Helping the healer: population-informed workplace wellness recommendations for physician well-being

Helping the healer: population-informed workplace wellness recommendations for physician well-being Abstract Background The need to keep physicians healthy and in practice is critical as demand for doctors grows faster than the supply. Workplace wellness programmes can improve employee health and retain skilled workers. Aims To broaden our understanding about ways to help doctors coping with mental health problems and to develop population-informed workplace wellness recommendations for physician populations. Methods Researchers surveyed physicians to document potential warning signs and prevention strategies. A survey was issued to doctors who presented to a physician health programme with mental health complaints. The survey captured respondents’ feedback about how to identify and prevent mental health problems. Data were analyzed using simple descriptive statistics. Results There were 185 participants. Half of respondents believed their problems could have been recognized sooner and 60% said they exhibited signs that could aid in earlier detection. Potential warnings included fluctuations in mood (67%), increased comments about stress/burnout (49%) and behavioural changes (32%). To improve detection, prevention and care-seeking for mental health problems, doctors endorsed multiple items related to the use of interpersonal supports, personal factors and organizational dynamics throughout the survey. Conclusions The findings confirmed earlier work demonstrating the value of social and organizational support in maintaining physician health. It further indicated that earlier identification and/or prevention of mental health problems is not only possible, but that medical organizations are uniquely situated to carry out this work. Burnout, peer support, physician health, survey, workplace wellness Introduction The need to keep doctors healthy and practising is critical as the demand for physicians grows faster than the supply throughout the world [1]. While health care systems struggle to meet workforce needs, many doctors feel the strain of meeting their professional duties by working longer hours and spending less time with patients [2]. This is associated with high rates of stress, burnout and other mental health conditions [3]. The toll of the workforce strain is readily apparent. In a survey of doctors, 16% said they were reducing their hours to part-time, retiring or quitting medicine altogether. Half of those planning to exit the workforce within the next year were younger than 55, and 75% felt pessimistic about the future of the profession [4]. When physicians are unwell, their professional practice can be negatively compromised [5]. Workplace wellness programmes demonstrate several benefits for companies, such as reducing absenteeism and burnout, while increasing productivity, morale and patient satisfaction [6]. Promoting a healthy workforce through wellness programmes may prevent doctors from changing jobs or leaving the medical field altogether [7]. Keeping workers healthy produces an unmistakable economic incentive. One estimate to replace a physician was nearly $1 million (US) dollars when including factors such as lost revenue, recruitment and signing bonuses [8]. However, workforce wellness is not a one-size-fits-all model. The most effective programmes are those designed to the needs of the population they serve [9]. Methods To understand how to best craft workforce wellness programmes for physician populations, researchers surveyed participants of a physician health programme to document warning signs, barriers to care and prevention strategies. Individuals responded to a modified programme evaluation survey tool developed by Peer Assistance Services, Inc., Denver, Colorado and Lori Crane, PhD, MPH, Professor and Chair, School of Public Health, University of Colorado. The survey captured respondents’ feedback about how to identify and prevent problems such as their own. Results Respondents (185) were primarily men (60%) aged between 40 and 69 years (77%). By design, all sought care for mental health issues. Over half were self-referred (51%) and currently practising (80%). Nearly 50% believed that their problem could have been recognized earlier. Other than themselves, respondents said spouses (51%), clergy (21%) and co-workers (20%) might detect early warnings. Sixty per cent of respondents said that they exhibited clues about their problem, such as mood changes (67%), comments about stress/burnout (49%) or behavioural indicators (irritability/outbursts: 32%). Other signs of trouble included decreased dependability, changes in physical condition and increased time to complete routine tasks (Table 1). Table 1. Clues exhibited by physicians with stress and other mental health issues (n = 185) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large Table 1. Clues exhibited by physicians with stress and other mental health issues (n = 185) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large The most common barrier to care was physicians’ schedules (47%), followed by denial of illness (45%), embarrassment (43%) and confidentiality concerns (39%). Personal supports helped physicians overcome care-seeking obstacles. Approximately 44% of respondents said they needed a better understanding of physician health issues. Possible avenues of prevention included additional education about risk factors (59%), awareness of workplace stressors (57%) and knowledge of peer-assistance programmes (57%). Respondents also believed prevention could be aided by increased collegial interactions with their colleagues (51%), mentorship (48%), education about the benefits of socialization (45%) and work-based interventions (41%) (Table 2). Table 2. Overcoming and preventing stress and other mental health problems Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large Table 2. Overcoming and preventing stress and other mental health problems Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large Discussion These findings suggest that tactics aimed at improving physician wellness—particularly for those struggling with mental health issues—are well suited for workplace-based interventions. Drawing on survey findings, we recommend that organizations consider a multi-faceted approach that incorporates the four P’s—policy, practice, preparation and programmes—into their planning. Confidentiality concerns remain a barrier to care-seeking. Policies must be refined so that they eliminate barriers to care-seeking and healthy living by their physician-employees. Organizations should make a thoughtful, objective review of internal practices that impede care-seeking, such as using in-house health care services which can foster dual-relationships and threaten privacy. We recommend regular evaluations of well-being among staff and investing in this information as an ongoing quality metric. Organizations must encourage the practice of healthy behaviours among its staff. While companies may offer generous leave, it is of little value if doctors feel overburdened or otherwise unable to use it. Encouraging wellness practices can occur in many ways, although modelling behaviours by senior staff is particularly useful. Organizations should strive to improve their team approach to personal well-being by emphasizing positivity, maintaining balance and consciously and regularly taking time out to maintain good work–life balance. Preparation encapsulates the educational needs of physicians and was a common request by respondents. It is particularly important to teach doctors about the practice implications associated with ill-health, including lapses in professionalism, poor patient outcomes and medical errors; managing workplace conflict; coping with a lawsuit; improving positive patient interactions; grief management; and taking time for interpersonal relationships. Implementing frequent, brief messages help to combat education fatigue. Given the importance of peers and family members expressed in this survey, organization should offer trainings to help co-workers and others learn to recognize and respond to a physician at risk. Curriculums that address one’s internal conflict about referring a physician to care, where to access help, and potential implications for care-seeking are desperately needed. Finally, workplace wellness activities should create novel programmes. Programmes that reduce the burden of administrative tasks, allowing for more time with patients, are essential. Respondents endorsed the use of collegial supports and personal coaching, both of which can enhance performance, productivity and retention [10]. Incorporating senior staff who support and employ wellness strategies into their own personal care practices is helpful for modelling, as are mentors who can share their own stories about struggling with—and overcoming—problem behaviour. Doctor’s lounges, largely absent from hospitals today, may help provide a brief respite during the day and offer the opportunity to connect with colleagues. Limitations of this study include the use of self-report data from a single site and lack of information about those who did not seek assistance. Further, what physicians believe may differ from what actually works. Workplace wellness has the ability to help physicians maintain their health and, ultimately, retain valued members of the medical workforce. Many of the suggestions here are relatively quick and inexpensive to implement, while potential rewards are great. Key points Professional stress among physicians correlated with poorer personal well-being, quality of care and retention. Doctors’ insight about warning signs and prevention strategies for their own problems are needed to develop population-informed workplace wellness recommendations. Targeted wellness activities centred around the four P’s—policy, practice, preparation and programmes—may help physicians maintain good health and improve practice. Competing interests None declared. References 1. World Health Organization . A Universal Truth: No Health Without a Workforce . Geneva, Switzerland : World Health Organization , 2014 . 2. Dyrbye LN , Varkey P , Boone SL , Satele DV , Sloan JA , Shanafelt TD . Physician satisfaction and burnout at different career stages . Mayo Clin Proc 2013 ; 88 : 1358 – 1367 . Google Scholar CrossRef Search ADS PubMed 3. Sablik Z , Samborska-Sablik A , Drożdż J . Universality of physicians’ burnout syndrome as a result of experiencing difficulty in relationship with patients . Arch Med Sci 2013 ; 9 : 398 – 403 . Google Scholar CrossRef Search ADS PubMed 4. Hawkins M. A Survey of America’s Physicians: Practice Patterns and Perspectives . The Physicians Foundation , 2012 . 5. Wallace JE , Lemaire JB , Ghali WA . Physician wellness: a missing quality indicator . Lancet 2009 ; 374 : 1714 – 1721 . Google Scholar CrossRef Search ADS PubMed 6. Baxter S , Sanderson K , Venn AJ , Blizzard CL , Palmer AJ . The relationship between return on investment and quality of study methodology in workplace health promotion programs . Am J Health Promot 2014 ; 28 : 347 – 363 . Google Scholar CrossRef Search ADS PubMed 7. Berry LL , Mirabito AM , Baun WB . What’s the hard return on employee wellness programs ? Harv Bus Rev 2011 ; 89 : 20 – 21 . Google Scholar PubMed 8. Cheung-Larivee K . How much is physician turnover really costing you ? Fierce Healthcare Daily Newsletter , 2011 . 9. Clinton Health Matters Initiative . Employee Health Improvement Framework . New York, NY : The Clinton Foundation , 2014 . PubMed PubMed 10. Firth-Cozens J . Interventions to improve physicians’ well-being and patient care . Soc Sci Med 2001 ; 52 : 215 – 222 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Occupational Medicine Oxford University Press

Helping the healer: population-informed workplace wellness recommendations for physician well-being

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Abstract Background The need to keep physicians healthy and in practice is critical as demand for doctors grows faster than the supply. Workplace wellness programmes can improve employee health and retain skilled workers. Aims To broaden our understanding about ways to help doctors coping with mental health problems and to develop population-informed workplace wellness recommendations for physician populations. Methods Researchers surveyed physicians to document potential warning signs and prevention strategies. A survey was issued to doctors who presented to a physician health programme with mental health complaints. The survey captured respondents’ feedback about how to identify and prevent mental health problems. Data were analyzed using simple descriptive statistics. Results There were 185 participants. Half of respondents believed their problems could have been recognized sooner and 60% said they exhibited signs that could aid in earlier detection. Potential warnings included fluctuations in mood (67%), increased comments about stress/burnout (49%) and behavioural changes (32%). To improve detection, prevention and care-seeking for mental health problems, doctors endorsed multiple items related to the use of interpersonal supports, personal factors and organizational dynamics throughout the survey. Conclusions The findings confirmed earlier work demonstrating the value of social and organizational support in maintaining physician health. It further indicated that earlier identification and/or prevention of mental health problems is not only possible, but that medical organizations are uniquely situated to carry out this work. Burnout, peer support, physician health, survey, workplace wellness Introduction The need to keep doctors healthy and practising is critical as the demand for physicians grows faster than the supply throughout the world [1]. While health care systems struggle to meet workforce needs, many doctors feel the strain of meeting their professional duties by working longer hours and spending less time with patients [2]. This is associated with high rates of stress, burnout and other mental health conditions [3]. The toll of the workforce strain is readily apparent. In a survey of doctors, 16% said they were reducing their hours to part-time, retiring or quitting medicine altogether. Half of those planning to exit the workforce within the next year were younger than 55, and 75% felt pessimistic about the future of the profession [4]. When physicians are unwell, their professional practice can be negatively compromised [5]. Workplace wellness programmes demonstrate several benefits for companies, such as reducing absenteeism and burnout, while increasing productivity, morale and patient satisfaction [6]. Promoting a healthy workforce through wellness programmes may prevent doctors from changing jobs or leaving the medical field altogether [7]. Keeping workers healthy produces an unmistakable economic incentive. One estimate to replace a physician was nearly $1 million (US) dollars when including factors such as lost revenue, recruitment and signing bonuses [8]. However, workforce wellness is not a one-size-fits-all model. The most effective programmes are those designed to the needs of the population they serve [9]. Methods To understand how to best craft workforce wellness programmes for physician populations, researchers surveyed participants of a physician health programme to document warning signs, barriers to care and prevention strategies. Individuals responded to a modified programme evaluation survey tool developed by Peer Assistance Services, Inc., Denver, Colorado and Lori Crane, PhD, MPH, Professor and Chair, School of Public Health, University of Colorado. The survey captured respondents’ feedback about how to identify and prevent problems such as their own. Results Respondents (185) were primarily men (60%) aged between 40 and 69 years (77%). By design, all sought care for mental health issues. Over half were self-referred (51%) and currently practising (80%). Nearly 50% believed that their problem could have been recognized earlier. Other than themselves, respondents said spouses (51%), clergy (21%) and co-workers (20%) might detect early warnings. Sixty per cent of respondents said that they exhibited clues about their problem, such as mood changes (67%), comments about stress/burnout (49%) or behavioural indicators (irritability/outbursts: 32%). Other signs of trouble included decreased dependability, changes in physical condition and increased time to complete routine tasks (Table 1). Table 1. Clues exhibited by physicians with stress and other mental health issues (n = 185) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large Table 1. Clues exhibited by physicians with stress and other mental health issues (n = 185) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) n (%) Said that earlier recognition of problem(s) might have been possible 94 (51) Exhibited clues to that would aid in earlier detection 111 (60) Clues exhibiteda  Change in mood (e.g. depression) 74 (67)  Increase in personal comments about stress or burnout 54 (49)  Behaviour change (irritability, physical roughness, verbal abuse) 36 (32)  Decrease in dependability 18 (16)  Change in physical condition 16 (14)  Repeated absenteeism and/or excessive tardiness 11 (10)  Increase in patient complaints/decrease in patient satisfaction 11 (10)  Omitted, illogical or illegible charting 7 (6)  Unavailability on the job/while on call 6 (5)  Discrepancies documenting medications/unaccounted doses 1 (<1)  Other 21 (19) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large The most common barrier to care was physicians’ schedules (47%), followed by denial of illness (45%), embarrassment (43%) and confidentiality concerns (39%). Personal supports helped physicians overcome care-seeking obstacles. Approximately 44% of respondents said they needed a better understanding of physician health issues. Possible avenues of prevention included additional education about risk factors (59%), awareness of workplace stressors (57%) and knowledge of peer-assistance programmes (57%). Respondents also believed prevention could be aided by increased collegial interactions with their colleagues (51%), mentorship (48%), education about the benefits of socialization (45%) and work-based interventions (41%) (Table 2). Table 2. Overcoming and preventing stress and other mental health problems Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large Table 2. Overcoming and preventing stress and other mental health problems Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) Not at all or a little Somewhat or a lota n (%) n (%) Which factors would help you to overcome barriers to seeking assistance at the peer-assistance programme?  Support by professional colleagues 72 (39) 104 (56)  Support by spouse/partners/friends 74 (40) 103 (55)  Knowledge of peer-assistance programme 83 (45) 92 (50)  Greater knowledge of peer-assistance programme services 93 (50) 84 (45)  Better understanding of physician health problems 94 (51) 82 (44)  Greater knowledge of ability to maintain medical licence 100 (54) 76 (41)  How to seek assistance from peer-assistance programme 102 (55) 75 (40)  Intervention by colleagues 109 (59) 67 (36)  Intervention by family or friends 112 (60) 63 (34)  More after hours options by peer-assistance programme 132 (71) 45 (25) How much could each of the following could help prevent problems like yours?  Training about how to identify risk factors 80 (43) 110 (59)  Awareness of workplace stressors 79 (43) 105 (57)  Awareness or use of peer-assistance programmes 59 (32) 105 (57)  Frequent contact with peers 85 (46) 94 (51)  Mentorship 82 (44) 89 (48)  Education about social supports outside of work 79 (43) 83 (45)  Work-based interventions, education or programmes 80 (43) 76 (41)  Understanding financial demands of medical profession 50 (27) 46 (25)  Less access to controlled substances in workplace 16 (9) 18 (10) aMultiple responses allowed, per cent shown are only from respondents who believed they exhibited clues. View Large Discussion These findings suggest that tactics aimed at improving physician wellness—particularly for those struggling with mental health issues—are well suited for workplace-based interventions. Drawing on survey findings, we recommend that organizations consider a multi-faceted approach that incorporates the four P’s—policy, practice, preparation and programmes—into their planning. Confidentiality concerns remain a barrier to care-seeking. Policies must be refined so that they eliminate barriers to care-seeking and healthy living by their physician-employees. Organizations should make a thoughtful, objective review of internal practices that impede care-seeking, such as using in-house health care services which can foster dual-relationships and threaten privacy. We recommend regular evaluations of well-being among staff and investing in this information as an ongoing quality metric. Organizations must encourage the practice of healthy behaviours among its staff. While companies may offer generous leave, it is of little value if doctors feel overburdened or otherwise unable to use it. Encouraging wellness practices can occur in many ways, although modelling behaviours by senior staff is particularly useful. Organizations should strive to improve their team approach to personal well-being by emphasizing positivity, maintaining balance and consciously and regularly taking time out to maintain good work–life balance. Preparation encapsulates the educational needs of physicians and was a common request by respondents. It is particularly important to teach doctors about the practice implications associated with ill-health, including lapses in professionalism, poor patient outcomes and medical errors; managing workplace conflict; coping with a lawsuit; improving positive patient interactions; grief management; and taking time for interpersonal relationships. Implementing frequent, brief messages help to combat education fatigue. Given the importance of peers and family members expressed in this survey, organization should offer trainings to help co-workers and others learn to recognize and respond to a physician at risk. Curriculums that address one’s internal conflict about referring a physician to care, where to access help, and potential implications for care-seeking are desperately needed. Finally, workplace wellness activities should create novel programmes. Programmes that reduce the burden of administrative tasks, allowing for more time with patients, are essential. Respondents endorsed the use of collegial supports and personal coaching, both of which can enhance performance, productivity and retention [10]. Incorporating senior staff who support and employ wellness strategies into their own personal care practices is helpful for modelling, as are mentors who can share their own stories about struggling with—and overcoming—problem behaviour. Doctor’s lounges, largely absent from hospitals today, may help provide a brief respite during the day and offer the opportunity to connect with colleagues. Limitations of this study include the use of self-report data from a single site and lack of information about those who did not seek assistance. Further, what physicians believe may differ from what actually works. Workplace wellness has the ability to help physicians maintain their health and, ultimately, retain valued members of the medical workforce. Many of the suggestions here are relatively quick and inexpensive to implement, while potential rewards are great. Key points Professional stress among physicians correlated with poorer personal well-being, quality of care and retention. Doctors’ insight about warning signs and prevention strategies for their own problems are needed to develop population-informed workplace wellness recommendations. Targeted wellness activities centred around the four P’s—policy, practice, preparation and programmes—may help physicians maintain good health and improve practice. Competing interests None declared. References 1. World Health Organization . A Universal Truth: No Health Without a Workforce . Geneva, Switzerland : World Health Organization , 2014 . 2. Dyrbye LN , Varkey P , Boone SL , Satele DV , Sloan JA , Shanafelt TD . Physician satisfaction and burnout at different career stages . Mayo Clin Proc 2013 ; 88 : 1358 – 1367 . Google Scholar CrossRef Search ADS PubMed 3. Sablik Z , Samborska-Sablik A , Drożdż J . Universality of physicians’ burnout syndrome as a result of experiencing difficulty in relationship with patients . Arch Med Sci 2013 ; 9 : 398 – 403 . Google Scholar CrossRef Search ADS PubMed 4. Hawkins M. A Survey of America’s Physicians: Practice Patterns and Perspectives . The Physicians Foundation , 2012 . 5. Wallace JE , Lemaire JB , Ghali WA . Physician wellness: a missing quality indicator . Lancet 2009 ; 374 : 1714 – 1721 . Google Scholar CrossRef Search ADS PubMed 6. Baxter S , Sanderson K , Venn AJ , Blizzard CL , Palmer AJ . The relationship between return on investment and quality of study methodology in workplace health promotion programs . Am J Health Promot 2014 ; 28 : 347 – 363 . Google Scholar CrossRef Search ADS PubMed 7. Berry LL , Mirabito AM , Baun WB . What’s the hard return on employee wellness programs ? Harv Bus Rev 2011 ; 89 : 20 – 21 . Google Scholar PubMed 8. Cheung-Larivee K . How much is physician turnover really costing you ? Fierce Healthcare Daily Newsletter , 2011 . 9. Clinton Health Matters Initiative . Employee Health Improvement Framework . New York, NY : The Clinton Foundation , 2014 . PubMed PubMed 10. Firth-Cozens J . Interventions to improve physicians’ well-being and patient care . Soc Sci Med 2001 ; 52 : 215 – 222 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Occupational MedicineOxford University Press

Published: Mar 27, 2018

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