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Among the physician specialities with the highest rate of burnout, pediatrics ranks #4. Texas Children’s is working to change that. Joining to discuss the health system’s well-being efforts are Dan Gollins, president of Texas Children’s Pediatrics and Urgent Care, and Sapna Singh, MD, director of physician engagement and wellness at Texas Children's Pediatrics. AMA Chief Experience Officer Todd Unger hosts.
- Learn more about the AMA Recovery Plan for America’s Physicians and advocacy efforts to reduce physician burnout.
- Find out more on physician burnout by specialty.
- Register for the 2024 Joy in Medicine™ Health System Recognition Program informational webinar.
- Learn more about the AMA Health System Program.
- Dan Gollins, president, Texas Children’s Pediatrics and Urgent Care
- Sapna Singh, MD, director of physician engagement and wellness, Texas Children's Pediatrics
Unger: Hello and welcome to the AMA Update video and podcast. Pediatrics is one of the specialties with the highest rates of burnout. Today, we're talking with one health system about how they're working to change that.
Here to discuss is Dan Gollins, president of Texas Children's Pediatrics and Urgent Care in Houston. And joining as well is Dr. Sapna Singh, a pediatrician and the medical director of physician engagement and wellness with Texas Children's Pediatrics also in Houston. I'm Todd Unger, AMA's chief experience officer in Chicago. Dan, Dr. Singh, welcome.
Gollins: Thank you for having us.
Dr. Singh: Thank you so much for having us, Todd.
Unger: Well, let's start with a little bit of background here. In an exclusive survey from the AMA, we saw that 53% of physicians are feeling burnt out. However, some specialties showed even higher rates of burnout—emergency medicine, number 1, at 62% followed by hospital medicine and family medicine. Pediatrics, number 4 at 55%. Dr. Singh, why don't you just start us off by talking about why you think your specialties has such a high level of burnout.
Dr. Singh: Well, Todd, it's unfortunate because pediatrics once upon a time was actually one of the few specialties that had such high physician satisfaction for the work that we do, working with children and families every day. But through COVID as well as some other issues that have arose through the years in health care in general, pediatricians have probably suffered quite a bit.
Medscape actually published a study just recently. And it looked at some of those factors. So bureaucratic tasks, including medical charting, forms, lots of prior authorizations, dealing with insurance companies was at the top of the list. And then followed by that was feeling a lack of respect, which when you dig into it, it's a lack of respect potentially from the employer health systems possibly, the administrators, and also patients and families as we walked through some of the controversies that we encountered in COVID around children as well.
We have seen as well that the female physician workforce has been impacted significantly through COVID. And pediatricians tend to be more skewed towards a more female workforce. And so when you look at that combined with the conflict of handling work-life balance, children at home online for school during COVID, but we were not able to do our work from home and had to be in the clinic.
And that push and pull, really, I think led to a lot of people coming to a place of feeling burnt out. And so now, trying to dig from that out of the pandemic is the work that I think a lot of us and my organization for sure is trying to do at this time.
Unger: Well, that's a good segue. Let's talk about digging out of that. Dan, at Texas Children's, you recently invested in a new strategy to treat burnout. Now, we heard about some of those underlying causes from Dr. Singh. What can you tell us about the changes that you're making to address things like that?
Gollins: Yeah, so we've really coming out of COVID wanted to focus on not the burnout but really engaging our physicians. And so spend a lot of time talking about what does that mean, what does that look like. We had a burnout committee before COVID and have quickly changed that to a physician engagement and wellness committee.
This is a positive thing. This should be a way to engage our physicians in a positive manner. So giving a physicians a voice at the table, I think that was what was really important to us is having Dr. Singh and her colleagues at the table to tell us what's important and open those lines of communication that weren't may be there during COVID because we're all focused on something else and giving the best care possible to our patients.
Unger: So you said you had been working on this problem before the pandemic. Got a lot of new work going on, including the engagement aspect. Was there anything in particular that really prompted you to step up efforts even more?
Gollins: I think 2021, for me, stepped into the role as president of this organization. And I took that time to go out and round on our 80-plus locations across the state of Texas. And what I heard was people felt abandoned. They felt alone. And they were tired.
And so when we came back to the organization, and I came back and talked to our leadership team and our physicians, we wanted to combat that. We wanted to find a different way to acknowledge that and open those lines of communication. So we ask for people to apply within the organization, our physicians come to the table, help us be part of the problem—or, sorry, part of the solution.
And so having them come to the table, Dr. Singh was voted by her peers to be our medical director for physician engagement and wellness. It is now a committee of our board—a subcommittee of our board. Dr. Singh has dedicated time to this. So we are being intentional about our efforts. We know this isn't easy. But I think some of the early work has been really hard to peel back the layers and see what is really going on, but we are feeling like we are starting to make progress led by Dr. Singh and her amazing team.
Unger: That's excellent and much needed. Dr. Singh, I want to talk a little bit about what this looks like in day-to-day practice because you mentioned up front a lot of those system level issues that folks are dealing with that drives burnout. When you think about now the work that's undergoing to address these problems, what are the changes that you're starting to see as a result?
Dr. Singh: Well, I mean, one of the things that I think has been very helpful is by establishing the engagement and wellness committee, and having this direct line of communication back with leadership. We are starting to see that physicians on the ground, boots on the ground are starting to bring concerns back to us, things that can make their life easier.
So, for example, when we were talking about the Epic, which is our EHR system that we use, there is a component of that where patients can send us messages through the portal. Messages were getting lengthy. Through COVID, there were sometimes very long messages delivered to our basket. And with the amount of work we're handling, the decision was made that, hopefully, we can try to limit maybe sometimes the character limit on those messages, help people be more concise, and ask more directed questions so that we could be more efficient when we are working on answering the questions that our patients have for us.
There has been other concerns that have been brought up through anonymous feedback links, which we worked on to create an avenue for people to voice concerns, especially when you talk about things like pebbles in my shoe. So as you move through your day-to-day work, if something comes up and it's a problem that you've dealt with over and over again but you just never had the time to stop and tell someone, we've actually created a link within our EHR system that you can access in real time and contact our president, Dan, directly or myself and anonymously voice your concerns.
So we've been actually able to address certain things that we didn't even know were concerns until they were brought back to us in that fashion. Yeah, so I think the biggest change I've seen is communication, the openness for people to really discuss what is creating inefficiency in your work environment, what is it that creates stress for you, how do you feel we can solve that.
And it's not just about complaining. It's about opening up to solutions and ideas that the physicians have and really working from there so that we're not dictating, again, from the top down and saying, "Well, this is our idea and this is what we're going to do." This is us having the physicians have a voice to tell us, what do you think would work, and how can we help implement that for you?
Unger: I'm sure that has a huge impact, just not the least of which is on hope because you're talking about communication both ways and then actually having it listened to and acted upon so that people feel like there's action taken. I have to imagine that having you in that role as medical director of physician engagement and wellness itself was a big step toward that. Do you feel like just having somebody in the position is just another step forward? Are you having that impact that you would hope for?
Dr. Singh: I hope I'm having the impact that we hope for. I will tell you that when Dan asked me to do this—this is not a position that's existed before. And I think that what he said earlier about, do you have a voice at the table, do you have a way to convey to leadership that these are the things that affect us here in the trenches day-to-day, and we'd like to work on that that's, what I feel my role is. I'm the advocate for the physicians. I'm the liaison.
And I think what has built trust between the physicians and myself is that we have had actionable items. We've implemented things that have been brought to the table. And so by having, like you said, action taken, it's huge.
And I think any time somebody has asked me in another organization, what are you guys doing, how are you making this work, the first thing I tell them is, do you have buy-in from the top? Do you have the people who can help make things happen, listening and also bought into the idea that these changes are absolutely necessary? We have that. We're so grateful that we have that.
And so I think that for me, my role isn't so much something that's independent of all of this. It's really me staying in the middle as a bridge between the physicians and then leadership and helping to bring both of us together to communicate effectively and also cooperate, do things together.
Unger: Now, Dr. Singh, I think Dan mentioned earlier when we were talking about these issues was one that was about feeling valued. And one of the results of the survey said, it's really just about half of pediatricians reported feeling valued. And underneath that are a lot of different things. But give us an example of how the work that you're doing might indicate that sense of feeling valued.
Dr. Singh: I will go back to something very specifically actually. As we came out of the pandemic, a big cause of just burnout for me personally, and I think most pediatricians, was the mental health epidemic that our children were undergoing. And there just weren't resources available to handle the amount of need that was there.
And so every time I was in a room talking to a child, a family counseling them through these new onset depression, anxiety, isolation, I had nowhere to really go to get some of the help that I needed, not at the volume that we were dealing with. And so, our organization, TCP, and with huge thanks to Dan, to our president; to our CMO Dr. Stan Spinner, we were able to actually invest in the REACH program.
And this is actually a workshop that's conducted over a weekend to teach primary care physicians how to handle psychiatric care in the clinic. It was a huge investment. It was offered to all of the physicians across TCP. And 200 plus have acted on this, have taken the course. And it is life altering.
I mean, I was able to within one week of having had that course go into a clinic room, see a child who had an issue and finally have a solution, have a solution in my hands for them. And so I can tell you that that one act alone was so incredibly helpful to us in our day-to-day work, in the work that I do with my patients.
I think when you talk to physicians, many people get confused that burnout is really like, I want to be helped, or I need something. I can tell you at the end of the day, if you do something to help build my relationship with the patient to the most optimal thing that I imagine in my mind, which is trust and care and being able to help, that helps us right there. That makes me feel more fulfilled in my actions, in my treatment.
And so I think that REACH program to me was one of the biggest buy-ins. I trusted being the director and being in this position after that one action because I really felt like at that point, they're listening. They're listening to us. We are being heard. And now, they're going to do things to help us.
Unger: That's not only a great example. But I just love what you said there because it's about helping you do your job better, which, as we know for physicians, such a calling around patient care and things that get in the way of that are what is so frustrating. And so I thought that was just such a great statement. Dan, you've got this program up and running now. What's on the horizon? What do you want to see Texas Children's do next?
Gollins: A snowball effect. We just need to keep moving forward. And I think some of the work Dr. Singh is doing, we've launched our well-being index survey for our physicians. We've actually launched it for staff, for managers, for best practice providers.
So our physicians were the first part of this. But we continued to move that needle forward with all aspects that we know in this first part, it had to start with the physicians. And we have some exciting programs on the horizon. We've got virtual scribe program, which we know will be beneficial to our physicians and our advanced practice providers.
But end of the day, it's all about communication. It is intentional in continuing to open those lines of communication with our physicians, with our engagement and wellness committee. I do think the best thing we ever did was align this with our quality team and our financials and our managed care committee and anybody else that has a seat at that table. We will not be successful if we do not have an engagement level for our physicians and Dr. Singh's partnership, our engagement wellness committee, our Chief Medical Officer Dr. Spinner, our other leaders in the organization.
They've been key. This isn't me. This isn't Dr. Singh. This is our physicians that are driving this. And I'm excited. I think we are headed down a really good path. And as around, we hear lots of really positive comments. And I don't know that that's happening everywhere outside of the organization.
Also recognize it's not perfect. We are not a perfect organization by any means. But we are making achievements and headways in that direction.
Unger: Well, well done. Dan, Dr. Singh, thank you so much for joining us today. One of the many ways that the AMA is working to reduce physician burnout is through the AMA Joy in Medicine™ Health System Recognition Program. To learn more about the program and how you can apply, visit ama-assn.org/joyinmedicine.
That wraps up today's episode. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please 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.