Q&A With Clif Knight, M.D.

Physician Well-being: Building on a Strong Foundation

January 02, 2019 09:34 am Michael Devitt

The AAFP has for years recognized that the complexities of our health care system, especially the difficulties posed by documentation and other administrative burdens, greatly increase stress on family physicians and have increased the rate of physician burnout. The Academy is dedicated to influencing improvements in the system while at the same time focusing on supporting family physicians in the stressful environments they encounter.

[mind body spirit soul you sticky notes]

Enter Physician Health First, an AAFP initiative created to help FPs address burnout and find ways to improve their well-being. Formally launched during the 2017 Family Medicine Experience in San Antonio, the first step in rolling out the initiative was to introduce members to an online portal designed, according to Clif Knight, M.D., the AAFP's senior vice president for education, to "inspire, energize and motivate" family physicians to assess their well-being, as well as to provide them the resources they need to address their risk of burnout.

Among those resources is a Well-being Planner the AAFP unveiled last year that allows members to set well-being goals, track and measure their progress, and create a personalized list of helpful resources. Also last year, the AAFP held its first-ever Family Physician Health and Well-being Conference in Naples, Fla., with initial evaluation results indicating that the conference was exactly what many AAFP members had been looking for.

With so much going on in the physician well-being arena, it can be difficult to keep track of what the Academy has already achieved and what it has in store for 2019. To help with that, AAFP News spoke at length with Knight on the topic. Here's a recap of that discussion.

Q: What are some of the physician well-being resources that our members may not be aware of, but that they should know about?

A: Our Physician Health First portal is a great place for our members to start. The particular resources I'd recommend there are the Maslach Burnout Inventory (MBI) and the Well-being Planner, and there are multiple links to other resources you can access from the portal.

Two resources that I routinely recommend outside the Academy include the Clinician Well-Being Knowledge Hub(nam.edu) created by the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience.(nam.edu) I serve as co-chair of the work group that developed the knowledge hub, which offers articles, research briefs and other materials -- including more than 100 AAFP resources -- that FPs can explore. The other is a set of resources available through the AMA called STEPS Forward(www.stepsforward.org) that have a lot of practice improvement strategies.

Q: The AAFP held its first physician well-being conference this past April in Florida. What kind of feedback did you get from attendees?

A: The reaction was uniformly positive. Ninety-eight percent of those who completed the evaluation of the conference rated it as excellent or above average, with 71 percent calling it excellent. The other 2 percent rated it as average. Those numbers are relatively unheard of.

We also asked attendees if they would plan to attend a conference like this on a yearly basis, and 50 percent said this was a conference they would plan to go to every year. In terms of verbal comments that I heard, many of the attendees said they plan to bring colleagues to next year's program. The attendees want other physicians to hear and learn the same things they heard.

Another thing people appreciated was the fact that they spent time with other FPs struggling with the same issues. They really appreciated the sort of shared experiences that the other attendees had and talked about. It made them feel like they weren't alone in experiencing this.

Our conference was deliberately focused on family physicians and very focused on providing practical solutions. I think that many of the other events that I've seen have, for lack of a better term, been a bit more academic rather than teaching the practical skills. Our conference really was designed so that people could go back home with a personalized plan of what they were going to do to address not only personal habits but also improvements in their practice to put a higher priority on well-being.

Q: What can you tell us about the 2019 well-being conference in Phoenix coming up in June?

A: The 2018 conference had three tracks: personal skills, practice improvement and organizational improvement. That will be the same format for 2019.

The conference chair for 2018, Mark Greenawald, M.D., will also be the conference chair for 2019, and we'll have a mix of returning faculty and new faculty.

And there has already been some work on planning a conference for 2020, as well. We plan on continuing to have this conference annually.

Q: What else does the Academy have on tap?

A: We will continue to add resources to the portal. One of the things in the works is an additional evaluation tool. We currently have the MBI, and we are moving toward also having a well-being assessment tool. We want to emphasize professional satisfaction and well-being, so rather than measuring burnout and trying to decrease a negative, we want to increase a positive.

Clif Knight, M.D.

We're working on a performance improvement module. Our plan is that it will be eligible for CME credit and that family physicians also can use it to get continuing certification credit to meet American Board of Family Medicine requirements. We plan to get that done in 2019.

In 2018, we launched the Transformation in Practice Series, or TIPS. As a module in the TIPS series, we released a resource on team documentation in October. It's directly addressing an important factor related to physician well-being in that it is designed to give you back time currently spent documenting patient encounters. We think that's a really important resource, and it's free to members.

Another new thing that we'll do is make available to our chapters a CME activity on improving physician well-being. We'll have a panel of speakers called the Physician Health First panel. We are training those speakers now. We've had nine chapters that have signed up to host presentations in the first six months of 2019, so we'll be taking that show on the road very soon.

We'll continue our partnership with the National Academy of Medicine on the Action Collaborative. We just wrapped up the second year of a four-year commitment that we have with them. 2019 will be a big year, because the National Academy of Medicine will release a consensus study that will raise public awareness and catalyze policy work to address systemic causes of burnout for clinicians. After the consensus study is released, we'll see how things go from there.

We're going to continue to look for more opportunities to add physician well-being courses and modules at all of our conferences and meetings. We get feedback from a lot of our FPs at other meetings about this.

Q: Overall, what is the Academy doing well in this area, and where do you see opportunities to improve?

A: I think that the Academy is doing great acknowledging the concerns about this issue and committing resources to addressing it. I think we're also effectively raising our members awareness' of the AAFP's resources. In a 2017 survey, 24 percent of members valued AAFP resources on physician well-being. In 2018, that increased to 43 percent. So, with respect to those parameters, things are going well.

I think we still have much work to do. Improving the health care system around administrative burden, regulatory issues, reporting requirements, electronic health records -- all of those are "system" things that the AAFP has committed to addressing, but the system is going be hard to change. It's going to take a long time.

You also have to consider the physician culture, which values self-sacrifice at the expense of self-care. That's another aspect of health care that's going to take a long time to address, but I think the Academy, with the National Academy of Medicine -- by addressing these issues at conferences, we're making a good effort. But again, to see how we can influence that culture or how much we can influence that culture, that's yet to be determined.

One of the ways we measure this broadly is that we ask our members, "If you had to do it again, would you choose to be a family physician?" Our baseline for that question was in 2017, when 55 percent of respondents said they would. In 2018, it increased to 57 percent. We still have a long way to go. Our ultimate goal is to make the practice of family medicine more enjoyable, more satisfying and more sustaining for those who've made it their career.

Q: Anything else you'd like to add?

A: I think that we continue to learn about what family physicians are troubled by. We need to continue to examine the root-cause problems in this. Something we really need to tackle that I think is harder to define is the moral distress family physicians feel from choosing a profession -- medicine -- that at its core is focused on patient and community values, but the health care system is so financially entrenched and continues moving more toward corporate and financial values.

The moral dilemma that I think a lot of family physicians feel is, "This isn't what I signed up to do." Physicians feel that the community values and the patient-centered values that are so important to what they do are being overshadowed by corporate and financial values. I'm not sure how we fix that, other than standing up and saying that when we make choices, we have to invest in patients, we have to invest in our community, we have to invest in addressing social determinants of health, and we have to invest in providing the right care at the right time, even if it's not consistent with the business model of corporate health care.

Related AAFP News Coverage
Physician Well-being a Focal Point for Academy in 2018
(1/2/2018)

Focus on Physician Well-being