Wednesday, May 23, 2018

Physician activism as an antidote to burnout

The growing number of physicians evidencing symptoms of burnout has many causes.  Yet one element stands out, according to research: a perceived loss of control over their time, working conditions, and other stress contributors.   ACP has launched a Physician Well-being and Professional Satisfaction Initiative that includes resources promoting individual well-being, advocating for system changes, improving the practice environment, and fostering local communities of well-being.  ACP’s Patients Before Paperwork is about challenging administrative tasks that contribute to burnout.

Yet over the past three days, I’ve observed another promising antidote to burnout:  individual and collective physician activism to change policies that affect their daily work and professional development.  Nearly 400 ACP members from 48 states and the District of Columbia came to Washington, DC to participate in our  annual Leadership Day on Capitol Hill.  Yesterday, they learned about how to be effective advocates with their elected lawmakers, the political and legislative environment in Congress, and the issues that ACP was asking them to bring to Congress. 

This morning, they heard from Rep. Peter Roskam (R-IL), chair of the Ways and Means health subcommittee, on the subcommittee’s Medicare Red Tape initiative, which gives clinicians the opportunity to inform lawmakers about administrative tasks that could be modified to make them less burdensome, if not eliminated altogether. Then, former CMS administrator CMS Andy Slavitt, recipient of ACP’s 2018 Joseph F. Boyle award for Distinguished Public Service, suggested to the attendees that health care proposals should be evaluated based on a simple test: does it make it easier or harder for patients to get the care they need? 

The attendees then headed to Capitol Hill, meeting with members of Congress and staff from their own states, presenting ACP’s ideas, as supported by their own personal experiences with patients, for improving patients’ care and physicians’ daily lives and professional development.

What does all of this have to do with physician burnout?  The doctors and medical students I observed this week were anything but a dispirited or despairing group, but happy and enthusiastic activists for their patients, and their profession.

When you think about it, it makes perfect sense that physician activism is a powerful antidote to burnout.  If burnout is about losing control, activism is about taking it back.   Physician-activists don’t accept a status quo that devalues the doctor-patient relationship, they advocate for policies to make things better.  As Margaret Meade once said, “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”

There is nothing more empowering than that.


Harrison said...

Leadership Day is a great event. I attended several times and have fond memories of every one of them. I can remember meeting with Paul Ryan twice, and he didn't listen to anything our group of physicians either time because he knew better what we wanted and what we wanted to tell him. He seemed to want to impress us with his policy wonk ability. No time for patient stories. And then there was the meeting with Rep Sensenbrenner, for 30 minutes with just me -- a doctor who did not live in his district, and a medical student from Milwaukee who did live in his district, and he was the 3rd or 4th most powerful member of the House Leadership at the time. He mainly wanted to impress upon me that nobody was cutting any budgets and that the most that Washington ever did was slow the rate of increase. He wasn't right about that particular issue but he wasn't interested in listening either. On the other side of the aisle, Russ Finegold met with us briefly and took some photo's with us - and listened but made no commitments. He said he understood our point.
I also went once with the California group after I moved here. A different experience. California coordinated visits much more than we did in Wisconsin. We were assigned times and visits and not necessarily with the member representing our district. My daughter was with me for that trip and so we went to Duncan Hunter's office separately. We happened to be there when he showed up in the morning and was talking with his aide about a movie he had gone to the night before. He acted like a kid. He was happy to shake my hand but we didn't talk about health policy. I talked a little with his health affairs aide but Duncan Hunter is not interested in health care and he is in a safe Republican district even now. He didn't listen either.
I learned a lot from Leadership Day. And it was a great Father-Daughter trip.

The legislative environment now is poisonous, but things will change. Physicians need to stay engaged.


DrJHO7 said...

I agree that advocacy, both at the national and state/local levels, reflects passion and purpose, and may be effective at getting things done/changed for the better with regard to our medical practice. I have always harbored disdain for most things political, but thoroughly enjoyed attending ACP's Leadership Day a few times on the Hill, and would definitely recommend it for anyone who hasn't yet participated. The experience was educational and enjoyable.
I think physicians who are suffering from burn-out, which is like an illness comparable to major depression in some ways, would be unlikely to attend something like this (though I agree the experience might be helpful) based on the nature of the problem. Burn-out negatively affects motivation, and the victim is more likely to avoid things medical.
In our State, commercial payors are paying physicians 5-15% lower than medicare and medicaid for E&M services, and there has been a significant grassroots uprising among primary care physicians, resulting in legislation to bring such payment up the parity with MCR as a starting baseline, with scheduled annual increases to a new threshold of 12% above MCR. For the 1st time since I can remember, this movement has the attention of the payors and it looks like something good may come of it. Physicians have been leaving primary care practices in droves and there is now a legitimate primary care access problem in Delaware. Could be too little/too late but it is refreshing to see the pot stirred so vigorously.