December 6, 2022, 3:54 p.m. Jay Lee, M.D., M.P.H. — It’s easy to feel sometimes that that we can’t change the system in which we work. But we have more power than we realize. I’ve seen that power unlocked during my medical career, and I see even more potential in some AAFP programs meant to improve all of our journeys, regardless of where we are on the path.
Consider physician well-being. When I graduated from medical school 20 years ago, there was little conversation about the concept. I began residency with no work-hour restrictions and routinely worked 80 to 100 hours (or more) per week during my intern year.
I was thrilled to be a physician and learned a lot caring for my patients during those early post-graduate years. But I was chronically exhausted and wasn’t learning to care for myself. I was forgoing my own wellness in order to continue caring for others. The mindset at the time was, “This is how we’ve always done it.”
In the middle of my second year, an 80-hour work week was implemented for residents nationwide. This change was driven by a generation of medical students and residents concerned about patient safety and, more proximally, physician health and well-being: Chronically sleep-deprived physicians don’t always make the best decisions even if they are well-trained and wicked smart.
Then, as a family medicine resident, I was fortunate to have Sue Melvin, D.O., as my program director. She led a faculty group that embodied a culture of caring.
I felt seen.
I felt acknowledged.
I felt heard.
I felt supported.
I felt respected.
Most important, I felt like I belonged.
That experience set a high bar as I sought employment beyond my training.
No wonder Long Beach Memorial Family Medicine Residency has continued to attract top-notch medical students in the Match. It’s not just because it’s the only program in the California with the word “Beach” in its name. There, I knew I could become the physician I wrote about in my personal statement.
Meanwhile, two things fundamentally changed as we moved from paper workflows to the electronic world. Things got sped up, and existing workflow errors got amplified. In the worst cases, workflow errors got sped up and amplified. Hello, administrative burden.
I trained in the era before electronic health records, so I vividly recall going to an actual in-box once a day to handle my administrative tasks: prescription refills, referrals, disability forms, etc. Several years after graduating from residency, I returned to join the faculty and lived through the transition from paper charts to EHR. One day, I ordered an albuterol nebulizer treatment for my wheezing patient by politely asking my nurse to administer it. The next day when the EHR went live, I needed more time and effort to achieve the same treatment for a different patient as my nurse politely reminded me to click buttons so the treatment could be administered.
As changes continue to occur in health care, sometimes rapidly and often adding administrative complexity, we must respond by tapping into those hidden powers I mentioned. The AAFP can help.
The Academy offers several programs at varying points in our career journey to build the skills we need. I have been privileged to serve as faculty for the Leading Physician Well-being program for the past couple of years. We just completed training for cohort 2 and now have more than 200 family physicians armed with the leadership, well-being and practice improvement tools to transform the health care system. Well-being improvement projects have been focused on a range of issues, including collecting baseline burnout data, forming well-being committees and redesigning workflows to reduce administrative burden.
Meanwhile, the Academy has launched programs and resources for medical student and resident members with support from a Health Resources and Services Administration grant. The Family Medicine Interest Group Well-being Champion program is being led by my LPW faculty colleague Catherine Pipas, M.D., M.P.H. The champions are building a program focused on medical student needs, including workshops on topics related to finances, resiliency, relationships, substance use prevention, burnout prevention and suicide prevention. The champions will present their own workshops, which include didactic presentations, hands-on activities and toolkits, to FMIGs and other student organizations on their campuses this fall. In the spring, they will trade topics and train to deliver workshops developed by their fellow champions.
Applications are open for the program’s second cohort of champions through Dec. 31.
For family medicine residents, the AAFP is providing new video coaching resources related to wellness and self-care, joy in practice and suicide prevention.
The Academy also is accepting applications from residency programs through Dec. 15 for a Project Extension for Community Healthcare Outcomes, or Project ECHO, which aims to increase morale and support residents’ well-being through a structured program led by experts. Participants in the online program will earn CME, support their peers and work through dozens of topics related to well-being.
The Academy also has made Talk Saves Lives available to student and resident members. The six part online course, developed by the American Foundation for Suicide Prevention, helps participants recognize suicide risk factors and warning signs; teaches participants how to seek help for themselves and to support others and explains how to access crisis resources and services.
I wish programs like these had been available when I was a medical student and resident. The current generation of medical students and residents will benefit greatly (as the LPW scholars who’ve been through that program have). Most importantly, we can all begin to recognize how broken the system is and learn how to “physicianeer” a better future no matter where we are in our career path. It’s never too early (or late) to begin to heal ourselves and make health primary.
Jay Lee, M.D., M.P.H., is a member of the AAFP Board of Directors.