You’re going to have trouble finding satisfaction in your physician career when you have the tendency to seek perfection. Just ask AMA member Lisa MacLean, MD, who often has found herself dwelling on what she could have or should have done better.
“Being a perfectionist was oftentimes a driver for me not being as happy in medicine as I would have liked to have been because, I had kind of a strong negative bias where I would always focus on the things that I did wrong and it was hard for me to celebrate my wins,” said Dr. MacLean, a psychiatrist at Henry Ford Health System, an AMA Health System Program Partner.
Understanding that she was not alone among her colleagues, Dr. MacLean leaped at the opportunity to become the director of physician wellness at Henry Ford. In her role, she performs similar duties as a chief wellness officer.
During a recent interview, Dr. MacLean discussed her role at Henry Ford and how the pandemic has affected physician well-being.
AMA: We’ve previously covered the efforts you and your colleagues have made to prevent physician burnout at Henry Ford. How has your role, or the things you have done to address burnout, changed since you started this work in 2017?
Dr. MacLean: The first thing that I did was I spent the first six months asking and listening—getting in there and doing focus groups, meeting a lot of people who were also passionate about this work. I needed to harness all those ideas and all that energy, because I recognized—and this would be true of a chief wellness officer—I can’t do this all by myself. I need other people in my sphere to help me do this work. Then we began to measure because I needed data to present to leadership. The third step has been to implement.
I began to divide the work into three areas. One was the culture of caring and that was really the leadership conversation. Do our policies align with what our leaders say? And if our leaders say that well-being and wellness are important, is there a consistency in what they expect of our physicians?
Something that happened at Henry Ford, our physicians said, “We don't feel like our vacation policy is fair.” Part of wellness is having time with our families—that’s really important to us. If our leadership says we care about you as a faculty member and we want you to have good work-life balance, then we have to consider having a vacation policy that allows that to happen. As an organization and leaders, we have to continue to evolve and think about what our policies are and whether or not they align with truly promoting health and well-being. The other area is ease of practice. It’s in this sphere that we’ve had the most challenges; I can't really go into a clinic and design a particular intervention that's going to make the work more efficient. The operations of a clinic and the flow of work is different depending on the department and type of work. What I can do is help people have those conversations and give them the tools that they need to have those conversations with their staff so that together, we can co-create interventions that work for the clinic.
Then the third area, which I think I've been able to do the most work in, has really been around meaning and work. When it comes to the individual, it’s putting together programming that helps build resilience or manage stress, and that's really in my wheelhouse because I'm a psychiatrist. So obviously I'm very comfortable in that space of—what kind of interventions are we going to develop that are going to help strong people be stronger?
AMA: What kind of progress have you seen on physician well-being since you started at Henry Ford?
Dr. MacLean: We have three years of data using the Well-being Index and every year it has been better and better. We're in the process of collecting data right now. We've already collected it for the residents and shockingly, overall, we still had less distress than we had last year, even though we had a pandemic.
Unfortunately, even though the overall distress was 14% lower, there was a significant rise in the third-year resident distress by over 140%. The incoming first-year residents also had 42% more distress than beginning first-year residents last year. As we look at these groups, we can hypothesize why. Many of our current third-year residents were on the front lines managing COVID-19 patients throughout the pandemic.
Additionally, even though our incoming first-year residents did not experience front line work, imagine beginning residency in the middle of a pandemic. We were very happy that even with these changes in our data, our overall distress level is less than the national averages. We're in the middle of collecting the data for the faculty, and I’m worried. Again, every year it had gotten better but our faculty really sacrificed during the pandemic. I am preparing for the distress level to be higher for our faculty this year.
Compounding the workforce distress, this pandemic has also put a financial strain on many health care organizations, and Henry Ford is not alone in that. They're working hard to try to get patients who were cancelled due to the pandemic back onto the clinic and OR schedules. Our physicians worked hard during the pandemic and now they're working really hard to play catch up. This high intensity of work is not sustainable, and I am concerned about our physicians. That is going to impact us nationally, just like with the implementation of the EMR, we saw a bump in burnout.
AMA: That brings up a good point. How do you approach physician well-being during a crisis and after?
Dr. MacLean: To always validate people's experiences has been really important. During this pandemic, it is important to acknowledge this is really difficult. This is hard on your families, and this is hard on health care. Demonstrating that empathy has been important before and especially during the pandemic.
Something that we needed to really be thinking about before, but now we really need to think about because of this pandemic, is flexibility. It's not going to be a one-size-fits-all in terms of how we might approach well-being with individuals. Now more than ever, approaching this in a way that allows for some flexibility is important. If health care organizations are not willing to do that, they're going to lose some really great physicians.
The other thing that’s really important in the context of the pandemic—and is one of the interventions we have done—is a peer-processing group. These peer-processing groups are there for anyone, not just physicians. We have a mental health professional and a clinical lead who go in and lead these small groups—usually about five to 10 people—in which we talk about our experiences during the pandemic. These groups are helpful. … It allows for not just a shared narrative, but a shared supporting of each other. Then it focuses on coping strategies and it introduces this concept of posttraumatic growth—how do we evolve?
AMA: You touched on flexibility and there has been much discussion about COVID-19 and the impact on women physicians. Do you think child care and balancing motherhood during the pandemic is going to affect burnout?
Dr. MacLean: Absolutely. There's a lot of talk nationally about social injustice and diversity and inclusion. We need to be acknowledging and looking to really build on that and to grow. With our female doctors, if we don't show that flexibility, it could get so much worse. My kids are in college and I'm stressed about them. They go to school in Indiana, so they're gone from my house and I'm stressed about that, but I think, “Oh my gosh, what if they were 4 [years old]?”
It's back to the culture-of-caring area. It's about being part of that conversation at the leadership level, where we acknowledge as an institution that this is an issue and that we support flexibility in the workplace. We are seeing a push down from our HR beginning to really acknowledge this. There's a lot more work to be done, but we're trying to figure that out.
There’s going to be—back to where we started in 2017—a lot of asking because the system doesn't want to just create interventions if the interventions aren’t what people want. During the peak of COVID in our state, we distributed the AMA COVID-19 survey and there was one question about child care which let us know the stress people were feeling.
Then we took it a step further and did an internal survey because we were really trying to understand how big this is and what next steps we need to take. Through asking, it began to at least open the scope and how big this is. This is important because we know that the squeaky wheel often gets the oil. It showed that it wasn't just a lone squeaky wheel. It wasn't just one person who's super loud. It was a lot of people. As an organization, it is something that needs to be worked on and receive additional resources. The tool also validated that we were having similar experiences as other organizations and that was important in terms of a shared national narrative.
AMA: As you continue to survey physicians and implement new programs, what are you proud of?Dr. MacLean: We hired a physician EAP [employee assistance program] therapist, Julie Hamilton, MSW. I'm really proud that I was part of that conversation that caused this to happen. As a result of that, doctors within our organization can get free mental health [services], like coaching and therapy. That was a huge win. She's been a great partner in doing this work and, together, we’ve touched so many people. One of our goals is to break down the stigma. We want to break down the walls. We want to improve accessibility by having someone at our organization that's an outstanding clinician, free, and who isn’t required to document in our medical record. Since we hired her, her referrals just keep growing.