Yu, of the California Academy of Family Physicians and national director of clinical and community partnerships at Aledade Inc., and Feist, president and co-founder of the Dr. Lorna Breen Heroes’ Foundation, offered family medicine leaders at the 2023 AAFP Leadership Conference steps physicians can take on both of those tracks to improve well-being.
Yu’s strategy for developing action plans is built on addressing the “joy stealers” that sap the satisfaction of family medicine, as well as finding what you need to thrive.
She saw how crucial that last element is in 2022, when in just a few weeks she contracted COVID-19 shortly before she was supposed to speak at that year’s Leadership Conference; learned that her family’s family physician, John Cheng, M.D., died trying to protect others from a gunman in a church; and had a heart attack
“All of us have these stories of how we’ve had to try and survive, and thrive, through the pandemic,” she said during the interactive session she led.
Yu asked attendees to think about the one thing they need in their practices to thrive, and to illustrate the idea with an ikigai diagram, using a Japanese concept of a reason for being or sense of purpose. In the session, it resembled a Venn diagram with four overlapping areas: mission, passion, vocation and profession.
Turning to joy stealers, the hours taken up by prior authorization and metrics take center stage, but issues like practice layout can also be a significant concern. Yu said FPs at one practice she visited were able to spend more time with patients by simply putting a printer in each treatment room rather than depending on a single printer at the front desk. The change increased productivity by an average of 25 minutes per person per day.
“Find those areas that drive you crazy, and try to fix the little things, because it’s the little things, that death by a thousand cuts, that make your day go not as well as you may have wanted,” Yu said.
Yu suggested other steps to boost well-being:
Feist also experienced the need for advancement on physician well-being at a personal level.
A little over three years ago, at the height of the first wave of the pandemic, he was serving as chief executive officer of the UVA Physicians Group when he and his wife received a call from his sister-in-law Lorna Breen, M.D., an emergency medicine physician and director of the emergency room at Allen Hospital in New York City.
Breen was nearly catatonic; after contracting COVID-19 and recovering, she returned to the hospital and resumed working 12- to 15-hour shifts. She had not slept in more than a week, and told Feist and his wife that she couldn’t get out of her chair.
Breen was admitted to a hospital for treatment, but she worried that receiving mental health care could cause her to lose her license. Feist would come to learn that many state medical licensing boards require physicians to disclose their personal mental health histories in ways that may not comply with the Americans With Disabilities Act.
Breen died by suicide on April 26, 2020.
Feist and his wife quickly took action to try to prevent such a tragedy from happening again. In June 2020, they formed the Dr. Lorna Breen Heroes’ Foundation to work on reducing physician burnout, improving well-being, and ensuring that when a physician seeks mental health treatment, it is viewed as a sign of strength, not weakness.
“We’ve tried to focus on rebalancing the scales toward systems change as well as individual support,” Feist explained. “We really need to flip it, because the market has been flooded by trying to ask you to be more resilient and solve the problems. We need to flip the scales. That is our primary focus.”
Through the efforts of the foundation and a coalition of more than 70 organizations, and with bipartisan support in Congress, on March 18, 2022, President Joe Biden signed into law the Dr. Lorna Breen Health Care Provider Protection Act to reduce and prevent suicide, burnout and other mental and behavioral health conditions.
The movement has since seen a surgeon general’s advisory on health care worker burnout; a National Academy of Medicine well-being advisory; and a suicide prevention resource from the American Hospital Association.
The foundation has also been instrumental at the state level with advocacy that has led several states to revise their licensure applications to remove or modify intrusive language about an applicant’s behavioral or mental health.
“Whether you’re talking about systems change or individual support or removing barriers to access, you will see that there are states that are taking up this legislation,” Feist said while encouraging attendees to get more involved.
“Many members of state congresses who are physicians are excellent advocates for this because they get it, and it sails right through, so if you are interested in learning more about the policy work that can support all of this, let me know,” he continued. “We believe that by taking this approach, we are addressing as comprehensively as we can the issues around your well-being.”
The Academy has made physician well-being a centerpiece of many recent and ongoing projects, including