I do as a surgical subspecialist.
In such a small community, the more my vascular surgery practice grows, the more likely the podiatrist and his wife (also a podiatrist) across the hall will grow their practice. Same holds true of the cardiologist upstairs and the nephrologist down the hall. It’s not rocket science that the more I help their businesses thrive, the more likely they are to do the same for mine. We are all one large family working together with the common goal to stay independent, a rarity these days amongst the conglomerate of hospitals taking over.
Wait, did I mention that I have never run a business before? Well, let me tell the most important lesson I have learned ... some days it is really hard. I remember having to let go my first medical assistant after her 90-day review. All of my medical training never prepared me for a how hard that conversation was going to be, and she wasn’t even losing her leg. My wife, a trained physical therapist, jumped right in until we eventually got the gusto to hire another MA. Fortunately, we found a remarkable individual who is worth her weight in gold. The same holds true for our other employees and we aren’t about to let them leave so we pay them well, fund 80% of their health insurance premiums, established a 401K with matching funds, and profit share with each employee. We foster an environment that makes our employees want to work hard, although like my patients, sometimes I think they come to work just to see The Girls.
All in all, we treat our staff with respect and provide a significant monetary carrot to each of them at the holidays; this is unmatched in our area. Happy employees are instrumental to my work life and have a direct impact on the success of my practice. All boats rise with the rising tide, and we are sailing smoothly.
Despite all the challenges and hard work, nothing is better than being your own boss. Nothing. I don’t know a single physician whose desire was to trek through grueling medical school and years of residency and fellowship to ultimately become an employee of an overly glorified postgraduate degree holder in health care administration. I cannot recall having had a single conversation with any surgeon or physician who is 100% happy with his or her working situation who isn’t self-employed. Do I work now more than I ever thought I would? Absolutely. But the work I am doing isn’t simply waking up at all hours to operate or trudge through countless hours in a lab or clinic. No, the work I do is running a successful small business – and even better yet, it is great!
Here I am on a Saturday morning writing a guest editorial for publication in the official newspaper of the Society for Vascular Surgery and I am loving it. Life is short and I’m trying to enjoy every minute that I have on this planet by spending my time working in a manner that I find enjoyable.
Being the fancy plumber in rural America provides me that opportunity. I hope others realize that it is still possible to navigate health care’s oftentimes unknown waters as a solo private practitioner and be successful. That they too could be taking the bull by the horns and changing up their work-life balance for the betterment of themselves, the care they provide to patients, and their families.
And in the meantime, I’ll jump back in my car and head due north for a 45-minute decompressing drive, chat with family and friends, dictate the last case of the day, and continue to enjoy the best of both worlds living in the big city and working with the most genuine folks in rural America. You should try it.
Dr. Santin is a vascular surgeon in private practice at Ohio Vein & Vascular, Wilmington.
References
1. Medscape Malpractice Report 2015: Why Most Doctors Get Sued, by Carol Peckham, Dec. 9, 2015.
2. Decrease Your Risk of Being Successfully Sued, by Nancy Young, Crozer-Chester Medical Center.
3. To Be Sued Less, Doctors Should Consider Talking to Patients More, by Aaron E. Carroll, New York Times, June 1, 2015.
Don’t just work hard; work hard at living
NEW YORK – “A physician falls overboard on a large cruise ship and passengers gather at the guard rail. The first passenger at the guardrail shakes his finger down at the drowning physician and says, ‘You need to learn how to swim!’ Another passenger says, ‘No, man, throw him a life preserver.’ ... Finally, a passenger says, ‘We need better guard rails.’ ”
That’s the analogy Cynthia K. Shortell, MD used to kick off her presentation on physician burnout and the need for resilience at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.
“Which of these is right? Well, of course, the answer is they all are,” said Dr. Shortell, who is a professor of surgery at Duke University Durham, N.C. But certainly, only the life preserver answer was appropriate at that time for the drowning physician, she added.
Continuing the analogy, Dr. Shortell pointed out that surely there is a man overboard, with 1 in 20 surgeons reporting suicidal ideation. That rate jumps threefold if the surgeon has had a recent medical error. In addition, vascular surgeons in particular are within the top tier of specialties at risk for burnout.
“We do need better guardrails,” she said, and described the need to actively engage with the health care system to help solve these issues, including those involving electronic medical records and operating room inefficiency and use. In addition, there is a great need for additional services that are provided to other high-end professionals, including food, concierge service, gym access, and other services that help with tasks of daily life when physicians need to spend most of their time at the hospital.
But, in the end, Dr. Shortell said, “We do need to learn to swim. Ultimately, we do need to take a role in having responsibility to solve this problem on our own. We need to change the way we think about our work, and the way we think about our health, and the way our culture values working hard instead of working hard at living.”
Dr. Shortell also highlighted the need to deal with musculoskeletal issues arising from the way that surgeons operate. This, along with good leadership, are key factors in preventing and remediating burnout.
Dr. Shortell had no disclosures relevant to her talk.
NEW YORK – “A physician falls overboard on a large cruise ship and passengers gather at the guard rail. The first passenger at the guardrail shakes his finger down at the drowning physician and says, ‘You need to learn how to swim!’ Another passenger says, ‘No, man, throw him a life preserver.’ ... Finally, a passenger says, ‘We need better guard rails.’ ”
That’s the analogy Cynthia K. Shortell, MD used to kick off her presentation on physician burnout and the need for resilience at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.
“Which of these is right? Well, of course, the answer is they all are,” said Dr. Shortell, who is a professor of surgery at Duke University Durham, N.C. But certainly, only the life preserver answer was appropriate at that time for the drowning physician, she added.
Continuing the analogy, Dr. Shortell pointed out that surely there is a man overboard, with 1 in 20 surgeons reporting suicidal ideation. That rate jumps threefold if the surgeon has had a recent medical error. In addition, vascular surgeons in particular are within the top tier of specialties at risk for burnout.
“We do need better guardrails,” she said, and described the need to actively engage with the health care system to help solve these issues, including those involving electronic medical records and operating room inefficiency and use. In addition, there is a great need for additional services that are provided to other high-end professionals, including food, concierge service, gym access, and other services that help with tasks of daily life when physicians need to spend most of their time at the hospital.
But, in the end, Dr. Shortell said, “We do need to learn to swim. Ultimately, we do need to take a role in having responsibility to solve this problem on our own. We need to change the way we think about our work, and the way we think about our health, and the way our culture values working hard instead of working hard at living.”
Dr. Shortell also highlighted the need to deal with musculoskeletal issues arising from the way that surgeons operate. This, along with good leadership, are key factors in preventing and remediating burnout.
Dr. Shortell had no disclosures relevant to her talk.
NEW YORK – “A physician falls overboard on a large cruise ship and passengers gather at the guard rail. The first passenger at the guardrail shakes his finger down at the drowning physician and says, ‘You need to learn how to swim!’ Another passenger says, ‘No, man, throw him a life preserver.’ ... Finally, a passenger says, ‘We need better guard rails.’ ”
That’s the analogy Cynthia K. Shortell, MD used to kick off her presentation on physician burnout and the need for resilience at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.
“Which of these is right? Well, of course, the answer is they all are,” said Dr. Shortell, who is a professor of surgery at Duke University Durham, N.C. But certainly, only the life preserver answer was appropriate at that time for the drowning physician, she added.
Continuing the analogy, Dr. Shortell pointed out that surely there is a man overboard, with 1 in 20 surgeons reporting suicidal ideation. That rate jumps threefold if the surgeon has had a recent medical error. In addition, vascular surgeons in particular are within the top tier of specialties at risk for burnout.
“We do need better guardrails,” she said, and described the need to actively engage with the health care system to help solve these issues, including those involving electronic medical records and operating room inefficiency and use. In addition, there is a great need for additional services that are provided to other high-end professionals, including food, concierge service, gym access, and other services that help with tasks of daily life when physicians need to spend most of their time at the hospital.
But, in the end, Dr. Shortell said, “We do need to learn to swim. Ultimately, we do need to take a role in having responsibility to solve this problem on our own. We need to change the way we think about our work, and the way we think about our health, and the way our culture values working hard instead of working hard at living.”
Dr. Shortell also highlighted the need to deal with musculoskeletal issues arising from the way that surgeons operate. This, along with good leadership, are key factors in preventing and remediating burnout.
Dr. Shortell had no disclosures relevant to her talk.
REPORTING FROM THE VEITHSYMPOSIUM
Burnout may jeopardize patient care
because of depersonalization of care, according to recent research published in JAMA Internal Medicine.
“The primary conclusion of this review is that physician burnout might jeopardize patient care,” Maria Panagioti, PhD, from the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre at the University of Manchester (United Kingdom) and her colleagues wrote in their study. “Physician wellness and quality of patient care are critical [as are] complementary dimensions of health care organization efficiency.”
Dr. Panagioti and her colleagues performed a search of the MEDLINE, EMBASE, CINAHL, and PsycInfo databases and found 47 eligible studies on the topics of physician burnout and patient care, which altogether included data from a pooled cohort of 42,473 physicians. The physicians were median 38 years old, with 44.7% of studies looking at physicians in residency or early career (up to 5 years post residency) and 55.3% of studies examining experienced physicians. The meta-analysis also evaluated physicians in a hospital setting (63.8%), primary care (13.8%), and across various different health care settings (8.5%).
The researchers found physicians with burnout were significantly associated with higher rates of patient safety issues (odds ratio, 1.96; 95% confidence interval, 1.59-2.40), reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68), and lower quality of care (OR, 2.31; 95% CI, 1.87-2.85). System-reported instances of patient safety issues and low professionalism were not statistically significant, but the subgroup differences did reach statistical significance (Cohen Q, 8.14; P = .007). Among residents and physicians in their early career, there was a greater association between burnout and low professionalism (OR, 3.39; 95% CI, 2.38-4.40), compared with physicians in the middle or later in their career (OR, 1.73; 95% CI, 1.46-2.01; Cohen Q, 7.27; P = .003).
“Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed,” Dr. Panagioti and her colleagues wrote in the study. “Interventions aimed at improving the culture of health care organizations, as well as interventions focused on individual physicians but supported and funded by health care organizations, are beneficial.”
Researchers noted the study quality was low to moderate. Variation in outcomes across studies, heterogeneity among studies, potential selection bias by excluding gray literature, and the inability to establish causal links from findings because of the cross-sectional nature of the studies analyzed were potential limitations in the study, they reported.
The study was funded by the United Kingdom NIHR School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre. The authors report no relevant conflicts of interest.
SOURCE: Panagioti M et al. JAMA Intern Med. 2018 Sept 4. doi: 10.1001/jamainternmed.2018.3713.
Because of a lack of funding for research into burnout and the immediate need for change based on the effect it has on patient care seen in Pangioti et al., the question of how to address physician burnout should be answered with quality improvement programs aimed at making immediate changes in health care settings, Mark Linzer, MD, wrote in a related editorial.
“Resonating with these concepts, I propose that, for the burnout prevention and wellness field, we encourage quality improvement projects of high standards: multiple sites, concurrent control groups, longitudinal design, and blinding when feasible, with assessment of outcomes and costs,” he wrote. “These studies can point us toward what we will evaluate in larger trials and allow a place for the rapidly developing information base to be viewed and thus become part of the developing science of work conditions, burnout reduction, and the anticipated result on quality and safety.”
There are research questions that have yet to be answered on this topic, he added, such as to what extent do factors like workflow redesign, use and upkeep of electronic medical records, and chaotic workplaces affect burnout. Further, regulatory environments may play a role, and it is still not known whether reducing burnout among physicians will also reduce burnout among staff. Future studies should also look at how burnout affects trainees and female physicians, he suggested.
“The link between burnout and adverse patient outcomes is stronger, thanks to the work of Panagioti and colleagues,” Dr. Linzer said. “With close to half of U.S. physicians experiencing symptoms of burnout, more work is needed to understand how to reduce it and what we can expect from doing so.”
Dr. Linzer is from the Hennepin Healthcare Systems in Minneapolis. These comments summarize his editorial regarding the findings of Pangioti et al. He reported support for Wellness Champion training by the American College of Physicians and the Association of Chiefs and Leaders in General Internal Medicine and that he has received support for American Medical Association research projects.
Because of a lack of funding for research into burnout and the immediate need for change based on the effect it has on patient care seen in Pangioti et al., the question of how to address physician burnout should be answered with quality improvement programs aimed at making immediate changes in health care settings, Mark Linzer, MD, wrote in a related editorial.
“Resonating with these concepts, I propose that, for the burnout prevention and wellness field, we encourage quality improvement projects of high standards: multiple sites, concurrent control groups, longitudinal design, and blinding when feasible, with assessment of outcomes and costs,” he wrote. “These studies can point us toward what we will evaluate in larger trials and allow a place for the rapidly developing information base to be viewed and thus become part of the developing science of work conditions, burnout reduction, and the anticipated result on quality and safety.”
There are research questions that have yet to be answered on this topic, he added, such as to what extent do factors like workflow redesign, use and upkeep of electronic medical records, and chaotic workplaces affect burnout. Further, regulatory environments may play a role, and it is still not known whether reducing burnout among physicians will also reduce burnout among staff. Future studies should also look at how burnout affects trainees and female physicians, he suggested.
“The link between burnout and adverse patient outcomes is stronger, thanks to the work of Panagioti and colleagues,” Dr. Linzer said. “With close to half of U.S. physicians experiencing symptoms of burnout, more work is needed to understand how to reduce it and what we can expect from doing so.”
Dr. Linzer is from the Hennepin Healthcare Systems in Minneapolis. These comments summarize his editorial regarding the findings of Pangioti et al. He reported support for Wellness Champion training by the American College of Physicians and the Association of Chiefs and Leaders in General Internal Medicine and that he has received support for American Medical Association research projects.
Because of a lack of funding for research into burnout and the immediate need for change based on the effect it has on patient care seen in Pangioti et al., the question of how to address physician burnout should be answered with quality improvement programs aimed at making immediate changes in health care settings, Mark Linzer, MD, wrote in a related editorial.
“Resonating with these concepts, I propose that, for the burnout prevention and wellness field, we encourage quality improvement projects of high standards: multiple sites, concurrent control groups, longitudinal design, and blinding when feasible, with assessment of outcomes and costs,” he wrote. “These studies can point us toward what we will evaluate in larger trials and allow a place for the rapidly developing information base to be viewed and thus become part of the developing science of work conditions, burnout reduction, and the anticipated result on quality and safety.”
There are research questions that have yet to be answered on this topic, he added, such as to what extent do factors like workflow redesign, use and upkeep of electronic medical records, and chaotic workplaces affect burnout. Further, regulatory environments may play a role, and it is still not known whether reducing burnout among physicians will also reduce burnout among staff. Future studies should also look at how burnout affects trainees and female physicians, he suggested.
“The link between burnout and adverse patient outcomes is stronger, thanks to the work of Panagioti and colleagues,” Dr. Linzer said. “With close to half of U.S. physicians experiencing symptoms of burnout, more work is needed to understand how to reduce it and what we can expect from doing so.”
Dr. Linzer is from the Hennepin Healthcare Systems in Minneapolis. These comments summarize his editorial regarding the findings of Pangioti et al. He reported support for Wellness Champion training by the American College of Physicians and the Association of Chiefs and Leaders in General Internal Medicine and that he has received support for American Medical Association research projects.
because of depersonalization of care, according to recent research published in JAMA Internal Medicine.
“The primary conclusion of this review is that physician burnout might jeopardize patient care,” Maria Panagioti, PhD, from the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre at the University of Manchester (United Kingdom) and her colleagues wrote in their study. “Physician wellness and quality of patient care are critical [as are] complementary dimensions of health care organization efficiency.”
Dr. Panagioti and her colleagues performed a search of the MEDLINE, EMBASE, CINAHL, and PsycInfo databases and found 47 eligible studies on the topics of physician burnout and patient care, which altogether included data from a pooled cohort of 42,473 physicians. The physicians were median 38 years old, with 44.7% of studies looking at physicians in residency or early career (up to 5 years post residency) and 55.3% of studies examining experienced physicians. The meta-analysis also evaluated physicians in a hospital setting (63.8%), primary care (13.8%), and across various different health care settings (8.5%).
The researchers found physicians with burnout were significantly associated with higher rates of patient safety issues (odds ratio, 1.96; 95% confidence interval, 1.59-2.40), reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68), and lower quality of care (OR, 2.31; 95% CI, 1.87-2.85). System-reported instances of patient safety issues and low professionalism were not statistically significant, but the subgroup differences did reach statistical significance (Cohen Q, 8.14; P = .007). Among residents and physicians in their early career, there was a greater association between burnout and low professionalism (OR, 3.39; 95% CI, 2.38-4.40), compared with physicians in the middle or later in their career (OR, 1.73; 95% CI, 1.46-2.01; Cohen Q, 7.27; P = .003).
“Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed,” Dr. Panagioti and her colleagues wrote in the study. “Interventions aimed at improving the culture of health care organizations, as well as interventions focused on individual physicians but supported and funded by health care organizations, are beneficial.”
Researchers noted the study quality was low to moderate. Variation in outcomes across studies, heterogeneity among studies, potential selection bias by excluding gray literature, and the inability to establish causal links from findings because of the cross-sectional nature of the studies analyzed were potential limitations in the study, they reported.
The study was funded by the United Kingdom NIHR School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre. The authors report no relevant conflicts of interest.
SOURCE: Panagioti M et al. JAMA Intern Med. 2018 Sept 4. doi: 10.1001/jamainternmed.2018.3713.
because of depersonalization of care, according to recent research published in JAMA Internal Medicine.
“The primary conclusion of this review is that physician burnout might jeopardize patient care,” Maria Panagioti, PhD, from the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre at the University of Manchester (United Kingdom) and her colleagues wrote in their study. “Physician wellness and quality of patient care are critical [as are] complementary dimensions of health care organization efficiency.”
Dr. Panagioti and her colleagues performed a search of the MEDLINE, EMBASE, CINAHL, and PsycInfo databases and found 47 eligible studies on the topics of physician burnout and patient care, which altogether included data from a pooled cohort of 42,473 physicians. The physicians were median 38 years old, with 44.7% of studies looking at physicians in residency or early career (up to 5 years post residency) and 55.3% of studies examining experienced physicians. The meta-analysis also evaluated physicians in a hospital setting (63.8%), primary care (13.8%), and across various different health care settings (8.5%).
The researchers found physicians with burnout were significantly associated with higher rates of patient safety issues (odds ratio, 1.96; 95% confidence interval, 1.59-2.40), reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68), and lower quality of care (OR, 2.31; 95% CI, 1.87-2.85). System-reported instances of patient safety issues and low professionalism were not statistically significant, but the subgroup differences did reach statistical significance (Cohen Q, 8.14; P = .007). Among residents and physicians in their early career, there was a greater association between burnout and low professionalism (OR, 3.39; 95% CI, 2.38-4.40), compared with physicians in the middle or later in their career (OR, 1.73; 95% CI, 1.46-2.01; Cohen Q, 7.27; P = .003).
“Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed,” Dr. Panagioti and her colleagues wrote in the study. “Interventions aimed at improving the culture of health care organizations, as well as interventions focused on individual physicians but supported and funded by health care organizations, are beneficial.”
Researchers noted the study quality was low to moderate. Variation in outcomes across studies, heterogeneity among studies, potential selection bias by excluding gray literature, and the inability to establish causal links from findings because of the cross-sectional nature of the studies analyzed were potential limitations in the study, they reported.
The study was funded by the United Kingdom NIHR School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre. The authors report no relevant conflicts of interest.
SOURCE: Panagioti M et al. JAMA Intern Med. 2018 Sept 4. doi: 10.1001/jamainternmed.2018.3713.
FROM JAMA INTERNAL MEDICINE
Key clinical point: Burnout among physicians was associated with lower quality of care because of unprofessionalism, reduced patient satisfaction, and an increased risk of patient safety issues.
Major finding: Physicians with burnout were significantly associated with higher rates of patient safety issues (odds ratio, 1.96; 95% confidence interval, 1.59-2.40), reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68), and lower quality of care (OR, 2.31; 95% CI, 1.87-2.85).
Study details: A systematic review and meta-analysis of 42,473 physicians from 47 different studies.
Disclosures: The study was funded by the United Kingdom National Institute of Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre. The authors reported no relevant conflicts of interest.
Source: Panagioti M et al. JAMA Intern Med. 2018 Sept 4. doi: 10.1001/jamainternmed.2018.3713.
New Survey on Burnout Coming to Members
Society for Vascular Surgery members are receiving an important email from the Mayo Clinic containing a survey from the SVS Wellness Task Force.
It is the second survey the task force has distributed, all aimed at ascertaining burnout and wellness statistics from SVS members.
“We need evidence,” said Malachi Sheahan, MD, who co-chairs the group with Dawn Coleman, MD. “We can’t make change without evidence.”
He issued a “Societal Call to Action” to SVS members at the end of a Friday session addressing burnout issues, “Promoting Physician Well-Being: Achieving Quadruple Aim.”
Dr. Sheahan disclosed statistics from the first task force survey, completed by 860 members. Collectively, members worked an average 73.5 hours a week, with five hours completing electronic medical records and 5.5 hours of administrative/scholarly activities added to 63 hours in the office.
“Eighty-nine percent feel burned out on occasion, everyone thinks they’re working too hard and when there are conflicts between work and personal life, they’re resolved in favor of the personal side only 8 percent of the time,” he said of the just-released data. He believes EMR will be the No. 1 conflict of vascular surgeons, with surgeons reporting they spend one hour charting for every one hour of patient time. “It’s just not working out,” he said.
Twenty percent said they had been sued for malpractice within the past two years, 37 percent reported being depressed within the month prior to completing the survey and the 8 percent who reported suicide ideation within the past year is double the national rate, Dr. Sheahan said. The second survey, launched Monday, focuses more on physical debility and should take fewer than 10 minutes to complete, he said. “Look for the survey, and please take it.”
He added that there are initiatives going forward that aim to change the environment and change the culture, including the SVS task force and the American Board of Surgery’s new lifelong learning initiative. “This is a call to action,” he said. “The main thing I want to say is that this is changeable. I don’t want you to think or say that we can’t do it. “We can. We just need evidence.”
Society for Vascular Surgery members are receiving an important email from the Mayo Clinic containing a survey from the SVS Wellness Task Force.
It is the second survey the task force has distributed, all aimed at ascertaining burnout and wellness statistics from SVS members.
“We need evidence,” said Malachi Sheahan, MD, who co-chairs the group with Dawn Coleman, MD. “We can’t make change without evidence.”
He issued a “Societal Call to Action” to SVS members at the end of a Friday session addressing burnout issues, “Promoting Physician Well-Being: Achieving Quadruple Aim.”
Dr. Sheahan disclosed statistics from the first task force survey, completed by 860 members. Collectively, members worked an average 73.5 hours a week, with five hours completing electronic medical records and 5.5 hours of administrative/scholarly activities added to 63 hours in the office.
“Eighty-nine percent feel burned out on occasion, everyone thinks they’re working too hard and when there are conflicts between work and personal life, they’re resolved in favor of the personal side only 8 percent of the time,” he said of the just-released data. He believes EMR will be the No. 1 conflict of vascular surgeons, with surgeons reporting they spend one hour charting for every one hour of patient time. “It’s just not working out,” he said.
Twenty percent said they had been sued for malpractice within the past two years, 37 percent reported being depressed within the month prior to completing the survey and the 8 percent who reported suicide ideation within the past year is double the national rate, Dr. Sheahan said. The second survey, launched Monday, focuses more on physical debility and should take fewer than 10 minutes to complete, he said. “Look for the survey, and please take it.”
He added that there are initiatives going forward that aim to change the environment and change the culture, including the SVS task force and the American Board of Surgery’s new lifelong learning initiative. “This is a call to action,” he said. “The main thing I want to say is that this is changeable. I don’t want you to think or say that we can’t do it. “We can. We just need evidence.”
Society for Vascular Surgery members are receiving an important email from the Mayo Clinic containing a survey from the SVS Wellness Task Force.
It is the second survey the task force has distributed, all aimed at ascertaining burnout and wellness statistics from SVS members.
“We need evidence,” said Malachi Sheahan, MD, who co-chairs the group with Dawn Coleman, MD. “We can’t make change without evidence.”
He issued a “Societal Call to Action” to SVS members at the end of a Friday session addressing burnout issues, “Promoting Physician Well-Being: Achieving Quadruple Aim.”
Dr. Sheahan disclosed statistics from the first task force survey, completed by 860 members. Collectively, members worked an average 73.5 hours a week, with five hours completing electronic medical records and 5.5 hours of administrative/scholarly activities added to 63 hours in the office.
“Eighty-nine percent feel burned out on occasion, everyone thinks they’re working too hard and when there are conflicts between work and personal life, they’re resolved in favor of the personal side only 8 percent of the time,” he said of the just-released data. He believes EMR will be the No. 1 conflict of vascular surgeons, with surgeons reporting they spend one hour charting for every one hour of patient time. “It’s just not working out,” he said.
Twenty percent said they had been sued for malpractice within the past two years, 37 percent reported being depressed within the month prior to completing the survey and the 8 percent who reported suicide ideation within the past year is double the national rate, Dr. Sheahan said. The second survey, launched Monday, focuses more on physical debility and should take fewer than 10 minutes to complete, he said. “Look for the survey, and please take it.”
He added that there are initiatives going forward that aim to change the environment and change the culture, including the SVS task force and the American Board of Surgery’s new lifelong learning initiative. “This is a call to action,” he said. “The main thing I want to say is that this is changeable. I don’t want you to think or say that we can’t do it. “We can. We just need evidence.”