Attending physicians do more than guide residents and fellows in the art of practicing medicine. They are also teaching them how to bring even more meaning to their work, and how to prioritize their own well-being for their benefit, and also for the good of their families, friends and patients—even their employers.
“We’re ingraining in our trainees what they're going to do for their entire careers, and as we all know, we as a profession are not good at taking care of ourselves,” said Ryan Pong, MD, a neuroanesthesiologist and vice president and chief academic officer at Virginia Mason Franciscan Health. “Our residents and our medical students are listening, and they are coming to us more primed than ever to be in tune with what they need to be successful, to have a long-lasting career without burnout.”
Virginia Mason Franciscan Health (VMFH), based in the Pacific Northwest, is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
VMFH has 15 physician-training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) across all of its sites, and aiding more than 225 residents and fellows in those programs with their well-being has been a focus of VMFH’s burnout-prevention efforts.
As with all physicians, resident burnout rates have fallen from some of the stratospheric heights seen in recent years. But work remains to be done, with a recently released national survey showing about half of residents and fellows reporting symptoms of burnout.
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
Going beyond the minimum
Before the ACGME limited residents’ workweeks to 80 hours in 2003, Dr. Pong said physicians in training would often put in 110 or 120 hours of work a week. The issue clearly needed to be tackled, but for VMFH, the basics of complying with shorter resident duty hours aren’t enough to sustain resident well-being.
“Limiting it to 80 hours is a good starting place, but that's not the only thing that we ought to be doing,” Dr. Pong said. “Well-being also focuses on: What's the meaning in your work? Is the meaning aligned with what you are here to do as a physician?”
VMFH also seeks to eliminate what the AMA has called “the pebble in the shoe”—the everyday annoyances that make it harder for physicians to practice medicine—deploying strategies from the Toyota Production System management philosophy that seeks to eliminate waste. This is where the globally-recognized Virginia Mason Production System was born.
“There is efficiency in practice, there is efficiency in the work that we're doing, and that makes for more meaningful days filled with satisfaction of being able to have more face-to-face time with our patients,” Dr. Pong said.
Coming from a place of trust
Well-being—or lack thereof—can permeate workplaces, which include physician residency programs. When it comes to organizational culture, Dr. Pong said it’s crucial to create an environment of trust, one where residents aren’t afraid to ask questions or admit there’s something they don’t know.
“Virginia Mason Franciscan Health is a very collegial place to work, and you never really feel alone,” he said. Residents “know that they can always go to their faculty or anybody and ask for help because it's a natural environment of learning that we have here.”
It’s more than seeking to have their own questions answered, though. Residents also need to feel comfortable speaking out. Dr. Pong recounted one memorable experience in which a thoracic surgeon, just before beginning an incision, asked the residents which of them would have stopped him if he had been about to remove the wrong lung. He wanted them to feel empowered to question even an experienced supervising physician.
It's about “creating that environment where a learner, anybody in the team can say: Hey, wait a minute. This doesn't make sense,” Dr. Pong said. “That psychological safety is so, so important.”
What attending physicians should remember
There aren’t just one-way well-being benefits, though, to the relationships between learners and leaders. Dr. Pong said the very act of teaching residents can help attending physicians find meaning in their own work.
“There's just really something inherently amazing about seeing the light go on in someone's eyes, and knowing that what you're telling them in this moment is not just going to affect this patient, but it's going to affect every single patient that this person, this student, this resident in front of you, is going to take care of for the rest of their careers,” he said. “And you've inspired that.”
Explore this topic further with the AMA STEPS Forward® toolkit, “Resident and Fellow Well-Being: Optimize Well-Being at Work for Physician Learners.”
