• Physician Well-being Leader Driven to Help Peers

    April 26, 2024, David Mitchell — Lauren Brown-Berchtold, M.D., FAAFP, is the program director of San Joaquin General Hospital’s Family Medicine residency as well as its advanced obstetrics fellowship. Although she’s passionate about teaching and maternal health, the issue that truly drives her is physician well-being.

    “We need to take care of the people who take care of our patients, our communities and our nation,” she said.

    Brown-Berchtold will have a busy month spreading that important message. As faculty for the AAFP’s Physician Well-being Conference, May 6-8 in Scottsdale, Ariz., she will present four different sessions on topics related to grief, resident well-being, stigma and mental health, and underrepresented groups in medicine. She also will be one of the speakers for a free webinar on physician well-being on May 22, which she said will explore how an individual’s personal stories can be used to help them move toward a state of well-being.

    “We grow up in what can be a really toxic and incredibly difficult training culture,” Brown-Berchtold said. “This is how medicine was designed to be: Lock down your feelings about what you see and hear and the impact it has on your life. Then, when the poison of not being able to express your emotions freely is too much, well, then we’re also going to judge you for having a hard time or being anxious or feeling sad about something you never processed 10 years ago.”

    Brown-Berchtold wants to help her peers because she has experienced similar situations. She was a fourth-year medical student in the midst of residency interviews when her mom died in a car accident.

    “My world fell apart,” she said. “A lot of really well-meaning people said things like ‘She would have wanted you to keep going and keep chasing what you’ve been working at for so long.’ So, I went through the Match instead of delaying. Intern year is arguably the hardest year of residency training, and I never had time to really put things back together.”

    By her second year, Brown-Berchtold was, in her own words, “a disaster.” She went to her program coordinator and acknowledged her concerns for herself and her patients. She took three months of leave and crammed 60 hours of therapy into one month during an intensive outpatient program.

    She was advised to report to her state’s physician health program, which is intended to help physicians dealing with issues such as addiction and depression. Brown-Berchtold did report and indicated she was suffering from depression, post-traumatic stress disorder and complicated grief.

    Brown-Berchtold was stunned when the PHP directed her to report to a facility in Austin, Texas — roughly 200 miles away from her residency program — for drug testing. She objected because substance abuse was not one of her diagnoses. She obtained a waiver to avoid drug testing but had to sign a contract with several stipulations, including that she be monitored for five years. Failure to comply with the terms would have meant risking the loss of her medical license.

    “That cost me thousands of dollars over the course of the next several years,” she said, “and I had no way out. You rapidly realize that, of course, people don’t admit they’re struggling. Why would you when you’re entered into something that makes you feel like you’re a criminal? You have no recourse to say, ‘Wait, I’m better now.’ We know that we have a huge burnout epidemic. We know physicians are killing themselves at rates higher than the general population, and yet if we ask for help, we’re punished.”

    In the decade since Brown-Berchtold’s struggles during residency, she has seen some positive changes in health care, including the removal of intrusive questions about mental health from many licensure and credentialing applications as well as reform of many state PHPs.

    “If I am currently impaired, someone needs to know that,” she said. “But the board doesn’t have a right to know that I had a therapist because, honestly, all humans should have a therapist.”

    Brown-Berchtold has been chair of her hospital’s physician well-being committee since 2020 and completed the six-week Stanford Physician Well-being Director Course in 2021. That same year, she participated in the first cohort of the AAFP’s Leading Physician Well-being program, a 10-month certificate course designed to help family doctors develop the leadership skills needed to spearhead change in their practices or health care organizations. 

    “When the AAFP came out with LPW, I was like, ‘Oh, these are my people,’” she said. “This is the longitudinal type of program I’m looking for, where it’s so long and so involved that you can really get quite in depth with the mentorship that that you’re getting from your faculty. I saw that, and I jumped on it immediately.”

    Brown-Berchtold left her native California after her mother’s death because she felt the need to get away. She came home in 2018 to practice 30 minutes from where she grew up, in the hospital where her husband was born.

    “It’s been incredible to come back home and serve my community,” she said.

    Brown-Berchtold picked a career in academic medicine, she said, because she viewed it as a way to broaden her influence.

    “If I am working on my own in a community, I am impacting a certain number of lives,” said Brown-Berchtold, who became program director last summer after four years as core faculty and a year as assistant director. “But if I’m working in a place where I’m graduating eight residents a year, any impact that I might be able to have on the community is magnified over the course of years.”

    Brown-Berchtold hopes she’s training doctors who will be not only clinically excellent but also prepared for the challenges the field presents.

    “As I graduate residents who I’ve had some part in teaching and making better doctors, I want them to be someone who’s not going to get five years out and say, ‘I’m burned out. I don’t know how to ask for help, and the only solution I see is to exit my career entirely,’” she said. “We know physician burnout leads to attrition from medicine. If we don’t treat burnout, we just keep losing more doctors, and we’re already in the middle of a primary care shortage. That’s the core of what keeps me in academics. I love teaching. I love helping people find purpose.”