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57% of women in medicine report experiencing burnout—compared to 47% of men. Anisha Singh, MD, a regional chief medical officer with ChenMed, joins to discuss this burnout gender gap and share how ChenMed has improved well-being for all its clinicians. AMA Chief Experience Officer Todd Unger hosts.
- Dr. Lorna Breen Heroes’ Foundation aims to reduce burnout of health care professionals and safeguard their well-being.
- Call or text 9-8-8 if you or anyone you know needs help. The National Suicide Prevention Lifeline (Formerly @800273TALK) is now: 988 Suicide and Crisis Lifeline. It provides free 24/7 confidential support for people in distress, crisis resources for you or your loved ones, and best practices for professionals in the U.S.
- Learn more about the AMA Recovery Plan for America’s Physicians.
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- Anisha Singh, MD, regional chief medical officer, ChenMed
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're taking a closer look at the gender gap in physician burnout according to the AMA's latest report on physician well-being. With me to discuss the findings and how one health system is bridging that gender gap is Dr. Anisha Singh, a regional chief medical officer with ChenMed in Cincinnati. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Singh, thanks so much for joining us.
Dr. Singh: It's great to be here.
Unger: The AMA's Organizational Biopsy assessment tool surveyed 13,000 clinicians across 30 states on the topic of well-being. 40% of men reported experiencing burnout compared to 57% of women. As a woman physician in a leadership position, we'd like to know your initial reaction to that gap.
Dr. Singh: Yep. I have heard of it. I also know that women physicians are 400% more higher death by suicide compared to women in any other profession. So I'm not surprised to hear about it. Recently, in Columbus, I went to attend an exhibition, which was about the physician's death by suicide. And that was very telling about this issue.
Unger: Now, were you work, only 44% of women reported experiencing burnout. ChenMed takes numerous steps to support well-being. And one of those steps is reserving time on physicians' schedules for care coordination. Can you tell us a little bit more about that?
Dr. Singh: Yes. So we know that the physicians have multiple tasks to do during the day. We have not only the patients that are coming in, but their phone messages, their emails. Some of the patients need a phone call. With all that in mind, we definitely need time, especially in a full-risk model, where we are trying to make sure that we are preventing ER and hospital visits, that we are available for our patients.
And for that matter, we need the time where we can reach out to the patient, attend to messages in an urgent fashion and not be sitting on it for two days. One delay in a phone message for a medication refill, for example, could lead to high blood pressure and a patient going into the ER. And the higher the number of ER visits and hospital admits, the worse the outcomes for the patient. Every hospital visit leads to deterioration in the health of the patient.
Unger: And another critical step in supporting well-being is, of course, listening to feedback about problems and solutions, especially from those that are most at risk of burnout. At ChenMed, women have significant representation in your wellness committee. And I'm curious, does that have an impact on your well-being efforts?
Dr. Singh: Yes. Yes. Of course. I'm part of, actually, the wellness committee. I'm part of the committee called The Best Destination for PCP's. And we are trying to do our level best to build a culture of well-being. So that's the foundation. And I find that very different from some of the hospitals and systems here.
Recently, I attended another meeting here for where all the hospitals in Cincinnati are talking about well-being. And it seems like the amount of time, energy and resources that we are putting in ChenMed, a lot of hospital well-being officers are struggling to get that kind of support. Here our chief medical officer all the way up are really engaged in it. We do PCP town halls. In fact, my next Cleveland PCP—because I'm the regional—for the Ohio regional chief medical officer. So we have centers in Cincinnati, Columbus, and Cleveland.
So this Wednesday, we have the PCP town hall in Cleveland where we gather all the physicians along with the human resources person on site, and we talk about the pain points, the challenges and then what actionable steps need to be taken before the next PCP town hall as far as patient daily flow, the doctor's daily flow. How can we improve that because the majority of the burnout comes from what we find at least in our situation, and also I know in the hospital settings, is the daily flow.
How is it going in the day? Doctors know. We are healers. We know what we need to do. But what comes in the way is, how is the staff supporting us? So as we do these town halls, we get to hear. And yes. PCP well-being and retention is a focus in ChenMed for all of us.
Unger: Interesting. Speaking of the root causes here, and you talked about workflow or daily flow, and I know that the research from the AMA focuses on things like system level issues, where the majority of those factors reside. So one of the interesting things in terms of the well-being report and the gap that we're seeing on the gender side is something a little bit different. And it said that 52% of men felt they were valued by the organization and only 44% of women felt that way. What do you think are some of the major causes of this kind of gap?
Dr. Singh: Yes. Good question. So there was a time when I had my own private practice. It was actually many years ago. It was a holistic weight care practice for women. And I had tons of women physicians that were my patients. And the constant theme was, of course, the sadness, the depression, the dissatisfaction at work was contributing to their weight.
But why was it there? It was there because women physicians are by nature—women in general are the vessel. They are the compassionate being that they are bringing more empathy. They're spending extra time with the patient. They're going above and beyond. The patient satisfaction may be well. But in terms of numbers or measurement of the metrics, though they are bringing in the revenue, but the volume just needs to be—in a fee for service model, the volume needs to be much higher. And sometimes women physicians feel like what they are bringing in, what their patients are acknowledging them for, the leadership is not acknowledging. They just want to look at the bottom line. That's one reason.
And the number two reason is really the time that the women need sometimes in their reproductive phase of life or because they may be caretakers, that they need some time where while they're meeting all the needs and yet being able to have that support when they're going through a challenging time or family time. And that is also I still find it in fee for service model just difficult for the leadership to meet that need.
So at the end of the day, the business of medicine then takes over. So women physicians then do not feel as valued as men. But I do find that very different in ChenMed. I think the answer for a lot of us is a full-risk model where what is valued is the outcome and not per patient what's happening in the day. And in the outcome model, I have found that women physicians, in fact, women nurse practitioners do very well too because now you're moving from this medicine of the mind to medicine of the heart.
Suddenly, the art of medicine comes into play. And I think, myself, I started as a physician and started as a PCP, went on to be the lead PCP, the senior medical director, the regional medical director and now the regional chief medical officer. And what I've been rewarded for is my outcomes, which are tied to my capacity to heal.
Unger: So very interesting. Kind of a mismatch between values and the business model is kind of what you're pointing out there. And also interesting, just as we look at other ways that ChenMed might be different here, you mentioned leadership. ChenMed has many women physician leaders like yourself. In terms of that kind of value, that feeling valued, recognized, what kind of impact do you think that's had on your organization?
Dr. Singh: So I think we are gender neutral in that sense. I think I do not find any difference between a male and a female physician in ChenMed. We are rewarded, acknowledged for what we bring to the table. And I think if I look at the nine we have in Ohio, we have five with female center medical directors. So that speaks a lot to the kind of opportunities we are getting.
The opportunities are actually gender neutral, race neutral, religion neutral, nationality neutral. It's all about bringing that authentic self and the hard work and dedication to the practice of medicine. It is not a run of the mill 9 to 5 job where you just come. I think sometimes doctors—the burnout is also coming from losing the purpose. And in here, we find the purpose. And as we find the purpose, man or woman is going to step up. And whoever steps up and whoever takes the ownership is rewarded based on just their abilities and their willingness and the culture that they bring.
Unger: Well, clearly all the work that you're doing to listen to your care teams, address their concerns, and of course, recognize their efforts have had a lot of impact. These days, most organizations have some kind of well-being effort in place and yet we continue to see these high levels of burnout and the gender gap that is persisting. What's one thing that might be holding back other organizations' well-being efforts?
Dr. Singh: I think having more voice of the physicians on the table, bringing more physician leadership. So here we work as dyads. So if you look at the other organizations, including hospital systems, a lot of the leadership is still non clinicians. And they are directing the physicians who may be in a leadership position, but may not have that strong a voice.
A lot of the well-being officers, actually, in some of the hospital systems that I'm noticing are actually not physicians themselves. They're trying to understand the problem of the physicians. But I think we need to bring this dyad that we have here, where each center is run by a senior medical director and a center director. And then me as a region, I'm run by—it's me, regional chief medical officer and the regional vice president.
So equal 50/50 partnership. A lot of these organizations are still operation heavy. They are looking at the top in their offices and looking at the numbers on a computer. And then they're trying to figure this out. And before you know it, they have lost culture. The conversation of well-being becomes sidelined very quickly whereas if you keep the physicians in equal partnership, I will not let that physician well-being take a second place at any point. While profit and loss is certainly what my monkey is, and yet it cannot come at the cost of physician well-being. In fact, the more I invest in physician well-being, the better the outcomes.
I started as a center medical director. I've shown it as a center medical director. And then I showed it in Cincinnati as a regional medical director. And now that's what I'm enjoying, trying to do the same thing for all of Ohio.
Unger: Wow. That is just terrific perspective. Dr. Singh, thanks so much for joining us today. Reducing burnout, of course, is one of the key objectives of AMA's Recovery Plan for America's Physicians. You can learn more about our efforts, including the organizational biopsy that Dr. Singh mentioned, at ama-assn.org/recovery. Thanks so much for joining us. We'll be back soon with another AMA Update. You can find all our videos and podcasts at ama-assn.org/podcasts. Thanks again. Take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.