The Importance of Community in Physician Health and Wellness
By B. R. Hartle
When Dr. Elizabeth Rhynold sat down to log in to her first meeting with her local Physician Health and Wellness hub, she felt apprehensive. A colleague had recommended her as a candidate to join this new Doctors Manitoba initiative. She agreed but thought of it as yet another request on her dwindling time. It was October 2020. As a geriatrician, she was increasingly overwhelmed by the pandemic’s first wave.
She had a sense of what physician health and wellness meant, but it did not go much beyond taking holidays, eating well, and exercise. In total honesty, the idea of sitting around talking about her own well-being felt indulgent, especially with so much uncertainty, strain, and sadness in the long-term care teams with whom she works.
“How could I take the time to work on my own burnout when there are so many people worse off than I am?” Dr. Rhynold said, speaking from her home in Virden where she lives with her family. “I also felt the need to keep to myself the ways I was feeling overwhelmed. I didn’t want anyone to worry about me.”
Then something happened.
The meeting started, the discussion got going, and she began to understand that she had a lot in common with the experiences of other physicians in her hub. She wondered how many others around her were exhausted and burnt-out, yet not wanting to admit it.
Other physicians in her hub had a similar experience.
Dr. Beverley Lee-Chen, a family doctor in Brandon and the Physician Champion for the Prairie Mountain hub, recalled coming back from a few missed days of work due to an illness and meeting with one of her patients. The patient mentioned they tried to book time to see her, but she was not available.
“Anytime a patient tells me that, it gives me such a feeling of guilt, as those comments often imply we were away by choice, to ‘have a holiday’ and weren’t there for our patients.”
To that patient, she replied, “No, I was sick and had to take some time to get better.”
The patient was surprised, saying, “What? You can get sick too? I didn’t know doctors could get sick.”
It took Dr. Lee-Chen a moment to see in this patient’s face a genuine reaction of true surprise, not a joke.
“I recall thinking, this view of us has got to change. We need to make it easier for us to not feel guilty for being sick ourselves.”
Communities of practice
Recent research into physician health suggests Dr. Lee-Chen and Dr. Rhynold are pointing to a big problem. According to a 2021 survey by Doctors Manitoba, more than a third of physicians and over half of residents screened positive for depression, with rates of burnout even higher. According to more local data, over half of physicians from the Community of Practice regions feel impacted by isolation and a lack of social support, with more than 80% stating more physician health and wellness resources are needed.
Doctors Manitoba has set out to help fix this problem.
Supported by Scotiabank, the Canadian Medical Association (CMA), and MD Financial, $1 million in funding over three years was provided to Doctors Manitoba to create the Physician Health and Wellness Communities of Practice pilot project — the latest in Doctors Manitoba’s efforts to improve physician well-being.
Community is what sets this project apart. Participants are not expected to have all of the answers. Rather, it’s a dialogue, informed by lived experience and data, data such as: for every clinical hour a physician spends with patients, two additional hours are spent on administrative tasks and data entry; each additional hour increases the odds of burnout from 3%-9%; physicians who spend less than 20% of their effort on the activity that is most meaningful to them are nearly three times more likely to be burned out.
Using “communities of practice” to address wellness is also unique. While the program model itself isn’t new, Doctors Manitoba is using it in a novel way. Typically, a community of practice refers to a group of people brought together around a common concern to learn from one another’s experiences and expertise. Doctors Manitoba adapted this model to also include the development and implementation of practical recommendations to improve physician health at both organizational and system levels.
Partnering with three regional health authorities — Prairie Mountain Health, Northern Health, and the Interlake-Eastern Regional Health Authority — each region created their own community of practice hub. The hubs include a diverse range of local physicians, health system leaders and community members.
At the heart of these hubs is a Physician Champion, designated with taking the group’s work and championing it with their region. In Prairie Mountain, the Physician Champion is Dr. Lee-Chen. In Interlake-Eastern, it is Dr. Michael Loudon, a family doctor and medical director of the Teulon Medical Clinic. Dr. Chukwuma Abara is the Physician Champion in the Northern Hub, where he is the Medical Director for Primary Care Clinics in Thompson, Gillam, Lynn Lake and Leaf Rapids.
The three hubs began meeting in 2020, with all meetings needing to be virtual due to the pandemic. Doctors Manitoba staff lead the discussions. Digital engagement tools are often used to help the groups brainstorm, reflect, and prioritize recommendations.
Dr. Elham Fattah, who practices in Thompson and is part of the Northern hub, was eager to contribute to this work. “Not only for the sake of physicians,” she said. “I strongly believe that if we improve the quality of life of physicians, we will improve patient care. That’s the ultimate goal for the health care system and for physicians, to improve the care of patients.”
The CMA recently released findings that add urgency to Dr. Fattah’s motivations. The CMA found that burnout is causing nearly half of Canadian physicians to consider reducing their clinical work in the next 24 months, a rate that would have significant implications for health care across Canada.
In addition, poor physician wellness is known to lead to a wide range of negative outcomes, including lower patient satisfaction and treatment adherence, increased risk of medical errors, early retirements and departures from practice, and general incivility in the workplace.
To be sure, there are many factors that compound physician burnout that are outside of the scope of the community of practice hubs. Health system restructuring, the pandemic, evolving patient complexities and expectations, technology implementation, and more, all play a role.
Still, there are opportunities for meaningful change. By focusing on the experiences of physicians and practical ways to improve wellness, the hope is these hubs can lead to sustainable improvements in the lives of physicians, patients, and the overall efficiency of health care in Manitoba.
The first goal was to make sure these hubs lived up to their namesake and that the people involved actually developed into a community. To achieve this, participants needed to feel comfortable opening up with one another.
Dr. Harsahil Singh, who was the initial Physician Champion in the Northern Hub before taking over as Chief Medical Officer with the NRHA, was attuned to the need to build community.
“We wanted to be able to come up with ideas together, to trust one another, and feel like we could be open about our lives and things that happened,” he said from his home in Thompson. “It can be very personal when you share stories about physician health and wellness. Some moments brought tears to peoples’ eyes, but I think those moments also made us much stronger.”
The experience in Prairie Mountain was similar. Participants in that group did not know each other well, or at all, before joining. When people began to speak about their experiences, the sense of community happened organically. Dr. Rhynold found it especially motivating to hear from physicians working in different settings than her own. “It was amazing how many themes we could all relate to even though we work in completely different settings. There was a lot of common ground.”
One key resource the hubs used to help focus their thinking was the Stanford Model of Professional Fulfillment. This model highlights three interrelated categories to help understand physician wellness, specifically: a culture of wellness, efficiency of practice, and personal resilience. A fulsome understanding of physician wellness must take these three dimensions into account.
For some participants, this model helped to ease the pressure they felt. Dr. Lee-Chen noted that a doctor can do an hour of yoga to feel better, “but if we’re just coming back to a job with the same frustrations, the same paperwork and administrative bureaucracy, that’s going to bring us back down again. But if those other things are improved, and we’ve done our yoga, then that’s a more sustainable way to improve the situation.”
For others, the Stanford Model helped to organize their thoughts around problems and possible solutions, changing how they viewed day-to-day activities. For instance, Dr. Rhynold recently participated in a regional quality improvement exercise with Prairie Mountain Health, where she was asked to prioritize a series of proposed initiatives. Because of her experience with these hubs, she recognized that she was also participating in a wellness intervention and used it as an opportunity to advocate for physician health.
“It took me some time to realize that physician health and wellness is more than just resources for personal resiliency,” she said, and credits the sense of community that was developed amongst her hub in helping her open up to these ideas. “There’s a lot of background information I had to be taught first, along with relationship building and knowing enough about each other that we could be vulnerable about how things are going.”
Now, each hub will take the ideas discussed over the past two years and distill them into evidence-informed actions that can be implemented within each region.
There is a wide range of ideas physicians would like to see. A physician’s day could be made more efficient by reducing multiple sign-ons to EMR. Retention of physicians in rural and Northern areas could be improved by helping physicians and their families better integrate into the broader community. Leadership development could be improved with more mentoring and stronger networks of communication. Better work distribution within regions could help physicians focus more on the work that is meaningful to them personally. More opportunities for physicians to connect with each other can increase collaboration and decrease isolation.
The challenge is how to apply the research and theory into practice. As Dr. Singh put it, “the solutions are only good if they are actionable.”
The hubs will gather their recommendations, determine the effort to implement each proposal along with its expected impact, then rank them.
Funding for the pilot project wraps up this year. Doctors Manitoba will compile findings and recommendations in a final report. The belief is these hubs have the potential to pay for themselves, with evidence of cost savings to the system, reduced medical errors, stronger recruitment and retention, to name just a few expected benefits. Securing the resources to make this work part of Doctors Manitoba’s ongoing operations would enable additional hubs throughout the province and help for the regions in sustaining this work.
For many of the physicians who participated in this pilot project, there is no alternative. To them, this work is now essential to the future of our healthcare system.
“We want to keep this work going,” Dr. Singh said. “You have to treat this as a priority in the same way surgical backlogs are a priority. Waitlists will go up if physicians and staff reduce their hours. A lot has changed over the last two years. 2022 is not 2019. If you expect people to work at the same capacity as 2019, which was already a broken healthcare system, you’re setting the system up to crumble. These cracks have widened over the pandemic. If we think people will spring back to normal, it will all crumble down.”