Dartmouth FP Puts Physician Health First

“We don’t have the capacity as a nation to withstand the loss of any more health professionals to suicide, to COVID or to attrition. We must find ways to allow health professionals to succeed in their work and to be well,” said Catherine Pipas, M.D., M.P.H., professor of Community and Family Medicine and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth in Hanover, N.H.

Pipas, who practiced at Dartmouth for 25 years, gave up clinical care in 2019 to focus on education, research and consulting related to physician well-being. She will be a mainstage speaker during the AAFP’s Residency Leadership Summit, March 3-5 in Kansas City, Mo., addressing the prioritization of well-being in family medicine training programs. Registration is open now.

“There are so many important topics in medicine,” Pipas said, “but there is none more important than this because if we don’t have a healthy workforce, we’re not going to have a healthy population.”

Pipas said she lost peers to suicide during medical school, residency training and in practice. In the aftermath of a suicide, schools, programs and health systems often make mental health counselors available. Although such resources are necessary, she said that tactic isn’t sufficient.

“We need to look at the underlying factors contributing to lack of well-being and to burnout, and prevent those, rather than waiting until tragedy occurs and try to comfort people,” said Pipas, who was an assistant program director early in her career. “We need to focus on solutions, and program directors are key leaders in fostering well-being for the future generation of family physicians.”

Pipas’ mainstage presentation will highlight national data and recommendations on advancing well-being efforts at the organization level, as well as providing examples of successful initiatives. She will guide attendees through a SWOT analysis to help identify their organizations’ strengths and weaknesses as well as opportunities and threats.

“I hope to inspire participants to think locally and challenge them to consider what they can do differently,” she said. “What next step are you going to take along this journey to promote not only personal well-being, but a culture of well-being in your program?”

Pipas also will present a subsequent workshop at the summit to help attendees prioritizate their own well-being.

“Walking the walk is one of the key aspects of successful well-being initiatives,” said Pipas, who emphasizes that leaders should give their teams and themselves permission to focus on their own well-being. “At the core of our work is the concept  that my own well-being is critical to my effectiveness as a clinician, educator, researcher, parent, spouse and member of my community. In addition, we need supportive environments in order to thrive. If my well-being is limited, so is my effectiveness in caring for others.”

Pipas said that far too often, physicians take on too much.

“I’ve seen too many people in my career who have said, ‘I’ve given so much there’s nothing left to give,’” she said. “That saddens me as a member of our profession. I’ve had that same experience. I’ve been in a place where I’ve had too many roles and responsibilities and was unwilling to use the word ‘no.’”

Pipas has taken on numerous local, state and national leadership roles during her career, including serving on the boards of the New Hampshire Board of Medicine, New Hampshire Academy of Science, New Hampshire AFP and the Society of Teachers of Family Medicine. She has served as a wellness consultant for about two dozen schools and organizations in recent years, published roughly 50 peer-reviewed articles and given more than 150 presentations as an invited lecturer.

“I have been part of that culture where physicians do as much as we can, feel like we’re not doing enough and continue to attempt to be superhuman,” she said. “Then we have impostor syndrome because superhuman is not possible. There have been times when I’ve looked in the mirror and asked, ‘Why am I not eating well? Why am I not exercising? Why am I not doing the things that fill my own tank, which then allow me care for others?”

Pipas said she’s still learning to say “no.” She recommends self-screening when pondering additional obligations.

“I mentor health professionals to assess their purposeful use of time,” she said. “Using a time log, I instruct them to record what they’ve done in the last 24/7 and ask, ‘Did those activities replenish you or deplete you? Is this something you are good at? Is this consistent with your top priorities? Is this something you chose to do consistent with your values and your wellbeing?’ I’ve learned that I can do anything, but I can’t do everything.”

Such introspection led Pipas to focus on well-being, not only locally but nationally. A Dartmouth colleague suggested the stories she was using in her well-being courses would make a good book. The result was “A Doctor’s Dozen: Twelve Strategies for Personal Health and a Culture of Wellness.” Each chapter of the 2018 book offers patient stories, lessons learned and actionable strategies.

Since 2020, she has been co-chair of the AAFP’s Leading Physician Well-being program, a tuition-free certificate program designed to help family physicians develop the leadership skills needed to spearhead change among clinicians in their practices and organizations. Last year she added the role of chair for the AAFP’s Physician Health First initiative, which offers tools and resources related to physician well-being. And this year she added the role of chair of the AAFP’s Well-being Educators Program.

The new educator program evolved from Leading-Physician Well-being. Eight scholars who completed LPW and implemented changes in their own organizations will be trained to educate their peers on topics related to well-being. Participants will attend monthly webinars as well as an in-person train-the-trainer retreat that coincides with the Residency Leadership Summit. Participants will design and implement content for Physician Health First and the 2024 Physician Health & Well-being Conference.

“It’s a small pilot group,” she said, “and we hope to expand it next year.”

Pipas is also mentoring medical students participating in the AAFP’s Family Medicine Interest Group Well-being Champions Program, which trains students to educate their peers on related topics.

“I’m optimistic because I’ve seen individual and system-wide results,” she said. “This Pandora’s box has been opened, and people are communicating challenges and solutions. When we allow ourselves to be authentic (not superhuman), set boundaries and design new processes and policies, we make real progress in changing our culture. Champions at all levels — from medical students, to program directors, to family medicine leaders — are talking the talk and walking the walk. We have momentum, and our forward movement will improve the health of medical professionals, our patients and our society.”